Eva Elisabet Ejlersen Wæhrens

Observation-based assessment of functional ability in patients with chronic widespread pain: A cross-sectional study

Summary Evaluated with the Assessment of Motor and Process Skills (AMPS), functional disability in women with chronic widespread pain is substantial and places the individual at risk of need of support for community living. ABSTRACT Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self‐report. The purpose of this study was to assess functional ability by using standardised, observation‐based assessment of ADL performance and to examine the relationship between self‐reported and observation‐based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills (AMPS), an observation‐based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below the 2.00 ADL motor cutoff and 107 (41.6%) below the 1.00 ADL process cutoff, indicating increased effort and/or inefficiency during task performance as well as a potential need of assistance for community living. Mean ADL motor ability measure was 1.07 and was significantly lower in patients diagnosed with FMS than plain CWP (1.02 vs 1.27 logits, P = .001). Mean ADL process ability measure was 1.09 logits and was without difference between FMS and plain CWP (1.07 vs 1.16 logits, P = .064). Only weak to moderate correlations between self‐reported functional ability and observation‐based AMPS ability measures were observed. The results of the study support the notion of considerable performance difficulties in women with CWP. The everyday life problems are substantial and place the individual at risk of need of support for community living.

Test-retest of computerized health status questionnaires frequently used in the monitoring of knee osteoarthritis: a randomized crossover trial

BackgroundTo compare data based on touch screen to data based on traditional paper versions of questionnaires frequently used to examine patient reported outcomes in knee osteoarthritis patients and to examine the impact of patient characteristics on this comparisonMethodsParticipants were recruited from an ongoing trial (http://ClinicalTrials.Gov Identifier: NCT00655941). 20 female participants, mean age 67 (SD 7), completed KOOS, VAS pain, function and patient global, SF-36, Physical Activity Scale, painDETECT, and the ADL Taxonomy. Patients were randomly assigned to one of two subgroups, completing either the paper or touch screen version first. Mean, mean differences (95% CI), median, median differences and Intraclass Correlation Coefficients (ICCs) were calculated for all questionnaires.ResultsICCs between data based on computerized and paper versions ranged from 0.86 to 0.99. Analysis revealed a statistically significant difference between versions of the ADL Taxonomy, but not for the remaining questionnaires. Age, computer experience or education-level had no significant impact on the results. The computerized questionnaires were reported to be easier to use.ConclusionThe computerized questionnaires gave comparable results to answers given on paper. Patient characteristics did not influence results and implementation was feasible.

Differences between questionnaire- and interview-based measures of activities of daily living (ADL) ability and their association with observed ADL ability in women with rheumatoid arthritis, knee osteoarthritis, and fibromyalgia

Objectives: Although self-report based on questionnaire is the common method to obtain information about activities of daily living (ADL) ability in rheumatic diseases, little is known about the relationship between measures of ADL ability based on questionnaire, interview, and observation. The present study examined whether measures of self-reported ADL ability based on questionnaire and interview yielded different results, determined whether the magnitude of the difference varied among women with rheumatoid arthritis (RA), knee osteoarthritis (OA), and fibromyalgia (FM), and investigated the relationships between self-reported and observed ADL ability. Method: The 47 ADL tasks of the ADL taxonomy were used to evaluate self-reported ADL ability based on questionnaire (ADL-Q) and interview (ADL-I), and the Assessment of Motor and Process Skills (AMPS) was used to obtain measures of observed ADL ability. Results: Participants across diagnostic groups reported significantly more ADL ability based on the ADL-Q than on the ADL-I. Moderate correlations were found between the ADL-Q and ADL-I ability measures. Although low to moderate correlations were seen between measures based on the AMPS ADL motor scale and the ADL-Q and ADL-I, respectively, correlations between measures based on AMPS ADL process scale and ADL-Q and ADL-I were generally low. Overall, there was no difference in how the measures based on the two modes of self-report related to the observed ADL ability measures. Conclusion: Measures of self-reported ADL ability based on either questionnaire or interview have limited relationship to each other or to observed performance of ADL tasks.

Improving quality of ADL performance after rehabilitation among people with acquired brain injury

The aim of this study was to evaluate whether people with brain injury show improvements in quality of performance of activities of daily living (ADL) after rehabilitation. A retrospective pre- and post-test design with no control group was used. Subjects received interdisciplinary rehabilitation consisting of restorative and compensatory strategies. Thirty-six adults with moderate to severe disability following acquired brain injury were evaluated using the Assessment of Motor and Process Skills (AMPS), an observational evaluation of the quality of ADL task performance. Paired t-tests revealed significant increase in ADL ability after intervention; effect sizes were medium. Improvements occurred across ages, within all diagnostic groups, and with no relation to time post-injury. It was concluded that people with moderate to severe disability following acquired brain injury improved in ADL ability after participating in an intensive, interdisciplinary rehabilitation programme. Although lack of a control group prevented a conclusively conclusion that the changes were due to the intervention provided, the fact that the subjects had shown slow spontaneous recovery and minimal improvements before the study was implemented supports the likelihood that their gains were largely the result of the intervention.

