Patient-Reported Variables Affecting Self-Perceived Overall Recovery Among People With Subacute Stroke.

IMPORTANCE: Patients' perception of overall recovery is a critical outcome for stroke rehabilitation. However, the perception of overall recovery cannot be obtained using multidimensional measures, because satisfaction in most domains of life does not guarantee satisfaction in overall recovery. A single overall recovery score seems a straightforward measure. However, the clinical implications of overall scores are restricted, because factors affecting patients' overall recovery are unclear, which can be prioritized to optimize the effectiveness of rehabilitation. OBJECTIVE: To examine patient-reported variables affecting overall recovery scores in patients with differing stroke severity. DESIGN: The 59 items of the Stroke Impact Scale 3.0 were selected using regression analysis with a forward selection to explain the overall recovery score (0% = no recovery; 100% = full recovery). Stroke severity was determined with the National Institutes of Health Stroke Scale. SETTING: Hospitals. PARTICIPANTS: Data of 950 patients collected 90 days after stroke. RESULTS: The models explained about 55% of the variance of the overall recovery scores with five to nine variables, but merely 16% of the variance was explained for patients with moderate stroke. As stroke severity increased, the number of identified variables decreased. Most identified variables were related to social participation and self-care activities (e.g., ability to help others, control the bowels, and dress the torso). Differences in the remaining variables depended on stroke severity. CONCLUSIONS AND RELEVANCE: Patients' priorities differ depending on stroke severity. The identified variables may be set as treatment goals to optimize patients' self-perceived overall recovery. Plain-Language Summary: How patients perceive their overall recovery after a stroke is a critical outcome for their stroke rehabilitation. This study demonstrated that patients with different stroke severity may have different priorities that influence their self-perceived levels of overall recovery. The variables identified in this study may help occupational therapy practitioners identify meaningful goals to optimize patients' self-perceived overall recovery.

The minimal important difference for the Postural Assessment Scale for Stroke Patients in the subacute stage.

BACKGROUND: The minimal important difference (MID) of the Postural Assessment Scale for Stroke Patients (PASS) remains unknown, limiting the interpretation of change scores. OBJECTIVES: To estimate the MID of the PASS in patients with subacute stroke. METHODS: Data at admission and discharge for 240 participants were retrieved from a longitudinal study. The "mobility" item of the Barthel Index was used as the anchor for indicating the improvement of posture control. Receiver operating characteristic (ROC) method was used to estimate the anchor-based MID of the PASS. RESULTS: The ROC method identified a MID of 3.0 points, with a sensitivity of 81.0 % and a specificity of 75.6 %. CONCLUSION: The MID of the PASS was 3.0 points, indicating that if a patient achieves an improvement of 3.0 or more points on the PASS, they have a clinically important improvement in posture control. Our results can help in interpreting change scores and aid in understanding the clinical values of treatment outcomes.

Using High-Definition Transcranial Alternating Current Stimulation to Treat Patients with Fibromyalgia: A Randomized Double-Blinded Controlled Study.

Objectives: This study aimed to investigate the safety and efficacy of high-definition transcranial alternating current stimulation (HD-tACS) to the left primary motor cortex (M1) in the treatment of fibromyalgia (FM) patients. Methods: In this randomized, double-blind, sham-controlled clinical trial, patients with FM were recruited in a teaching hospital. Thirty-eight patients were randomized to active HD-tACS (n = 19) or sham stimulation (n = 19). Active stimulation included a daily session of 20-min stimulation of 1 mA HD-tACS over the left M1 for ten sessions in two weeks. The primary outcome was the change in pain intensity and quality of life, assessed using the numeric rating scale (NRS) and the fibromyalgia impact questionnaire (FIQ) at baseline and after two weeks of treatment. Secondary outcomes included other core symptoms of FM (psychological distress, sleep quality, hyperalgesia measured by pressure pain threshold) and changes in biomarkers' total Tau and Aß1-42. All analyses were based on intention-to-treat for a significance level of p < 0.05. Results: Of the 38 randomized patients, 35 completed the study. After two weeks, HD-tACS induced a significant reduction in FIQ score post-treatment. However, there were no significant differences in NRS and FIQ scores compared to sham stimulation. Most adverse events were mild in severity. Nevertheless, one patient receiving HD-tACS attempted suicide during the trial. Conclusions: These results suggest that HD-tACS may effectively reduce pain, psychological distress, and symptom impacts in FM patients. However, we found no significant differences between the two groups. Future studies investigating HD-tACS in FM are warranted.

