Diane Playford - Academia.edu (original) (raw)
Papers by Diane Playford
Sheffield: Trent Institute for Health …
PLOS ONE
Objectives To determine the psychometric validity, using Rasch analysis, of summing the three con... more Objectives To determine the psychometric validity, using Rasch analysis, of summing the three constituent parts of the Glasgow Coma Scale (GCS). Design National (registry-based) retrospective study. Setting England and Wales. Patients All individuals who sustained a traumatic injury and were: admitted for more than three days; required critical care resources; transferred for specialist management; or who died from their injuries. Main outcomes and measures Demographic information (i.e., age at time of injury, and sex), item sub-scores of the first available GCS (either completed by the attending paramedics or on arrival to hospital), injury severity as denoted by the Injury Severity Scale (ISS), and outcome (survival to hospital discharge or 30-days post-injury, whichever is earliest). Results 321,203 cases between 2008 and 2017. 55.9% were male, the median age was 62.7 years (IQR 44.2–80.8), the median ISS was 9 (IQR 9 to 17), and 6.6% were deceased at 30 days. The reliability sta...
Parkinsonism & Related Disorders, 2011
Background: The impact of Parkinson's disease (PD) on the quality of life of both patients and th... more Background: The impact of Parkinson's disease (PD) on the quality of life of both patients and their carers has not been well documented. Objective: This study describes the health status of both PD patients and caregivers as measured on a generic measure of health status (SF-12), and then explores to what extent patient self-reported health, as measured on the disease-specific Parkinson's Disease Questionnaire (PDQ-39), is associated with carer strain and self-reported quality of life. Methods: A postal survey was carried out of both patients and caregivers through local branches of Parkinson's UK. Questionnaire packs were sent to those on the database with a diagnosis of PD. The patient was asked to give the carer questionnaire to their main caregiver, if they had one. Results: Results from the SF-12 suggests that PD has substantial adverse effects on both the physical and mental well-being of patients when compared with population norms. While carer physical health was not found to be substantially different from that of the general population, emotional health was lower than that of the general population. Furthermore, results suggest that the self-reported health status of PD patients is associated with higher levels of caregiver strain and poorer emotional health. Conclusion: PD impacts on both the well being of both patients and caregivers; the data provide evidence that the health status of the patient, in particular their physical health, has a significant impact on the well-being of their caregiver.
Brain, 1993
Nine L-dopa naive patients with clinically diagnosed parkinsonism were studied using positron emi... more Nine L-dopa naive patients with clinically diagnosed parkinsonism were studied using positron emission tomography with 6-L-[ 18 F]fluorodopa ([ 18 F]dopa, a pre-synaptic tracer) and ["C]raclopride (which binds to D 2 receptors). Putamen [ 18 F]dopa uptake was reduced in all patients, confirming a loss of function affecting the nigrostriatal projection. In eight patients the putamen with the lowest [ 18 F]dopa uptake (always contralateral to the clinically most affected side) had the highest [ u C]raclopride binding, suggesting upregulation of the post-synaptic D 2 receptors. In the ninth patient [ n C]raclopride binding was lower in the putamen with the lowest [ 18 F]dopa uptake, indicating an additional post-synaptic deficit. All nine patients were shown to be L-dopa responsive. The subsequent clinical course of the former eight patients has been typical of idiopathic Parkinson's disease, whilst the ninth patient has developed postural hypotension, urinary incontinence and respiratory stridor typical of multiple system atrophy. Reduced [ n C]raclopride binding in L-dopa naive parkinsonian patients might serve as a useful early marker of this condition.
