Evaluating individual change with the Quality of Life in Neurological Disorders (Neuro-QoL) Short Forms

Publication date: Available online 29 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Allan J. Kozlowski, David Cella, Kristian P. Nitsch, Allen W. Heinemann
ObjectiveTo provide a clinically useful means of interpreting change for individual patients on the Neurological Quality of Life (Neuro-QoL) adult short forms (SFs) by applying a Classical Test Theory concept for interpreting individual change.DesignSecondary analysis of existing data.SettingCommunity.ParticipantsPersons with neurological conditions including stroke, epilepsy, amyotrophic lateral sclerosis, multiple sclerosis, and Parkinson's disease residing in community settings. Interventions: Not applicable.Main Outcome MeasuresNeuro-QOL SFs for Applied Cognition-General Concerns, Applied Cognition-Executive Function, Applied Cognition-Combined, Ability to Participate in Social Roles and Activities, Satisfaction with Social Roles and Activities, Positive Affect and Well-Being, Depression, Stigma, Upper Extremity Function (Fine Motor, Activities of Daily Living), Lower Extremity Function (Mobility), Anxiety, Sleep Disturbance, Fatigue, and Emotional and Behavioral Dyscontrol.MethodsWe estimated conditional minimal detectable change (cMDC) indices from the pooled standard errors (SEs) adjusted for a 95% confidence interval (CI) using the average of the SEs for any given pair of scores multiplied by the z-score, or [(SEScore1 +SEScore2)/2 · 1.96].ResultsThe cMDC indices are generally smallest in the mid-range of all scales, ranging from 3.6 to 11.2 T-score points, and higher on the outer quartiles ranging from 3.7 to 21.6 T-score points. The lowest mid-range cMDCs were for Satisfaction with Social Roles and Activities (3.6-4.7 T-score points) and the largest was for Sleep Disturbance (9.4-11.2 T-score points).ConclusionsChange indices can help clinicians and investigators identify differences for individual patients or subjects that are large enough to motivate treatment change. cMDCs can reduce misclassification of magnitudes of change that are near the margins of error across the range of the Neuro-QoL SFs.



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Dimensionality and item-difficulty hierarchy of the lower-extremity Fugl-Meyer assessment in individuals with sub-acute and chronic stroke

Publication date: Available online 29 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Chitralakshmi K. Balasubramanian, Chih-Ying Li, Mark G. Bowden, Pamela W. Duncan, Steven A. Kautz, Craig A. Velozo
ObjectiveTo investigate the dimensionality and item-difficulty hierarchy of the lower extremity section of the Fugl-Meyer assessment (FMA-LE).DesignSecondary analyses of data pooled from four existing datasets: a Phase III randomized controlled trial investigating the effectiveness of body weight support and a treadmill for rehabilitation of walking post-stroke and three cross-sectional studies investigating the link between impaired motor performance post-stroke and walking.SettingUniversity research centers and rehabilitation centers.ParticipantsA pooled sample of 535 individuals with a stroke (age = 61.91 ± 12.42 years; male = 313).InterventionsNot applicable.Main Outcome Measure(s)Confirmatory factor analyses (CFA) and Rasch residual Principal component analysis (PCA) investigated the dimensionality of the FMA-LE. The Rasch analysis rating scale model (RSM) investigated item-difficulty hierarchy of the FMA-LE.ResultsThe CFA showed adequate fit of a three-factor model with 2/3 indices (CFA = 0.95; TLI = 0.94; RMSEA = 0.124) showing good model fit. Rasch PCA showed that removal of the reflex and coordination items explained 90.8% of variance in the data, suggesting that the abnormal synergy items contributed to the measurement of a unidimensional construct. However, RSM results revealed deviations in the item-difficulty hierarchy of the unidimensional abnormal synergy items from the originally proposed stepwise sequence of motor recovery.Conclusion(s)Our findings suggest that the FMA-LE might represent a multidimensional construct challenging the use of a total score of the FMA-LE to predict lower extremity motor recovery. Removal of the misfit items resulted in creation of a unidimensional scale comprised of the abnormal synergy items. However, this unidimensional scale deviates from the originally proposed hierarchical ordering.



