Development of the assessment standards of the International Classification of Functioning, Disability, and Health (ICF) Geriatric Core Set through a modified Delphi method.

BACKGROUND: There is currently a lack of functional assessment tools based on the International Classification of Functioning, Disability, and Health (ICF) theoretical framework that are specific for older adults. OBJECTIVE: The aim of the present study was to develop Chinese assessment standards of the ICF Geriatric Core Set for functional evaluation of older adults. METHODS: A two-stage study process was conducted to develop the assessment standards of the ICF Geriatric Core Set: establishment of candidate assessment standards, and a modified Delphi consensus process including a pilot survey and two-round formal expert survey. Thirty participants in the field of ICF and geriatric rehabilitation were recruited. The suitability of the assessment standards in the questionnaires was rated using a Likert 5-level scoring method. The arithmetic mean, the full mark ratio and the coefficient of variation (CV) were used as screening indicators for the assessment standards, and modification was made for several standards, in line with the Delphi results and the expert panel discussion. RESULTS: Thirty-three candidate assessment standards belonging to 17 categories were generated. A total of 26 and 24 experts in the field of ICF and geriatric rehabilitation participated in the two-round survey, respectively. Five standards belonging to four categories entered into the second-round survey directly, five standards belonged to five categories entered with minor modification, and nine standards belonging to seven categories were redesigned based on the literature and discussion of the expert panel. In the second-round survey,15 assessment standards belonging to 15 categories met the screening requirements and four assessment standards belonged to the two remaining categories that needed a criterion and which the expert panel discussed for the final decision. CONCLUSIONS: Using the modified Delphi method, the assessment standards of the ICF Geriatric Core Set have been developed.Future work should focus on the reliability and validity of the the assessment standards and their application to the health management of older adults.

Agreement Between Single Raters and Team Rating When Applying the International Classification of Functioning, Disability and Health's Rehabilitation Set.

OBJECTIVE: To quantify the agreement between functional assessments by a single rater and a team using the Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set in a clinical situation. DESIGN: Inter-rater, multi-centre agreement study. SUBJECTS: A total of 193 adult inpatients admitted to 5 rehabilitation centres at 5 hospitals in China Methods: The Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set was used by either a single rater or a team to assess 193 patients at 5 Chinese hospitals. Percentage of agreement and quadratic-weighted kappa coefficients were computed. Evaluation times were compared with paired t-tests. RESULTS: The mean team and individual evaluation times were not significantly different. The percentage of agreement ranged from 46.1% to 94.2% depending on the item, and the quadratic-weighted kappas ranged from 0.43 to 0.92. Eight categories (26.6%) showed a weighted kappa exceeding 0.4, 11 others (36.7%) exceeded 0.6, and another 11 (36.7%) produced kappas of more than 0.8. CONCLUSION: Either a single rater or a team of raters can produce valid and consistent ratings when using the Chinese version of the International Classification of Functioning, Disability and Health Rehabilitation Set to assess patients in a rehabilitation department. The team rating approach is suitable for clinical application.

Psychometric properties of the International Classification of Functioning, Disability and Health Rehabilitation Set: a Rasch analysis.

The International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set was proposed by the WHO ICF Research branch as a minimum standard for assessing and reporting functioning in a wide range of clinical settings. This study investigates the psychometric properties of ICF Rehabilitation Set using Rasch analysis. It was a multicenter, cross-sectional study involving 515 inpatients in the subacute or chronic phase of recovery from various health conditions selected by quota sampling (stratified by neurological, cardiopulmonary, musculoskeletal and other conditions). Registered physicians or nurses used the developed operational items of the ICF Rehabilitation Set to rate patients' functioning. A Rasch model was performed in assessing the psychometric properties of the ICF Rehabilitation Set. Good reliability was observed in the activity and participation components, but the body functions component needs additional items to distinguish among people with moderate or severe problems. After recalibration, the body functions, activities and participation components showed fit to the Rasch model. However, deletions mandated by the Rasch model decreased the functioning information reflected by the ICF Rehabilitation Set.

A team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation set in clinical evaluation.

OBJECTIVE: To develop a team approach to applying the International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in clinical evaluation. DESIGN: A Delphi study. SUBJECTS: Experts from rehabilitation institutions in China including physicians, nurses, physiotherapists and occupational therapists. METHODS: A 2-round Delphi survey and expert panel discussion were used to generate the team approach. Firstly, the candidate types of professionals for team rating were chosen through expert panel discussion. A carefully selected group of participants was then asked to score the suitability of physicians, nurses, or other candidate therapists for each category's rat-ing, applying the International Classification of Functioning, Disability and Health Rehabilitation Set in clinical evaluation. After initial assignment of cate-gory to types of professionals, a second round Delphi survey was conducted to quantify the professionals' agreement with the category assignments and generate a final team evaluation approach. RESULTS: Thirty of the category assignments achiev-ed consensus. The final team evaluation approach assigned 6 categories to physicians to evaluate, 7 categories to nurses, 9 categories to physiotherapists, and 8 to occupational therapists. CONCLUSION: Such a team evaluation approach could facilitate implementation of the ICF-RS in clinical settings and provide a more convenient assessment tool for professionals.