Brain, 1993
Positron emission tomography was used to measure regional cerebral blood flow (rCBF) in 12 patien... more Positron emission tomography was used to measure regional cerebral blood flow (rCBF) in 12 patients with amyotrophic lateral sclerosis (ALS) and six age-matched controls. Scans were performed at rest, and while subjects performed stereotyped and freely selected movements of a joystick with their right hand. Statistical parametric mapping was used to determine significant differences in rCBF between the two groups at rest and during activation. The ALS group showed no significant difference in global cerebral blood flow at rest compared with controls. However, rCBF at rest was significantly (P < 0.01) reduced in the ALS group in the primary sensorimotor cortex, the lateral premotor cortex, the supplementary motor area, the anterior cingulate cortex, the paracentral lobule and the superior and inferior parietal cortex. Comparison of the increase in rCBF caused by freely selected joystick movements over the resting state between the two groups of subjects showed significantly (P < 0.001) greater activation in ALS patients in the ventral third (face area) of the contralateral primary sensorimotor cortex and in the adjacent contralateral ventral premotor and parietal association cortices; significantly (P < 0.01) greater activation of the contralateral anterior insula and the ipsilateral anterior cingulate cortex (dorso-caudal area 24) was also present in ALS patients. When a comparison of the rCBF response to the free selection task with that to the stereotyped task was performed between the two groups of subjects, ALS patients showed significantly impaired (P < 0.01) activation of the rostral anterior cingulate cortex (area 32), medial prefrontal cortex (area 10), left parahippocampal gyrus and retrosplenial cortex. The pattern of reduced rCBF at rest in ALS patients probably reflects a combination of neuronal loss in all areas of cortex projecting through the pyramidal tract together with loss of projections from the sensorimotor cortex to the motor association areas. The expansion of the upper limb output zone of the sensorimotor cortex in ALS patients during contralateral upper limb movement may represent cortical reorganization in response to Betz cell loss or corticospinal tract disruption. Abnormal recruitment of non-primary motor areas may also represent functional adaptation to a corticospinal tract lesion. Focally impaired activation of the medial prefrontal cortex and parahippocampal gyrus in ALS patients during the process of internal generation of movement could underlie the frontal lobe cognitive deficits reported in previous neuropsychological studies of ALS.
European journal of physical and rehabilitation medicine, Jan 8, 2016
Measurement of long term health outcome after trauma remains non-standardised and ambiguous which... more Measurement of long term health outcome after trauma remains non-standardised and ambiguous which limits national and international comparison of burden of injuries. The World Health Organisation (WHO) has recommended the application of the International Classification of Function, Disability and Health (ICF) to measure rehabilitation and health outcome worldwide. No previous poly-trauma studies have applied the ICF comprehensively to evaluate outcome after injury. To apply the ICF categorisation in patients with traumatic injuries to identify a minimum data set of important rehabilitation and health outcomes to enable national and international comparison of outcome data. A mixed methods design of patient interviews and an on-line survey. An ethnically diverse urban major trauma centre in London. Adult patients with major traumatic injuries (poly-trauma) and international health care professionals (HCPs) working in acute and post-acute major trauma settings. Mixed methods investiga...
PLOS ONE, 2016
Our results show that specific subcomponents of executive functions are able to predict fall risk... more Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance. * Fall rate per 100 days of patient hospital stay = 71 (number of falls)/5353(total person days) x 100 = 1.33 ** Others: miscellaneous peripheral and central nervous system illnesses.
Movement Disorders, 2002
We evaluated the efficacy of physiotherapy, occupational therapy, and speech and language therapy... more We evaluated the efficacy of physiotherapy, occupational therapy, and speech and language therapy in Parkinson's disease by synthesizing six Cochrane systematic reviews. All randomised, controlled trials examining the efficacy of a paramedical therapy versus control intervention and all those comparing the efficacy of two forms of active therapy in Parkinson's disease were included. Trials were identified by searching biomedical databases, reference lists, hand searching, and contacting investigators. The main outcome measures were quality of life, speech intelligibility, activities of daily living, and individual measures of motor and speech impairment. We identified 16 physiotherapy randomised controlled trials (399 patients), two occupational therapy trials (84 patients), and five speech and language therapy for dysarthria trials (154 patients). None of these studies examined nonpharmacological swallowing therapy for dysphagia. We were unable to perform metaanalysis of the results because the trials used heterogeneous therapy methods and outcome measures. The trials also had marked methodological flaws that could have introduced bias. In summary, we failed to find conclusive evidence of benefit for any form of paramedical therapy sufficient to recommend them in routine clinical practice. However, this lack of evidence is not proof of a lack of effect. Further large pragmatic randomised controlled trials are required to determine the effectiveness of paramedical therapies in Parkinson's disease.
