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1. Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study

Author

Katzan, Irene, Schuster, Andrew, and Kinzy, Tyler

Subjects
Information technology, T58.5-58.64, Public aspects of medicine, RA1-1270
Abstract

BackgroundContinuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. ObjectiveThe primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. MethodsA total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. ResultsParticipants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. ConclusionsThe use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.

Published
2021
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3. The impact of perioperative stroke and delirium on outcomes after surgical aortic valve replacement

Author

Miller, Marissa A., Taddei-Peters, Wendy C., Jeffries, Neal O., Buxton, Dennis, Geller, Nancy L., Gordon, David, Burke, Catherine, Lee, Albert, Smith, Tyrone, Moy, Claudia S., Gombos, Ilana Kogan, Weisel, Richard, Gardner, Timothy J., O'Gara, Patrick T., Rose, Eric A., Gelijns, Annetine C., Parides, Michael K., Ascheim, Deborah D., Moskowitz, Alan J., Bagiella, Emilia, Moquete, Ellen, Shah, Kinjal, Overbey, Jessica R., Pan, Stephanie, Chang, Helena, Chase, Melissa, Goldfarb, Seth, Gupta, Lopa, Kirkwood, Katherine, Dobrev, Edlira, Levitan, Ron, O'Sullivan, Karen, Santos, Milerva, Ye, Xia, Mack, Michael, Winkle, Rachelle, Boswell, Haley, Fenlon, Amanda, Johnson, Melissa, Jones, Jessica, Kolb, Megan, Lam, Sarah, Miranda, Lucy, Ward, Jackie, Whitman, Renessa, Zingler, Brittany, Ryan, William, Smith, Robert L., Grayburn, Paul, Nosnik, Pedro, Gillinov, A. Marc, Blackstone, Eugene H., Moazami, Nader, Starling, Randall C., Barzilai, Benico, Grimm, Richard A., Soltesz, Edward G., Katzan, Irene, Strippy, Brian, Smith, Shoi, Garcia, Michelle, Alice bowman, Mary, Geither, Carrie, Wang, Robert, Argenziano, Michael, Borger, Michael, Takayama, Hiroo, Leon, Martin B., Goldsmith, Lyn, Schwartz, Allan, Sookraj, Nadia, McCright-Gill, Talaya, Sreekanth, Sowmya, McCullough, Jock N., Iribarne, Alexander, DeSimone, Joseph P., DiScipio, Anthony W., Stokes, Henry, Ivany, Amanda St., Petty, Gaylin, Smith, Peter K., Alexander, John H., Milano, Carmelo A., Glower, Donald D., Huber, Joel, Morganlander, Joel, Mathew, Joseph P., Welsh, Stacey, Casalinova, Sarah, Johnson, Victoria, Lane, Kathleen, Smith, Derek, Tipton, Greg, Berry, Mark F., Williams, Judson B., Englum, Brian, Hartwig, Matthew, Thourani, Vinod H., Guyton, Robert, Lattouf, Omar, Chen, Edward, Vega, J. David, Baer, Jefferson, Nguyen, Duc, Halkos, Michael, Baio, Kim, Prince, Tamara, Cook, Natascha, Neill, Alexis A., Voisine, Pierre, Senechal, Mario, Dagenais, François, Laforce, Robert, Jr., O'Connor, Kim, Dussault, Gladys, Caouette, Manon, Tremblay, Hugo, Gagne, Nathalie, Dumont, Julie, Landry, Patricia, Groh, Mark A., Trichon, Benjamin H., Binns, Oliver A., Ely, Stephen W., Johnson, Alan M., Hansen, Todd H., Short, John G., Taylor, Reid D., Mangusan, Ralph, Nanney, Tracy, Aubart, Holly, Cross, Kristin, McPeters, Leslie, Riggsbee, Christina, Rixey, Lucy, Michler, Robert E., DeRose, Joseph J., Jr., Goldstein, Daniel J., Bello, Ricardo A., Taub, Cynthia, Spevack, Daniel, Kirchoff, Kathryn, Meli, Rebecca, Garcia, Juan, Goldenberg, Jon, Kealy, Lauren, Perrault, Louis P., Bouchard, Denis, Tanguay, Jean François, O'Meara, Eileen, Lacharité, Jonathan, Robichaud, Sophie, Horvath, Keith A., Corcoran, Philip C., Siegenthaler, Michael P., Murphy, Mandy, Iraola, Margaret, Greenberg, Ann, Kumkumian, Greg, Milner, Mark, Nadareishvili, Zurab, Whitson, Bryan A., Hasan, Ayesha, McDavid, Asia, Fadorsen, Denise, Ouzounian, Maral, Yau, Terry, Farkouh, Michael, Woo, Anna, Cusimano, Robert James, David, Tirone, Feindel, Christopher, Fumakia, Nishit, Christie, Shakira, Mullen, John C., Bissonauth, Asvina, Hripko, Alexandra, Gammie, James S., Noor, Zahid, Mackowick, Kristen, Deasey, Stephanie, Al-Suqi, Manal, Collins, Julia, Acker, Michael A., Messé, Steven, Kirkpatrick, James, Mayer, Mary Lou, McDonald, Caitlin, Fok, Holley, Maffei, Breanna, Cresse, Stephen, Gepty, Christine, Bowdish, Michael, Starnes, Vaughn A., Shavalle, David, Heck, Christi, Hackmann, Amy, Baker, Craig, Fleischman, Fernando, Cunningham, Mark, Lozano, Edward, Hernandez, Michelle, Ailawadi, Gorav, Kron, Irving L., Johnston, Karen, Ghanta, Ravi K., Dent, John M., Kern, John, Yarboro, Leora, Ragosta, Michael, Annex, Brian, Bergin, Jim, Burks, Sandra, Cosner, Mike, Green, China, Loya, Samantha, Kim, Hye Ryun, Bull, David A., Desvigne-Nickens, Patrice, Dixon, Dennis O., Gottesman, Rebecca, Haigney, Mark, Holubkov, Richard, Iadecola, Constantino, Jacobs, Alice, Meslin, Eric M., Murkin, John M., Spertus, John A., Sellke, Frank, McDonald, Cheryl L., Canty, John, Dickert, Neal, Ikonomidis, John S., Kim, KyungMann, Williams, David O., Yancy, Clyde W., Chaturvedi, Seemant, Chimowitz, Marc, Fang, James C., Richenbacher, Wayne, Rao, Vivek, Furie, Karen L., Miller, Rachel, Cook, Jennifer, D'Alessandro, David, Han, Frederick, Pinney, Sean, Walsh, Mary N., Greer, David, Ishida, Koto, Stapf, Christian, Hung, Judy, Zeng, Xin, Hung, David, Satitthummanid, Sudarat, Billelo, Michel, Davatzikos, Christos, Erus, Guray, Karpf, Lauren, Desiderio, Lisa, Browndyke, Jeffrey N., James, Michael L., Toulgoat-Dubois, Yanne, Brassard, Rachele, Virmanu, Renu, Romero, Maria E., Braumann, Ryan, Messé, Steven R., Mack, Michael J., Southerland, Andrew M., Moy, Claudia Scala, and Bowdish, Michael E.

