Joyce M. Engel

Associations Between Physical Performance and Executive Function in Older Adults With Mild Cognitive Impairment: Gait Speed and the Timed “Up & Go” Test

Background Older adults with amnestic mild cognitive impairment (aMCI) are at higher risk for developing Alzheimer disease. Physical performance decline on gait and mobility tasks in conjunction with executive dysfunction has implications for accelerated functional decline, disability, and institutionalization in sedentary older adults with aMCI. Objectives The purpose of this study was to examine whether performance on 2 tests commonly used by physical therapists (usual gait speed and Timed “Up & Go” Test [TUG]) are associated with performance on 2 neuropsychological tests of executive function (Trail Making Test, part B [TMT-B], and Stroop-Interference, calculated from the Stroop Word Color Test) in sedentary older adults with aMCI. Design The study was a cross-sectional analysis of 201 sedentary older adults with memory impairment participating in a longitudinal intervention study of cognitive function, aging, exercise, and health promotion. Methods Physical performance speed on gait and mobility tasks was measured via usual gait speed and the TUG (at fast pace). Executive function was measured with the TMT-B and Stroop-Interference measures. Results Applying multiple linear regression, usual gait speed was associated with executive function on both the TMT-B (β=−0.215, P=.003) and Stroop-Interference (β=−0.195, P=.01) measures, indicating that slower usual gait speed was associated with lower executive function performance. Timed “Up & Go” Test scores (in logarithmic transformation) also were associated with executive function on both the TMT-B (β=0.256, P<.001) and Stroop-Interference (β=0.228, P=.002) measures, indicating that a longer time on the TUG was associated with lower executive function performance. All associations remained statistically significant after adjusting for age, sex, depressive symptoms, medical comorbidity, and body mass index. Limitations The cross-sectional nature of this study does not allow for inferences of causation. Conclusions Physical performance speed was associated with executive function after adjusting for age, sex, and age-related factors in sedentary older adults with aMCI. Further research is needed to determine mechanisms and early intervention strategies to slow functional decline.

Psychosocial Factors and Adjustment to Chronic Pain in Persons With Physical Disabilities: A Systematic Review

OBJECTIVEnTo systematically review the research findings regarding the associations between psychosocial factors and adjustment to chronic pain in persons with physical disabilities.nnnDATA SOURCESnA key word literature search was conducted using articles listed in PubMed, PsychInfo, and CINAHL up to March 2010, and manual searches were made of all retrieved articles to identify published articles that met the review inclusion criteria.nnnSTUDY SELECTIONnTo be included in the review, articles needed to (1) be written in English, (2) include adults with a physical disability who report having pain, (3) include at least 1 measure of a psychosocial predictor domain, (4) include at least 1 criterion measure of pain or patient functioning, and (5) report the results of associations between the psychosocial factors and criterion measures used in the study. Twenty-nine studies met the inclusion criteria.nnnDATA EXTRACTIONnThree reviewers tabulated study details and findings.nnnDATA SYNTHESISnThe disability groups studied included spinal cord injury (SCI), acquired amputation, cerebral palsy (CP), multiple sclerosis (MS), and muscular dystrophy (MD). Psychosocial factors were shown to be significantly associated with pain and dysfunction in all disability groups. The psychosocial factors most closely associated with pain and dysfunction across the samples included (1) catastrophizing cognitions; (2) task persistence, guarding, and resting coping responses; and (3) perceived social support and solicitous responding social factors. Pain-related beliefs were more strongly associated with pain and dysfunction in the SCI, CP, MS, and MD groups than in the acquired amputation group.nnnCONCLUSIONSnThe findings support the importance of psychosocial factors as significant predictors of pain and functioning in persons with physical disabilities. Clinical trials to test the efficacy of psychosocial treatments for pain and dysfunction are warranted, as are studies to determine whether psychosocial factors have a causal influence on pain and adjustment in these populations.

Hypnotic analgesia for chronic pain in persons with disabilities: a case series.