Performance-based assessment of activities of daily living (ADL) ability among women with chronic widespread pain

&NA; Functional ability, including the ability to perform activities of daily living (ADL), is considered a core outcome domain in chronic pain clinical trials and is usually assessed through generic or disease‐specific self‐report questionnaires. Research, however, indicates that self‐report and performance‐based assessment of ADL offer distinct but complementary information about ability. The present study, therefore, investigated the applicability of a performance‐based measure of ADL ability, the Assessment of Motor and Process Skills (AMPS), among 50 women with chronic widespread pain. The investigated psychometric properties of the AMPS included discrimination between a sample of healthy women and those with chronic widespread pain, as well as stability when no intervention was provided and sensitivity to change following intervention. Data were obtained based on a repeated measures design performing AMPS evaluations twice pre‐ and twice post‐rehabilitation. Results indicated that the ADL motor ability measures of the participants were significantly lower than those of healthy women of same age, the ADL motor and ADL process ability measures remained stable when no intervention was provided and the ADL motor ability measures were sensitive to change following a 2‐week interdisciplinary rehabilitation program. A weak correlation (rs = −0.35) was found between self‐reported ADL ability as measured by the physical function subscale of the Functional Impact Questionnaire (FIQ) and performance‐based ADL motor measures, and no correlation (rs = −0.02) was found between FIQ ADL measures and ADL process ability, supporting the need for both performance‐based and self‐reported assessment of ADL.

Developing linear ADL ability measures based on the ADL Taxonomy: A Rasch analysis

Purpose. The aim of this pilot study was to explore the possibility of developing linear measures of ADL ability based on the ADL Taxonomy and a three-category rating scale. Method. Data were obtained from medical records of adults with moderate to severe brain injury. The participants were rated on the ADL taxonomy, and recorded on the ADL Taxonomy Circle, based on direct observations. By applying the Rasch rating scale model, we examined the possibility of converting the raw ordinal scores into equal-interval estimates of the participants’ ADL ability. Results. The data analysis indicated that the rating scale used in this study displays sound psychometric properties. Items from the ADL taxonomy defined one construct after 10 actions were removed, but retention of all items did not disrupt the measurement system. Except for one item in each of five different activity domains, the item difficulty hierarchy was the same as in the hierarchy originally published, supporting reliability of the item difficulty estimates. The ADL taxonomy discriminated well between different levels of ability in this sample of persons with brain injury. Conclusion. This preliminary study indicates that the ADL taxonomy has potential to become a linear measure of a persons ability to perform ADL tasks.

Interdisciplinary rehabilitation of patients with chronic widespread pain: primary endpoint of the randomized, nonblinded, parallel-group IMPROvE trial.

Summary Multicomponent treatment targeting patients with chronic widespread pain resulted in an objectively measured improvement of functional ability at 6‐month follow‐up, not reflected in patient‐reported outcomes. ABSTRACT This study examined the functional and psychological outcomes of a 2‐week, group‐based multicomponent treatment course that targeted patients with chronic widespread pain. Patients (192 included in the intention‐to‐treat population), all fulfilling the 1990 American College of Rheumatology classification criteria for fibromyalgia, were consecutively recruited from a tertiary care setting and randomized (1:1) to either the treatment course or a waiting list control group. Co‐primary outcomes were the Assessment of Motor and Process Skills (AMPS) and SF‐36 Mental Composite Score (MCS) evaluated at 6‐month follow‐up. Primary endpoints were partly achieved with a statistically significant improvement in AMPS activities of daily living motor (group mean difference: 0.20 [95% confidence interval (CI): 0.09 to 0.31] logits; P = .0003) and AMPS activities of daily living process (0.20 [95% CI: 0.12 to 0.27] logits, P < .0001) ability measures, whereas no difference in the SF‐36 MCS (1.14 [95% CI: −1.52 to 3.81], P = .40) was observed. Individual patient responses varied, and the proportion of patients achieving a clinically meaningful change of at least 0.3 logits on the AMPS seemed influenced by the reporting of a pending social welfare application at the time of enrollment. We conclude that even in fibromyalgia patients presenting with a substantial disability established over many years, the 2‐week multicomponent treatment course resulted in observable improvement of functional ability in a subgroup of patients at 6‐month follow‐up. This improvement, however, was not reflected in secondary patient reported outcomes, including scores of self‐reported functional ability on standardized questionnaires. We suggest including observation‐based assessments in future clinical trials focusing on functional outcomes in patients with fibromyalgia.