Apathy exacerbates postural control impairments in stroke survivors: The potential effects of cognitive dual-task for improving postural control.

Apathy is a stressor and debilitating common condition for both stroke survivors and their caregivers. However, its effects on the postural control of these patients have not yet been investigated. Improved postural stability through withdrawing attention from postural control by concurrent cognitive task (i.e. dual-task condition) has been reported previously, but the effect of apathy, as a confounding factor, remains unknown. This study aimed to examine the effects of apathy and dual-task condition on postural control of chronic stroke survivors from biomechanical and neurophysiological perspectives. Twenty non-apathetic stroke survivors, 20 apathetic stroke survivors, and 20 sex-, age-, weight-, and height-matched healthy subjects were assessed using different postural sway measures and electromyography activity of ankle and hip muscles while quietly standing on rigid and foam surfaces under single-task, easy dual-task, and difficult dual-task conditions. The results showed postural instability and neuromuscular stiffening of stroke survivors, particularly apathetic stroke survivors, compared with healthy controls as evidenced by significantly greater postural sway measures and increased co-contraction of ankle muscles as well as hip muscles. Notably, concurrently performing a cognitive task significantly reduced postural instability and neuromuscular stiffening in chronic stroke survivors even in those with apathy. In conclusion, apathy exacerbates postural control impairments in chronic stroke survivors promoting an inefficient conscious mode of postural control. It is recommended that distracting the attention away from postural control by performing a concurrent cognitive task can be considered an effective strategy while designing interventions for improving postural control in apathetic stroke survivors.

Psychometric properties of dexterity questionnaire-24 in Iranian chronic stroke survivors.

INTRODUCTION: Dexterity is one of the most critical upper extremity functions that may be impaired in chronic stroke survivors. This study aimed to investigate the psychometric properties of DextQ-24 in Iranian chronic stroke survivors. METHOD: A total of 123 people with chronic stroke were included in the study. Internal consistency and test-retest reliability were assessed through Cronbach's alpha and Interclass Correlation (ICC), respectively. Dimensionality was performed by Exploratory Factor Analysis. In addition, to assess the convergent validity of DextQ-24, Box and Block Test, Motor Activity Log Questionnaire, ABILHAND Questionnaire, and Purdue Pegboard Test were used. Discriminant validity of DextQ-24 was measured between different stages of recovery (Brunnstrom stage). Acceptability was calculated by ceiling and floor effect. RESULTS: Cronbach's alpha and ICC were 0.92 and 0.91, respectively. The 24 items of this questionnaire were classified into six components. Further, a moderate to strong correlation between the total score of DextQ-24 with other tools | r = 0.41-0.84 | was obtained. The results of discriminant validity approved the ability of the total score of DextQ-24 to separate different stages of recovery. The results also reported that this questionnaire did not have a significant ceiling and floor effect. CONCLUSION: The results of our study showed that the Persian DextQ-24 has high reliability and a good convergent and discriminant validity in people with chronic stroke for dexterity measurement as a PROM questionnaire.

Psychometric features of brief pain inventory for Parkinson's disease during medication states.

PURPOSE: Patients with idiopathic Parkinson's disease (PD) suffer from different non-motor symptoms, including pain. The present study aimed to measure the psychometric properties of the Brief Pain Inventory (BPI) in patients with PD during ON- and OFF-states. METHODS: We recruited 460 patients with PD and 100 non-PD controls. The pain was assessed by the BPI, King's Parkinson's disease Pain Scale (KPPS), Neuropathic Pain Symptom Inventory (NPSI), Visual Analogue Scale-Pain (VAS-pain), and short-form McGill Pain Questionnaire-2 (SF-MPQ-2) in both medication states. Internal consistency and test-retest reliability was examined using Cronbach's alpha coefficient and intra-class correlation coefficient (ICC). Dimensionality and convergent validity of BPI were also investigated. Diagnostic accuracy and discriminative validity were determined by Receiver Operating Characteristics (ROC) curve analysis and Area Under the Curve (AUC). RESULTS: Cronbach's alpha was satisfactory (α = 0.91-0.97) in both states. The ICC values were 0.85-0.96 in ON- and OFF-state. Factor analysis revealed two factors. A high correlation was obtained between BPI subscales and other scales. AUC >0.91, sensitivity, and specificity> 0.77 were observed for discriminating different pain levels. Furthermore, appropriate diagnostic accuracy was found (AUC, sensitivity, and specificity >0.67) between non-PD control and PD patients. CONCLUSION: The BPI has acceptable psychometric features as well as diagnostic accuracy for patients with PD.Implications for rehabilitationPain as a non-motor symptom in PD can affect daily and social activities.The BPI is used to assess pain severity and interference in activities.For better treatment, pain should be assessed in off-state like to on-state.BPI has satisfactory reliability and validity in different medication states in PD.