Published
2024
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15. Patient Versus Clinician Proxy Reliability of the AM-PAC '6-Clicks' Basic Mobility and Daily Activity Short Forms

Author

Johnson, Joshua K., Lapin, Brittany, Bethoux, Francois, Skolaris, Alexis, Katzan, Irene, and Stilphen, Mary

Subjects
Therapeutics, Physiological -- Evaluation, Physical therapy -- Evaluation, Proxy -- Evaluation, Medical care -- Quality management, Health
Abstract

Objective. The purpose of this study was to test the reliability of the Activity Measure for Post-Acute Care (AM-PAC) '6-Clicks' mobility and activity short forms between patients and therapist proxies. As a secondary aim, reliability was examined when patients completed their self-report before versus after the therapist evaluation. Methods. Patients being seen for an initial physical therapist (N =70) or occupational therapist (N =71) evaluation in the acute care hospital completed the '6-Clicks' mobility short form (if a physical therapist evaluation) or activity short form (if an occupational therapist evaluation). Whether patients completed their self-assessment before or after the evaluation was randomized. Patient- and therapist-rated '6-Clicks' raw scores were converted to AM-PAC T-scores for comparison. Reliability was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots, and agreement was assessed with weighted kappa values. Results. The ICCs for the '6-Clicks' mobility and daily activity short forms were 0.57 (95% CI = 0.42-0.69) and 0.45 (95% CI =0.28-0.59), respectively. For both short forms, reliability was higher when the patient completed the self-assessment after versus before the therapist evaluation (ICC =0.67, 95% CI = 0.47-0.80 vs ICC=0.50, 95% CI = 0.26-0.67 for the mobility short form; and ICC = 0.52, 95% CI =0.29-0.70 vs ICC= 0.34, 95% CI = 0.06-0.56 for the activity short form). Conclusion. Reliability of the '6-Clicks' total scores was moderate for both the mobility and activity short forms, though higher for the mobility short form and when patients' self-report occurred after the therapist evaluation. Impact. Reliability of the AM-PAC '6-Clicks' short forms is moderate when comparing scores from patients with those of therapists responding as proxies. The short forms are useful for measuring participants' function in the acute care hospital; however, it is critical to recognize limitations in reliability between clinician- and patient-reported AM-PAC scores when evaluating longitudinal change and recovery. Keywords: Activities of Daily Living, Acute Care, Measurement: Basic Theory and Science, Mobility, Introduction Many individuals in acute care hospitals experience new or worsening deficits in physical function and their ability to participate in daily activities. (1,2) Individual's functional status in the hospital [...]

