Rehab Centers: A General Theoretical Framework for Interpreting Patient-Reported Outcomes Estimated From Ordinally Scaled Item Responses.

A general theoretical framework for interpreting patient-reported outcomes estimated from ordinally scaled item responses.

Filed under: Rehab Centers

Stat Methods Med Res. 2013 Feb 19;
Massof RW

A simple theoretical framework explains patient responses to items in rating scale questionnaires. Fixed latent variables position each patient and each item on the same linear scale. Item responses are governed by a set of fixed category thresholds, one for each ordinal response category. A patient’s item responses are magnitude estimates of the difference between the patient variable and the patient’s estimate of the item variable, relative to his/her personally defined response category thresholds. Differences between patients in their personal estimates of the item variable and in their personal choices of category thresholds are represented by random variables added to the corresponding fixed variables. Effects of intervention correspond to changes in the patient variable, the patient’s response bias, and/or latent item variables for a subset of items. Intervention effects on patients’ item responses were simulated by assuming the random variables are normally distributed with a constant scalar covariance matrix. Rasch analysis was used to estimate latent variables from the simulated responses. The simulations demonstrate that changes in the patient variable and changes in response bias produce indistinguishable effects on item responses and manifest as changes only in the estimated patient variable. Changes in a subset of item variables manifest as intervention-specific differential item functioning and as changes in the estimated person variable that equals the average of changes in the item variables. Simulations demonstrate that intervention-specific differential item functioning produces inefficiencies and inaccuracies in computer adaptive testing.
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To be involved or not to be involved: A survey of public preferences for self-involvement in decision-making involving mental capacity (competency) within Europe.

Filed under: Rehab Centers

Palliat Med. 2013 Feb 20;
Daveson BA, Bausewein C, Murtagh FE, Calanzani N, Higginson IJ, Harding R, Cohen J, Simon ST, Deliens L, Bechinger-English D, Hall S, Koffman J, Ferreira PL, Toscani F, Gysels M, Ceulemans L, Haugen DF, Gomes B,

Background:The Council of Europe has recommended that member states of European Union encourage their citizens to make decisions about their healthcare before they lose capacity to do so. However, it is unclear whether the public wants to make such decisions beforehand.Aim:To examine public preferences for self-involvement in end-of-life care decision-making and identify associated factors.Design:A population-based survey with 9344 adults in England, Belgium, Germany, Italy, the Netherlands, Portugal and Spain.Results:Across countries, 74% preferred self-involvement when capable; 44% preferred self-involvement when incapable through, for example, a living will. Four factors were associated with a preference for self-involvement across capacity and incapacity scenarios, respectively: higher educational attainment ((odds ratio = 1.93-2.77), (odds ratio = 1.33-1.80)); female gender ((odds ratio = 1.27, 95% confidence interval = 1.14-1.41), (odds ratio = 1.30, 95% confidence interval = 1.20-1.42)); younger-middle age ((30-59 years: odds ratio = 1.24-1.40), (50-59 years: odds ratio = 1.23, 95% confidence interval = 1.04-1.46)) and valuing quality over quantity of life or valuing both equally ((odds ratio = 1.49-1.58), (odds ratio = 1.35-1.53)). Those with increased financial hardship (odds ratio = 0.64-0.83) and a preference to die in hospital (not a palliative care unit) (odds ratio = 0.73, 95% confidence interval = 0.60-0.88), a nursing home or residential care (odds ratio = 0.73, 95% confidence interval = 0.54-0.99) were less likely to prefer self-involvement when capable. For the incapacity scenario, single people were more likely to prefer self-involvement (odds ratio = 1.34, 95% confidence interval = 1.18-1.53).Conclusions:Self-involvement in decision-making is important to the European public. However, a large proportion of the public prefer to not make decisions about their care in advance of incapacity. Financial hardship, educational attainment, age, and preferences regarding quality and quantity of life require further examination; these factors should be considered in relation to policy.
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Nonpharmacological enhancement of cognitive function in Parkinson’s disease: A systematic review.

Filed under: Rehab Centers

Mov Disord. 2013 Feb 20;
Hindle JV, Petrelli A, Clare L, Kalbe E

Cognitive decline and dementia are frequent in patients with Parkinson’s disease (PD). The evidence for nonpharmacological therapies in Alzheimer’s disease and other dementias has been studied systematically, but the evidence is unclear for their efficacy in cognition and dementia in PD. An international collaboration produced a comprehensive, systematic review of the effectiveness and of nonpharmacological and noninvasive therapies in cognitively intact, cognitively impaired, and PD dementia groups. The interventions included cognitive rehabilitation, physical rehabilitation, exercise, and brain stimulation techniques but excluded invasive treatments, such as surgery and deep brain stimulation. The potential biases and evidence levels for controlled trials (CTs) were analyzed based on Cochrane and National Institute for Health and Clinical Excellence criteria. After exclusions, 18 studies were reviewed, including 5 studies of cognitive training, 4 of exercise and physical therapies, 4 of combined cognitive and physical interventions, and 5 of brain stimulation techniques. The methodology, study populations, interventions, outcomes, control groups, analyses, results, limitations, biases, and evidence levels of all reviewed studies were described. There were 9 CTs, including 6 randomized CTs (RCTs). Although 5 trials showed positive results, only 1 study of cognitive training achieved evidence grading of 1+ with a low risk of bias. There were no studies on PD dementia. Current research on nonpharmacological therapies for cognitive dysfunction and dementia in PD is very limited in quantity and quality. There is an urgent need for rigorous RCTs of nonpharmacological treatments for cognitive impairment and dementia in PD. © 2013 Movement Disorder Society.
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