Diane D. Allen

Effect of Pretreatment of Food Gluten With Prolyl Endopeptidase on Gluten-Induced Malabsorption in Celiac Sprue

BACKGROUND & AIMS We sought to determine whether prolyl endopeptidase (PEP) treatment of food gluten would obviate the intestinal dysfunction produced by small amounts of dietary gluten supplement in patients with celiac sprue. METHODS Twenty asymptomatic patients with histologically proven celiac sprue completed a randomized, double-blind, cross-over study involving two 14-day stages. Each patient consumed a low dose of a gluten supplement daily (5 g; equivalent to 1 slice of bread) in 1 stage and gluten pretreated with PEP in the other stage. Patients completed a daily symptom questionnaire and a D-xylose urine excretion and a 72-hour quantitative fecal fat were monitored before and after each stage. RESULTS Despite clinical remission at baseline, 40% of patients had at least 1 abnormal celiac antibody, 20% had an abnormal urine xylose, and 63% had an abnormal fecal fat test result. There was no difference in symptoms as a function of the type of gluten consumed. In response to gluten not treated with PEP, an appreciable proportion of patients developed malabsorption of fat (7 of 17, 41%) or xylose (8 of 14, 57%). When the gluten was pretreated with PEP, fat malabsorption was avoided in 5 of 7 and xylose malabsorption in 4 of 8 of these same patients. CONCLUSIONS A significant proportion of asymptomatic patients with celiac sprue have abnormal celiac antibodies and fat or carbohydrate malabsorption. Pretreatment of gluten with PEP avoided the development of fat or carbohydrate malabsorption in the majority of those patients who developed fat or carbohydrate malabsorption after a 2-week gluten challenge.

Low-Dose Gluten Challenge in Celiac Sprue: Malabsorptive and Antibody Responses

BACKGROUND & AIMS Undiagnosed patients with symptoms of celiac sprue often present to physicians after establishing dietary gluten exclusion. Although they must resume a gluten-containing diet for evaluation, there are no guidelines regarding duration of the gluten challenge, gluten dose, or monitoring parameters. We investigated the effects of a short-term gluten challenge in asymptomatic treated adult celiac patients on intestinal absorption and celiac antibody tests. METHODS Eight adult asymptomatic celiac patients consumed either 5 or 10 g of partially hydrolyzed gluten per day in an orange juice mixture for 21 days while maintaining their usual gluten-free diet. A symptom questionnaire, serum antibodies (antigliadin immunoglobulin [Ig]A and antitransglutaminase IgA and IgG), D-xylose urine excretion test, and 72-hour quantitative fecal fat test were monitored. RESULTS Two patients (25%) had at least 1 abnormal celiac antibody test at baseline. There was no increase in antibodies during gluten exposure compared with baseline for any of the patients (P > .05). At baseline, 1 patient had abnormal urine xylose excretion, and 3 patients had abnormal fecal fat values. At day 15 of gluten challenge, all patients had reduced xylose absorption compared with baseline (P = .0019), and 5 of 8 participants (63%) reduced their xylose excretion to the abnormal range. Seven of 8 patients (88%) had increased fecal fat excretion at day 15 (P = .026), and 6 of these (75%) had steatorrhea by day 15. CONCLUSIONS Short-term gluten challenge in asymptomatic adult celiac patients produces carbohydrate and fat malabsorption but does not increase transglutaminase and antigliadin antibody titers.

Validation of the International Classification of Functioning Disability and Health framework using multidimensional item response modeling

