Comparison of Content and Psychometric Properties of Malnutrition Outcome Measures : A Systematic Review

Funding Information: The research received funding from project No 18-00-A01612-000006 financed by European agricultural fund for rural development. Publisher Copyright: © 2022 Foundation for Rehabilitation Information. All rights reserved.Objective: To determine the most-often used outcome measures for malnutrition risk and malnutrition, analyse outcome measure content, and assess psychometric properties. Methods: MEDLINE, SAGE Journals, Web of Science, SCOPUS, ProQuest and Science Direct databases were searched to identify outcome measures. Outcome measure content was compared using the International Classification of Functioning Disability and Health (ICF). Psychometric properties were also systematically searched and compared. This review was prepared according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 1,311 studies met the inclusion criteria. The most-often used outcome measures for detecting malnutrition or its risk overall were: body mass index (590), albumin (469), Mini Nutritional Assessment (312), haemoglobin (251), and Subjective Global Assessment (139). The most psychometrically sound outcome measure was Mini Nutritional Assessment, but the most comprehensive measure, covering the most ICF categories, was Patient-Generated Subjective Global Assessment, with a total of 58 meaningful concepts. Conclusion: The results provide an insight into the content and psychometric quality of malnutrition risk and malnutrition outcome measures. There was some variation between the way reviewers linked meaningful concepts to ICF, and literature gaps were identified regarding psychometric properties. These results can be used to help select the most appropriate malnutrition outcome measure. LAY ABSTRACT Malnutrition leads to a decline in physical and mental functioning, as well as activity limitations, which can result in poor disease outcomes and reduced quality of life. Early identification of malnutrition depends on choosing the most appropriate diagnostic method. This article systematically analyses the outcome measures most commonly used in research for detecting malnutrition risk and malnutrition in adults. The content of the most common outcome measures was analysed using the International Classification of Functioning Disability and Health (ICF). Linking rules, and the psychometric properties of the measures were systematically searched, analysed according to an already established framework, and compared.publishersversionPeer reviewe

Systematization of rehabilitation interventions for neuro-oncological patients using international classification of health interventions : a scoping review

Publisher Copyright: © 2024, Medical Journals Sweden AB. All rights reserved.BACKGROUND: To ensure equitable and effective rehabilitation for neuro-oncological patients the development of an effective treatment strategy is necessary. OBJECTIVE: To identify evidence for interventions used in acute rehabilitation for patients with neuro-oncological conditions and to systematize them according to the International Classification of Health Interventions (ICHI) classification Methods: A scoping review was conducted, comprising 3 parts: identification of interventions in publications; linking the interventions to ICHI classification; and identifying problems targeted by these interventions and linking them to International Classification of Functioning, Disability and Health (ICF) categories. RESULTS: The search strategy selected a total of 6,128 articles. Of these, 58 publications were included in the review. A total of 150 interventions were identified, 47 of which were unique interventions. Forty-three of the interventions were linked to the ICHI classification; 4 of these interventions were evidence level I, 18 evidence level II, 23 evidence level III, and 2 evidence level IV. Five interventions were linked to the ICF One-Level Classification, and the remaining 42 interventions were linked to the ICF Two-Level Classification. All interventions regarding the Body Systems and Functions were linked to the ICF Two-Level Classification. Only 5 interventions in the Activities and Participation domain, 3 interventions in the Health-related Behaviors domain, and 1 intervention in the Environment domain were linked to the ICF Two-Level Classification. Two identified problems (inpatient nursing and comprehensive inpatient rehabilitation) were not classified according to the ICF. DISCUSSION: A total of 47 unique interventions were identified, revealing a significant focus on addressing issues related to bodily functions and structures. The study also highlighted the challenge of linking specific interventions to ICHI codes, particularly when the source documentation lacked adequate detail. While this review offers valuable insights into rehabilitation for neuro-oncological patients and lays the groundwork for standardized coding and data exchange, it also emphasizes the need for further refinement and validation of the ICHI classification to better align with the multifaceted interventions used in rehabilitation. CONCLUSION: There is evidence in the literature of 47 interventions used by various rehabilitation professionals in the acute rehabilitation of neuro-oncological patients. However, most of these interventions are evidence level II and III. Four interventions (virtual reality, mirror therapy, robotic upper extremity training to improve function, and cognitive group therapy) are not included in the ICHI. The problems analysed in the literature that are targeted by interventions often do not coincide with the purpose of the specific intervention or are too broadly defined and not specific. These findings emphasize the need for greater precision in describing and documenting interventions, as well as the importance of aligning interventions more closely with ICF categories, particularly in the domains of Activities and Participation. This work highlights the heterogeneity in the reporting of rehabilitation interventions, and the challenges in mapping them to standardized classifications, emphasizing the ongoing need for refining and updating these classification systems.Peer reviewe

