Two-Year Results of a Five-Year Personalized Integrative Obesity Coaching Program (IBO) Based upon a Systems Health Perspective and an Evolutionary Longitudinal Study Approach.

This study presents the outcomes of a 5-year personalized integrative coaching program for adults with obesity (body mass index BMI ≥ 30 kg/m2), based upon a systems health perspective, during the first 2 years. This longitudinal study, which had an evolutionary design, included all adults who enrolled in the program. Health-related quality of life (HRQoL) was measured with the Short Form-36 (SF-36), and physical outcomes included weight, waist circumference, aerobic capacity, lipid profile, and HbA1c. Subsequently, participants completed questionnaires (e.g., the Symptom Checlist-90 (SCL-90) and the Checklist Individual Strength (CIS)). Seventy-nine adults with a mean BMI of 39.5 kg/m2 (SD 5.3) were included. Forty-four participants completed 2 years in the program. Compared to baseline, there were significant improvements in the SF-36 subscales 'physical functioning' (MD 9.9 points, 95% CI: 2.1-17.5, p = 0.013) and 'general health perceptions' (MD 9.3 points, 95% CI 2.9-15.7, p = 0.006). Furthermore, significant improvements in physical outcomes and psychosocial questionnaires (e.g., weight loss (MD 3.5 kg, 95% CI: 1.2-5.7, p = 0.003), waist circumference (MD 5.1 cm, 95% CI: 2.4-7.8, p < 0.001), and CIS fatigue (MD 6.8, 95% CI: 3.1-10.5, p = 0.001) were observed. This study highlights the importance of a systems health perspective supporting the development of a personalized integrative coaching program for adults with obesity in a 'real-world' setting.

Developing a Personalized Integrative Obesity-Coaching Program: A Systems Health Perspective.

Current obesity management strategies are failing to achieve sustainable and favorable long-term results. We propose a more personalized, dynamic, and systemic perspective on the interactions of key determinants and coaching advice on obesity. The aim of this study was to use a systems view on overweight, complexity science, and a transdisciplinary process to develop a five-year personalized integrative obesity-coaching and research program. Managers, medical specialists, clinical psychologists, dieticians, physical- and psychomotor therapists, and lifestyle coaches aligned their perspectives and objectives with experts in systems thinking and systems biology. A systems health model of obesity was used to identify the causal relations of variables with the most influence on obesity. The model helped to align and design a personalized integrative obesity-coaching program and to identify the key variables to monitor the progress and to adjust the personalized program, depending on the goals and needs of the participant. It was decided to use subtyping of participants by a systems biologist, based on traditional Chinese medicine symptoms, as a novel method to personalize the intervention. The collaborative transdisciplinary approach based upon a systems view on obesity was successful in developing a personalized and adaptive five-year obesity-coaching and research program.

Clinical usability, reliability, and repeatability of noncontact scanners in measuring residual limb volume in persons with transtibial amputation.

BACKGROUND: In previous studies, noncontact 3D scanners were found to be the most reliable in measuring volume of the residual limb after a transtibial amputation (TTA). Meanwhile newly developed noncontact scanners became available to measure residual limb volume after TTA but should be tested for clinical usability and reliability. OBJECTIVE: To determine the clinical usability, reliability, and repeatability of noncontact scanners in measuring residual limb volume in persons with a TTA. STUDY DESIGN: Original research report; repeated measurements. METHODS: Three noncontact scanners (Rodin4D, Omega Tracer, and Biosculptor) were used to measure the residual limb volume on two occasions by two observers in 30 persons with an unilateral or bilateral TTA. Clinical usability was assessed as scores of the Post-Study System Usability Questionnaire, participant satisfaction (0-10 scale), and time to take the measurement. RESULTS: The usability score of the Omega Scanner 3D (123.4) and Rodin4D (121.3) was significantly better compared with the Biosculptor (117.8). Participant experience was equal for all. The residual variance was 8.4%, where participant and scanning system explained most of the error variance (80.7%). Repeatability coefficients of the systems were 16.5 cc (Omega Scanner 3D), 26.4 cc (Rodin4D), and 32.8 cc (Biosculptor). The time to perform the measurements was significantly longer (+80 seconds) for the Omega Scanner 3D. CONCLUSIONS: For measuring residual limb volume in TT amputees, Omega software (state version 12.2) combined with the Rodin4D scanner was more usable and reliable than the Rodin 4D or Biosculptor systems, when operated by staff with limited experience and training.

