PROMIS Physical Function Scale Bookmarking and Validation

• Quick, valid and responsive outcome measure are critical for physical therapists • The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) is a universal, 124 item, computer adapted system (CAT) that evaluates various health domains including physical function without a ceiling or floor effect. • PROMIS demonstrates good convergent validity with the Health Assessment Questionnaire Disability Index (HAQ-DI) and Short-form 36 (SF-36) physical function subscale1 and also with ‘gold standard\u27 International Knee Documentation Committee (IKDC) scale. PROMIS score can also predict poor outcomes at various follow-up lengths ranging from 3-52 weeks2. • The modified physical performance test (mPPT) is a performance-based test containing several functional tasks and is used to assess physical frailty in older individuals3. • Patient reported outcomes (PRO) require less time and equipment compared to performance based measures. • Purpose: To evaluate the relationship between scores on mPPT and PROMIS. Additionally, to map-out the scoring system of the PROMIS, to allow therapists to utilize it’s T-score in clinical practice

What Does a PROMIS T-score Mean for Physical Function?

Introduction/Purpose: The use of patient-reported outcomes (PRO) continues to expand beyond research to involve standard of care assessments. Although the PROMIS physical function (PF) is normalized to a T-score it is unclear how to interpret and apply this information in the daily care of patients. The T-score is abstract and unanchored to patient abilities impairing its clinical utility when shared with the patient. Patient questions are concrete such as “when will I be able to run again after this procedure?” The purpose of this research was to link PROMIS PF T-scores with physical function activities and provide a visual map of this linkage to aid in treatment assessment and address concrete patient education

What Does a PROMIS T-score Mean for Physical Function?

Category: Basic Sciences/Biologics, Outcomes Measurement Introduction/Purpose: The use of patient-reported outcomes (PRO) continues to expand beyond research to involve standard of care assessments. Although the PROMIS physical function (PF) is normalized to a T-score it is unclear how to interpret and apply this information in the daily care of patients. The T-score is abstract and unanchored to patient abilities impairing its clinical utility when shared with the patient. Patient questions are concrete such as “when will I be able to run again after this procedure?” The purpose of this research was to link PROMIS PF T-scores with physical function activities and provide a visual map of this linkage to aid in treatment assessment and address concrete patient education. Methods: The 124 items used by the PROMIS PF item response model (ver. 1.0) were obtained. Of the 124 items, 61 items were placed into tasks categories associated with activities of daily living (ADL’s) [hygiene, toileting, bathing, dressing, and transfers], standing, walking (i.e. ambulation), stairs, and running. Other items not included on this lower extremity assessment were specific to the upper extremity, included tasks (i.e. house work) not typically assessed on previous measures, and global questions covering multiple tasks. For each of the 61 items there were 4 item response parameters (Likert scale) used to place patients in 5 categories ranging from low (unable) to high ability (able without difficulty), resulting in 305 possible responses. A one page visual map of the association of the highest PROMIS T- score for each task was produced (Figure 1). Results: Patients who report independence in ALL ADL’s score a minimum T-score of 47. Independence (highest ability) for ADL’s results in the following T-scores: hygiene (30), toileting (35), dressing (39), bathing (39), transfers (47), standing (46), walking (52.5), stairs (52.5), and running (72.5). T-scores that ranged from lowest to highest based on the Likert responses were: hygiene (12-30), toileting (14-35), dressing (10-39), bathing (16-39), transfers (15-47), standing (19-46), walking (20-52.5), stairs (21-52.5), and running (35-72.5). Specifically, patients report the inability to transfer, walk, climb stairs, or run with scores of 15, 20, 21, and 35 respectively. Similarly, high scores (no difficulty) for transfers (47), walking (52.5), stairs (52.5), and running (72.5) may be used to set goals in response to treatment or return to work/sports. Conclusion: PROs provide real time assessments and a road map to follow patients throughout a treatment course. Understanding the translation of the outcome score (T-score) to patient physical activity allows the patient and physician to have realistic expectations of recovery. Applying this PF and activity linkage data to cohorts of patients with common surgeries will allow patients to gain a better understanding of the recovery duration and return to activity timing. Providing this patient friendly knowledge will help enhance patient engagement and patient satisfaction

Atribuição de falsas crenças no desenvolvimento de linguagem de crianças com síndrome de Down Attribution of false beliefs in the language development of children with Down syndrome

OBJETIVO: Avaliar atribuição de falsa crença em indivíduos com Síndrome de Down. MÉTODOS: Onze crianças usuárias de comunicação verbal, com síndrome de Down, retardo mental de grau leve a grave, de ambos os sexos, na faixa etária entre quatro e oito anos e atendidas em instituição compuseram o Grupo Down (GD). Além disso, 85 crianças sem alterações do desenvolvimento, na faixa etária entre quatro e seis anos, matriculadas em EMEI, constituíram o Grupo Controle (GC). Foram utilizados o Teste de Vocabulário por Imagem Peabody (TVIP) para a comparação do nível de compreensão verbal dos grupos, e o "teste dos smarties" adaptado, para avaliar a atribuição de falsa crença. RESULTADOS: Na análise do TVIP verificou-se diferença estatisticamente significante entre os grupos, sendo que o GD apresentou pontuação abaixo do terceiro desvio-padrão e, as crianças do GC, abaixo do primeiro desvio-padrão. Em relação à análise da atribuição de falsa crença, o GC apresentou progressão de acertos em todas as questões conforme o aumento da faixa etária. O mesmo não foi observado para o GD, sendo que os melhores resultados foram os dos indivíduos com maior tempo de terapia fonoaudiológica na instituição. Não houve correlação entre o nível de vocabulário receptivo e a habilidade de falsa crença. CONCLUSÃO: Em todas as questões houve melhor desempenho do GC em comparação ao GD. Sendo assim, foi possível analisar a falsa crença em crianças com síndrome de Down.<br>PURPOSE: To evaluate the attribution of false belief in individuals with Down syndrome. METHODS: Eleven children of both genders with Down syndrome and ages between four and eight years composed the Down Group (DG). All subjects used verbal communication, had mild to severe mental retardation, and were attended at the same institution. In addition, 85 children within normal development with ages between four and six years were recruited at an elementary school, constituting the Control Group (CG). The Peabody Picture Vocabulary Test (PPVT) was used to compare the level of verbal comprehension of the groups, and the adaptation of the "smarties test" was used to assess the attribution of false belief. RESULTS: The analysis of the PPVT showed a statistically significant difference between the groups, with the DG presenting scores below the third standard deviation, and the CG, below the first standard deviation. Regarding the false belief analysis, the CG presented increasing scores in all questions as the age group increased. The same was not observed for the DG, whose subjects with best results were those that attended speech-language therapy for a longer time at the institution. No correlation was found between receptive vocabulary level and the ability of false belief. CONCLUSION: The CG showed a better performance in all questions of the false belief test, when compared to the DG. Thus, it was possible to evaluate false belief in children with Down syndrome

Approaching the econo-socio-legal

This article offers a systematic introduction to a body of historical and contemporary research that is distinctive in its commitment to the observations that the economy and the law are mutually constitutive, and that both are in turn mutually constitutive of wider social life, including that part of social life relating to how we think and communicate about the econo-socio-legal. The aim is to offer a framework for approaching econo-socio-legal thinking and practice from the past, present, and future