Comparison of content and psychometric properties for assessment tools used for brain tumor patients : a scoping review

Funding Information: This study was supported by Riga Stradiņš University internal grant. Publisher Copyright: © 2021, The Author(s).Aims: To determine the most frequently utilized functional status assessment instruments for patients with brain tumors, compare their contents, using the International Classification of Functioning, Disability and Health (ICF), and their psychometric properties. Methods: A scoping review was conducted to explore possible assessment instruments and summarize the evidence. A systematic literature search was performed for identification of the frequently used functional assessment tool in clinical trials in PubMed, ScienceDirect, and ProQuest databases. The content of most used instruments was linked to the ICF categories. The psychometric qualities of these assessment tools were systematically searched and analyzed. Results: Nine most used assessment tools in clinical trials were identified. The most frequently used assessment instrument is the Karnofsky Performance Scale, which is developed for a general assessment of oncological patients. Out of four self-assessment tools, two were disease-specific (EORTC QLQ-BN20 and FACT-Br), EORTC QLQ-C30 has been shown good psychometric properties in patients with brain tumors as well as in patients with various oncological diseases, similar to the SF-36, it is used in patients with brain tumors as well as in patients with various diseases. The Functional Independence Measure and the Barthel Index were two objective assessment tools that described functioning, but two were neuropsychological tests (MMSE and Trial Making Test). Two hundred eighty-three meaningful concepts were identified and linked to 102 most relevant second-level categories covering all components of the ICF. Forty-nine studies reporting psychometric properties of those nine assessment tools were identified, indicating good reliability and validity for all the instruments. Conclusion: Nine most frequently utilized functional status assessment instruments for patients with brain tumors represent all components of the ICF and have good psychometric properties. However, the choice of the tool depends on the clinical question posed and the aim of its use.publishersversionPeer reviewe

Pragmatic solutions to reduce the global burden of stroke : a World Stroke Organization-Lancet Neurology Commission

Peer reviewe

Zero to eight : young children and their internet use

EU Kids Online has spent seven years investigating 9-16 year olds’ engagement with the internet, focusing on the benefits and risks of children’s internet use. While this meant examining the experiences of much younger children than had been researched before EU Kids Online began its work in 2006, there is now a critical need for information about the internet-related behaviours of 0-8 year olds. EU Kids Online’s research shows that children are now going online at a younger and younger age, and that young children’s “lack of technical, critical and social skills may pose [a greater] risk” (Livingstone et al, 2011, p. 3).peer-reviewe

Rehabilitācijas rezultātu salīdzinājums personām pēc insulta Latvijā un Zviedrijā. Promocijas darba kopsavilkums