The Potential for Recovery and Repair Impact of the Disease on the Patients Rehabilitation and Th... more The Potential for Recovery and Repair Impact of the Disease on the Patients Rehabilitation and Therapy Input Evaluating the Outcome of Rehabilitation Interventions Service Delivery (Potential Models of Care) Index
European Journal of Physical and Rehabilitation Medicine
BACKGROUND Telerehabilitation is a feasible and potentially effective alternative to in-person re... more BACKGROUND Telerehabilitation is a feasible and potentially effective alternative to in-person rehabilitation. However, specific guidance, training and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment is limited. OBJECTIVE The aims of this survey of United Kingdom (UK) based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practice in telerehabilitation for physical disabilities and movement impairment. The ultimate aim will be to use the findings to inform a practical toolkit and training package for telerehabilitation use. METHODS UK rehabilitation practitioners were invited to complete an online questionnaire in November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups and via social media. Closed questionnaire items were analysed using descr...
BMJ Open
ObjectiveTo identify the available guidance and training to implement telerehabilitation movement... more ObjectiveTo identify the available guidance and training to implement telerehabilitation movement assessments for people (adults and children) with a physical disability, including those recovering from COVID-19.DesignRapid scoping review.Included sources and articlesPubMed, CINAHL, PsychInfo, Cochrane, Embase, Web of Science, PEDro, UK Health Forum, WHO, National Archives and NHS England were searched using the participant–concept–context framework from 2015 to August 2020. Primary studies that recruited individuals with physical disabilities and guidance documents aimed at providers to implement movement-related telerehabilitation were included.Results23 articles (11 primary research studies, 3 systematic reviews and 9 guidance documents) were included out of 7857 that were identified from the literature search. Two main issues were found: (1) telerehabilitation guidance (from both research studies and guidance documents) was not specific to movement-related assessment and (2) mos...
Multiple Sclerosis Journal
Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identif... more Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identifying the different treatment options (choice talk), considering the advantages and disadvantages of each option (option talk), and then supporting making the decision in the light of an individual’s experiences and values (decision talk). It is most effective when working with an ‘activated patient’, that is, one who is prepared for the shared decision-making role. In rehabilitation, many decisions are preference sensitive. These decisions may be framed as ‘goal setting’. Skilled clinicians can support patients to learn goal setting skills until the person has the skills to maintain health supporting behaviours most of the time, only seeing a clinical team at times of change or crisis. The steps in goal setting can be summarised as building empathy, creating a contract, identifying priorities, summarising the conversation, articulating the goal, defining actions, building coping plans, a...
Disability and rehabilitation, May 1, 2018
Selecting the most appropriate health-related work outcome to evaluate an intervention can be fra... more Selecting the most appropriate health-related work outcome to evaluate an intervention can be fraught with difficulty. To aid clinicians in navigating this problem we have developed a model, which illustrates how pathology can affect specific measureable quantities, such as work instability. Using a modified-Delphi procedure, a panel of experts met initially to analyze the content of 95 health-related work outcome measures and organize the identified areas of measurement into a coherent model, complemented by a narrative review of the literature. This initial model underwent two rounds of stakeholder-based feedback, the results of which were incorporated in the final expert panel meeting to produce the States-traits Work Instability Model (SWIM). The States-traits Work Instability Model (SWIM) illustrates how changes to an individual's physical and psychological states and traits might affect their work-related performance, well-being and self-efficacy. Moreover, each concept ut...
Clinical rehabilitation, 2018
To determine whether tests of cognitive function and patient-reported outcome measures of motor f... more To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Prospective cohort study. Tertiary neurological and neurosurgical center. In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). The principal outcome was a fall during the in-patient stay ( n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the...
Topics in stroke rehabilitation, Jan 3, 2018
Stroke is a leading cause of disability worldwide. The most common impairment resulting from stro... more Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness. To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population. Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning. 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0-2), or using the response pattern (0-5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index - 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall ...
Sheffield: Trent Institute for Health …
PLOS ONE
Objectives To determine the psychometric validity, using Rasch analysis, of summing the three con... more Objectives To determine the psychometric validity, using Rasch analysis, of summing the three constituent parts of the Glasgow Coma Scale (GCS). Design National (registry-based) retrospective study. Setting England and Wales. Patients All individuals who sustained a traumatic injury and were: admitted for more than three days; required critical care resources; transferred for specialist management; or who died from their injuries. Main outcomes and measures Demographic information (i.e., age at time of injury, and sex), item sub-scores of the first available GCS (either completed by the attending paramedics or on arrival to hospital), injury severity as denoted by the Injury Severity Scale (ISS), and outcome (survival to hospital discharge or 30-days post-injury, whichever is earliest). Results 321,203 cases between 2008 and 2017. 55.9% were male, the median age was 62.7 years (IQR 44.2–80.8), the median ISS was 9 (IQR 9 to 17), and 6.6% were deceased at 30 days. The reliability sta...