High-Definition Transcranial Direct Current with Electrical Theta Burst on Post-Stroke Motor Rehabilitation: A Pilot Randomized Controlled Trial.

BACKGROUND: High-definition transcranial electrical theta burst superimposing direct current stimulation (HD-tDCS-eTBS) not only incorporates the therapeutic advantages of tDCS and TBS but enhances stimulation focality and practicality. However, the applicability of this innovative neuromodulatory device in post-stroke rehabilitation remains uncertain. OBJECTIVE: This study aimed to assess the efficacy and safety of the HD-tDCS-eTBS on upper extremity (UE) motor function in patients with chronic stroke. METHODS: A patient-blinded, randomized controlled study was conducted. Twenty-four participants were randomly assigned into either the active HD-tDCS-eTBS group or sham HD-tDCS-eTBS group. Both groups received 20 minutes of active/sham HD-tDCS-eTBS combined with 30 minutes of conventional UE rehabilitation each time, 3 times a week for 4 weeks. Outcome measures including the Fugl-Meyer Assessment of Upper Extremity, Wolf Motor Function Test, Jebsen-Taylor Hand Function Test, Finger-Nose Test, and Modified Ashworth Scale were assessed before and immediately after the intervention period. RESULTS: Spasticity of shoulder adductor (P = .05), elbow extensor (P = .04), and thumb flexor (P < .01) were significantly reduced in the active HD-tDCS-eTBS group versus the sham group. Nonsignificant trends in the improvements of most other outcome measures were in favor of the active HD-tDCS-eTBS group with moderate to large effect sizes (P = .06-.26, ηp2 = 0.06-0.16). No severe adverse events except for slight skin redness under the stimulus electrode was detected after the HD-tDCS-eTBS. CONCLUSIONS: Our findings support that HD-tDCS-eTBS is safe and has therapeutic potential for post-stroke UE motor rehabilitation. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT04278105).

Improving the utility of the European Health Literacy Survey Questionnaire: a computerized adaptive test for patients with stroke.

PURPOSE: Health literacy among patients is crucial for effective stroke management. The European Health Literacy Survey Questionnaire is a theory-based measure that comprehensively captures 12 domains of health literacy. We aimed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire to efficiently assess health literacy among patients with stroke. MATERIALS AND METHODS: The European Health Literacy Survey Questionnaire data of 311 patients and item parameters were retrieved from a Rasch validation study. Real data simulations were performed to develop a computerized adaptive test of the European Health Literacy Survey Questionnaire and explore its efficiency and reliability. RESULTS: The computerized adaptive test of the European Health Literacy Survey Questionnaire displayed suitable reliability in all 12 domains (0.72-0.84) with a mean test length of 17 items (36.2% of the 47-item European Health Literacy Survey Questionnaire). CONCLUSIONS: Our findings indicate that the computerized adaptive test of the European Health Literacy Survey Questionnaire, which assesses 12 domains of health literacy among patients with stroke in a timely and precise fashion, is efficient and reliable.Implications for rehabilitationThe computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the subjective fit of personal health literacy competencies to environmental demands, providing insight into patient strengths and weaknesses when dealing with health tasks and interacting with health systems.The computerized adaptive test of the European Health Literacy Survey Questionnaire assesses the 12 domains of health literacy among patients with stroke in a timely and precise manner.Our study has demonstrated the utility of the computerized adaptive test of the European Health Literacy Survey Questionnaire in reducing the assessment burden of patients in clinical practice.Developing of the computerized adaptive test of the European Health Literacy Survey Questionnaire provided findings that may benefit researchers and clinicians interested in developing efficient outcome measures.

Designing and pilot testing a novel high-definition transcranial burst electrostimulation device for neurorehabilitation.

