Daniel Deforge - Academia.edu (original) (raw)

Papers by Daniel Deforge

Research paper thumbnail of Sexuality and Reproductive Health Following Spinal Cord Injury: Evidence Report/Technology Assessment, Number 109

Research paper thumbnail of Temporal stability and responsiveness of the Montreal Cognitive Assessment following acquired brain injury

Brain Injury, 2015

To evaluate the temporal stability and responsiveness of the Montreal Cognitive Assessment (MoCA)... more To evaluate the temporal stability and responsiveness of the Montreal Cognitive Assessment (MoCA) in acquired brain injury (ABI). English-speaking adults with stroke or moderate-to-severe traumatic brain injury were administered alternate forms of the MoCA (version 1, then 2), 6 weeks apart. Chronic group participants (n = 40) were community-dwelling, at least 1 year post-ABI (mean = 12.1 years, SD = 9.0), and presumed clinically stable. Sub-acute group participants (n = 36) were 30.8 days post-ABI (SD = 12.4) and were undergoing intensive rehabilitation. Individuals with an unstable medical or psychiatric condition or severe receptive aphasia were not eligible. The chronic group scored 21.6 (SD = 4.5) initially and 22.7 (SD = 3.8) on the second administration, demonstrating a small but significant practise effect (p = 0.009). The Pearson test-re-test correlation coefficient was 0.83. Using reliable change methodology in the chronic group, the 80% confidence interval (CI) for change across the two administrations was -2 to +4, adjusting for practise. Applied to the sub-acute group, 39% improved and 0% declined. The MoCA is a brief standardized tool that appears useful for monitoring cognitive change after ABI. The findings enable clinicians to detect statistically reliable change across serial MoCA administrations in individuals with an ABI.

Research paper thumbnail of Validity of the Walking Scale for Spinal Cord Injury and Other Domains of Function in a Multicenter Clinical Trial

Neurorehabilitation and Neural Repair, 2007

Objective. To demonstrate criterion (concurrent and predictive) and construct validity of the Wal... more Objective. To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT). Design. Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). Participants/Methods. Body weight−supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks. Primary outcome measures were the Functional Independence Measure (FIM), 50-foot walking speed (50FW-S), and 6-minute walking distance (6MW-D), tested 3, 6, and 12 months after entry. Secondary measures were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), WISCI, and FIM locomotor score (LFIM), assessed at 6 centers by blinded observers. Data for the 2 arms were combined since no significant differences in outcomes had been found. Results. Correlations with WISCI at 6 months were significant with BBS (r = .90), LEMS (r = .85), LFIM (r = .89), FIM (r = .77), 50FW-S (r = .85), and 6MW-D (r = .79); similar correlations occurred at 3 and 12 months. Correlations of change scores from baseline WISCI were significant for change scores from baseline of LEMS/BBS/LFIM. Correlation of baseline LEMS and WISCI at 12 months were most significant (r = .73). The R 2 of baseline LEMS explained 57% of variability of WISCI levels at 3 months. Conclusion. Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI. of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.

Research paper thumbnail of Poster 103 Examining Reliable Change on the Montreal Cognitive Assessment Following Acquired Brain Injury

Archives of Physical Medicine and Rehabilitation, 2013

Objective: Describe the Client's Intervention Priorities (CIP), an innovative interdisciplinary s... more Objective: Describe the Client's Intervention Priorities (CIP), an innovative interdisciplinary self-evaluation tool for establishing rehabilitation priorities based on perceived functioning in daily activities (DA) and social roles (SR). We previously established that the CIP has very good content validity, reliability, and internal consistency. In this second study, we describe the results for construct validity and clinical sensitivity. Design: Convergent validity was evaluated by correlating responses on the CIP and level of social participation, using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). Clinical sensitivity was assessed using chi-square analyses, and through associations with MPAI-4 at beginning/end of rehabilitation. Impact of psychological factors (Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI-II), on patients' perceived progression in DA and SR was examined via correlational analyses. Setting: Outpatient interdisciplinary rehabilitation program. Participants: Individuals with traumatic brain injury (N Z 70). Interventions: Not applicable. Main Outcome Measures: CIP e DA and SR scores; MPAI-4 e Ability, Adjustment and Participation subscales scores. Results: DA and SR scores of the CIP correlate significantly (p<.05) with MPAI-4 Ability index, BAI, and BDI-II at the beginning and end of rehabilitation. Significant (p<.05) correlations are also found with the Participation index of the MPAI-4. The CIP is highly sensitive to clinical changes observed during rehabilitation. Conclusions: The CIP has solid metrological qualities and is clinically sensitive. This justifies its use not only to establish intervention priorities, but also as a measure of clinical progression during the rehabilitation process.

