Marissa E. Mendelsohn

Specificity of functional mobility measures in older adults after hip fracture: a pilot study.

Mendelsohn ME, Leidl DS, Overend TJ, Petrella RJ: Specificity of functional mobility measures in older adults after hip fracture: A pilot study. Am J Phys Med Rehabil 2003;82:766-774. Objective To determine the relationships between measures of functional mobility (Timed Up and Go [TUG], Self-Paced Walking [SPW], Berg Balance Scale [BBS]) and global functional status (FIM™ instrument), the motor component of the FIM instrument (motor FIM), and the mobility/locomotor-specific FIM component (ML-FIM) in older patients admitted to an inpatient rehabilitation program after hip fracture. Design The TUG, SPW, BBS, and FIM instrument were administered within 24 hr after admission and before discharge to 20 patients undergoing inpatient rehabilitation after a hip fracture. Results Significant correlations at admission were found between FIM and TUG scores (r = −0.47; p < 0.05), TUG and motor FIM (r = −0.45; p < 0.05), TUG and ML-FIM (r = −0.58; p < 0.01), FIM and BBS (r = 0.60; p < 0.01), motor FIM and BBS (r = 0.50; p < 0.05), and ML-FIM and BBS (r = 0.45; p < 0.05). At discharge, a significant correlation was found between the motor FIM and SPW (r = −0.49; p < 0.05). Change scores between both the motor FIM and ML-FIM and TUG scores were significantly correlated (r = −0.47, p < 0.05, r = −0.50, p < 0.05, respectively). Conclusions The FIM instrument, motor FIM, and ML-FIM may not be specific measures of functional mobility in patients with hip fracture.

A Systematic Review of Screening Tools for Predicting the Development of Dementia

La détection précoce de la démence est essentielle pour guider les praticiens en premier ligne de soins de santé concernant de nouvelles évaluations cliniques et des traitements. Il y a une pénurie de la littérature qui évalue l’efficacité des outils de dépistage pour prédire le développement de la démence; ainsi, nous avons effectué une revue systématique pour combler cette lacune. Le but de l’examen systématique était de formuler des recommandations pour les praticiens de soins de santé sur lequel outil de dépistage prévoit mieux le développement de la démence et serait la plus faisable dans le contexte de soins primaires. On a cherché dix bases de données, ce qui a donné 751 articles. Parmi eux, 12 ont satisfait les critères de pertinence pour être inclus. Les outils de dépistage ont été évalués pour la précision des tests, la couverture du domaine cognitif, la capacité prédictive, et la faisabilité. Quatre outils de dépistage ont été recommandées. L’Examen cognitive d’Addenbrooke (ECA) a été considéré comme l’outil idéal. Une version revisée de cet outil est utilisée maintenant dans la pratique clinique, mais les propriétés psychometriques de l’ECA-R restent à déterminer. Early detection of dementia is essential to guide front-line health care practitioners in further clinical evaluations and treatments. There is a paucity of literature assessing the effectiveness of screening tools to predict the development of dementia, thus we conducted a systematic review to fill this gap. The purpose of the systematic review was to make recommendations to health care practitioners on which screening tool best predicts the development of dementia and is most feasible in the primary care setting. Ten databases were searched for relevant articles, yielding 751 papers. Of these, 12 met relevance criteria for inclusion. Screening tools were assessed for test accuracy, cognitive domain coverage, predictive ability, and feasibility. Four screening tools were recommended. Addenbrooke’s Cognitive Examination (ACE) was considered to be the ideal tool. A revised version of this tool is now used in clinical practice but the psychometric properties of the ACE-R remain to be established.

Effect of rehabilitation on hip and knee proprioception in older adults after hip fracture: a pilot study.

Mendelsohn ME, Overend TJ, Petrella RJ: Effect of rehabilitation on hip and knee proprioception in older adults after hip fracture: A pilot study. Am J Phys Med Rehabil 2004;83:624–632. Objective:Impaired proprioception may predispose patients with hip fracture to increased risk of future disability. The purpose of the study was to determine the effect of rehabilitation on proprioceptive changes in both the hip and knee joints of patients after hip fracture. Design:Data were collected on 30 patients with hip fracture (mean age, 79.6 ± 6.7 yrs) who attended physical and occupational therapy sessions five times per week during a rehabilitation hospital stay of 24.8 ± 8.1 days. Proprioception was assessed with an electrogoniometer within 48 hrs of admission to and discharge from the rehabilitation unit. The passive-to-active reproduction of joint angle technique determined absolute angular error in non–weight-bearing positions at 15, 30, and 60 degrees of hip flexion and knee extension in both injured and noninjured sides. Results:Absolute angular error decreased significantly (P < 0.05) from admission (5.3 ± 2.6 degrees, 4.1 ± 3.1 degrees) to discharge (3.0 ± 2.3 degrees, 2.8 ± 3.1 degrees) in hip flexion and knee extension, respectively, on the injured side. Absolute angular error was significantly less (P < 0.05) at 15 degrees compared with 30 and 60 degrees of hip flexion at admission and discharge on the injured side. Conclusions:Hip and knee joint proprioception significantly improved in the injured side after the rehabilitation program. This may be an important outcome regarding future disability in this population.