TMS-Induced Central Motor Conduction Time at the Non-Infarcted Hemisphere Is Associated with Spontaneous Motor Recovery of the Paretic Upper Limb after Severe Stroke.

BACKGROUND: Stroke affects the neuronal networks of the non-infarcted hemisphere. The central motor conduction time (CMCT) induced by transcranial magnetic stimulation (TMS) could be used to determine the conduction time of the corticospinal tract of the non-infarcted hemisphere after a stroke. OBJECTIVES: Our primary aim was to demonstrate the existence of prolonged CMCT in the non-infarcted hemisphere, measured within the first 48 h when compared to normative data, and secondly, if the severity of motor impairment of the affected upper limb was significantly associated with prolonged CMCTs in the non-infarcted hemisphere when measured within the first 2 weeks post stroke. METHODS: CMCT in the non-infarcted hemisphere was measured in 50 patients within 48 h and at 11 days after a first-ever ischemic stroke. Patients lacking significant spontaneous motor recovery, so-called non-recoverers, were defined as those who started below 18 points on the FM-UE and showed less than 6 points (10%) improvement within 6 months. RESULTS: CMCT in the non-infarcted hemisphere was prolonged in 30/50 (60%) patients within 48 h and still in 24/49 (49%) patients at 11 days. Sustained prolonged CMCT in the non-infarcted hemisphere was significantly more frequent in non-recoverers following FM-UE. CONCLUSIONS: The current study suggests that CMCT in the non-infarcted hemisphere is significantly prolonged in 60% of severely affected, ischemic stroke patients when measured within the first 48 h post stroke. The likelihood of CMCT is significantly higher in non-recoverers when compared to those that show spontaneous motor recovery early post stroke.

Does Transcranial Magnetic Stimulation Have an Added Value to Clinical Assessment in Predicting Upper-Limb Function Very Early After Severe Stroke?

BACKGROUND: The added prognostic value of transcranial magnetic stimulation (TMS)-induced motor-evoked potentials (MEPs) to clinical modeling for the upper limb is still unknown early poststroke. OBJECTIVE: To determine the added prognostic value of TMS of the adductor digiti minimi (TMS-ADM) to the clinical model based on voluntary shoulder abduction (SA) and finger extension (FE) during the first 48 hours and at 11 days after stroke. METHODS: This was a prospective cohort study with 3 logistic regression models, developed to predict upper-limb function at 6 months poststroke. The first model showed the predictive value of SA and FE measured within 48 hours and at 11 days poststroke. The second model included TMS-ADM, whereas the third model combined clinical and TMS-ADM information. Differences between derived models were tested with receiver operating characteristic curve analyses. RESULTS: A total of 51 patients with severe, first-ever ischemic stroke were included. Within 48 hours, no significant added value of TMS-ADM to clinical modeling was found ( P = .369). Both models suffered from a relatively low negative predictive value within 48 hours poststroke. TMS-ADM combined with SA and FE (SAFE) showed significantly more accuracy than TMS-ADM alone at 11 days poststroke ( P = .039). CONCLUSION: TMS-ADM showed no added value to clinical modeling when measured within first 48 hours poststroke, whereas optimal prediction is achieved by SAFE combined with TMS-ADM at 11 days poststroke. Our findings suggest that accuracy of predicting upper-limb motor function by TMS-ADM is mainly determined by the time of assessment early after stroke onset.

Reliability and sources of variation of the ABILHAND-Kids questionnaire in children with cerebral palsy.