Validity and Reliability of the Persian Version of Parkinson's Disease Sleep Scale-2.

OBJECTIVE: Sleep problems are nonmotor symptoms in Parkinson's disease that should be carefully evaluated for better management and treatment. Parkinson's Disease Sleep Scale (PDSS-2) is one of the most reliable tools for measuring sleep difficulties in people with Parkinson's disease. This study investigated the psychometric properties of the Persian version of PDSS-2. METHODS: Four hundred and fifty-six people with Parkinson's disease with a mean age ±standard deviation of 60.7 ± 11.3 years were engaged in this study. Acceptability was assessed by floor and ceiling effects. Dimensionality was measured by exploratory factor analysis. The convergent validity of PDSS-2 with the Hospital Anxiety and Depression Scale (HADS) was assessed. Internal consistency and test-retest reliability were assessed with Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. RESULTS: No noticeable ceiling and floor effect was detected. The dimensionality analysis showed three factors. A high correlation was obtained between PDSS-2 and HADS (anxiety subscale). Excellent internal consistency with α = 0.94, and good test-retest reliability with ICC = 0.89 were obtained. CONCLUSION: This study showed that the Persian version of Parkinson's Disease Sleep Scale has acceptable validity and reliability for measuring sleep disturbances in people with Parkinson's disease.

Barthel Index and modified Rankin Scale: Psychometric properties during medication phases in idiopathic Parkinson disease.

BACKGROUND: Independence in activities of daily living (ADL) is one of the most important aspects in planning treatment for people with Parkinson disease (PD). The Barthel Index (BI) and modified Rankin Scale (mRS) are commonly used in neurological diseases. OBJECTIVE: This study was conducted to confirm the validity and reliability of the BI and mRS in PD during ON and OFF medication phases. METHODS: We included 260 individuals with a diagnosis of idiopathic PD. The disability in ADL was measured by the BI, mRS, Parkinson's Disease Questionnaire-39 (PDQ-39), Unified Parkinson Disease Rating Scale-Activities of Daily Living (UPDRS-ADL), and Schwab and England ADL scale (SE). Test-retest, inter-rater reliability, and internal consistency were assessed by the intra-class correlation (ICC) and Cronbach α coefficients. Dimensionality was evaluated by factor analysis. Convergent validity was assessed by the SE, Berg Balance Scale (BBS), PDQ-39 and UPDRS-ADL. RESULTS: For the 260 participants (187 [71.9%] males; mean [SD] age 60.3 [12.3] years), both the BI and mRS achieved an acceptable level of test-retest and inter-rater reliability (ICC=0.77 to 0.91) in ON and OFF medication phases. The Cronbach α for BI was 0.85 and 0.88, respectively. We found 1 and 2 factors for BI in ON and OFF phases, respectively. Investigation of convergent validity showed moderate to high correlation for the BI with the UPDRS-ADL, SE, PDQ-39 (ADL), BBS and mRS scores in ON and OFF phases (ρ=0.51-0.74) and mRS with SE, UPDRS-ADL, PDQ-39 (ADL) and BBS scores (ρ=0.48-0.82). CONCLUSION: The BI and mRS showed acceptable validity and reliability to measure the degree of disability in patients with PD in daily activities in both ON and OFF medication phases.