Doug Johnson-Greene

Relationship Between Performance Validity Testing, Disability Status, and Somatic Complaints in Patients With Fibromyalgia

Fibromyalgia is a chronic pain-related disorder that typically includes cognitive complaints as well as non-specific somatic complaints, such as fatigue and sleep disturbance (Wolfe et al., 2010). Fibromyalgia has also been shown to be associated with a high rate of failure on performance validity testing (PVT), which has not been examined with respect to other self-reported symptoms that are now part of the diagnostic criteria for the disorder. We evaluated 85 patients with fibromyalgia who completed objective measures of pain, sleep, and fatigue along with symptom validity measures (Word Memory Test or Test of Memory Malingering and Reliable Digit Span). Three groups were formed based on effort testing: Two PVTs Failed, One PVT Failed, and No PVTs Failed. We also formed three groups based on disability status: On Disability, Applying for Disability, and Not on Disability. A total of 37% of the patients failed one or both PVTs. PVT group analyses were significant for daily pain, weekly pain, and sleep, but not fatigue. Disability status analyses were significant for daily pain, weekly pain, and fatigue, but not sleep. The implication of this study is that PVT performance and disability status are associated with exaggeration of non-cognitive symptoms such as pain, sleep, and fatigue in persons with fibromyalgia. This study reinforces the importance of effort testing when working with medical populations.

Functional cooking skills and neuropsychological functioning in patients with stroke: An ecological validity study

Efforts to relate neuropsychological performance to real-world task functioning have predominantly yielded lackluster results, typically with neuropsychological performance accounting for modest amounts of variance in function. Nonetheless, the ecological validity of neuropsychological measures for predicting functional abilities remains a strong research interest and clinical necessity. This study relates neuropsychological performance to performance on a standardised cooking task (Rabideau Kitchen Evaluation – Revised; RKE-R) in persons with stroke. Results showed that while the composite score of mean neuropsychological performance had the largest association with meal preparation, several neuropsychological measures were significantly related to the RKE-R. Groups of left and right hemisphere stroke patients were not significantly different in terms of RKE-R performance. These results suggest that functional cooking task performance is related to intact cognitive abilities in delayed verbal memory, simple auditory attention, and visuospatial skills, as well as overall cognitive performance. Implications for neuropsychologists are discussed.

Prognostic models for predicting posttraumatic seizures during acute hospitalization, and at 1 and 2 years following traumatic brain injury.

Posttraumatic seizures (PTS) are well‐recognized acute and chronic complications of traumatic brain injury (TBI). Risk factors have been identified, but considerable variability in who develops PTS remains. Existing PTS prognostic models are not widely adopted for clinical use and do not reflect current trends in injury, diagnosis, or care. We aimed to develop and internally validate preliminary prognostic regression models to predict PTS during acute care hospitalization, and at year 1 and year 2 postinjury.

Discriminating cognitive screening and cognitive testing from neuropsychological assessment: implications for professional practice

Abstract Objective: To provide clarification on the distinction between cognitive screening, cognitive testing, and neuropsychological assessment and highlight practical implications. Method: Non-systematic brief clinical review. Results: There is a present lack of explicit distinction between the various levels of measurement of cognitive functioning with regard to goals, indications for use, levels of complexity, and outcome. There is also a lack of guidance regarding the identification of who should be responsible for the administration and interpretation at each level. Conclusions: There is a growing awareness of the importance of cognitive health and disability, and of the importance of measurement of cognitive functions across the lifespan. For example, cognitive screening has been mandated by the Patient Protection and Affordable Care Act of 2010, and language contained within new psychiatric diagnostic criteria and healthcare regulatory changes reflect increased consideration of the importance of measurement of cognition. Changes such as these necessitate greater clarity on this important issue as it bears implications for professional practice, which ranges from education and training competencies, practice standards, and the way that neuropsychologists clarify and advocate for the value of specialty referrals for comprehensive assessment in a competitive and ever-changing healthcare market.

The Relationship Between Performances on Neuropsychological Symptom Validity Testing and the MCMI-III in Patients With Fibromyalgia

Fibromyalgia is a disorder that frequently presents with both cognitive complaints and psychiatric symptoms. This study investigated the association between Symptom Validity Test (SVT) performance and psychiatric symptoms as measured by the Millon Clinical Multiaxial Inventory-III (MCMI-III), a common measure of psychopathology. A total of 72 fibromyalgia patients at a tertiary care clinic completed the MCMI-III, an embedded cognitive symptom validity test (Reliable Digit Span), and a stand-alone cognitive symptom validity test (the Word Memory Test or Test of Memory Malingering). Of these patients, 21% failed a stand-alone SVT, whereas an additional 15% failed both a stand-alone and embedded SVT. Individuals who failed both stand-alone and embedded cognitive SVTs had higher scores on a number of MCMI-III personality subscales and had elevated scores on MCMI-III modifying indices compared to individuals who passed cognitive SVTs. Moreover, SVT performance was significantly correlated with multiple MCMI-III scores, including modifying indices, as well as the somatoform, depression, and anxiety subscales. In sum, cognitive and psychological symptom validity scores were significantly related. Given the new emphasis on cognitive complaints as part of the fibromyalgia diagnostic criteria, neuropsychological evaluation of both cognitive and psychological symptom validity should be a part of a comprehensive diagnostic assessment.

