Measuring Perceived Change in Mobility and Balance in Older Adults: A Mixed-Methods Approach

Background/ Purpose: A priority in healthcare for older adults is to detect declines in mobility and balance before falls occur with potential consequences of morbidity, disability, even mortality. Self-report and performance measures have varying degrees of respondent and administrative burden. We investigated the role of a single global self-rating in the detection of mobility decline. Change by repeated self-rated mobility state was compared to transition rating of self-perceived change over six months. Additionally, repeated state and transition reported change were compared with performance change. We anticipated discordance, and explored the support for potential theories to explain discordance. Methods: Using a prospective, exploratory, observational cohort study with mixed-methods analysis, we focused on the natural history of age-related mobility change. Community-dwelling older adults provided state and transition global ratings of mobility and balance over six months, and completed questionnaires and performance tests of physical function. A subset of the older adults participated in semi-structured interviews to identify themes for domain definitions of mobility and balance, and the timeframe and frames of reference used for state ratings. Analyses included correlations for agreement between measures, and comparisons of means to investigate groups established based on discordance.Results: Participants, n=104, had data at two consecutive time points, and 33 participated in interviews. Domain definitions and state timeframes varied. Two main frames of reference were identified. The serial state and transition based rating of change were discordant, as were self-rated and performance change. Nearly 75 percent of those with gait speed decline of at least 0.10 m/s reported worsening by transition, and about 25 percent selected a lower state rating.Conclusions: Transition ratings appear more sensitive than serial state ratings for detection of decline in gait speed, while decline by serial state rating may be more specific to larger performance changes. Self-ratings appear to communicate valuable information about mobility and balance not available from other measures, and we recommend an expanded use of open-ended questions in research and clinical practice

Cancer Rehabilitation Publications (2008–2018) With a Focus on Physical Function: A Scoping Review

Background: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our knowledge. Purpose: This scoping review systematically identified literature published between 2008 and 2018 related to the screening, assessment, and interventions associated with physical function in people living with and beyond cancer. Data Sources: PubMed and CINAHL were searched up to September 2018. Study Selection: Study selection included articles of all levels of evidence on any disease stage and population. A total of 11,483 articles were screened for eligibility, 2507 full-text articles were reviewed, and 1055 articles were selected for final inclusion and extraction. Data Extraction: Seven reviewers recorded type of cancer, disease stage, age of participants, phase of treatment, time since diagnosis, application to physical function, study design, impairments related to physical function, and measurement instruments used. Data Synthesis: Approximately one-third of the articles included patients with various cancer diagnoses (30.3%), whereas the rest focused on a single cancer, most commonly breast (24.8%). Most articles (77%) measured physical function following the completion of active cancer treatment with 64% representing the assessment domain. The most commonly used measures of physical function were the Medical Outcomes Study 36-Item Health Survey Questionnaire (29%) and the European Organization for Research and Treatment of cancer Quality of Life Questionnaire-Cancer 30 (21.5%). Limitations: Studies not written in English, study protocols, conference abstracts, and unpublished data were excluded. Conclusions: This review elucidated significant inconsistencies in the literature regarding language used to define physical function, measurement tools used to characterize function, and the use of those tools across the cancer treatment and survivorship trajectory. The findings suggested that physical function in cancer research is predominantly measured using general health-related quality-of-life tools rather than more precise functional assessment tools. Interdisciplinary and clinician-researcher collaborative efforts should be directed toward a unified definition and assessment of physical function

“The Lark Ascending” Arranged for Flute Choir

Inspired by the emotion presented in the piece, I proposed and was granted funding from the C. Farrell Scholarship for Fine Arts committee and Undergraduate Research Scholarship committee to arrange Ralph Vaughn Williams’ The Lark Ascending for flute choir. In arranging the work, I challenged myself to work with limited instrument colors, instrument ranges, and score adaptation–which all require a creative and flexible outlook on the work as a whole. Certainly, arranging a piece of this length and complexity was not a simple undertaking. Arranging this work required technical understanding of Williams’ piece and instrument adaptation, and challenged me to make creative choices regarding musical gesture. As per my project proposal, I am conducting and rehearsing my arrangement with the CWU flute choir, working with the group toward a cumulative performance on May 4