Parkinsonism & Related Disorders, 2011
Background: The impact of Parkinson's disease (PD) on the quality of life of both patients and th... more Background: The impact of Parkinson's disease (PD) on the quality of life of both patients and their carers has not been well documented. Objective: This study describes the health status of both PD patients and caregivers as measured on a generic measure of health status (SF-12), and then explores to what extent patient self-reported health, as measured on the disease-specific Parkinson's Disease Questionnaire (PDQ-39), is associated with carer strain and self-reported quality of life. Methods: A postal survey was carried out of both patients and caregivers through local branches of Parkinson's UK. Questionnaire packs were sent to those on the database with a diagnosis of PD. The patient was asked to give the carer questionnaire to their main caregiver, if they had one. Results: Results from the SF-12 suggests that PD has substantial adverse effects on both the physical and mental well-being of patients when compared with population norms. While carer physical health was not found to be substantially different from that of the general population, emotional health was lower than that of the general population. Furthermore, results suggest that the self-reported health status of PD patients is associated with higher levels of caregiver strain and poorer emotional health. Conclusion: PD impacts on both the well being of both patients and caregivers; the data provide evidence that the health status of the patient, in particular their physical health, has a significant impact on the well-being of their caregiver.
Brain, 1993
Nine L-dopa naive patients with clinically diagnosed parkinsonism were studied using positron emi... more Nine L-dopa naive patients with clinically diagnosed parkinsonism were studied using positron emission tomography with 6-L-[ 18 F]fluorodopa ([ 18 F]dopa, a pre-synaptic tracer) and ["C]raclopride (which binds to D 2 receptors). Putamen [ 18 F]dopa uptake was reduced in all patients, confirming a loss of function affecting the nigrostriatal projection. In eight patients the putamen with the lowest [ 18 F]dopa uptake (always contralateral to the clinically most affected side) had the highest [ u C]raclopride binding, suggesting upregulation of the post-synaptic D 2 receptors. In the ninth patient [ n C]raclopride binding was lower in the putamen with the lowest [ 18 F]dopa uptake, indicating an additional post-synaptic deficit. All nine patients were shown to be L-dopa responsive. The subsequent clinical course of the former eight patients has been typical of idiopathic Parkinson's disease, whilst the ninth patient has developed postural hypotension, urinary incontinence and respiratory stridor typical of multiple system atrophy. Reduced [ n C]raclopride binding in L-dopa naive parkinsonian patients might serve as a useful early marker of this condition.
Brain, 1993
Positron emission tomography was used to measure regional cerebral blood flow (rCBF) in 12 patien... more Positron emission tomography was used to measure regional cerebral blood flow (rCBF) in 12 patients with amyotrophic lateral sclerosis (ALS) and six age-matched controls. Scans were performed at rest, and while subjects performed stereotyped and freely selected movements of a joystick with their right hand. Statistical parametric mapping was used to determine significant differences in rCBF between the two groups at rest and during activation. The ALS group showed no significant difference in global cerebral blood flow at rest compared with controls. However, rCBF at rest was significantly (P < 0.01) reduced in the ALS group in the primary sensorimotor cortex, the lateral premotor cortex, the supplementary motor area, the anterior cingulate cortex, the paracentral lobule and the superior and inferior parietal cortex. Comparison of the increase in rCBF caused by freely selected joystick movements over the resting state between the two groups of subjects showed significantly (P < 0.001) greater activation in ALS patients in the ventral third (face area) of the contralateral primary sensorimotor cortex and in the adjacent contralateral ventral premotor and parietal association cortices; significantly (P < 0.01) greater activation of the contralateral anterior insula and the ipsilateral anterior cingulate cortex (dorso-caudal area 24) was also present in ALS patients. When a comparison of the rCBF response to the free selection task with that to the stereotyped task was performed between the two groups of subjects, ALS patients showed significantly impaired (P < 0.01) activation of the rostral anterior cingulate cortex (area 32), medial prefrontal cortex (area 10), left parahippocampal gyrus and retrosplenial cortex. The pattern of reduced rCBF at rest in ALS patients probably reflects a combination of neuronal loss in all areas of cortex projecting through the pyramidal tract together with loss of projections from the sensorimotor cortex to the motor association areas. The expansion of the upper limb output zone of the sensorimotor cortex in ALS patients during contralateral upper limb movement may represent cortical reorganization in response to Betz cell loss or corticospinal tract disruption. Abnormal recruitment of non-primary motor areas may also represent functional adaptation to a corticospinal tract lesion. Focally impaired activation of the medial prefrontal cortex and parahippocampal gyrus in ALS patients during the process of internal generation of movement could underlie the frontal lobe cognitive deficits reported in previous neuropsychological studies of ALS.