Research paper thumbnail of Concordance in Goal Setting Between Patients with Multiple Sclerosis and Their Rehabilitation Team

American Journal of Physical Medicine & Rehabilitation, 2006

To determine the concordance between patients with multiple sclerosis and their clinical team mem... more To determine the concordance between patients with multiple sclerosis and their clinical team members on the identification of goals for an inpatient rehabilitation stay. Prospective cohort study of patients admitted for rehabilitation in an adult inpatient neurospinal unit at a Rehabilitation Centre in Ottawa, Canada. Twenty-seven patients (11 men and 16 women, mean age of 45.3 yrs) with either a laboratory or a clinically supported diagnosis of multiple sclerosis. Patients rated 55 goals from a preexisting list, indicating the importance of each goal to be addressed during the inpatient stay. The goals fell into five broad domains of health/medical issues, daily activities, mobility, community life, and personal well-being. Patients also identified their five most important individual goals. In a separate session, the clinical team also rated the 55 goals in relation to each patient and identified an independent list of the five most important rehabilitation goals. Main outcome measures included concordance between patient and team ratings in the identification of goals, ratings of the likelihood of success of achieving each goal, and ratings of the amount of change required to realize a minimal clinically important difference. The patients and the team agreed on an average of 1.7 of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s five top-rated goals. Compared with the team, patients gave higher importance ratings to goals within the health/medical, mobility, and daily activities domains. They also considered that a greater average improvement would be required to achieve a meaningful benefit, and they gave higher ratings of the likelihood of success in achieving their selected goals. Patients with multiple sclerosis and clinical team members do not necessarily agree on specific goals for a rehabilitation stay. Patients may also have greater expectations than clinicians with respect to the amount of improvement and the likelihood of achieving their goals.

Research paper thumbnail of Male erectile dysfunction following spinal cord injury: a systematic review

Spinal Cord, 2006

Study design: Systematic review. Objective: To review sexuality in persons with spinal cord injur... more Study design: Systematic review. Objective: To review sexuality in persons with spinal cord injuries (SCIs), and to report the effectiveness of erectile interventions. Methods: Reports from six databases , selected annual proceedings (1997)(1998)(1999)(2000)(2001)(2002) and manufacturer's information were screened against eligibility criteria. Included reports were abstracted and data pooled from case-series reports regarding intracavernous injections and sildenafil. Results: From 2127 unique reports evaluated, 49 were included. Male sexual dysfunction was addressed in these reports of several interventions (behavioural therapy, topical agents, intraurethral alprosatadil, intracavernous injections, vacuum tumescence devices, penile implants, sacral stimulators and oral medication). Penile injections resulted in successful erectile function in 90% (95% CI: 83%, 97%) of men. Sildenafil resulted in 79% (95% CI: 68%, 90%) success; the difference in efficacy was not statistically significant. Five case-series reports involving 363 participants with penile implants demonstrated a high satisfaction rate, but a 10% complication rate. Conclusions: A large body of evidence addressing sexuality in males focuses on erection. Penile injection, sildenafil and vacuum devices generally obviate the need for penile implants to address erectile dysfunction. Interventions may positively affect sexual activity in the short term. Longterm sexual adjustment and holistic approaches beyond erections remain to be studied. Rigorous study design and reporting, using common outcome measures, will facilitate higher quality research. This will positively impact patient care.