Objective.Non-invasive brain stimulation has been promoted to facilitate neuromodulation in treating neurological diseases. Recently, high-definition (HD) transcranial electrical stimulation and a novel electrical waveform combining a direct current (DC) and theta burst stimulation (TBS)-like protocol were proposed and demonstrated high potential to enhance neuroplastic effects in a more-efficient manner. In this study, we designed a novel HD transcranial burst electrostimulation device and to preliminarily examined its therapeutic potential in neurorehabilitation.Approach.A prototype of the transcranial burst electrostimulation device was developed, which can flexibly output a waveform that combined a DC and TBS-like protocol and can equally distribute the current into 4 × 1 HD electrical stimulation by automatic impedance adjustments. The safety and accuracy of the device were then validated in a series ofin vitroexperiments. Finally, a pilot clinical trial was conducted to assess its clinical safety and therapeutic potential on upper-extremity rehabilitation in six patients with chronic stroke, where patients received either active or sham HD transcranial burst electrostimulation combined with occupational therapy three times per week for four weeks.Main results.The prototype was tested, and it was found to comply with all safety requirements. The output parameters were accurate and met the clinical study needs. The pilot clinical study demonstrated that the active HD transcranial burst electrostimulation group had greater improvement in voluntary motor function and coordination of the upper extremity than the sham control group. Additionally, no severe adverse events were noted, but slight skin redness under the stimulus electrode immediately after stimulation was seen.Conclusions.The results demonstrated the feasibility of incorporating the HD electrical DC and TBS-like protocol in our device; and the novel neuromodulatory device produced positive neurorehabilitation outcomes in a safe fashion, which could be the basis for the future clinical implementation for treating neurological diseases.Trial registration:ClinicalTrials.gov Identifier: NCT04278105. Registered on 20 February 2020.

FRET processes of bi-fluorophoric sensor material containing tetraphenylethylene donor and optical-switchable merocyanine acceptor for lead ion (Pb2+) detection in semi-aqueous media.

A novel aggregation-induced emission (AIE) structure containing a tetraphenylethene (TPE) unit covalently linked with a merocyanine (MC) unit was synthesized and investigated in semi-aqueous solutions with 90% water fraction. The open-form structure of red-emissive MC unit combined with TPE unit was utilized as a bi-fluorophoric sensor to detect lead(II) ion, which could be transformed from the close-form structure of non-emissive SP unit upon UV exposure. Moreover, the TPE unit as an energy donor with the blue-green photoluminescence (PL) emission at 480 nm was combined with the MC unit as an energy acceptor with the red PL emission at 635 nm. Due to the Förster resonance energy transfer (FRET) processes, the bi-fluorophoric sensor produced more efficient ratiometric PL behavior to induce a stronger red PL emission than that of the mono-fluorophoric MC unit. Hence, the PL sensor responses of the AIE bi-fluorophoric structure toward lead(II) ion could be further amplified via the FRET-OFF processes to turn off red PL emission of the coordinated MC acceptor and to recover blue-green PL emission of the TPE donor. Accordingly, the best LOD value for the AIE sensor detection toward Pb2+ was 0.27 µM. The highest red MC emission with the optimum FRET process of AIE sensor could be utilized in cell viability tests to prove the non-toxic and remarkable bio-marker of AIE sensor to detect lead(II) ion in live cells. The developed FRET-OFF processes with ratiometric PL behavior of the bi-fluorophoric AIE sensor can be utilized for future chemo- and bio-sensor applications.

Effectiveness of shared decision-making intervention in patients with lumbar degenerative diseases: A randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of shared decision-making (SDM) intervention among patients with lumbar degenerative diseases (LDDs) in terms of decision self-efficacy, control preferences, SDM process, decision satisfaction, and conflict. METHODS: A total of 130 outpatients with LDDs recruited from orthopedic or rehabilitation clinics were randomly assigned to the SDM intervention (n = 67) or comparison (n = 63) groups. Patients in the intervention group received decision aids (DAs) with decision coaching and those in controlled group received standard educational materials from a health educator. The primary outcome was decision self-efficacy, and secondary outcomes were control preference, SDM process, conflict, and satisfaction. RESULTS: The SDM intervention significantly improved decision self-efficacy (mean difference [MD] = 7.1, 95% confidence interval [CI]: 1.7-12.5, partial η2 = 0.05) and reduced conflict (MD = -7.0, 95% CI: -12.2 to -1.9, partial η2 = 0.06), especially in patients without family involvement, compared with the health education group. However, no significant between-group differences were observed in other outcomes. CONCLUSION: SDM intervention improved SDM self-efficacy and reduced conflict in patients with LDDs. PRACTICE IMPLICATIONS: Clinicians can integrate DAs and decision coaching in SDM conversations. SDM intervention seems to engage patients in decision-making, especially those without family involvement.