Astonishing Splashes of Color Here and There: Suggestions of the Programmatic in Ernst Toch's Peter Pan, Op. 76

Despite composing over thirty orchestral works, four operas, and numerous chamber pieces in various genres, much of the Austrian émigré composer Ernst Toch’s (1887-1964) oeuvre has fallen into obscurity. One of his relatively unknown works, Peter Pan, Op. 76, is of particular interest because, despite its eye-catching title, it was not composed with programmatic intent. The change of title from A Fairytale for Orchestra to Peter Pan, however, invites application of James M. Barrie’s (1860-1937) Peter Pan narrative to his piece, and, indeed, the work contains structural and motivic elements that might be linked to that story.masters, M.A., Music -- University of Idaho - College of Graduate Studies, 2021-0

Academy of Oncologic Physical Therapy EDGE Task Force: A Systematic Review of Measures of Balance in Adult Cancer Survivors

Background and Purpose: Balance impairments are prevalent in adult cancer survivors, leading to increased fall risk and reduced quality of life. To identify survivors in need of balance and fall interventions and to track change with intervention, health care providers need measures with sound psychometric properties and high clinical utility. The purpose of this systematic review was to identify reliable, valid, and clinically useful measures of balance impairments in adult cancer survivors. Secondary purposes were to obtain minimal detectable change of identified balance measures and to determine use of measures to evaluate fall risk. Methods: A systematic review was conducted to assess psychometric properties and clinical utility of balance measures identified from the literature search. Two reviewers in a team independently extracted data from articles and evaluated cumulative evidence for each balance measure using the Cancer EDGE Task Force Outcome Measure Rating Form. Results: The search located 187 articles, with 54 articles retained for quality assessment of balance measures. The Fullerton Advanced Balance Scale and gait speed were highly recommended (rated 4). Balance Evaluation Systems Test, Timed Up and Go, and Five Times Sit to Stand were recommended (rated 3). Limitations: Selection bias is possible. Samples and settings across reviewed studies were widely heterogeneous. Conclusions: We recommend 5 balance measures for use in adult cancer survivors. Future research with existing balance measures should establish norms, responsiveness, and predictive validity for fall risk, while expanding to focus on imbalance in midlife survivors. Patient-reported outcome measures are needed for cancer-related imbalance.http://deepblue.lib.umich.edu/bitstream/2027.42/171458/2/Academy of Oncologic Physical Therapy_EDGE.pdfPublished versio

Comparison of non-surgical treatment methods for patients with lumbar spinal stenosis: protocol for a randomized controlled trial

Abstract Background Lumbar spinal stenosis is the most common reason for spinal surgery in older adults. Previous studies have shown that surgery is effective for severe cases of stenosis, but many patients with mild to moderate symptoms are not surgical candidates. These patients and their providers are seeking effective non-surgical treatment methods to manage their symptoms; yet there is a paucity of comparative effectiveness research in this area. This knowledge gap has hindered the development of clinical practice guidelines for non-surgical treatment approaches for lumbar spinal stenosis. Methods/design This study is a prospective randomized controlled clinical trial that will be conducted from November 2013 through October 2016. The sample will consist of 180 older adults (>60 years) who have both an anatomic diagnosis of stenosis confirmed by diagnostic imaging, and signs/symptoms consistent with a clinical diagnosis of lumbar spinal stenosis confirmed by clinical examination. Eligible subjects will be randomized into one of three pragmatic treatment groups: 1) usual medical care; 2) individualized manual therapy and rehabilitative exercise; or 3) community-based group exercise. All subjects will be treated for a 6-week course of care. The primary subjective outcome is the Swiss Spinal Stenosis Questionnaire, a self-reported measure of pain/function. The primary objective outcome is the Self-Paced Walking Test, a measure of walking capacity. The secondary objective outcome will be a measurement of physical activity during activities of daily living, using the SenseWear Armband, a portable device to be worn on the upper arm for one week. The primary analysis will use linear mixed models to compare the main effects of each treatment group on the changes in each outcome measure. Secondary analyses will include a responder analysis by group and an exploratory analysis of potential baseline predictors of treatment outcome. Discussion Our study should provide evidence that helps to inform patients and providers about the clinical benefits of three non-surgical approaches to the management of lumbar spinal stenosis symptoms. Trial registration ClinicalTrials.gov identifier: NCT0194343