Identification of differentially expressed microRNAs and their target genes in the hippocampal tissues of Fmr1 knockout mice.

Fragile X syndrome (FXS) is one of the most common forms of inherited mental retardation; it is usually associated with the transcriptional silencing of the Fmr1 gene and loss of its encoded protein, the fragile X mental retardation protein (FMRP). FMRP is an RNA-binding protein and participates in regulating the development of dendritic spines and synaptic plasticity. To uncover the possible role of microRNAs (miRNAs) in FXS and their relationship with FMRP, we used microarray analysis to investigate the miRNA expression profiles in the hippocampal tissues of Fmr1 knockout (Fmr1-KO) mice and wild type (WT) mice. A total of 75 differentially expressed miRNAs were identified, of which 58 were significantly upregulated and no miRNAs were significantly downregulated in Fmr1-KO mice. Quantitative real-time PCR (qRT-PCR) analysis was applied to validate the expression of 7 upregulated miRNAs; results indicated that the levels of only miR-449a and miR-720 were significantly upregulated. We further used bioinformatics software and databases to predict the target genes of these two miRNAs. The genes were related to dendritic spine development and synaptic plasticity; the qRT-PCR and western blotting results showed that cyclin-dependent kinase 5 (CDK5) and synaptotagmin 1 (SYT1) were differentially expressed in the Fmr1-KO mice and WT mice. In conclusion, this study evidenced diverse changes in the expression of miRNAs, and validated the miRNAs and their targeted genes in Fmr1-KO mice. Although further studies are required to better understand the function of miRNAs in FXS, the present research highlights a potential role of miRNAs in the pathogenesis of FXS.

A mobile app implementing the international classification of functioning, disability and health rehabilitation set.

BACKGROUND: The Chinese assessment standards of the International Classification of Functioning, Disability and Health Rehabilitation Set is available now. It is coming to be used as a basic functional evaluation tool in China. With data accumulating, a mobile application is needed to eliminate the extra cost of data entry, storage, and graphical presentation of trends. This study aimed to design, develop and test a mobile app based on the International Classification of Functioning, Disability and Health Rehabilitation Set Rehabilitation Set. METHODS: The study had three phases. The first involved specifying the functional requirements of the app. Then an app was designed and refined to meet those requirements. In a pilot test, the app was used by rehabilitation professionals in clinical practice and their comments were collected for its further modification in one-on-one interviews. RESULTS: The app met the initial requirements, and the pilot study showed it worked as designed. The pilot study also showed that the app is user-friendly and convenient to use in rehabilitation practice. Some feedback was given to improve the app. CONCLUSION: An Android mobile app implementing the International Classification of Functioning, Disability and Health Rehabilitation Set was successfully developed.

Long noncoding RNA MEG3 silencing protects against hypoxia-induced pheochromocytoma-12 cell injury through inhibition of TIMP2 promoter methylation.

Hypoxia is a common pathological process caused by insufficient oxygen. Long noncoding RNAs (lncRNAs) have been proven to participate in this pathology. Hypoxia is reported to significantly reduce the secretion of tissue inhibitor of metalloproteinase 2 (TIMP2) and TIMP2 induces pheochromocytoma-12 (PC12) cell cycle arrest. Thus, our study aimed to explore the mechanism by which lncRNA maternally expressed gene 3 (MEG3) was implicated in hypoxia-induced PC12 cell injury through TIMP2 promoter methylation. To elucidate the potential biological significance of MEG3 and the regulatory mechanism between MEG3 and TIMP2, a hypoxia-induced PC12 cell injury model was generated. The hypoxia-exposed cells were subjected to a series of overexpression plasmids and short hairpin RNAs, followed by the measurement of levels of MEG3, TIMP2, lactate dehydrogenase (LDH), malondialdehyde (MDA), superoxide dismutase (SOD), reactive oxygen species (ROS), Bcl-2-associated X protein, B-cell lymphoma-2, and caspase-3, as well as the changes in MMP, cell proliferation, apoptosis, and cell cycle progression. On the basis of the findings, MEG3 was upregulated in hypoxia-injured PC12 cells. MEG3 recruited methylation proteins DNMT3a, DNMT3b, and MBD1 and accelerated TIMP2 promoter methylation, which in turn inhibited its expression. Moreover, PC12 cells following MEG3 silencing and TIMP2 overexpression exhibited significantly decreased levels of LDH, MDA, and ROS along with cell apoptosis, yet increased SOD and MMP levels, as well as cell cycle entry to the S phase and cell proliferation. In conclusion, MEG3 silencing suppresses hypoxia-induced PC12 cell injury by inhibiting TIMP2 promoter methylation. This study may provide novel therapeutic targets for hypoxia-induced injury.