Standardized Symptom Measurement of Individuals with Early Lyme Disease Over Time

Objective Understanding the Lyme disease (LD) literature is challenging given the lack of consistent methodology and standardized measurement of symptoms and the impact on functioning. This prospective study incorporates well-validated measures to capture the symptom picture of individuals with early LD from time of diagnosis through 6-months post-treatment. Method One hundred seven patients with confirmed early LD and 26 healthy controls were evaluated using standardized instruments for pain, fatigue, depressive symptoms, functional impact, and cognitive functioning. Results Prior to antibiotic treatment, patients experience notable symptoms of fatigue and pain statistically higher than controls. After treatment, there are no group differences, suggesting that symptoms resolve and that there are no residual cognitive impairments at the level of group analysis. However, using subgroup analyses, some individuals experience persistent symptoms that lead to functional decline and these individuals can be identified immediately post-completion of standard antibiotic treatment using well-validated symptom measures. Conclusions Overall, the findings suggest that ideally-treated early LD patients recover well and experience symptom resolution over time, though a small subgroup continue to suffer with symptoms that lead to functional decline. The authors discuss use of standardized instruments for identification of individuals who warrant further clinical follow-up.

Evaluating Use of the Siebens Domain Management Model During Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Stroke Patients

To evaluate use of the Siebens Domain Management Model (SDMM) during stroke inpatient rehabilitation (IR) to increase functional independence and rate of discharge to home.

Changes in cognition and continence as predictors of rehabilitation outcomes in individuals with severe traumatic brain injury.

The study objective was to examine postacute changes in bowel and bladder continence and cognition after severe traumatic brain injury (TBI) in persons with long-term functional recovery to full independence. This case series included nine patients initially admitted to inpatient rehabilitation (IR) with severe TBI who had returned to prior responsibilities and functional independence by 8 to 15 mo. Patients had initial Glasgow Coma Scale scores of 3 to 6, posttraumatic amnesia durations of 18 to 70 d, time-to-follow-commands of 16 to 56 d, initial abnormal brain computed tomography scans, and initial pupil abnormalities. IR Functional Independence Measure (FIM) cognitive and sphincter score improvements were compared with national TBI FIM data from Uniform Data Systems for Medical Rehabilitation (UDSMR) for 2010 (n = 16,368). All patients had IR improvements in cognitive and sphincter FIM scores approximately twice the national UDSMR data for 2010. All patients had combined IR discharge sphincter FIM scores that were 12 or greater, indicating independence to modified independence with bowel and bladder function with no incontinence. Five participants (55%) were admitted to IR with sphincter FIM scores of 11 to 12, indicating recovery of continence during acute care. These findings suggest potential usefulness of IR cognitive FIM score changes and of the recovery of bowel and bladder continence for predicting favorable functional outcomes following severe TBI.

Evaluating Siebens Domain Management Model for Inpatient Rehabilitation to Increase Functional Independence and Discharge Rate to Home in Geriatric Patients

OBJECTIVE To evaluate the Siebens Domain Management Model (SDMM) for geriatric inpatient rehabilitation (IR) to increase functional independence and dispositions to home. DESIGN Before and after study. SETTING IR facility. PARTICIPANTS During 2010 (preintervention), 429 patients aged ≥75 years who were on average admitted to IR 8.2 days postacute care, and during 2012 (postintervention), 524 patients aged ≥75 years who were on average admitted to IR 5.5 days postacute care. Case-mix group (CMG) comorbidity tier severity, preadmission living setting, and living support were similar in both groups. INTERVENTION The SDMM involving weekly adjustments of IR care focused on potential barriers to discharge home. MAIN OUTCOME MEASURES FIM efficiency, length of stay (LOS), and disposition rates to community/home, acute care, and long-term care (LTC) to compare pre-/postintervention facility data and comparison of facility to national CMG-adjusted data from the Uniform Data System for Medical Rehabilitation for both years (2010/2012). RESULTS Pre-/postintervention group admission FIM scores were similar (t=2.96, P<.003), but the preintervention group had on average 2.6 days greater LOS during IR and greater time to onset of IR (8.2 vs 5.5d) from acute care. Preintervention FIM efficiency was 2.1, whereas postintervention FIM efficiency was 2.76, a significant difference (t=4.1, P<.0001). There were significantly more discharges to the community in the postintervention group (74.4%) than the preintervention group (58.5%, χ(2)=26.2, P<.0001). There were significantly fewer patients discharged to LTC in the postintervention group (χ(2)=30.47, P<.0001). The preintervention group did not significantly differ from the 2010 national data, but the postintervention group significantly differed from the 2012 national data for both greater FIM efficiency (t=-5.5, P<.0001) and greater discharge to community (χ(2)=34, P<.0001). LOS decreased by 2.6 days in the postintervention group compared with the preintervention group, whereas LOS decreased by only 0.6 days nationally from 2010 to 2012, a significant difference with postintervention LOS lower than the national data (t=31.1, P<.0001). CONCLUSIONS Use of the SDMM during IR in geriatric patients is associated with increased functional independence and discharges to home/community and reduced institutionalization.

Neurocognitive predictors of performance on a telephone task following stroke

A growing body of evidence indicates that cognitive function is related to functional ability; however, little attention has been paid to which neuropsychological measures are predictive of specific daily tasks. The purpose of the current study was to determine the neurocognitive predictors of a performance-based telephone task in a sample of patients with recent stroke. A sample of 51 individuals with stroke completed a battery of neuropsychological measures and a telephone task. Regression analyses indicated that measures of visuoperception and global cognitive function were the best predictors of ability to use the telephone. Results are discussed in light of previous findings with different patient populations and different measures of functional ability.