PURPOSE: To determine reliability of the ABILHAND-Kids, explore sources of variation associated with these measurement results, and generate repeatability coefficients. METHOD: A reliability study with a repeated measures design was performed in an ambulatory rehabilitation care department from a rehabilitation center, and a center for special education. A physician, an occupational therapist, and parents of 27 children with spastic cerebral palsy independently rated the children's manual capacity when performing 21 standardized tasks of the ABILHAND-Kids from video recordings twice with a three week time interval (27 first-, and 25 second video recordings available). Parents additionally rated their children's performance based on their own perception of their child's ability to perform manual activities in everyday life, resulting in eight ratings per child. RESULTS: ABILHAND-Kids ratings were systematically different between observers, sessions, and rating method. Participant × observer interaction (66%) and residual variance (20%) contributed the most to error variance (9%). Test-retest reliability was 0.92. Repeatability coefficients (between 0.81 and 1.82 logit points) were largest for the parents' performance-based ratings. CONCLUSION: ABILHAND-Kids scores can be reliably used as a performance- and capacity-based rating method across different raters. Parents' performance-based ratings are less reliable than their capacity-based ratings. Resulting repeatability coefficients can be used to interpret ABILHAND-Kids ratings with more confidence. Implications for Rehabilitation The ABILHAND-Kids is a valuable tool to assess a child's unimanual and bimanual upper limb activities. The reliability of the ABILHANDS-Kids is good across different observers as a performance- and capacity-based rating method. Parents' performance-based ratings are less reliable than their capacity-based ones. This study has generated repeatability coefficients for clinical decision making.

Measurement properties and usability of non-contact scanners for measuring transtibial residual limb volume.

BACKGROUND: Non-contact scanners may have potential for measurement of residual limb volume. Different non-contact scanners have been introduced during the last decades. Reliability and usability (practicality and user friendliness) should be assessed before introducing these systems in clinical practice. OBJECTIVES: The aim of this study was to analyze the measurement properties and usability of four non-contact scanners (TT Design, Omega Scanner, BioSculptor Bioscanner, and Rodin4D Scanner). STUDY DESIGN: Quasi experimental. METHODS: Nine (geometric and residual limb) models were measured on two occasions, each consisting of two sessions, thus in total 4 sessions. In each session, four observers used the four systems for volume measurement. Mean for each model, repeatability coefficients for each system, variance components, and their two-way interactions of measurement conditions were calculated. User satisfaction was evaluated with the Post-Study System Usability Questionnaire. RESULTS: Systematic differences between the systems were found in volume measurements. Most of the variances were explained by the model (97%), while error variance was 3%. Measurement system and the interaction between system and model explained 44% of the error variance. Repeatability coefficient of the systems ranged from 0.101 (Omega Scanner) to 0.131 L (Rodin4D). Differences in Post-Study System Usability Questionnaire scores between the systems were small and not significant. CONCLUSION: The systems were reliable in determining residual limb volume. Measurement systems and the interaction between system and residual limb model explained most of the error variances. The differences in repeatability coefficient and usability between the four CAD/CAM systems were small. Clinical relevance If accurate measurements of residual limb volume are required (in case of research), modern non-contact scanners should be taken in consideration nowadays.

How Do Fugl-Meyer Arm Motor Scores Relate to Dexterity According to the Action Research Arm Test at 6 Months Poststroke?

OBJECTIVE: To determine the optimal cutoff scores for the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) with regard to predicting no, poor, limited, notable, or full upper-limb capacity according to frequently used cutoff points for the Action Research Arm Test (ARAT) at 6 months poststroke. DESIGN: Prospective. SETTING: Rehabilitation center. PARTICIPANTS: Patients (N=460) with a first-ever ischemic stroke at 6 months poststroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Based on the ARAT classification of poor to full upper-limb capacity, receiver operating characteristic curves were used to calculate the area under the curve, optimal cutoff points for the FMA-UE were determined, and a weighted kappa was used to assess the agreement. RESULTS: FMA-UE scores of 0 through 22 represent no upper-limb capacity (ARAT 0-10); scores of 23 through 31 represent poor capacity (ARAT 11-21); scores of 32 through 47 represent limited capacity (ARAT 22-42); scores of 48 through 52 represent notable capacity (ARAT 43-54); and scores of 53 through 66 represent full upper-limb capacity (ARAT 55-57). Overall, areas under the curve ranged from .916 (95% confidence interval [CI], .890-.943) to .988 (95% CI, .978-.998; P<.001). CONCLUSIONS: There is considerable overlap in the area under the curve between the ARAT and FMA-UE. FMA-UE scores >31 points correspond to no to poor arm-hand capacity (ie, ≤21 points) on the ARAT, whereas FMA-UE scores >31 correspond to limited to full arm-hand capacity (ie, ≥22 points) on the ARAT.

How reproducible are transcranial magnetic stimulation-induced MEPs in subacute stroke?