Published
2022
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27. Chronic Stroke Outcome Measures for Motor Function Intervention Trials

Author

Bushnell, Cheryl, Bettger, Janet Prvu, Cockroft, Kevin M, Cramer, Steven C, Edelen, Maria Orlando, Hanley, Daniel, Katzan, Irene L, Mattke, Soeren, Nilsen, Dawn M, Piquado, Tepring, Skidmore, Elizabeth R, Wing, Kay, and Yenokyan, Gayane

Subjects
Clinical Research, Stroke, Brain Disorders, Aging, Rehabilitation, Chronic Disease, Clinical Trials as Topic, Disability Evaluation, Early Medical Intervention, Expert Testimony, Humans, Lower Extremity, Outcome Assessment, Health Care, Recovery of Function, Research Design, Upper Extremity, stroke, lower extremity, chronic disease, suvivors, upper extremity, Cardiorespiratory Medicine and Haematology, Public Health and Health Services, Cardiovascular System & Hematology
Abstract

BackgroundAbout half of survivors with stroke experience severe and significant long-term disability. The purpose of this article is to review the state of the science and to make recommendations for measuring patient-centric outcomes in interventions for motor improvement in the chronic stroke phase.Methods and resultsA 9-member expert panel reviewed evidence to identify measures of upper and lower extremity function used to date as outcomes in trials with patients who experienced a stroke ≥6 months before assessment. Outcome measures were screened using StrokEDGE consensus panel recommendations, and evaluated for availability of a published minimal clinically important difference. Measures meeting these criteria were further evaluated with regard to their level of measurement, psychometric properties, and ability of minimal clinically important difference to capture gains associated with improved function and clinical relevance to patients, to arrive at recommendations. A systematic literature review yielded 115 clinical trials of upper and lower extremity function in chronic stroke that used a total of 34 outcome measures. Seven of these had published minimal clinically important differences and were recommended or highly recommended by StrokEDGE. Those are the Fugl-Meyer Upper Extremity and Lower Extremity scales, Wolf Motor Function Test, Action Research Arm Test, Ten-Meter and Six-Minute Walk Tests, and the Stroke Impact Scale. All had evidence for their psychometric performance, although the strength of evidence for validity varied, especially in populations with chronic stroke Fugl-Meyer Upper and Lower Extremity scales showing the strongest evidence for validity.ConclusionsThe panel recommends that the Fugl-Meyer Upper and Lower Extremity scales be used as primary outcomes in intervention trials targeting motor function in populations with chronic stroke. The other 6 measures are recommended as secondary outcomes.

Published
2015

29. Use of the Activity Measure for Post-Acute Care '6 Clicks' Basic Mobility Inpatient Short Form and National Institutes of Health Stroke Scale to Predict Hospital Discharge Disposition After Stroke

Author

Covert, Stephanie, Johnson, Joshua K., Stilphen, Mary, Passek, Sandra, Thompson, Nicolas R., and Katzan, Irene

Subjects
Hospitals -- Admission and discharge, Activities of daily living -- Analysis, Stroke patients -- Care and treatment -- Behavior, Health
Abstract