The Doctoral Thesis was carried out at the Department of Rehabilitation, Rīga Stradiņš University, Latvia in collaboration with the Institute of Neuroscience and Physiology, University of Gothenburg, Sweden, with the support of the Swedish Institute, the Visby Programme. Defence: at the public session of the Doctoral Council of Medicine on 19 December 2016 at 15.00 in 26a Anniņmuižas Boulevard, Riga, in the Conference hall, Rīga Stradiņš University.Stroke is one of the most common causes of long-term disability that leads to substantial economic and social burden for individuals, families, communities and nations. Rehabilitation aims to improve person’s functioning and decrease adverse consequences of stroke in all levels. Therefore, defining an optimal model of stroke care is in the interests of patients, health professionals, researchers and policymakers. One of the ways towards it is by investigating and comparing the outcomes of the stroke care systems currently in use. The aim of this thesis was to explore the determinants of rehabilitation outcomes for persons after stroke and to compare them between those living in Latvia or in Sweden, using the bio-psycho-social model suggested by World Health Organization (WHO). This project was organized in four parts. Part 1 focused on comparison between two in-patient rehabilitation systems and the differences in level of independence at discharge from rehabilitation between two cohorts were compared in 1055 and 1748 persons after stroke, living in Latvia and Sweden, respectively. For all following parts of this research work, cross-sectional study design was used. In Part 2, the influence of dependence level at discharge from rehabilitation on self-perceived disability in chronic phase of stroke was investigated in 255 persons from Latvia. Part 3 explored personal factors’ (age, gender, place of residence and time since onset of stroke) role in perception of functional limitations, barriers and facilitators in 243 persons living in Sweden. The relevance of the same factors in persons after stroke living in Latvia was evaluated in Part 4. Functional Independence Measure, International Classification of Functioning, Disability and Health Core Set for stroke and World Health Organization Disability Assessment Schedule 2.0 were used for outcome assessment. Socio-demographic and medical data, as well as information on organisational aspects of rehabilitation were also used as variables. Both theoretical as well as statistical analyses were used to compare rehabilitation systems in Latvia and Sweden. Appropriate regression analyses were used in all parts of this work. It seems that the components of stroke care are similar in rehabilitation systems in Latvia and Sweden. However, both populations vary in their basic medical and sociodemographic characteristics, as well as in the level of independence at admittance and discharge. There are also potential differences in the content and organizational aspects of rehabilitation. The levels of independence in daily activities at discharge from rehabilitation are significant factors that influenced perception of disability in the chronic phase of stroke. Personal factors such as age, gender, place of residence and time since onset of stroke can influence self-perceived functioning and environmental factors, as defined in the framework of the ICF, in persons living in Sweden. Same factors were also significant in the model that evaluated problems in ‘Activities and Participation’ persons living in Latvia. However, the role of those factors where rather small in both populations. Thus, the results of this thesis shows that different aspects of WHO’s suggested biopsycho- social model influence rehabilitation outcomes for persons after stroke and results depends on the country of residence (Latvia or Sweden). Functional, organizational, social and personal factors are of importance. Some of the factors are modifiable by the healthcare system, but some are the responsibility of society as a whole

Rehabilitācijas rezultātu salīdzinājums personām pēc insulta Latvijā un Zviedrijā. Promocijas darbs

The Doctoral Thesis was carried out at the Department of Rehabilitation, Rīga Stradiņš University, Latvia in collaboration with the Institute of Neuroscience and Physiology, University of Gothenburg, Sweden, with the support of the Swedish Institute, the Visby Programme. Defence: at the public session of the Doctoral Council of Medicine on 19 December 2016 at 15.00 in 26a Anniņmuižas Boulevard, Riga, in the Conference hall, Rīga Stradiņš University.Stroke is one of the most common causes of long-term disability that leads to substantial economic and social burden for individuals, families, communities and nations. Rehabilitation aims to improve person’s functioning and decrease adverse consequences of stroke in all levels. Therefore, defining an optimal model of stroke care is in the interests of patients, health professionals, researchers and policymakers. One of the ways towards it is by investigating and comparing the outcomes of the stroke care systems currently in use. The aim of this thesis was to explore the determinants of rehabilitation outcomes for persons after stroke and to compare them between those living in Latvia or in Sweden, using the bio-psycho-social model suggested by World Health Organization (WHO). This project was organized in four parts. Part 1 focused on comparison between two in-patient rehabilitation systems and the differences in level of independence at discharge from rehabilitation between two cohorts were compared in 1055 and 1748 persons after stroke, living in Latvia and Sweden, respectively. For all following parts of this research work, cross-sectional study design was used. In Part 2, the influence of dependence level at discharge from rehabilitation on self-perceived disability in chronic phase of stroke was investigated in 255 persons from Latvia. Part 3 explored personal factors’ (age, gender, place of residence and time since onset of stroke) role in perception of functional limitations, barriers and facilitators in 243 persons living in Sweden. The relevance of the same factors in persons after stroke living in Latvia was evaluated in Part 4. Functional Independence Measure, International Classification of Functioning, Disability and Health Core Set for stroke and World Health Organization Disability Assessment Schedule 2.0 were used for outcome assessment. Socio-demographic and medical data, as well as information on organisational aspects of rehabilitation were also used as variables. Both theoretical as well as statistical analyses were used to compare rehabilitation systems in Latvia and Sweden. Appropriate regression analyses were used in all parts of this work. It seems that the components of stroke care are similar in rehabilitation systems in Latvia and Sweden. However, both populations vary in their basic medical and sociodemographic characteristics, as well as in the level of independence at admittance and discharge. There are also potential differences in the content and organizational aspects of rehabilitation. The levels of independence in daily activities at discharge from rehabilitation are significant factors that influenced perception of disability in the chronic phase of stroke. Personal factors such as age, gender, place of residence and time since onset of stroke can influence self-perceived functioning and environmental factors, as defined in the framework of the ICF, in persons living in Sweden. Same factors were also significant in the model that evaluated problems in ‘Activities and Participation’ persons living in Latvia. However, the role of those factors where rather small in both populations. Thus, the results of this thesis shows that different aspects of WHO’s suggested biopsycho- social model influence rehabilitation outcomes for persons after stroke and results depends on the country of residence (Latvia or Sweden). Functional, organizational, social and personal factors are of importance. Some of the factors are modifiable by the healthcare system, but some are the responsibility of society as a whole