European journal of physical and rehabilitation medicine, Jan 8, 2016
Measurement of long term health outcome after trauma remains non-standardised and ambiguous which... more Measurement of long term health outcome after trauma remains non-standardised and ambiguous which limits national and international comparison of burden of injuries. The World Health Organisation (WHO) has recommended the application of the International Classification of Function, Disability and Health (ICF) to measure rehabilitation and health outcome worldwide. No previous poly-trauma studies have applied the ICF comprehensively to evaluate outcome after injury. To apply the ICF categorisation in patients with traumatic injuries to identify a minimum data set of important rehabilitation and health outcomes to enable national and international comparison of outcome data. A mixed methods design of patient interviews and an on-line survey. An ethnically diverse urban major trauma centre in London. Adult patients with major traumatic injuries (poly-trauma) and international health care professionals (HCPs) working in acute and post-acute major trauma settings. Mixed methods investiga...
PLOS ONE, 2016
Our results show that specific subcomponents of executive functions are able to predict fall risk... more Our results show that specific subcomponents of executive functions are able to predict fall risk, while a more global cognitive dysfunction is associated with poorer balance. * Fall rate per 100 days of patient hospital stay = 71 (number of falls)/5353(total person days) x 100 = 1.33 ** Others: miscellaneous peripheral and central nervous system illnesses.
Movement Disorders, 2002
We evaluated the efficacy of physiotherapy, occupational therapy, and speech and language therapy... more We evaluated the efficacy of physiotherapy, occupational therapy, and speech and language therapy in Parkinson's disease by synthesizing six Cochrane systematic reviews. All randomised, controlled trials examining the efficacy of a paramedical therapy versus control intervention and all those comparing the efficacy of two forms of active therapy in Parkinson's disease were included. Trials were identified by searching biomedical databases, reference lists, hand searching, and contacting investigators. The main outcome measures were quality of life, speech intelligibility, activities of daily living, and individual measures of motor and speech impairment. We identified 16 physiotherapy randomised controlled trials (399 patients), two occupational therapy trials (84 patients), and five speech and language therapy for dysarthria trials (154 patients). None of these studies examined nonpharmacological swallowing therapy for dysphagia. We were unable to perform metaanalysis of the results because the trials used heterogeneous therapy methods and outcome measures. The trials also had marked methodological flaws that could have introduced bias. In summary, we failed to find conclusive evidence of benefit for any form of paramedical therapy sufficient to recommend them in routine clinical practice. However, this lack of evidence is not proof of a lack of effect. Further large pragmatic randomised controlled trials are required to determine the effectiveness of paramedical therapies in Parkinson's disease.
The Potential for Recovery and Repair Impact of the Disease on the Patients Rehabilitation and Th... more The Potential for Recovery and Repair Impact of the Disease on the Patients Rehabilitation and Therapy Input Evaluating the Outcome of Rehabilitation Interventions Service Delivery (Potential Models of Care) Index
European Journal of Physical and Rehabilitation Medicine
BACKGROUND Telerehabilitation is a feasible and potentially effective alternative to in-person re... more BACKGROUND Telerehabilitation is a feasible and potentially effective alternative to in-person rehabilitation. However, specific guidance, training and support for practitioners who undertake remote assessments in people with physical disabilities and movement impairment is limited. OBJECTIVE The aims of this survey of United Kingdom (UK) based health and social care practitioners were to explore experiences, assess training needs, and collate ideas on best practice in telerehabilitation for physical disabilities and movement impairment. The ultimate aim will be to use the findings to inform a practical toolkit and training package for telerehabilitation use. METHODS UK rehabilitation practitioners were invited to complete an online questionnaire in November to December 2020. Opportunity and snowball sampling were used to recruit participants from professional and educational networks, special interest groups and via social media. Closed questionnaire items were analysed using descr...
