Development and validation of a quality appraisal tool for validity studies (QAVALS).

Background: Appraisal of methodological quality of included studies is an important component of conducting systematic reviews. Although several quality appraisal tools are available for intervention studies, fewer tools are available for non-randomized designs, especially for studies of measurement properties.Objectives: The purpose of this study was to develop a quality appraisal tool specific to validity studies (QAVALS) and to examine its reliability and validity.Methods: Following identification of key concepts, an initial list of 34 possible items was developed. Content experts rated each item as either 'essential', 'useful but not essential', and 'not necessary'. The content validity ratio (CVR) and content validity index (CVI) were calculated to establish content validity following two rounds of review. Inter-rater and test-retest reliability were assessed by two external reviewers using weighted kappa coefficients.Results: Items below a CVR of 0.50 were eliminated resulting in the modified version with 27 items. Following the second round, the final tool with 24 items was developed. The content validity index of QAVALS was 0.90. QAVALS demonstrated excellent test-retest reliability (k = 0.80-0.84, 95% CI = 0.76-0.90) and good overall inter-rater reliability (k = 0.70, 95% CI = 0.61-0.79).Limitations: Individual item reliability was low for four items. Further research is warranted to examine reliability using larger number of studies and raters with different experience levels.Conclusion: QAVALS is the first quality appraisal tool specifically designed to address common types of validity. The QAVALS demonstrates strong content validity, good overall inter-rater and excellent test-retest reliability.

Reliability and Validity of Patient-Reported, Rater-Based, and Hybrid Physical Activity Assessments in COPD: A Systematic Review.

Selecting valid and reliable PA assessments in chronic obstructive pulmonary disease (COPD) is crucial to ensure that the information obtained is accurate, valuable, and meaningful. The purpose of this systematic review was to compare the validity and reliability among PA assessments in COPD. An electronic database search of PubMed and CINAHL was completed in December 2019 using MeSH terms on physical activity, COPD, validation, and questionnaires. Transparency in reporting was assessed with the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist while methodological quality was assessed with the modified Quality Appraisal tool for Reliability studies (QAREL) for reliability studies and the Quality Appraisal of Validity Studies (QAVALS) for validity studies. The search yielded fifteen different measures. The Stanford 7-day recall (PAR) demonstrated the strongest correlations with SenseWear Armband on energy expenditure (r = 0.83; p < 0.001) and moderate correlations for time spent in activity over 3 METs (r = 0.54, p < 0.001). The Multimedia Activity Recall (MARCA) also demonstrated moderate to good correlations with both SenseWear and Actigraph GT3X + accelerometers (r = 0.66-0.74). Assisted and computerized PRO measures (PAR and MARCA) and hybrid measures (C-PPAC and D-PPAC) demonstrate better psychometric properties as compared to other subjective measures and may be considered for quantification of PA in COPD. However, observations drawn from single validation studies limit strength of recommendations and further research is needed to replicate the findings.

"Katz activities of daily living disability in older cancer survivors by age, stage, and cancer type".

PURPOSE/OBJECTIVE: The purpose of this study was to describe ADL impairments using the Katz ADL Index by cancer type, stage, and age in older cancer survivors. METHODS: Cross-sectional data from cohorts 9-14 (year 2006-2013) of the Surveillance, Epidemiology and End Results national cancer registry and Medicare Health Outcomes Survey linkage were used to describe ADL performance using the Katz ADL Index. Mean Katz scores and frequency of ADL disability were reported across cancer types for all eight cancers (colon, lung, breast, prostate, bladder, kidney, non-Hodgkin's lymphoma, uterine) and by stage and age for the four large cancers (colon, lung, breast, prostate). RESULTS: In this sample of 6,973 cancer survivors, ADL deficits were the greatest in uterine cancer survivors (µ = 4.72, SD = 1.44). When considering age, Katz scores were most impaired in breast (µ = 3.90, SD = 1.93) and prostate survivors (µ = 4.35, SD = 1.84) age > 85 years. When considering stage, Katz scores were most impaired in stage four survivors of prostate (µ = 4.14, SD = 1.82) or breast (µ = 4.43, SD = 2.05) cancer. Across all cancer types and age groups, with the exception of stage 4 prostate cancer, ADL deficits were consistently impaired in the same order, from most impaired to least: continence, transfers, bathing, dressing, toileting, and, lastly, feeding. CONCLUSIONS: Screening for ADL impairments is needed for older cancer survivors as Katz ADL disability differs by cancer type, stage, and age with greater impairment with advanced age and stage. IMPLICATIONS FOR CANCER SURVIVORS: Interventions to address ADL limitations should be considered for older cancer survivors.