Comparison of Rehabilitation Outcomes for Persons After Stroke in Latvia and Sweden. Summary of the Doctoral Thesis

Promocijas darbs ir izstrādāts Rīgas Stradiņa universitātes Rehabilitācijas katedrā Latvijā sadarbībā ar Gēteborgas Universitātes Neirozinātnes un fizioloģijas institūtu Zviedrijā un ar Zviedru institūta Visbijas programmas atbalstu. Aizstāvēšana: 2016. gada 19. decembrī plkst. 15.00 Rīgas Stradiņa universitātes Medicīnas promocijas padomes atklātā sēdē Rīgā, Anniņmuižas bulvārī 26a konferenču zālē.Insults ir viens no visbiežāk sastopamiem ilgstošas invaliditātes iemesliem pieaugušo populācijā. Tas rada ievērojamas ekonomiskas un sociālas problēmas indivīdiem, viņu ģimenēm, sabiedrībām un nācijām. Rehabilitācijas mērķis ir uzlabot personas funkcionēšanu un mazināt insulta nelabvēlīgās sekas jebkurā aprūpes līmenī. Šī iemesla dēļ gan pacientu, gan veselības aprūpes profesionāļu, kā arī pētnieku un politiķu interesēs ir atrast optimālu insulta aprūpes modeli. Viens no veidiem, kā šim modelim tuvoties, ir izpētīt un salīdzināt insulta aprūpes iznākumus, kas tiek izmantoti šobrīd. Šī darba mērķis bija salīdzināt rehabilitācijas rezultātus personām pēc insulta Latvijā un Zviedrijā, izmantojot Pasaules Veselības organizācijas ieteikto biopsihosociālo modeli. Šis darbs sastāv no četrām daļām. Pirmajā pētījuma daļā ir veikts divu stacionārās rehabilitācijas sistēmu (Latvijas un Zviedrijas) salīdzinājums, kā arī salīdzinātas neatkarības līmeņa atšķirības rehabilitācijas beigās starp divām grupām – 1055 Latvijā dzīvojošām un 1784 Zviedrijā dzīvojošām personām pēc insulta. Pārējām pētījuma daļām tika izmantots šķērsgriezuma pētījuma dizains. Otrajā daļā tika pētīta neatkarības līmeņa – rehabilitācijas kursa beigās – ietekme uz personu vērtējumu par viņu invaliditātes pakāpi hroniskā insulta fāzē 255 personām no Latvijas. Trešajā daļā tika pētīta personālo faktoru (vecuma, dzimuma, dzīvesvietas un laika kopš insulta) loma, nosakot 243 Zviedrijā dzīvojošu personu vērtējumu par funkcionēšanas ierobežojumiem, kā arī vides faktoru kavētājiem un veicinātājiem. Šo pašu faktoru nozīme Latvijā dzīvojošām personām pēc insulta tika vērtēta pētījuma ceturtajā daļā. Kā iznākuma novērtēšanas instrumenti tika izmantoti: Funkcionālās neatkarības mērījums, Starptautiskās funkcionēšanas, nespējas un veselības klasifikācijas (SFK) insulta pamatkopa un Pasaules Veselības organizācijas Invaliditātes novērtēšanas saraksta 2. versija. Kā mainīgie tika izmantoti sociodemogrāfiskie un medicīniskie dati, kā arī informācija par rehabilitācijas organizatoriskajiem aspektiem. Tika veikts gan teorētisks, gan statistisks salīdzinājums starp Latvijas un Zviedrijas rehabilitācijas sistēmām. Atbilstošas regresijas analīzes tika veiktas visās šī pētījuma daļās. Latvijas un Zviedrijas sistēmās insulta aprūpes komponenti šķiet līdzīgi. Tomēr abas populācijas atšķiras ar pamata medicīniskajiem rādītājiem, sociodemogrāfisko raksturojumu un neatkarības līmeni rehabilitācijas sākumā un beigās. Iespējams, ka tās savā starpā atšķiras arī ar rehabilitācijas saturu un organizatoriskajiem aspektiem. Neatkarības līmenis ikdienas aktivitāšu veikšanā rehabilitācijas kursa beigās ir nozīmīgs faktors, kas ietekmē personas vērtējumu par viņa invaliditātes līmeni hroniskā insulta fāzē. Tādi personālie faktori kā vecums, dzimums, dzīvesvieta un laiks kopš insulta ietekmē Zviedrijā dzīvojošu personu vērtējumu par funkcionēšanu un vides faktoriem atbilstoši SFK konceptam. Šie paši faktori, novērtēti “aktivitāšu un līdzdalības” domēnā, bija nozīmīgi arī Latvijas populācijā. Tomēr šo faktoru loma abās populācijās bija diezgan maza. Šī darba rezultāti apstiprina, ka dažādi Pasaules Veselības organizācijas ieteiktā biopsihosociālā modeļa aspekti ietekmē rehabilitācijas rezultātus personām pēc insulta, turklāt tie atšķiras atkarībā no valsts, kurā persona dzīvo (Latvijā vai Zviedrijā). Svarīgi ir gan funkcionālie, gan sociālie, gan personālie faktori. Dažus no šiem faktoriem var ietekmēt, izmantojot veselības aprūpes sistēmu, bet citi ir visas sabiedrības atbildība