[Effects of acupuncture on muscle tension of lower limb in children with spastic cerebral palsy].

OBJECTIVE: To observe the effects of acupuncture at different acupoints in yin meridians and yang meridians on lower limb muscle tension in children with spastic cerebral palsy. METHODS: Ninety children with spastic cerebral palsy aged between 2 to 6 years old were divided into a yin-meridian group, a yang-meridian group and a rehabilitation group, 30 cases in each one. The patients in the rehabilitation group were treated with routine rehabilitation treatment; the patients in the yin-meridian group were treated with routine rehabilitation treatment and acupuncture at Xuehai (SP 10), Yinlingquan (SP 9), Sanyinjiao (SP 6), Taixi (KI 3) and Taichong (LR 3) along yin meridians; the patients in the yang-meridian group were treated with routine rehabilitation treatment and acupuncture at Futu (ST 32), Zusanli (ST 36), Yanglingquan (GB 34), Guangming (GB 37) and Xuanzhong (GB 39) along yang meridians. All the three groups were treated once each other day, 10 times as one course, and totally 20-day treatment was given. Before and after treatment, modified Ashworth scale (MAS), clinical spasm index (CSI) and integrated electromyography (iEMG) of surface electromyogram of gastrocnemius muscle were evaluated. RESULTS: Compared before treatment, the MAS and CSI in the yin-meridian group and yang-meridian group were improved after treatment (P<0.05, P<0.01); the differences before and after treatment in the rehabilitation group were not significant (both P>0.05). After treatment, the differences between the rehabilitation group and yin-meridian group, yang-meridian group were significant (P<0.05, P<0.01); the differences of MAS and CSI between the yin-meridian group and yang-meridian group were not significant (both P>0.05). Compared before the treatment, the right-side iEMG and left-side iEMG were reduced in the yin-meridian group and yang-meridian group (all P<0.05); the right-side iEMG was increased in the rehabilitation group (P<0.05). After treatment, the iEMG in the yin-meridian group and yang-meridian group were lower than that in the rehabilitation group (all P<0.05); the differences of iEMG before and after treatment in the yin-meridian group and yang-meridian group were higher than that in the rehabilitation group (all P<0.05); the differences of iEMG between the yin-meridian group and yang-meridian group were not significant (both P>0.05). CONCLUSION: Acupuncture at yin meridians and yang meridians could reduce muscle tension of lower limb and improve limb spasticity in children with spastic cerebral palsy, and the two acupuncture methods have similar clinical curative effect.

[Analysis on factors for effects of motor function of cerebral palsy children assisted by acupuncture-Retrospective analysis with 520 cases attached].

OBJECTIVE: To analyze the effects of motor function of cerebral palsy children by the adjuvant therapy of acupuncture and its factors retrospectively. METHODS: Five hundred and twenty cerebral palsy children in hospital (from January 2005 to December 2014) who meet the criteria were selected through Doctor Workstation of our hospital. The cases were divided into groups according to the type of cerebral palsy, gestational age, complication, treatment time and age. Based on the physical rehabilitation, all the patients were assisted by acupuncture. Scalp acupuncture was used at Zhiqizhen (seven-intelligent needles), motor area, foot-motor-sensory area, etc. Body acupuncture were mainly at the governor vessel and yangming meridians of hand and foot. Treatment was given once every other day for eight months. Effects were evaluated by gross motor function classification system (GMFCS) and gross motor function measure (GMFM). RESULTS: ① GMFCS:after eight-month treatment, the total effective rate of children with spastic cerebral palsy was superior to those of mixed type and involuntary movement type[77.9% (300/385) vs 60.3% (38/63), 56.9% (41/72), both P<0.01]. The total effective rates of the above three types with gestational age from 37 to 42 weeks were better than those of the corresponding types with gestational age (P<0.01, P<0.05). The efficacy of children with mental retardation and language disorderwas higher than that of epilepsy and hearing disorder (P<0.01, P<0.05). The total effective rates of patients in the three types with the age of 1-2 were better than those of the corresponding types with the age of 2-4 (all P<0.05). ② GMFM:after three-month and eight-month treatment, the GMFM scores of the three types were increased in different degrees (all P<0.01), and after eight-month treatment, the score of the spastic type was increased more obviously than those of the other two types (both P<0.01). CONCLUSIONS: The motor function of cerebral palsy children can be improved assisted by acupuncture, and the effect may be related to treating time, cerebral palsy type, gestational age, complication and age.