Effects of inspiratory muscle training in advanced multiple sclerosis.

BACKGROUND: Respiratory training using Threshold Inspiratory Muscle Trainer (IMT) has not been examined adequately in multiple sclerosis (MS). The primary objective in this study of persons with advanced MS was to investigate the training effect of IMT. The secondary objective was to evaluate the retention of IMT benefits. METHODS: This study was a repeated measures within-subject design (before-after trial).. Participants were recruited from a long-term care facility specialized in progressive neurologic conditions. Thirty-six non-ambulatory persons with advanced MS volunteered. Inspiratory muscle exercise using the threshold IMT were performed daily for 10 weeks at 3 sets of 15 repetitions per day. Resistance was progressed weekly based on perceived rate of exertion and symptoms. Primary outcome measures were maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) that were measured at baseline, after 5 and 10 weeks of IMT exercises (training period), and at 4 and 8 weeks after the IMT training ended (retention). Linear mixed-effect regression models with time (i.e. weeks from baseline) as the fixed factor and participants as the random effect factor were applied separately to test each hypothesis. Effect size was calculated using partial eta square (η2p). Two-tailed significance level was p < 0.05. RESULTS: Participants were 60.5 ±â€¯8.6 years old. Expanded Disability Status Scale was 8.5 ±â€¯0.4. Baseline MIP were 25.9 ±â€¯16.4 cmH2O (33.2% %± 19.8% of predicted values) and MEP were 23.5 ±â€¯15.7 cmH2O (25.8% %± 14.4% of predicted values). Compared to the baseline, MIP increased significantly to 30.1 ±â€¯17.9 cmH2O (38.9% %± 22.4% of predicted values) and 30.6 ±â€¯17.6 cmH2O (39.6% %± 22.3% of predicted values) after 5 (p < 0.05) and 10 weeks (p < 0.05) of IMT exercises. MIP improvements were retained in an 8-week washout period. MEP did not differ significantly by time. CONCLUSION: In persons with advanced MS, 10-week IMT training increased inspiratory muscle strength. This study is the first to demonstrate the retention of benefits following daily IMT exercises at 8 weeks after training ended.

Predictors of falls in older survivors of breast and prostate cancer: A retrospective cohort study of surveillance, epidemiology and end results-Medicare health outcomes survey linkage.

OBJECTIVES: To identify predictors of falls in older breast and prostate cancer survivors. METHODS: This retrospective cohort study analyzed population-based Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey (SEER-MHOS) linkage. Inclusion criteria were age >65 years at cancer diagnosis, first primary female breast or prostate cancer, cancer staging information available, completion of baseline MHOS during years 2-3 and follow-up MHOS during years 4-5 post-diagnosis, and falls information available. Data from 437 breast and 660 prostate cancer survivors were analyzed. Multivariable logistic regression was constructed to evaluate variables from baseline MHOS with relation to falls from follow-up MHOS. Model accuracy was assessed using area under receiver-operating-characteristic curve (AUC). RESULTS: At follow-up MHOS, 26% of breast and 22% of prostate cancer survivors reported falls in the past 12 months. In breast cancer, a history of falls (odds ratio (OR) = 4.95, 95% confidence interval (CI) = 2.44-10.04) and sensory impairment in feet (OR = 3.33, 95%CI = 1.51-7.32) were significant predictors of falls. In prostate cancer, a history of falls (OR = 3.04, 95%CI = 1.79-5.15), unmarried (OR = 1.82, 95%CI = 1.12-2.95), lower physical summary score of quality-of-life(OR = 0.96, 95%CI = 0.94-0.98), urinary incontinence (OR = 1.69, 95%CI = 1.08-2.65), older age at diagnosis (OR = 1.05, 95%CI = 1.01-1.09), and shorter time post-diagnosis (OR = 0.96, 95%CI = 0.93-0.99) were significant predictors of falls. AUC was 0.67 and 0.77 for breast and prostate cancer, respectively, indicating moderate accuracy of models in detecting fallers. CONCLUSIONS: Asking older breast and prostate cancer survivors about falls in the past 12 months is imperative in fall prevention. Further examination of deficits specific to each cancer is necessary to assess fall risks.

