Measuring Health: A Guide to Rating Scales and Questionnaires

The primary clinical outcome measure for evaluating multiple sclerosis in clinical trials has been Kurtzke's expanded disability status scale (EDSS). New therapies appear to favourably impact the course of multiple sclerosis and render continued use of placebo control groups more difficult. Consequently, future trials are likely to compare active treatment groups which will most probably require increased sample sizes in order to detect therapeutic efficacy. Because more responsive outcome measures will be needed for active arm comparison studies, the National Multiple Sclerosis Society's Advisory Committee on Cinical Trials of New Agents in Multiple Sclerosis appointed a Task Force that was charged with developing improved clinical outcome measures. This Task Force acquired contemporary clinical trial and historical multiple sclerosis data for meta-analyses of primary and secondary outcome assessments to provide a basis for recommending a new outcome measure. A composite measure encompassing the major clinical dimensions of arm, leg and cognitive function was identified and termed the multiple sclerosis functional composite (MSFC). The MSFC consists of three objective quantitative tests of neurological function which are easy to administer. Change in this MSFC over the first year of observation predicted subsequent change in the EDSS, suggesting that the MSFC is more sensitive to change than the EDSS. This paper provides details concerning the development and testing of the MSFC.

Development of a multiple sclerosis functional composite as a clinical trial outcome measure

Health measurement scales

Specific receptors for vitamin D have been identified in human muscle tissue. Cross-sectional studies show that elderly persons with higher vitamin D serum levels have increased muscle strength and a lower number of falls. We hypothesized that vitamin D and calcium supplementation would improve musculoskeletal function and decrease falls. In a double-blind randomized controlled trial, we studied 122 elderly women (mean age, 85.3 years; range, 63-99 years) in long-stay geriatric care. Participants received 1200 mg calcium plus 800 IU cholecalciferol (Cal+D-group; n = 62) or 1200 mg calcium (Cal-group; n = 60) per day over a 12-week treatment period. The number of falls per person (0, 1, 2-5, 6-7, >7 falls) was compared between the treatment groups. In an intention to treat analysis, a Poisson regression model was used to compare falls after controlling for age, number of falls in a 6-week pretreatment period, and baseline 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D serum concentrations. Among fallers in the treatment period, crude excessive fall rate (treatment - pretreatment falls) was compared between treatment groups. Change in musculoskeletal function (summed score of knee flexor and extensor strength, grip strength, and the timed upg p < 0.01) based on the fall categories stated above. Among fallers of the treatment period, the crude average number of excessive falls was significantly higher in the Cal-group (p = 0.045). Musculoskeletal function improved significantly in the Cal+D-group (p = 0.0094). A single intervention with vitamin D plus calcium over a 3-month period reduced the risk of falling by 49% compared with calcium alone. Over this short-term intervention, recurrent fallers seem to benefit most by the treatment. The impact of vitamin D on falls might be explained by the observed improvement in musculoskeletal function.

https://onlinelibrary.wiley.com/doi/pdf/10.1359/jbmr.2003.18.2.343

Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial.

There is a lack of consistency among researchers and clinicians in the use of terminology that describes changes in motor ability following neurological injury Specifically, the terms and definitions of motor compensation and motor recovery have been used in different ways, which is a potential barrier to interdisciplinary communication This Point of View describes the problem and offers a solution in the form of definitions of compensation and recovery at the neuronal, motor performance, and functional levels within the framework of the International Classification of Functioning model

https://journals.sagepub.com/doi/pdf/10.1177/1545968308328727

What Do Motor “Recovery” and “Compensation” Mean in Patients Following Stroke?

https://www.archives-pmr.org/article/0003-9993(94)90130-9/pdf

Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies.

Manual dexterity is frequently evaluated in rehabilitation services to estimate hand function. Several tests have been developed for this purpose, including the Purdue Pegboard, which measures fine...

The Purdue Pegboard Test: Normative data for people aged 60 and over

Objectives Grip strength is an important prerequisite for good performance of the upper limb, hence it is important to evaluate it correctly However, one of the main difficulties in evaluating the grip strength of elderly patients is the absence of valid norms Therefore, the objective of this study was to develop normative data for maximum grip strength of persons aged 60 years and older Method The grip strength of 360 subjects aged 60 years and older, randomly recruited by age and gender strata, was evaluated with the Jamar dynamometer and the Martin vigorimeter according to the protocol of the American Society of Hand Therapists Results Grip strength diminishes curvilinearly with age, and men are consistently stronger than women The data are presented by the means, standard deviations, and range, and as predictive equations obtained by regression analysis In addition to age and gender, hand circumference and body height proved to be the best indicators of grip strength for this population of elderly subjects Conclusion The random recruitment of subjects, the high participation rate in the study, and the comparability of the subjects who agreed to participate and those who refused give this study the high external validity that is essential to any norm study The predictive equations will help occupational therapists to better estimate the expected grip strength of elderly patients than they could if using only age and gender

Normative Data for Grip Strength of Elderly Men and Women

Grip strength is considered to be a good indicator of upper limb strength. The Jamar dynamometer and the Martin vigorimeter are two instruments frequently used to assess grip strength in clinical and research settings. The purpose of this study was to compare these instruments for assessing grip strength in 360 people aged 60 to 94 years, randomly selected from the electoral list. Anthropometric data were also collected. Data analyses were done using the maximum value on 3 trials with each instrument. Although the Martin vigorimeter is a pressure measure implying a dynamic movement as opposed to the static strength measure of the Jamar dynamometer, results indicate a very high correlation between the two measures. Grip strength measured by the Jamar dynamometer is even more dependent on hand anthropometry than measurements with the Martin vigorimeter.

Comparison of the Jamar dynamometer and the Martin vigorimeter for grip strength measurements in a healthy elderly population.

Accurate assessment of upper extremity performance is a critical element in determinimg the potential independance of the physically impaired person. An upper extremity function test for the elderly, the TEMPA (Test Evaluant les Membres superieurs des Personnes Âgees), was developed, involving nine tasks related to routine daily activities. Each task is measured by three sub-scores: speed of execution, functional rating and task analysis. A test-retest and interrater reliability study was conducted with a sample of 29 subjects, aged 62 to 82 years, with various upper extremity impairments and varying degrees of functional independance. Intraclass correlation coefficients ranged from moderate to high (0.70 to 1.0), demonstrating temporal stability and sound agreement between evaluators. A preliminary construct validity study was conducted by correlating score of the TEMPA with functional independance to basic personal care (Spearman's Rho = 0.74). The TEMPA is a reliable instrument that appears to fill a v...

Élisabeth Dutil

Papers

Validation of the Box and Block Test as a measure of dexterity of elderly people: reliability, validity, and norms studies.

The Purdue Pegboard Test: Normative data for people aged 60 and over

Normative Data for Grip Strength of Elderly Men and Women

Comparison of the Jamar dynamometer and the Martin vigorimeter for grip strength measurements in a healthy elderly population.

Development and Reliability of an Upper Extremity Function Test for the Elderly: The TEMPA