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Utility of ultrasound for imaging osteophytes in patients with insertional achilles tendinopathy

Publication date: Available online 29 December 2015
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Ruth L. Chimenti, Peter C. Chimenti, Mark R. Buckley, Jeff R. Houck, A. Samuel Flemister
ObjectiveTo examine 1) the validity of ultrasound imaging to measure osteophytes, and 2) the association between osteophytes and IAT.DesignCase-control studySettingAcademic medical centerParticipants20 persons with chronic unilateral IAT (Age: 58.7 ± 8.3 years, 50% female) and 20 age- and gender-matched controls (Age: 57.4 ± 9.8 years, 50% female) participated in this case-control study.InterventionNot applicable.Main Outcome MeasuresSymptoms severity was assessed using the Foot and Ankle Ability Measure (FAAM), Victorian Institute of Sport Assessment- Achilles questionnaire (VISA-A), and the Numerical Rating Scale (NRS). Length of osteophytes was measured bilaterally in both groups using ultrasound imaging and additionally on the symptomatic side of the IAT group using radiographs. The intraclass correlation coefficient was used to examine the agreement between ultrasound and radiograph measures. McNemar, Wilcoxon Signed Rank and Fisher's exact tests were used to compare the frequency and length of osteophytes between sides and groups. Pearson correlation was used to examine the association between osteophyte length and symptom severity.ResultsThere was good agreement (ICC ≥0.75) between ultrasound and radiograph osteophyte measures. There were no statistically significant differences (P>0.05) between sides or groups in the frequency of osteophytes. Osteophytes were larger on the symptomatic side of the IAT group compared to the asymptomatic side (P= 0.01) and controls (P=0.03). There were no associations between osteophyte length and symptom severity.ConclusionsUltrasound imaging is a valid measure of osteophyte length, which is associated with IAT. While a larger osteophyte indicates pathology, it does not indicate more severe IAT symptom severity.



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Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy (CEA) for Carotid Artery Stenosis.

Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy (CEA) for Carotid Artery Stenosis.

World Neurosurg. 2015 Dec 17;

Authors: Rong X, Yang W, Garzon-Muvdi T, Ye X, Caplan JM, Colby GP, Coon AL, Tamargo RJ, Huang J

Abstract
OBJECTIVE: Patients undergoing carotid endarterectomy (CEA) are at risk of developing ipsilateral stroke or transient ischemic attacks (TIA). In this study, we explored factors associated with development of these events following CEA in patients with long-term follow-up.
METHODS: We performed a retrospective analysis of all neurosurgical patients that underwent CEA and presented with ipsilateral ischemic stroke, TIA or amaurosis fugax. Factors were compared against the outcome variable in univariate analysis. Multivariate logistic regression model was utilized to identify independent predictive variables. We used Kaplan-Meier analysis (log-rank test) to compare the effect of variables on long-term event-free survival.
RESULTS: Our study included 270 patients with an average age of 67.2 years. Two hundred and forty-nine patients within our study cohort (92.2%) with 273 CEAs were followed at our institution. One hundred and eighty-seven (68.5%) patients were symptomatic at presentation. The average follow-up was 50.2 months (113.2 lesion-years). Event-free survival was 91.6% and 89.9% at 2 years and 5 years, respectively. Family history of stroke(p=0.002), cigarette smoking(p=0.021) and atrial fibrillation(p=0.005) significantly increased the risk of adverse events whereas symptomatic presentation demonstrated a trend towards significance(p=0.057). A higher risk for ischemic events was observed in female patients as compared to male with asymptomatic presentation(p=0.005).
CONCLUSIONS: Our data suggest that family history of stroke, cigarette smoking and atrial fibrillation are independent risk factors for developing ischemic events after CEA. In patients with asymptomatic presentation, female gender is also a risk factor. Identification of patients at risk is critical for tailored post-operative patient management and patient education.