Factors associated with self-reported falls, balance or walking difficulty in older survivors of breast, colorectal, lung, or prostate cancer: Results from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey linkage.

BACKGROUND: Cancer and its treatment affect body systems that are important in preventing falls and controlling balance/walking. This study examined factors associated with self-reported falls and balance/walking difficulty in the past 12 months in older survivors of four major cancers. METHODS: This was a cross-sectional study analyzing population-based data from Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS). Data from cohorts 9 to 14 (January 2006 to December 2013) were extracted. Inclusion criteria were: age ≥65 years at cancer diagnosis, first MHOS completed during years 1-5 post-cancer diagnosis, first primary breast (n = 2725), colorectal (n = 1646), lung (n = 752), and prostate (n = 4245) cancer, and availability of cancer staging information. Primary outcomes were self-reported falls and balance/walking difficulty in the past 12 months. Multivariable logistic regression was constructed for each cancer type to examine independent factors associated with falls and balance/walking difficulty. RESULTS: In all cancer types, advancing age at cancer diagnosis and dependence in activities of daily living were significant independent factors associated with increased odds of reporting falls and balance/walking difficulty in the past 12 months. Additionally, depression was independently associated with falls and sensory impairment in feet was independently linked to balance/walking difficulty in all cancer types. Other independent factors of falls and balance/walking difficulty varied across cancer types. In breast cancer only, localized or regional cancer stage was significantly associated with increased odds of reporting falls and balance/walking difficulty, whereas treatment with radiation decreased the odds of falling. No association between falls and balance/walking difficulty with time since cancer diagnosis, cancer stage, or cancer treatment was found in colorectal, lung, and prostate cancer. CONCLUSION: There exists some heterogeneity in factors associated with self-reported falls and balance/walking difficulty between different cancer types. Future research is necessary to ascertain factors predictive of falls and balance/walking difficulty in older cancer survivors, particularly factors related to cancer diagnosis and treatment.

Prevalence of self-reported falls, balance or walking problems in older cancer survivors from Surveillance, Epidemiology and End Results-Medicare Health Outcomes Survey.

OBJECTIVE: To determine the prevalence of falls and balance/walking problems in the past 12months among older cancer survivors before and after cancer diagnosis. MATERIALS AND METHODS: We analyzed cross-sectional data from individuals aged ≥65years with first primary cancer from the Surveillance, Epidemiology, and End Results and Medicare Health Outcomes Survey (SEER-MHOS) linkage (n=12,659). The first MHOS completed by each survivor from 0 to 2years before cancer diagnosis to 1-4years after cancer diagnosis were included. We estimated unadjusted and demographic-adjusted prevalence of falls and balance/walking problems for each type of cancer during five one-year time periods before and after cancer diagnosis. RESULTS: Adjusted prevalence of falls was significantly higher post-diagnosis than pre-diagnosis in prostate (12% during years 1-2 pre-diagnosis vs. 17%-20% during years 1-4 post-diagnosis)(p=0.01) and lung cancer (17% during years 1-2 pre-diagnosis vs. 28% during years 1-2 post-diagnosis)(p=0.019). Adjusted prevalence of balance/walking problems were significantly higher post-diagnosis than pre-diagnosis in non-Hodgkin's lymphoma (26% during years 1-2 pre-diagnosis vs. 45% during years 1-2 post-diagnosis)(p=0.012), breast (32% during years 1-2 pre-diagnosis vs. 41% during years 3-4 post-diagnosis)(p=0.001), prostate (22% during years 1-2 pre-diagnosis vs. 28%-29% during years 1-4 post-diagnosis)(p=0.012), and lung cancer (33% during years 1-2 pre-diagnosis vs. 40% during year 0-1 pre-diagnosis and 46% during years 1-2 post-diagnosis)(p=0.018). Prevalence did not differ across time periods in other cancers. CONCLUSIONS: Falls and balance/walking problems may become more frequent after the diagnosis of some cancers. Screening, surveillance, and interventions need to consider functional deficits and cancer diagnosis.

