Chantal Viscogliosi

Measuring social participation: reliability of the LIFE-H in older adults with disabilities

Purpose: Much more attention should be paid to instruments documenting social participation as this area is increasingly considered a pivotal outcome of a successful rehabilitation. The purpose of this study was to document the reliability of a participation measure, the Assessment of Life Habits (LIFE-H), in older adults with functional limitations. Methods: Eighty-four individuals with physical disabilities living in three different environments were assessed twice with the LIFE-H, an instrument that documents the quality of social participation by assessing a persons performance in daily activities and social roles (life habits). Results: The intraclass correlation coefficients (ICC) computed for intrarater reliability exceeded 0.75 for seven out of the 10 life habits categories. For interrater reliability, the total score and daily activities subscore are highly reliable (ICC ⩽ 0.89), and the social roles subscore is moderately reliable (ICC = 0.64). ‘Personal care’ is the category with the highest ICC, and for five other categories ICCs are moderate to high (< 0.60). Conclusion: LIFE-H is a valuable addition to instruments that mostly emphasize the concepts of function or functional independence. It is particularly meaningful to evaluate the participation of older adults in significant social role domains such as recreation and community life. It may be considered among the instruments having the best fit with the ICF definition of participation (the persons involvement in a life situation) and a majority of its related domains.

Differences in Participation According to Specific Cognitive Deficits Following a Stroke

This study compared participation following a stroke according to the presence of specific cognitive deficits. Participation is defined as the involvement of a person in daily activities and social roles. Three weeks after being discharged home, 197 older adults (aged 65 years and older) who had a stroke were evaluated using the Assessment of Life Habits, which includes 12 domains of daily activities and social roles. The presence of a cognitive deficit was determined by the scores obtained on tests assessing memory, visual perception, language, unilateral attention, and the inhibition component of executive functions. After adjusting for depressive symptoms, time since stroke, and comorbidities, five of the domains of participation are significantly more restricted by some cognitive deficits. Memory deficits affect the communication (p = .006) and leisure (p = .032) domains. In the presence of visual perception deficits, the nutrition (p = .019), communication (p = .004), and responsibilities (p < .0005) domains are more limited. Language deficits have an impact on several domains of participation, namely communication (p < .0005), responsibilities (p < .0005), community life (p = .001), and leisure (p = .021). Unilateral neglect and deficits in the inhibition component of executive functions are not found to restrict participation. Overall, participation after stroke is related to cognitive function. Looking carefully at individual domains of activities and roles provides essential information in guiding rehabilitation interventions aimed at enhancing participation after discharge.

Measuring the impact of cognitive and psychosocial interventions in persons with mild cognitive impairment with a randomized single-blind controlled trial: rationale and design of the MEMO+ study.

BACKGROUND Several studies have suggested that cognitive training is a potentially effective way to improve cognition and postpone cognitive decline in older adults with mild cognitive impairment (MCI). The MEMO+ study is a randomized, controlled, single-blind trial designed to test the efficacy, specificity, and long-term effect of a cognitive training intervention and a psychosocial intervention in persons with MCI. METHODS One hundred and sixty-two participants with MCI will be recruited. They will be randomized into three groups: cognitive training, psychosocial intervention, and no-contact. Each intervention will last for eight weeks (one session per week) and a booster training session will be provided three months after the end of the intervention. Various proximal and distal outcomes will be measured at pre-intervention as well as at one week, three months, and six months post-training. Proximal outcomes include memory and psychological health measures. Distal outcomes focus on self-rated functioning in complex daily activities and strategies used in daily life to enhance function. Socio-demographic factors (age, gender, and education), general cognition, personality traits, engagement in activities, and self-efficacy will be used as moderators. Enrolment began in April 2012 and will be completed by December 2014. CONCLUSIONS This study is likely to have a significant impact on the well-being of persons with MCI by contributing to the development of adapted and scientifically supported cognitive and psychosocial interventions.

Provision of Rehabilitation Services in Québec Following Stroke: A Comparative Survey Conducted by Postal Questionnaire

Il n’existe pas de données sur l’offre de service en réadaptation pour les aînés ayant subi un accident vasculaire cérébral (AVC) selon le type de régions. Une enquête a permis de documenter l’offre des services de réadaptation proposés à la clientèle aînée de 65 ans et plus ayant subi un AVC. Au total, les répondants de 295 ressources localisées dans trois régions sociosanitaires du Québec ont complété un questionnaire postal décrivant les services offerts en termes de type d’interventions (associées à neuf aptitudes et à sept domaines de participation sociale) et de type de services (évaluation, réadaptation active, maintien). Les résultats indiquent que l’offre de services de réadaptation proposée par le plus grand nombre de ressources aux personnes âgées ayant subi un AVC concerne les aptitudes motrices et les déplacements. De façon inattendue, au niveau d’interventions associées à quatre aptitudes et à deux domaines de participation sociale, l’offre de services en réadaptation active apparaît plus élevée dans les régions incluant des zones rurales qu’en région métropolitaine. We conducted a survey to document the rehabilitation services available to clients aged 65 years and older who had suffered a stroke. In all, respondents– gleaned from 295 resources located in three health regions in the province of Québec– completed a postal questionnaire describing the services that they offer, in terms of type of intervention (related to nine capabilities and seven areas of social participation) and type of services (evaluation, rehabilitation, and support). The results show that most rehabilitation services offered to older people with stroke address motor skills and mobility. Somewhat unexpectedly, for four capability-related interventions and two social-participation-related interventions, there appear to be more active rehabilitation services offered in regions with rural areas than in metropolitan regions.

MEMO+: Efficacy, Durability and Effect of Cognitive Training and Psychosocial Intervention in Individuals with Mild Cognitive Impairment

There is no consensus on the efficacy of cognitive training in persons with mild cognitive impairment (MCI) because of the paucity of well‐designed randomized controlled trials. The objective was to assess the effect of memory training on the cognitive functioning of persons with MCI and its durability and to evaluate whether this effect generalizes to daily life and whether positive effects could be obtained from psychosocial intervention.