Cross-Validation of the Factorial Validity of the Stroke Impact Scale 3.0 in Patients With Stroke.

IMPORTANCE: The Stroke Impact Scale 3.0 appears to be a promising outcome measure of health-related quality of life (HRQOL) for clients with stroke. However, because the factorial validity of the Stroke Impact Scale 3.0 remains unclear, its validity is limited. OBJECTIVE: To examine the underlying structure of the Stroke Impact Scale 3.0 by comparing the currently available eight- and four-domain structures simultaneously. DESIGN: Secondary data analysis of responses to the Stroke Impact Scale 3.0 from a previous psychometric validation study. SETTING: Five general hospitals in northern and southern Taiwan. PARTICIPANTS: Two hundred sixty-three patients with stroke from rehabilitation wards (inpatients) and neurology and rehabilitation clinics (outpatients). OUTCOMES AND MEASURES: Confirmatory factor analysis was used to examine the eight- and four-domain structures of the Stroke Impact Scale 3.0. Four fit indices were considered simultaneously to examine the model fits of both structures. RESULTS: The eight- and four-domain structures of the Stroke Impact Scale 3.0 were not supported by all four indices (χ²/df = 2.7 and 5.0, comparative fit index = .79 and .86, root mean square error of approximation = .08 and .12, standardized root mean square residual = .08 and .08, respectively). The unidimensionality of each domain in the two structures was not supported. CONCLUSIONS AND RELEVANCE: Neither the eight- nor the four-domain structure of the Stroke Impact Scale 3.0 was supported, suggesting that scores may not provide valid assessments of HRQOL in clients with stroke. Further modification and validation of the Stroke Impact Scale 3.0 are warranted. WHAT THIS ARTICLE ADDS: Our findings suggest that the eight- and four-domain scores of the Stroke Impact Scale 3.0 may not be valid. Therefore, until more supporting evidence is developed, these scores should be interpreted cautiously in regard to clients' HRQOL; alternatively, other measures could be used.

Correlations between subjective rating and objective assessment of balance function in individuals with stroke.

PURPOSE: To examine the relationships among therapist-reported, patient-reported, and objective assessment scores of balance function. METHODS: Inpatients with stroke and occupational therapists were recruited. The objective balance scores were measured using the Balance Computerized Adaptive Testing (Balance CAT) system. The therapist and patient-reported scores were evaluated using a visual analogue scale (VAS) and Likert-type scale. RESULTS: Eighty-eight patients and 16 therapists participated. The correlations (r= 0.64 and 0.65; R-squared about 0.42 at baseline and follow-up assessments, respectively) between the therapist-reported VAS scores and the Balance CAT system were larger than those (r = 0.31 and 0.21) between the patient-reported VAS scores and the Balance CAT system. Low correlations (r = 0.27 and 0.26 for VAS and Likert-type scores, respectively) were found between the therapist-reported and patient-reported change scores. Low correlations (r = 0.12-0.17) were found between the change scores of therapist- and patient-reported ratings and those of the Balance CAT system. CONCLUSIONS: The therapists' judgments explained <50% of variance of the Balance CAT system scores. Neither therapist-reported nor patient-reported change scores reflected the changes demonstrated by the objective assessments. Further studies are warranted to confirm our findings.Implications for RehabilitationNeither therapist- nor patient-reported balance function and change could effectively reflect the scores resulting from objective assessments.The routine use of objective balance assessments should not be replaced by therapists' subjective judgments.Communications regarding the balance function measured by objective assessments between therapists and patients can help patients to better understand their balance function and progress.

Efficient FRET Approaches toward Copper(II) and Cyanide Detections via Host-Guest Interactions of Photo-Switchable [2]Pseudo-Rotaxane Polymers Containing Naphthalimide and Merocyanine Moieties.