Predictors of static balance in ambulatory persons with multiple sclerosis.

People with multiple sclerosis (MS) experience a high rate of falls and have decreased static and dynamic balance. The purpose of this study was to determine best predictors of static standing balance, as measured by a single limb stance (SLS) timed test, in ambulatory persons with MS (PwMS) from among commonly used medical and rehabilitation clinical tests. Ambulatory PwMS participated in a single test session. Medical exam data gathered included the Function System (FS) neurologic exam and Expanded Disability Status Score (EDSS). A variety of commonly administered rehabilitation clinical tests addressing static balance, dynamic balance, gait endurance, functional lower extremity strength, abdominal and respiratory muscle strength were completed. Descriptive statistics, Pearson product moment correlations, and forward step-wise linear regressions were calculated. Twenty-eight ambulatory PwMS completed this study. Mean age was 54.74 years. Mean SLS score was 14.6 s. Pyramidal, sensory, bowel/bladder, and visual FS scores and the EDSS were significantly correlated with SLS. Maximal step length scores were significantly correlated with SLS at P less than 0.05 and the Functional Stair Test (FST) and 6-min walk test were correlated with SLS at P less than 0.10. Medical exam data EDSS and FS sensory explain 72.1% of the variance in SLS scores. Rehabilitation exam data FS sensory and FST explain 68.8% of the variance. The FS sensory, EDSS, and FST together explain 73.3% of the variance.

Reliability, Validity, and Minimal Detectable Change of Balance Evaluation Systems Test and Its Short Versions in Older Cancer Survivors: A Pilot Study.

BACKGROUND: Cancer is primarily a disease of older adults. About 77% of all cancers are diagnosed in persons aged 55 years and older. Cancer and its treatment can cause diverse sequelae impacting body systems underlying balance control. No study has examined the psychometric properties of balance assessment tools in older cancer survivors, presenting a significant challenge in the selection of outcome measures for clinicians treating this fast-growing population. PURPOSE: This study aimed to determine the reliability, validity, and minimal detectable change (MDC) of the Balance Evaluation System Test (BESTest), Mini-Balance Evaluation Systems Test (Mini-BESTest), and Brief-Balance Evaluation Systems Test (Brief-BESTest) in community-dwelling older cancer survivors. METHODS: This study was a cross-sectional design. Twenty breast and 8 prostate cancer survivors participated [age (SD) = 68.4 (8.13) years]. The BESTest and Activity-specific Balance Confidence (ABC) Scale were administered during the first session. Scores of Mini-BESTest and Brief-BESTest were extracted on the basis of the scores of BESTest. The BESTest was repeated within 1 to 2 weeks by the same rater to determine the test-retest reliability. For the analysis of the inter-rater reliability, 21 participants were randomly selected to be evaluated by 2 raters. A primary rater administered the test. The 2 raters independently and concurrently scored the performance of the participants. Each rater recorded the ratings separately on the scoring sheet. No discussion among the raters was allowed throughout the testing. Intraclass correlation coefficients (ICCs), standard error of measurement, minimal detectable change (MDC), and Bland-Altman plots were calculated. Concurrent validity of these balance tests with the ABC Scale was examined using the Spearman correlation. RESULTS: The BESTest, Mini-BESTest, and Brief-BESTest had high test-retest (ICC = 0.90-0.94) and interrater reliability (ICC = 0.86-0.96), small standard error of measurement (0.86-2.47 points), and MDC (2.39-6.86 points). The Bland-Altman plot revealed no systematic errors. The scores of BESTest, Mini-BEST, and Brief-BEST were correlated significantly with those of ABC Scale (P < .01), supporting their concurrent validity. DISCUSSION: The BESTest, Mini-BESTest, and Brief-BESTest showed high interrater and test-retest reliability, and excellent concurrent validity with the ABC Scale for community-dwelling cancer survivors aged 55 years and older who had completed cancer treatments for at least 3 months. Future studies are necessary to determine the predictive values for determining fall risks using balance assessment tools in older cancer survivors. CONCLUSIONS: Clinicians can utilize the BESTest and its short versions to evaluate balance problems in community-dwelling older cancer survivors and apply the established MDC to assess the intervention outcomes.