PURPOSE: Motor evoked potentials (MEPs) and total motor conduction time (TMCT) induced by transcranial magnetic stimulation (TMS) are used to make assumptions about the prognosis of motor outcome after stroke. Understanding the different sources of variability is fundamental to the concept of reliability. Reliability testing of TMS-MEPs and TMCTs within and between two independent examiners in healthy and stroke subjects is still an unexplored field in the clinical neurophysiology. Assessing the reproducibility of TMS measurements requires studies to investigate the test-retest reliability of TMS-induced MEPs and TMCT. The authors set out to test the reliability of these TMS measurements. METHODS: Eighteen patients with stroke and 8 healthy volunteers were tested twice within a 1-week period by 2 examiners using TMS to determine MEPs and TMCT for the abductor pollicis brevis muscle of their affected and unaffected hands. RESULTS: The authors found moderate to perfect reliability of TMS-induced MEPs in healthy volunteers, noninfarcted hemispheres (perfect agreement), and infarcted hemispheres (Kappa's = 0.45-0.87). Reliability of TMCT was good to excellent in the volunteers (intraclass correlation coefficients = 0.77-0.97), excellent in the noninfarcted hemispheres (intraclass correlation coefficients = 0.97-1.00), and poor to excellent in the infarcted hemispheres (intraclass correlation coefficients = 0.44-0.90). CONCLUSIONS: The reliability of TMS-induced MEPs and TMCT measurements in healthy volunteers and the noninfarcted hemisphere of patients with stroke with an upper paretic limb was good to excellent. In contrast, TMS measurements in the infarcted hemisphere were less consistent. Based on the lower reproducibility of TMCT measurements in the infarcted hemisphere, we recommend to repeat the TMCT measurements to improve the reliability of tests.

Variation in results of volume measurements of stumps of lower-limb amputees: a comparison of 4 methods.

OBJECTIVE: To analyze the reliability of 4 methods (water immersion, computer-aided design [CAD] photometric method, CAD hand scanner, and circumferential measurements) for stump volume measurement in transtibial amputees. DESIGN: Repeated measurements. SETTING: General community, ambulatory care. PARTICIPANTS: Transtibial amputees (N=26; mean age ± SD, 58.7±11.0y). INTERVENTIONS: Stump volume of patients with an amputation was measured on 2 occasions, each consisting of 2 sessions. In each session, stump volume was measured by 2 observers using each of the 4 methods. Sequence of observers and measurement methods was determined randomly. MAIN OUTCOME MEASURE: Repeatability coefficients, as a measure for reliability, for each method were calculated, as well as variance components to estimate the influence of measurement conditions on stump volumes measured. RESULTS: Repeatability coefficients varied from 129mL CAD hand scanner to 158mL CAD photometric method. Error variance contributed 12% to the total variance. Methods contributed 36%, method-amputee and occasion-amputee interactions contributed both 25% to the error variance. CONCLUSIONS: Repeatability coefficient was lowest for the CAD hand scanner, which indicates the best reliability. Substantial differences existed in stump volumes measured between the 4 methods.

Effects of overloading of the lower hemiparetic extremity on walking speed in chronic stroke patients: A pilot study.

The objective of this pilot study was to investigate the carry-over effects on comfortable walking speed after overloading the lower hemiparetic extremity in chronic stroke patients. A single subject research study was conducted using a withdrawal design (A-B-A-B-A) on three patients with ischaemic middle cerebral artery infarction. Chronic stroke patients were recruited with stage 3 or 4 Fugl-Meyer scores in the lower extremity and the ability to ambulate independently without walking aids. Based on this withdrawal design, the daily procedure included walking at comfortable speeds 5x10 meters during the A_1 phase and 3x10 meters during all subsequent phases. This procedure was repeated for five consecutive days. Two lbs (B_1) and 6 lbs (B_2) weight cuffs were attached to the distal lower hemiparetic extremity and randomized over the two B phases. Control (A_1, A_2, A_3) and intervention (B_1, B_2) phases were alternated with brief resting periods. Mean comfortable walking speed for 10 meters constituted the outcome variable. All patients showed significant differences between phases (chi^2 = 34.187; p<0.001). However, with the exception of a carry-over effect between the A_1 (0.86 m/sec) and A_2 (0.89~m/sec) phases in one subject (p=0.043) no significant carry-over effects were found on ensuing A_2 and A_3 control phases. Although gradual improvements in comfortable walking speed between subsequent days were found the present pilot study did not demonstrate favorable group effects on comfortable walking speed as a result of limb overloading.