Research paper thumbnail of Sexuality and Reproductive Health Following Spinal Cord Injury: Evidence Report/Technology Assessment, Number 109

Research paper thumbnail of Temporal stability and responsiveness of the Montreal Cognitive Assessment following acquired brain injury

Brain Injury, 2015

To evaluate the temporal stability and responsiveness of the Montreal Cognitive Assessment (MoCA)... more To evaluate the temporal stability and responsiveness of the Montreal Cognitive Assessment (MoCA) in acquired brain injury (ABI). English-speaking adults with stroke or moderate-to-severe traumatic brain injury were administered alternate forms of the MoCA (version 1, then 2), 6 weeks apart. Chronic group participants (n = 40) were community-dwelling, at least 1 year post-ABI (mean = 12.1 years, SD = 9.0), and presumed clinically stable. Sub-acute group participants (n = 36) were 30.8 days post-ABI (SD = 12.4) and were undergoing intensive rehabilitation. Individuals with an unstable medical or psychiatric condition or severe receptive aphasia were not eligible. The chronic group scored 21.6 (SD = 4.5) initially and 22.7 (SD = 3.8) on the second administration, demonstrating a small but significant practise effect (p = 0.009). The Pearson test-re-test correlation coefficient was 0.83. Using reliable change methodology in the chronic group, the 80% confidence interval (CI) for change across the two administrations was -2 to +4, adjusting for practise. Applied to the sub-acute group, 39% improved and 0% declined. The MoCA is a brief standardized tool that appears useful for monitoring cognitive change after ABI. The findings enable clinicians to detect statistically reliable change across serial MoCA administrations in individuals with an ABI.

Research paper thumbnail of Validity of the Walking Scale for Spinal Cord Injury and Other Domains of Function in a Multicenter Clinical Trial

Neurorehabilitation and Neural Repair, 2007

Objective. To demonstrate criterion (concurrent and predictive) and construct validity of the Wal... more Objective. To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT). Design. Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). Participants/Methods. Body weight−supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks. Primary outcome measures were the Functional Independence Measure (FIM), 50-foot walking speed (50FW-S), and 6-minute walking distance (6MW-D), tested 3, 6, and 12 months after entry. Secondary measures were the Lower Extremity Motor Score (LEMS), Berg Balance Scale (BBS), WISCI, and FIM locomotor score (LFIM), assessed at 6 centers by blinded observers. Data for the 2 arms were combined since no significant differences in outcomes had been found. Results. Correlations with WISCI at 6 months were significant with BBS (r = .90), LEMS (r = .85), LFIM (r = .89), FIM (r = .77), 50FW-S (r = .85), and 6MW-D (r = .79); similar correlations occurred at 3 and 12 months. Correlations of change scores from baseline WISCI were significant for change scores from baseline of LEMS/BBS/LFIM. Correlation of baseline LEMS and WISCI at 12 months were most significant (r = .73). The R 2 of baseline LEMS explained 57% of variability of WISCI levels at 3 months. Conclusion. Concurrent validity of the WISCI scale was supported by significant correlations with all measures at 3, 6, and 12 months. Correlation of change scores supports predictive validity. The LEMS at baseline was the best predictor of the WISCI score at 12 months and explained most of the variance, which supported both predictive and construct validity. The combination of the LEMS, BBS, WISCI, 50FW-S, and LFIM appears to encompass adequate descriptors for outcomes of walking trials for incomplete SCI. of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.

Research paper thumbnail of Poster 103 Examining Reliable Change on the Montreal Cognitive Assessment Following Acquired Brain Injury