A supramolecular [2]pseudo-rotaxane containing a naphthalimide-based pillararene host and a spiropyran-based imidazole guest was synthesized and investigated in a semiaqueous solution with 90% water fraction. Upon UV exposure, the close-form structure of nonemissive spiropyran guest could be transformed into the open-form structure of red-emissive merocyanine guest reversibly, which was utilized as a monofluorophoric sensor to detect copper(II) and cyanide ions. Moreover, the naphthalimide host as an energy donor with green photoluminescence (PL) emission at 505 nm was complexed with the merocyanine guest as an energy acceptor with red PL emission at 650 nm in 1:1 molar ratio to generate a [2]pseudo-rotaxane polymer, which was further verified by the diffusion coefficients of DOSY nuclear magnetic resonance (NMR) measurements. Due to the Förster resonance energy transfer (FRET) processes, the bifluorophoric [2]pseudo-rotaxane produced more efficient ratiometric PL behavior to induce a stronger red PL emission than that of the monofluorophoric guest; therefore, the PL sensor responses of the supramolecular [2]pseudo-rotaxane toward copper(II) and cyanide ions could be further amplified via the FRET-OFF processes to turn off red PL emission of the reacted merocyanine acceptor and to recover green PL emission of the naphthalimide donor. Accordingly, the best and prominent values of the limit of detection (LOD) for the host-guest detections toward Cu2+ and CN- were 0.53 and 1.34 µM, respectively. The highest red MC emission with the optimum FRET processes of [2]pseudo-rotaxane was maintained around room temperature (20-40 °C) in wide pH conditions (pH = 3-13), which can be utilized in the cell viability tests to prove the nontoxic and remarkable biomarker of [2]pseudo-rotaxane to detect Cu2+ and CN- in living cells. The developed FRET-OFF processes with ratiometric PL behavior of the bifluorophoric supramolecular [2]pseudo-rotaxane polymer will open a new avenue to the future applications of chemo- and biosensors.

Development of a battery of phase-adaptive health literacy tests for stroke survivors.

OBJECTIVE: We aimed to develop a health literacy battery for three phases of stroke (HL-3S). METHODS: Three Rasch-based item banks corresponding to health care, disability prevention, and health promotion in the acute, subacute, and chronic phases of stroke, respectively, were developed by a multidisciplinary stroke team. To construct the HL-3S, a panel of clinical and Rasch experts selected items from the three Rasch-based item banks according to content representativeness and item difficulty diversity. Additionally, the validity and reliability of the HL-3S were examined using Rasch analysis. RESULTS: This study included 442 patients. Each of the three tests in the HL-3S contained 10 items with a 5-point scale of difficulty levels. The items in HL-3S demonstrated unidimensionality, local independence, and favorable Rasch reliability. CONCLUSION: The HL-3S, with 10 items in each test, had favorable construct validity and Rasch reliability. The HL-3S can be considered as a quick-to-administer and phase-adaptive test battery of health literacy for stroke survivors. PRACTICE IMPLICATIONS: Clinicians may select one of the tests in the HL-3S corresponding with the patient's stroke recovery timeline and thereby provide adaptive health education programs to increase the patient's ability to actively participate in health care, disability prevention, and health promotion, respectively.

A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke.

BACKGROUND AND PURPOSE: Previous evidence that the Postural Assessment Scale for Stroke (PASS) and the Berg Balance Scale (BBS) have similar responsiveness is doubtful. Compared with the BBS, the PASS has more items assessing basic balance abilities (such as postural transition during lying and sitting), so it should be more likely to detect changes in patients with severe balance deficits. We aimed to compare the responsiveness of the PASS and the BBS in patients with stroke who have severe balance deficits. METHODS: The PASS and BBS scores of 49 patients with severe balance deficits at 14 and 30 days after stroke were retrieved. The group-level responsiveness was examined with the standardized response mean (SRM). The individual-level responsiveness was examined by the proportion of patients who achieved clinically significant improvements (ie, their pre-post change scores in the PASS/BBS exceeded the minimal detectable change with 95% confidence of each measure). The responsiveness of the 2 measures was compared using the bootstrap approach. RESULTS AND DISCUSSION: The comparisons of responsiveness showed significant differences between the PASS and the BBS at both the group and individual levels. At the group level, the PASS indicated moderate changes in balance function (SRM = 0.79), but the BBS indicated only small changes (SRM = 0.39). At the individual level, the PASS showed that 42.9% of patients had clinically significant improvements, while the BBS showed that only 6.1% of patients had clinically significant improvements. CONCLUSIONS: Compared with the BBS, the PASS was better able to detect balance improvements in patients having severe balance deficits. The PASS is recommended as an outcome measure to detect change in balance in patients with stroke who have severe balance deficits.