BMJ Open
ObjectiveTo identify the available guidance and training to implement telerehabilitation movement... more ObjectiveTo identify the available guidance and training to implement telerehabilitation movement assessments for people (adults and children) with a physical disability, including those recovering from COVID-19.DesignRapid scoping review.Included sources and articlesPubMed, CINAHL, PsychInfo, Cochrane, Embase, Web of Science, PEDro, UK Health Forum, WHO, National Archives and NHS England were searched using the participant–concept–context framework from 2015 to August 2020. Primary studies that recruited individuals with physical disabilities and guidance documents aimed at providers to implement movement-related telerehabilitation were included.Results23 articles (11 primary research studies, 3 systematic reviews and 9 guidance documents) were included out of 7857 that were identified from the literature search. Two main issues were found: (1) telerehabilitation guidance (from both research studies and guidance documents) was not specific to movement-related assessment and (2) mos...
Multiple Sclerosis Journal
Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identif... more Shared decision-making occurs when the decision is ‘preference sensitive’. It consists of identifying the different treatment options (choice talk), considering the advantages and disadvantages of each option (option talk), and then supporting making the decision in the light of an individual’s experiences and values (decision talk). It is most effective when working with an ‘activated patient’, that is, one who is prepared for the shared decision-making role. In rehabilitation, many decisions are preference sensitive. These decisions may be framed as ‘goal setting’. Skilled clinicians can support patients to learn goal setting skills until the person has the skills to maintain health supporting behaviours most of the time, only seeing a clinical team at times of change or crisis. The steps in goal setting can be summarised as building empathy, creating a contract, identifying priorities, summarising the conversation, articulating the goal, defining actions, building coping plans, a...
Disability and rehabilitation, May 1, 2018
Selecting the most appropriate health-related work outcome to evaluate an intervention can be fra... more Selecting the most appropriate health-related work outcome to evaluate an intervention can be fraught with difficulty. To aid clinicians in navigating this problem we have developed a model, which illustrates how pathology can affect specific measureable quantities, such as work instability. Using a modified-Delphi procedure, a panel of experts met initially to analyze the content of 95 health-related work outcome measures and organize the identified areas of measurement into a coherent model, complemented by a narrative review of the literature. This initial model underwent two rounds of stakeholder-based feedback, the results of which were incorporated in the final expert panel meeting to produce the States-traits Work Instability Model (SWIM). The States-traits Work Instability Model (SWIM) illustrates how changes to an individual's physical and psychological states and traits might affect their work-related performance, well-being and self-efficacy. Moreover, each concept ut...
Clinical rehabilitation, 2018
To determine whether tests of cognitive function and patient-reported outcome measures of motor f... more To determine whether tests of cognitive function and patient-reported outcome measures of motor function can be used to create a machine learning-based predictive tool for falls. Prospective cohort study. Tertiary neurological and neurosurgical center. In all, 337 in-patients receiving neurosurgical, neurological, or neurorehabilitation-based care. Binary (Y/N) for falling during the in-patient episode, the Trail Making Test (a measure of attention and executive function) and the Walk-12 (a patient-reported measure of physical function). The principal outcome was a fall during the in-patient stay ( n = 54). The Trail test was identified as the best predictor of falls. Moreover, addition of other variables, did not improve the prediction (Wilcoxon signed-rank P < 0.001). Classical linear statistical modeling methods were then compared with more recent machine learning based strategies, for example, random forests, neural networks, support vector machines. The random forest was the...
Topics in stroke rehabilitation, Jan 3, 2018
Stroke is a leading cause of disability worldwide. The most common impairment resulting from stro... more Stroke is a leading cause of disability worldwide. The most common impairment resulting from stroke is upper-limb weakness. To determine the usefulness and psychometric validity of the upper-limb subscale of the STREAM in an acute stroke population. Rasch Analysis, including unidimensionality assumption testing, determining model fit, and analysis of: reliability, residual correlations, and differential item functioning. 125 individuals were assessed using the upper-limb subscale of the Stroke Rehabilitation Assessment of Movement (STREAM) tool. Rasch analysis suggests the STREAM is a unidimensional measure. However, when scored using the originally proposed method (0-2), or using the response pattern (0-5) neither variant fit the Rasch model (p < 0.05). Although, the reliability was good (Person-Separation Index - 0.847 and 0.903, respectively). Correcting for the disordered thresholds, and thereby producing the new scoring pattern, led to substantial improvement in the overall ...