Objective. Therapists in the hospital are charged with making timely discharge recommendations to improve access to rehabilitation after stroke. The objective of this study was to identify the predictive ability of the Activity Measure for Post-Acute Care '6 Clicks' Basic Mobility Inpatient Short Form (6 Clicks mobility) score and the National Institutes of Health Stroke Scale (NIHSS) score for actual hospital discharge disposition after stroke. Methods. In this retrospective cohort study, data were collected from an academic hospital in the United States for 1543 patients with acute stroke and a 6 Clicks mobility score. Discharge to home, a skilled nursing facility (SNF), or an inpatient rehabilitation facility (IRF) was the primary outcome. Associations among these outcomes and 6 Clicks mobility and NIHSS scores, alone or together, were tested using multinomial logistic regression, and the predictive ability of these scores was calculated using concordance statistics. Results. A higher 6 Clicks mobility score alone was associated with a decreased odds of actual discharge to an IRF or an SNF. The 6 Clicks mobility score alone was a strong predictor of discharge to home versus an IRF or an SNF. However, predicting discharge to an IRF versus an SNF was stronger when the 6 Clicks mobility score was considered in combination with the NIHSS score, age, sex, and race. Conclusion. The 6 Clicks mobility score alone can guide discharge decision making after stroke, particularly for discharge to home versus an SNF or an IRF. Determining discharge to an SNF versus an IRF could be improved by also considering the NIHSS score, age, sex, and race. Future studies should seek to identify which additional characteristics improve predictability for these separate discharge destinations. Impact. The use of outcome measures can improve therapist confidence in making discharge recommendations for people with stroke, can enhance hospital throughput, and can expedite access to rehabilitation, ultimately affecting functional outcomes., Anew or recurrent stroke is experienced by an estimated 795,000 adults annually in the United States and often results in serious long-term disability. (1) Appropriate rehabilitation has been shown to [...]

Published
2020
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40. Utilities Estimated from PROMIS Scales for Cost-Effectiveness Analyses in Stroke.

Author

Thompson, Nicolas R., Lapin, Brittany R., and Katzan, Irene L.

Abstract

Background: The EQ-5D and Health Utilities Index Mark 3 (HUI-3) are preference-based measures used in cost-effectiveness studies. The Patient Reported Outcomes Measurement Information System (PROMIS) Preference scoring system (PROPr) is a new preference-based measure. In addition, algorithms were previously developed to map PROMIS Global Health (PROMIS-GH) items to HUI-3 using linear equating (HUILE) and 3-level EQ-5D using linear (EQ5DLE). We sought to evaluate and compare estimated utilities based on PROPr and PROMIS-GH in adult stroke survivors. Methods: We performed a retrospective cohort study of adults diagnosed with 1 of ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage seen in an outpatient clinic between 2015 and 2019. Patients completed PROMIS scales and other measures. We computed a modified version of PROPr (mPROPr) and compared the distributional characteristics and correlations with stroke outcomes for mPROPr, HUILE, and EQ5DLE. Results: T toal of 4,159 stroke survivors (average age 62.7 ± 14.7 y, 48.4% female, 77.6% ischemic stroke) were included. Mean utility estimates for mPROPr, EQ5DLE, and HUILE were 0.333 ± 0.244, 0.739 ± 0.201, and 0.544 ± 0.301, respectively. Correlations between the modified Rankin Scale and each of mPROPr and HUILE were both −0.48 and −0.43 for EQ5DLE. Regression analyses indicated that mPROPr scores may be too low for stroke patients in good health and that EQ5DLE scores may be too high for stroke patients in poor health. Conclusions: All 3 PROMIS-based utilities were associated with measures of stroke disability and severity, but the distributions of utilities were very different. Our study highlights the problem cost-effectiveness researchers face of valuing health states with certainty. For researchers using utilities estimated from PROMIS scales, our study indicates that mapping PROMIS-GH item scores to HUI-3 via linear equating may be most appropriate in stroke patients. Highlights: A new preference-based measure has been developed from the Patient Reported Outcomes Measurement Information System (PROMIS), known as the PROMIS-Preference (PROPr) scoring system, and published equations mapping PROMIS Global Health (PROMIS-GH) items to the Health Utilities Index Mark 3 (HUI-3) and EQ-5D-3L are available for use in cost-effectiveness studies. Our study provides distributional characteristics and comparisons of utilities estimated using a modified version of PROPr and equations mapping PROMIS-GH items to EQ-5D-3L and HUI-3 in a sample of stroke survivors. The results of our study show large differences in the distributions of utilities estimated using the different health state measures, and these differences highlight the ongoing difficulty researchers face in valuing health states with certainty. [ABSTRACT FROM AUTHOR]

Published
2023
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48. sj-docx-1-mdm-10.1177_0272989X231182446 – Supplemental material for Utilities Estimated from PROMIS Scales for Cost-Effectiveness Analyses in Stroke

Author

Thompson, Nicolas R., Lapin, Brittany R., and Katzan, Irene L.

Subjects
Public Health and Health Services not elsewhere classified, Health and Community Services, Sociological Methodology and Research Methods
Abstract

Supplemental material, sj-docx-1-mdm-10.1177_0272989X231182446 for Utilities Estimated from PROMIS Scales for Cost-Effectiveness Analyses in Stroke by Nicolas R. Thompson, Brittany R. Lapin and Irene L. Katzan in Medical Decision Making

Published
2023
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