PMID: 26709157 [PubMed - as supplied by publisher]

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Diagnostic Value of Somatosensory Evoked Potential Monitoring During Cerebral Aneurysm Clipping.

Diagnostic Value of Somatosensory Evoked Potential Monitoring During Cerebral Aneurysm Clipping.

World Neurosurg. 2015 Dec 17;

Authors: Thirumala PD, Udesh R, Muralidharan A, Thiagarajan K, Crammond DJ, Balzer JR, Chang YF

Abstract
BACKGROUND: Perioperative stroke is a known complication in patients undergoing surgical clipping of cerebral aneurysms.
OBJECTIVE: To evaluate whether intra-operative changes in somatosensory evoked potential (SSEP) monitoring during cerebral aneurysm clipping is diagnostic of perioperative stroke.
METHODS: An electronic search of PubMed, Embase and Web of Science databases was done for studies published through May 2015 on SSEP monitoring in cerebral aneurysm clipping for predicting post-operative outcomes. All titles and abstracts were independently screened based on predetermined criteria. Inclusion criteria included randomized clinical trials and prospective or retrospective cohort reviews; patients with intracranial aneurysms who underwent surgical clipping with intra-operative SSEP monitoring and postoperative neurological assessment; studies published in English on adult humans ≥ 18 years with sample size of ≥ 50; studies inclusive of an abstract with adequate details on outcomes.
RESULTS: A total of 14 articles with a sample population of 2015 patients were analyzed. SSEP monitoring demonstrated a strong mean specificity of 84.5% (95%CI-76.3-90.3) but weaker sensitivity of 56.8% (95%CI, 44.1-68.6) for predicting stroke. A diagnostic odds ratio of 7.772 (95% CI, 5.133-11.767) suggested that the odds of observing an SSEP change among those with a post-operative neurological deficit were 7 times higher than those without a neurological deficit.
CONCLUSION: Intra-operative SSEP monitoring is highly specific for predicting neurological outcome following cerebral aneurysm clipping. Patients with post-operative neurological deficits are 7 times more likely to have had intra-operative SSEP changes. SSEP monitoring may help design prevention strategies to reduce stroke rates following cerebral aneurysm clipping.

PMID: 26709156 [PubMed - as supplied by publisher]

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Epilepsy: A Disruptive Force in History.

Epilepsy: A Disruptive Force in History.

World Neurosurg. 2015 Dec 17;

Authors: Ali R, Connolly ID, Feroze AH, Awad AJ, Choudhri OA, Grant GA

Abstract
Since first described in a Mesopotamian text in 2000 BC, countless individuals have offered their perspectives on epilepsy's cause, treatment, and even deeper spiritual significance. However, despite the attention the disease has received through the millennia, it has only been within the past half-century that truly effective treatment options have been available. As a result, for the vast majority of recorded history, individuals with epilepsy have not only had to deal with the uncertainty of their next epileptic seizure but also the concomitant stigma and ostracization. Interestingly, these individuals have included several prominent historical figures, including Julius Caesar, Vladimir Lenin, and Fyodor Dostoyevsky among others. The fact that epilepsy has appeared in the lives of influential historical people means that the disease has played some role in affecting the progress of human civilization. Epilepsy has cut short the lives of key political leaders, affected the output of talented cultural icons, and, especially within the past half century, influenced the collective understanding of neuroscience and the human nervous system. In this article, the authors review how epilepsy throughout history has manifested itself in the lives of prominent figures and how the disease has helped shape the course of humanity's political, cultural, and scientific evolution.

PMID: 26709155 [PubMed - as supplied by publisher]

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Endoscopic Resection of Intraventricular Brain Tumors in Children.

Endoscopic Resection of Intraventricular Brain Tumors in Children.

World Neurosurg. 2015 Dec 17;

Authors: Sandberg DI

PMID: 26709154 [PubMed - as supplied by publisher]

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