How and how much is spirituality discussed in palliative care consultations for advanced cancer patients with and without a question prompt list?

OBJECTIVE: Patients want to discuss spirituality more with their doctors but feel disempowered. Question prompt lists (QPLs) assist conversations. This study assessed the impact of a QPL on spirituality discussions in Palliative Care (PC). METHODS: This was a sub-study of a trial in which PC patients were randomised to either receive a QPL prior to a consultation or not, to see whether its provision influenced advanced cancer patients'/caregivers' questions and discussion of topics relevant to end-of-life care during consultations with a PC physician. Consultations were recorded and transcribed. Transcriptions were analysed to examine the frequency and content of spirituality discussions. We conducted logistic regression to investigate the impact of the QPL and other predictors. RESULTS: 174 patients participated. Spirituality was discussed in half the consultations. Patients receiving a QPL discussed spirituality 1.38 times more than controls. This finding did not reach statistical significance. First PC consultation and being asked about their concerns by the doctor were significant predictors of a spiritual discussion. CONCLUSION: Patients are more likely to discuss spirituality in their first PC consultation, and when their doctor asks them about their concerns. PRACTICE IMPLICATIONS: Doctors caring for patients at the end of life should routinely raise spiritual issues.

[Study on DNA methylation profiles in non-syndromic cleft lip/palate based on bioinformatics].

PURPOSE: To study DNA methylation patterns of non-syndromic cleft lip/palate(NSCL/P) using bioinformatic methods, including methylated positions and regions. METHODS: Whole blood DNA methylation data of NSCL/P samples was download from Gene Expression Omnibus(GEO) database, including 67 NSCL/P cases and 59 controls without birth defects. Data analysis included ①data cleaning, such as probes filtering, quality control and normalization; ②differential methylation analysis, including methylated positions and regions; ③Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis on differential methylated genes. R 3.4.3 software was used for data cleaning, differential methylated positions and regions analysis. DAVID6.8 tool was used for GO and KEGG analysis. RESULTS: 814 differential methylated positions were detected (adjusted P＜0.001，|Δß|＞0.125）, of which 178 were hypermethylated in NSCL/P patients, and 636 were hypomethylated. In addition, 386 differential methylated regions were identified (P＜0.05), of which 204 were hypermethylation regions and 182 were hypomethylation regions. GO analysis showed that 38 differential methylated genes were involved in 7 kinds of biological processes, 163 differential methylated genes were involved in 3 kinds of molecular functions, and 114 differential methylated genes were involved in 3 kinds of cellular components (P＜0.01). KEGG analysis showed that 59 differential methylated genes were involved in 9 kinds of signal pathways. CONCLUSIONS: Abnormal DNA methylation patterns of NSCL/P might be an important epigenetic mechanism affecting the development of NSCL/P. This study might contribute to the identification of identification of biomarkers and targeted interventions of NSCL/P.

Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study.

OBJECTIVE: The authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients' levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke. DESIGN: This is a data-mining study based on data from a previous study using simulation analysis to develop and validate the CAT-5F. SETTING: One rehabilitation unit in a medical center in Taiwan served as the setting for this study. PARTICIPANTS: Data were retrieved from totals of 540 (initial assessment) and 309 (discharge assessment) participants with stroke assessed in a previous study. The assessment data (N=540) were from the BI, PASS, and STREAM. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome measures for this study were from BI, PASS, and STREAM. RESULTS: The CAT-5F using the optimal stopping rule (limited reliability increased <0.010) had good Rasch reliability across the 5 functions (0.86-0.96) and needed 12.7 items, on average, for the whole administration. The concurrent validity (Pearson product-moment correlation coefficient, r=0.91-0.96) and responsiveness (standardized response mean=0.33-0.91) of the CAT-5F were sufficient in the patients. CONCLUSION: The CAT-5F has sufficient administrative efficiency, reliability, concurrent validity, and responsiveness to simultaneously assess basic activities of daily living, postural control, upper extremity/lower extremity motor functions, and mobility in patients with stroke.

Health literacy and cancer care coordination in Chinese migrant patients and their carers: A cross-sectional survey.