History of falls, gait, balance, and fall risks in older cancer survivors living in the community.

Older cancer survivors may be predisposed to falls because cancer-related sequelae affect virtually all body systems. The use of a history of falls, gait speed, and balance tests to assess fall risks remains to be investigated in this population. This study examined the relationship of previous falls, gait, and balance with falls in community-dwelling older cancer survivors. At the baseline, demographics, health information, and the history of falls in the past year were obtained through interviewing. Participants performed tests including gait speed, Balance Evaluation Systems Test, and short-version of Activities-specific Balance Confidence scale. Falls were tracked by mailing of monthly reports for 6 months. A "faller" was a person with ≥1 fall during follow-up. Univariate analyses, including independent sample t-tests and Fisher's exact tests, compared baseline demographics, gait speed, and balance between fallers and non-fallers. For univariate analyses, Bonferroni correction was applied for multiple comparisons. Baseline variables with P<0.15 were included in a forward logistic regression model to identify factors predictive of falls with age as covariate. Sensitivity and specificity of each predictor of falls in the model were calculated. Significance level for the regression analysis was P<0.05. During follow-up, 59% of participants had one or more falls. Baseline demographics, health information, history of falls, gaits speed, and balance tests did not differ significantly between fallers and non-fallers. Forward logistic regression revealed that a history of falls was a significant predictor of falls in the final model (odds ratio =6.81; 95% confidence interval =1.594-29.074) (P<0.05). Sensitivity and specificity for correctly identifying a faller using the positive history of falls were 74% and 69%, respectively. Current findings suggested that for community-dwelling older cancer survivors with mixed diagnoses, asking about the history of falls may help detect individuals at risk of falling.

Effects of task context during standing reach on postural control in young and older adults: a pilot study.

Reaching is an important component of daily activities with goals to interact and acquire objects in the environment. The task context of reaching, as determined by the behavioral goal and the properties of the object, can influence the control of posture and movements. This study examined age differences in postural stability during a forward reach under two task contexts, grasping versus pointing to a target. Young and older participants living in the community performed the tasks from the standing position. They reached forward, grasped or pointed to a target, and then returned to an upright posture as fast as possible. Postural stability was analyzed using the center of pressure (COP) during two phases of the task: the reaching movement phase and the returning movement phase. In the grasping context, the COP path deviations were significantly larger in older compare to young participants during both the reach and the return movement phases. In addition, during the return movement phase, only older participants showed a context-dependent increase in COP path deviations after grasping compared to pointing. The results highlight the impact of task context on postural stability during standing reach in young and older adults. Interventions for older adults with balance problems should consider incorporating activities that involve the interaction with objects of various properties in the environment. Future studies are necessary to investigate the factors underlying the person-environment interplay of postural control and the adaptation of anticipatory postural control associated with object interaction during functional tasks in older adults.

History of falls, balance performance, and quality of life in older cancer survivors.

Older cancer survivors may be predisposed to falls because of the sequalae associated with cancer and its treatments. This study examined the association between the fall history, balance performance, and health-related quality of life (QoL) in older, community-dwelling cancer survivors who had completed primary cancer treatments. Forty-one cancer survivors (age = 67.9 ± 8.8 years) participated in the study. Balance performance was examined using the Activities-specific Balance Confidence Scale (ABC) and the Balance Evaluation Systems Test (BESTest). Scores from the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36v2 were obtained to assess the QoL. The demographics and health status were comparable between the fallers and non-fallers. While 54% of the participants had experienced at least one fall in the past 12 months, 30% had experienced two or more falls. Spearman's correlation analysis revealed a significant relationship between the outcomes from the ABC and the PCS (p < 0.001), and between the BESTest and the PCS (p < 0.001). Only the PCS significantly differentiated fallers from non-fallers (p < 0.01). Logistic regression analysis estimated that a one-unit increase in the PCS score significantly reduced the odds of falling by 13% (p < 0.01). The results demonstrate that in older cancer survivors, falls are a significant problem and balance control is a determinant of perceived physical function and well-being. Older cancer survivors reporting a poor QoL in the physical health domain may have higher risks of falling. Future studies are needed to examine the risk factor profiles of falls and the interventions to prevent falls in older cancer survivors.