Long-Term Consequences of Major Extremity Trauma: A Pilot Study.

SUMMARY: Limited data are available on the longer-term physical and psychosocial consequences after major extremity trauma apart from literature on the consequences after major limb amputation. The existing literature suggests that although variations in outcome exist, a significant proportion of service members and civilians sustaining major limb trauma will have less than optimal outcomes or health and rehabilitation needs over their life course. The proposed pilot study will address this gap in current research by locating and consenting METRC participants with the period of 5-7 years postinjury, identifying potential participation barriers and appropriate use of incentives, and conducting the follow-up examination at several data collection sites. The resulting data will inform the primary objective of refining and developing specific hypotheses to determine the design, scope, and feasibility of the main long-term consequences of major extremity trauma. Three METRC enrollment centers will contact past participants to achieve the goal of completing an interview, select patient-reported outcomes, perform a medical record review, and conduct an in-person clinic visit that will consist of a physical examination, blood draw, and x-ray of the study injury area. If successful, it will be possible to design studies to further examine these effects and develop future therapeutic interventions.

Diagnostic and Clinical Utility of the GAD-2 for Screening Anxiety Symptoms in Individuals With Multiple Sclerosis.

OBJECTIVE: To assess the diagnostic and clinical utility of the 2-item Generalized Anxiety Disorder Scale (GAD-2) for screening anxiety symptoms in individuals with multiple sclerosis (MS). DESIGN: Cross-sectional. SETTING: University-affiliated MS neurology and rehabilitation center. PARTICIPANTS: The sample comprised adults (N=99) (ages 19-72; mean ± SD=46.2±13.0; 75% women) with a physician-confirmed MS diagnosis who were receiving care in a university-affiliated MS center. Disease durations ranged from 1 to 37 years (mean ± SD=10.7±8.4). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed the 7-item Generalized Anxiety Disorder Scale (GAD-7) and GAD-2. Internal consistency was calculated for both measures. Area under the receiver operating characteristics curve (AUC), the 95% confidence interval for the AUC, and Youden's J were calculated to determine the optimal GAD-2 cutoff score for identifying clinically significant anxiety symptoms, as defined by the previously validated GAD-7 cutoff score of ≥8. RESULTS: Internal consistency was excellent for the GAD-7 (Cronbach α=.91) and acceptable for the GAD-2 (α=.77), and the measures were highly correlated (r=.94). The GAD-2 had excellent overall accuracy for identifying clinically significant anxiety symptoms (AUC=0.97; 95% confidence interval, 0.94-1.00). A GAD-2 cutoff score of ≥3 provided an optimal balance of good sensitivity (0.87) and excellent specificity (0.92) for detecting clinically significant anxiety symptoms. Alternatively, a cutoff score of ≥2 provided excellent sensitivity (1.00) and fair specificity (0.76). CONCLUSIONS: The GAD-2 is a clinically useful and psychometrically valid tool for screening anxiety symptoms in MS rehabilitation and neurology care settings. Importantly, this tool has the potential to identify individuals with MS who are at risk for anxiety disorders and who may benefit from rehabilitation psychology interventions to ultimately improve functioning and quality of life.

Sleep Disturbance and Cognitive Dysfunction in Multiple Sclerosis: a Systematic Review.

PURPOSE OF REVIEW: The present review summarizes recent research on the association between sleep disturbance and cognitive dysfunction in MS. Assessment methodology, domain-specific associations between sleep disturbance and cognitive dysfunction, and implications for future research and treatment are discussed. RECENT FINDINGS: All 12 studies included in this review found significant associations between sleep disturbance and cognitive dysfunction; however, results varied considerably depending on the assessment method used and the cognitive domain assessed. Self-reported sleep disturbance generally predicted self-report but not objective measures of cognitive dysfunction. Objective sleep measures (e.g., polysomnography, actigraphy) generally predicted objective impairments in processing speed and attention; however, objective sleep disturbance was more variable in predicting performance in other cognitive domains (e.g., memory, executive function). Sleep disturbance may help predict future cognitive decline in MS. Results highlight the need to integrate sleep assessment into routine MS care. Interventions aimed treating sleep disturbance may offer promise for improving cognitive dysfunction in MS.

Construct validity of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES).

BACKGROUND: The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) is a measure of cognitive-communication and executive functions involving everyday tasks. Scores are predictive of employment status; however, the measure's construct validity is unclear. OBJECTIVE: The study's objective was to assess the linear association of FAVRES test performance with performance on a number of neuropsychological measures in a sample of individuals with neurocognitive deficits. METHODS: Twenty-two adults completed the FAVRES, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Delis-Kaplan Executive Function System (D-KEFS), Color-Word Interference (CWI), Tower and Trail Making (TM). RESULTS: FAVRES Total Accuracy score significantly correlated with CWI Inhibition (r = -0.43) and Tower (r = 0.60). Total Rationale significantly correlated with CWI Inhibition (r = -0.49), TM Number-Letter Switching (r = -0.48) and Tower (r = 0.55). Total Reasoning significantly correlated with CWI Inhibition (r = -0.71), Inhibition Switching (r = -0.50), TM Number-Letter Switching (r = -0.67) and Tower (r = 0.69) but also correlated with a number of measures involving other elements of cognition. CONCLUSION: Results provide evidence of convergent validity for the FAVRES as a measure of executive functions. Accuracy and Rationale scores also appear to have good discriminant validity.