Abstract Thirty-three adults with chronic pain and a disability were treated with hypnotic analgesia. Analyses showed significant pre- to posttreatment changes in average pain intensity that was maintained at 3-month follow-up. Significant changes were also found in pain unpleasantness and perceived control over pain but not in pain interference or depressive symptoms. Hypnotizability, concentration of treatment (e.g., daily vs. up to weekly), and initial response to treatment were not significantly associated with treatment outcome. However, treatment-outcome expectancy assessed after the first session showed a moderate association with treatment outcome. The findings support the use of hypnotic analgesia for the treatment of pain in persons with disabilities for some patients but not the use of pretreatment measures of hypnotizability or treatment-outcome expectancy for screening patients for treatment. 1This research was supported by grant number R01 HD42838 from the National Institutes of Health, National Institute of Child and Health, National Center for Medical Rehabilitation Research, grant number H133B031129 from the Department of Education, National Center of Disability and Rehabilitation Research, and the Hughes M. and Katherine G. Blake Endowed Professorship in Health Psychology awarded to MPJ. The authors gratefully acknowledge the assistance of Chiara LaRotonda and Kristin McArthur in data collection and data entry.

Symptom burden in individuals with cerebral palsy

The current study sought to (1) determine the relative frequency and severity of eight symptoms in adults with cerebral palsy (CP), (2) examine the perceived course of these eight symptoms over time, and (3) determine the associations between the severity of these symptoms and psychosocial functioning. Eighty-three adults with CP completed a measure assessing the frequency, severity, and perceived course of eight symptoms (pain, weakness, fatigue, imbalance, numbness, memory loss, vision loss, and shortness of breath). Respondents also completed measures of community integration and psychological functioning. The results indicated that pain, fatigue, imbalance, and weakness were the most common and severe symptoms reported. All symptoms were reported to have either stayed the same or worsened, rather than resolved, over time. The symptoms were more closely related to social integration than to home integration, productive activity, or psychological functioning. Memory loss was a unique predictor of social integration in the multivariate context. This study highlighted several common and problematic symptoms experienced by adults with CP. Additional research is needed to identify the most effective treatments for those symptoms that affect community integration and psychological functioning as a way to improve the quality of life of individuals with CP.

Pain Catastrophizing in Youths With Physical Disabilities and Chronic Pain

OBJECTIVEnThe current study examined the associations between catastrophizing and pain intensity, psychological adjustment, functional ability, and community participation in youths with physical disability and chronic pain.nnnMETHODSnParticipants consisted of 80 youths, aged 8-20 years, with cerebral palsy (n = 34), neuromuscular disease (n = 22), or spina bifida (n = 24). Measures from a cross-sectional survey included demographic, pain, and disability information, the Pain Catastrophizing Scale, the Child Health Questionnaire, and the Functional Disability Inventory.nnnRESULTSnResults suggested that catastrophizing was significantly associated with pain intensity and psychological adjustment; however, catastrophizing did not demonstrate significant associations with functional ability or community participation.nnnCONCLUSIONSnThe study extends previous findings of significant associations between catastrophizing and both pain intensity and psychological adjustment to samples of youths with chronic pain and disabilities not previously examined. Further research that examines the causal association between catastrophizing and outcomes in youths with chronic pain and physical disability is warranted.

The Development and Preliminary Validation of the Pediatric Survey of Pain Attitudes

ObjectiveBiopsychosocial models of pain hypothesize patient attitudes, and beliefs about pain play a key role in adjustment to chronic pain. The purpose of this study was to facilitate research testing the utility of biopsychosocial models in youths with physical disabilities by developing and testing the validity of a measure of pain-related beliefs that could be used with younger patients. DesignOne hundred four youths with physical disabilities were administered, via interview, a measure of pain-related beliefs developed for youths with chronic pain—the Pediatric Survey of Pain Attitudes (Peds-SOPA)—and a modified Brief Pain Inventory Pain Interference scale. ResultsItem analyses yielded a 29-item pain belief attribution that assessed seven belief domains. The internal consistency (Cronbach alpha) of the subscales varied from good to excellent (0.67–0.92). Pearson correlations between Peds-SOPA and the modified Brief Pain Inventory showed moderate associations between pain beliefs and pain interference for the Medical Cure (r = 0.29), Emotion (r = 0.27), and Disability (r = 0.36) scales. ConclusionsThe findings indicate the Peds-SOPA scales are reliable and that a subset of the scales is associated with an important pain-related domain (pain interference), providing preliminary support for the validity of the Peds-SOPA scales.

Survey results of pain treatments in adults with cerebral palsy.