OBJECTIVES: This study aimed to describe the levels of health literacy and experience of care coordination among Chinese migrant patients with cancer and their carers in Australia, and to examine factors associated with these. METHODS: Patients' self-reported data were collected using the Health Literacy and Cancer Care Coordination questionnaires. We conducted multivariate linear regression analyses to investigate predictors of patients' health literacy and their care experience. Canonical correlation analysis was used to examine the relationship between patients' health literacy and their care experience. RESULTS: A total of 68 patients and eight carers participated in the survey. Patients and carers reported similar levels of health literacy, with the lowest scores being in the "Having sufficient information to manage health" and "Navigating the health system" subscales. Gender (P = 0.026, partial η2  = 0.281) and educational attainment (P = 0.015, partial η2  = 0.250) had significant and large effects on patients' health literacy, after controlling for each other. Educational attainment showed a significant and medium association with patients' experience of cancer care coordination (P = 0.041, partial η2  = 0.101). A large and positive correlation was found between patients' health literacy and experience of cancer care coordination (canonical correlation = 0.81). CONCLUSIONS: Our findings reveal the health literacy and care coordination needs of Chinese migrant patients with cancer in Australia, especially those with lower educational attainment. Future efforts are necessary to enhance Chinese migrants' health literacy and establish an accessible and easy-to-navigate care environment.

Computerized Adaptive Testing System of Functional Assessment of Stroke.

The computerized adaptive testing system of the functional assessment of stroke (CAT-FAS) can simultaneously assess four functions (motor functions of the upper and lower extremities, postural control, and basic activities of daily living) with sufficient reliability and administrative efficiency. CAT, a modern measurement method, aims to provide a reliable estimate of the examinee's level of function rapidly. CAT administers only a few items whose item difficulties match an examinee's level of function and, thus, the administered items of CAT can provide sufficient information to reliably estimate the examinee's level of function in a short time. The CAT-FAS was developed through four steps: (1) determining the item bank, (2) determining the stopping rules, (3) validating the CAT-FAS, and (4) establishing a platform of online administration. The results of this study indicate that the CAT-FAS has sufficient administrative efficiency (average number of items = 8.5) and reliability (group-level Rasch reliability: 0.88 - 0.93; individual-level Rasch reliability: ≥70% of patients had Rasch reliability score ≥0.90) to simultaneously assess four functions in patients with stroke. In addition, because the CAT-FAS is a computer-based test, the CAT-FAS has three additional advantages: the automatic calculation of scores, the immediate storage of data, and the easy exporting of data. These advantages of the CAT-FAS will be beneficial to data management for clinicians and researchers.

Rasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer.

BACKGROUND: Shared decision making (SDM) is a best practice to help patients make optimal decisions by a process of healthcare, especially for women diagnosed with breast cancer and having heavy burden in long-term treatments. To promote successful SDM, it is crucial to assess the level of perceived involvement in SDM in women with breast cancer. OBJECTIVE: The aims of this study were to apply Rasch analysis to examine the construct validity and person reliability of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in women with breast cancer. METHODS: The construct validity of SDM-Q-9 was confirmed when the items fit the Rasch model's assumptions of unidimensionality: (1) infit and outfit mean square ranged from 0.6 to 1.4; (2) the unexplained variance of the first dimension of the principal component analysis was less than 20%. Person reliability was calculated. RESULTS: A total of 212 participants were recruited in this study. Item 1 did not fit the model's assumptions and was deleted. The unidimensionality of the remaining 8 items (SDM-Q-8) was supported with good item fit (infit and outfit mean square ranging from 0.6 to 1.3) and very low unexplained variance of the first dimension (5.3%) of the principal component analysis. The person reliability of the SDM-Q-8 was 0.90. CONCLUSIONS: The SDM-Q-8 was unidimensional and had good person reliability in women with breast cancer. IMPLICATIONS FOR PRACTICE: The SDM-Q-8 has shown its potential for assessing the level of perceived involvement in SDM in women with breast cancer for both research and clinical purposes.

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients.

OBJECTIVES: To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P. DESIGN: Data were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS. SETTING: Medical center. PARTICIPANTS: Patients (N=212) with first onset of stroke within 14 days before hospitalization. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Group-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach. RESULTS: The BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change. CONCLUSIONS: The responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.