Archives of Physical Medicine and Rehabilitation, 2013

Objective: Describe the Client's Intervention Priorities (CIP), an innovative interdisciplinary s... more Objective: Describe the Client's Intervention Priorities (CIP), an innovative interdisciplinary self-evaluation tool for establishing rehabilitation priorities based on perceived functioning in daily activities (DA) and social roles (SR). We previously established that the CIP has very good content validity, reliability, and internal consistency. In this second study, we describe the results for construct validity and clinical sensitivity. Design: Convergent validity was evaluated by correlating responses on the CIP and level of social participation, using the Mayo-Portland Adaptability Inventory-4 (MPAI-4). Clinical sensitivity was assessed using chi-square analyses, and through associations with MPAI-4 at beginning/end of rehabilitation. Impact of psychological factors (Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI-II), on patients' perceived progression in DA and SR was examined via correlational analyses. Setting: Outpatient interdisciplinary rehabilitation program. Participants: Individuals with traumatic brain injury (N Z 70). Interventions: Not applicable. Main Outcome Measures: CIP e DA and SR scores; MPAI-4 e Ability, Adjustment and Participation subscales scores. Results: DA and SR scores of the CIP correlate significantly (p<.05) with MPAI-4 Ability index, BAI, and BDI-II at the beginning and end of rehabilitation. Significant (p<.05) correlations are also found with the Participation index of the MPAI-4. The CIP is highly sensitive to clinical changes observed during rehabilitation. Conclusions: The CIP has solid metrological qualities and is clinically sensitive. This justifies its use not only to establish intervention priorities, but also as a measure of clinical progression during the rehabilitation process.

Research paper thumbnail of Concordance in Goal Setting Between Patients with Multiple Sclerosis and Their Rehabilitation Team

American Journal of Physical Medicine & Rehabilitation, 2006

To determine the concordance between patients with multiple sclerosis and their clinical team mem... more To determine the concordance between patients with multiple sclerosis and their clinical team members on the identification of goals for an inpatient rehabilitation stay. Prospective cohort study of patients admitted for rehabilitation in an adult inpatient neurospinal unit at a Rehabilitation Centre in Ottawa, Canada. Twenty-seven patients (11 men and 16 women, mean age of 45.3 yrs) with either a laboratory or a clinically supported diagnosis of multiple sclerosis. Patients rated 55 goals from a preexisting list, indicating the importance of each goal to be addressed during the inpatient stay. The goals fell into five broad domains of health/medical issues, daily activities, mobility, community life, and personal well-being. Patients also identified their five most important individual goals. In a separate session, the clinical team also rated the 55 goals in relation to each patient and identified an independent list of the five most important rehabilitation goals. Main outcome measures included concordance between patient and team ratings in the identification of goals, ratings of the likelihood of success of achieving each goal, and ratings of the amount of change required to realize a minimal clinically important difference. The patients and the team agreed on an average of 1.7 of the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s five top-rated goals. Compared with the team, patients gave higher importance ratings to goals within the health/medical, mobility, and daily activities domains. They also considered that a greater average improvement would be required to achieve a meaningful benefit, and they gave higher ratings of the likelihood of success in achieving their selected goals. Patients with multiple sclerosis and clinical team members do not necessarily agree on specific goals for a rehabilitation stay. Patients may also have greater expectations than clinicians with respect to the amount of improvement and the likelihood of achieving their goals.

Research paper thumbnail of Male erectile dysfunction following spinal cord injury: a systematic review

Spinal Cord, 2006

Study design: Systematic review. Objective: To review sexuality in persons with spinal cord injur... more Study design: Systematic review. Objective: To review sexuality in persons with spinal cord injuries (SCIs), and to report the effectiveness of erectile interventions. Methods: Reports from six databases , selected annual proceedings (1997)(1998)(1999)(2000)(2001)(2002) and manufacturer's information were screened against eligibility criteria. Included reports were abstracted and data pooled from case-series reports regarding intracavernous injections and sildenafil. Results: From 2127 unique reports evaluated, 49 were included. Male sexual dysfunction was addressed in these reports of several interventions (behavioural therapy, topical agents, intraurethral alprosatadil, intracavernous injections, vacuum tumescence devices, penile implants, sacral stimulators and oral medication). Penile injections resulted in successful erectile function in 90% (95% CI: 83%, 97%) of men. Sildenafil resulted in 79% (95% CI: 68%, 90%) success; the difference in efficacy was not statistically significant. Five case-series reports involving 363 participants with penile implants demonstrated a high satisfaction rate, but a 10% complication rate. Conclusions: A large body of evidence addressing sexuality in males focuses on erection. Penile injection, sildenafil and vacuum devices generally obviate the need for penile implants to address erectile dysfunction. Interventions may positively affect sexual activity in the short term. Longterm sexual adjustment and holistic approaches beyond erections remain to be studied. Rigorous study design and reporting, using common outcome measures, will facilitate higher quality research. This will positively impact patient care.