Objective: The aims of this study were to identify the types and frequencies of pain treatments used by individuals with cerebral palsy, examine the perceived effectiveness of these treatments, and identify the types of healthcare providers that were accessed for pain-related services. Design: A cross-sectional survey design was used. A total of 83 adults (mean [SD] age, 40.3 [13.6] yrs) with cerebral palsy indicated their pain location and intensity during the past 3 mos. Next, they indicated their use of 24 different pain treatments and the effectiveness of each. Finally, participants indicated the frequency of pain-related healthcare visits to specific providers over the past 6 mos. Results: Of the participants, 63% reported experiencing chronic pain and rated their pain intensity over the past week as 5.1 of 10, on average. The most common pain locations were the lower back, hips, and legs. Physical interventions (e.g., physical therapy, strengthening) were the most common pain treatments reportedly used and were rated as moderately effective. Many other treatments were also used, and participants sought pain-related care from a variety of providers. Conclusions: Although participants reportedly accessed pain care from a variety of providers and perceived that several types of treatments were effective, many of the treatments rated as effective were rarely used or provided. Future research using clinical trial methods would further elucidate the specific pain treatments that are most beneficial for adults with cerebral palsy.

Validity of three rating scales for measuring pain intensity in youths with physical disabilities.

There is growing evidence confirming that youths with physical disabilities are at risk for chronic pain. Although many scales for assessing pain intensity exist, it is unclear whether they are all equally suitable for youths. The aim of this study was to address this knowledge gap by comparing the validity of the Numerical Rating Scale (NRS‐11), the Wong Baker FACES Pain Rating Scale (FACES), and a 6‐point categorical Verbal Rating Scale (VRS‐6) for assessing pain intensity among youths (aged 8–20) with physical disabilities.

Pain extent and function in youth with physical disabilities.

Background The aim of this study was to increase our understanding of the role that spatial qualities of pain (location and extent) play in functioning, among youths with disabilities and chronic pain. Methods One-hundred and fifteen youths (mean age 14.4 years; SD ±3.3 years) with physical disabilities and chronic pain were interviewed and were asked to provide information about pain locations and their average pain intensity in the past week, and to complete measures of pain interference, psychological function and disability. Most of the participants in this sample were males (56%), Caucasian (68%), and had a cerebral palsy (34%) or muscular dystrophy (25%) problem. Most participants did not report high levels of disability ( X¯=12.7, SD ±9.5, range 0–60) or global pain intensity ( X¯=3.2, SD ±2.4, range 0–10). Results Pain at more than one body site was experienced by 91% of participants. There were positive associations between pain extent with pain interference (r = 0.30) and disability (r = 0.30), and a negative association with psychological function (r = –0.38), over and above average pain intensity. Additionally, pain intensity in the back (as opposed to other locations) was associated with more pain interference (r = 0.29), whereas pain intensity in the shoulders was associated with less psychological function (r = –0.18), and pain intensity in the bottom or hips was associated with more disability (r = 0.29). Conclusion The findings support the need to take into account pain extent in the assessment and treatment of youths with physical disabilities and chronic pain, call our attention about the need to identify potential risk factors of pain extent, and develop and evaluate the benefits of treatments that could reduce pain extent and target pain at specific sites.

Psychometric properties of the short form of the Children's Depression Inventory (CDI-S) in young people with physical disabilities

OBJECTIVEnDepression is a significant issue for young people with physical disabilities. Efficient and reliable questionnaires are needed to evaluate and monitor the efficacy of depression treatments in this population. The aim of this study was to evaluate the reliability and validity of the 10-item version of the Childrens Depression Inventory (CDI-S) in a sample of young people with physical disabilities.nnnMETHODSnA convenience sample of young people with physical disabilities (N=97) was recruited and interviewed. Reliability was evaluated using the Cronbachs α and examining the item-total correlations. Validity was evaluated by computing Pearson correlations between scores on the CDI-S and measures of pain and psychological functioning (anxiety and depression).nnnRESULTSnThe CDS-I items loaded on a single factor. The internal consistency of the scale was good (Cronbachs α=0.84) and the CDI-S showed moderate significant correlations with pain intensity (r=0.29), pain interference (r=0.46) and psychological functioning (r=-0.57). Two of the items, however, did not perform well (i.e., item-total correlations <0.3, and Cronbachs α improved when they were deleted).nnnCONCLUSIONnThe findings support the reliability and validity of the CDI-S scores for use in young people with physical disabilities. The measures psychometric properties should be studied in larger samples. In addition, there is a new brief version of the CDI (CDI-S 2) that needs to be evaluated in order to determine which of the two scales is better for assessing depression in young people with physical disabilities.