Use of the Digital Assistant Vigo in the Home Environment for Stroke Recovery: Focus Group Discussion With Specialists Working in Neurorehabilitation

BackgroundThere is a lack of resources for the provision of adequate rehabilitation after a stroke, thus creating a challenge to provide the necessary high-quality, patient-centered, and cost-efficient rehabilitation services at a time when they are needed the most. Tablet-based therapeutic programs present an alternative way to access rehabilitation services and show a new paradigm for providing therapeutic interventions following a stroke anytime and anywhere. The digital assistant Vigo is an artificial intelligence–based app that provides an opportunity for a new, more integrative way of carrying out a home-based rehabilitation program. Considering the complexity of the stroke recovery process, factors such as a suitable population, appropriate timing, setting, and the necessary patient-specialist support structure need to be thoroughly researched. There is a lack of qualitative research exploring the perspectives of professionals working in neurorehabilitation of the content and usability of the digital tool for the recovery of patients after a stroke. ObjectiveThe aim of this study is to identify the requirements for a tablet-based home rehabilitation program for stroke recovery from the perspective of a specialist working in stroke rehabilitation. MethodsThe focus group study method was chosen to explore specialists’ attitudes, experience, and expectations related to the use of the digital assistant Vigo as a home-based rehabilitation program for stroke recovery in domains of the app’s functionality, compliance, usability, and content. ResultsIn total, 3 focus groups were conducted with a participant count of 5-6 per group and the duration of the discussion ranging from 70 to 80 minutes. In total, 17 health care professionals participated in the focus group discussions. The participants represented physiotherapists (n=7, 41.2%), occupational therapists (n=7, 41.2%), speech and language therapists (n=2, 11.8%), and physical medicine and rehabilitation physicians (n=1, 5.9%). Audio and video recordings of each discussion were created for further transcription and analysis. In total, 4 themes were identified: (1) the clinician’s views on using Vigo as a home-based rehabilitation system, (2) patient-related circumstances facilitating and limiting the use of Vigo; (3) Vigo’s functionality and use process (program creation, individual use, remote support); and (4) complementary and alternative Vigo use perspectives. The last 3 themes were divided further into 10 subthemes, and 2 subthemes had 2 sub-subthemes each. ConclusionsHealth care professionals expressed a positive attitude toward the usability of the Vigo app. It is important that the content and use of the app be coherent with the aim to avoid (1) misunderstanding its practical use and the need for integration in practice and (2) misusing the app. In all focus groups, the importance of close involvement of rehabilitation specialists in the process of app development and research was highlighted