Purpose. To examine the construct validity of the International Classification of Functioning Disability and Health (ICF) framework using multidimensional item response modelling and data collected in different regions from patients with five chronic health conditions. We assume that the ICF components should represent statistically called dimensions that are distinct although related. Method. Retrospective validation study using the ICF Core Sets from a convenience sample of patients in an international multicentre, cross-sectional database obtained in different rehabilitation centres. Health professionals working in 89 rehabilitation centres in 32 countries collected data from 3227 rehabilitation patients using the respective ICF Core Sets. Patients included had one of the following health conditions: low back pain (LBP), rheumatoid arthritis (RA), osteoarthritis (OA), obesity (OB) or post-stroke. Data from questions regarding a patients functioning based on body structures and functions, activities, participation along the ICF Core Sets were analysed with multidimensional item response modelling. Results. The multidimensional models fit the data better than a model with few or no specifications regarding an underlying framework. For example, a model separating four dimensions ‘body structures’, ‘body functions’, ‘activities’ and ‘participation’ fits the data better than a model differentiating between ‘body functions and structures’ and ‘activities and participation’. The ICF framework with its components represents underlying statistically called dimensions. Conclusion. The results of this study support the construct validity of the functioning part of the ICF. The distinct dimensions may facilitate the alignment of ICF components with other measures used clinically and in research. Based on our results it is justifiable to construct instruments integrating ICF categories within components.

Proposing 6 Dimensions Within the Construct of Movement in the Movement Continuum Theory

Background and Purpose The Movement Continuum Theory (MCT) provides a potential basis for movement assessment and intervention, but “movement” lacks specificity. The purposes of this study were to propose and evaluate a subdivision of movement into multiple dimensions. Subjects A convenience sample of 318 adults completed a 24-item self-report measure of movement ability. Methods A multimethod approach was used to identify, operationalize, and test a multidimensional model of movement. Data analysis included a comparison of the fit of unidimensional and multidimensional models using item response theory methods and inspection of response patterns. Results A model specifying 6 dimensions—flexibility, strength, accuracy, speed, adaptability, and endurance—fit respondent data significantly better than the unidimensional model, even with high pair-wise correlations between dimensions. Response patterns showed large differences rather than uniform scores across dimensions for over half of the respondents. Discussion and Conclusion Subdividing movement into the proposed dimensions fits the data and potentially strengthens the usefulness of the MCT as a theoretical foundation for managing movement effectively.

Validity and Reliability of the Movement Ability Measure: A Self-Report Instrument Proposed for Assessing Movement Across Diagnoses and Ability Levels

Background and Purpose Physical therapists lack instruments that assess movement across diagnoses and ability levels while focusing on physical therapy–specific outcomes. This article describes the creation of a Movement Ability Measure (MAM) and initial evidence of validity and reliability. Subjects More than 300 adult volunteers with various movement levels completed the 24-item questionnaire. Methods Item response theory methods were used to create the MAM and gather evidence of content and construct validity, test-retest and other types of reliability, and concurrent validity with the California Functional Evaluation instrument and self-acknowledgement of movement problems. Results The intraclass correlation coefficient for test-retest reliability was .92. Person separation reliability was .98. Correlation (r) with the California Functional Evaluation instrument was .76. Respondents who denied having movement problems perceived a significantly higher level of movement ability than those who claimed to have a little, some, or a lot of movement problems in the preceding week. Discussion and Conclusion The MAM shows promise for documenting perceived movement ability across ability levels and diagnoses.

Responsiveness of the Movement Ability Measure: A Self-Report Instrument Proposed for Assessing the Effectiveness of Physical Therapy Intervention

Background and Purpose Designed as a self-report assessment, the Movement Ability Measure (MAM) may contribute to effectiveness research if it proves responsive to change. The purpose of this article is to report evidence of responsiveness of the MAM. Subjects Thirty-five adults starting outpatient physical therapy intervention completed the MAM at the initial visit, at 2 weeks, and at 2 months or discharge. Thirty-four no-intervention volunteers completed the MAM twice. Methods The MAM responses were analyzed with item response theory methods; t tests were used to compare responses across test occasions. Results Paired t tests revealed significant changes in the intervention group at both 2 weeks and 2 months, with an effect size of 0.90 and a responsiveness index of 5.62 at discharge. At 2 weeks and at discharge, 57% and 80% of participants, respectively, showed gains greater than the minimal clinically important difference. Participants in the no-intervention group showed no significant change. Discussion and Conclusion The MAM responses revealed significant and clinically important changes following intervention. The MAM shows promise as a self-report measure of the effectiveness of physical therapy intervention.