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PubMed2005

Functional outcome scales in traumatic brain injury: a comparison of the Glasgow Outcome Scale (Extended) and the Functional Status Examination.

Clinical trials aimed at developing therapies for traumatic brain injury (TBI) require outcome measures that are reliable, validated, and easily administered. The most widely used of these measures, the Glasgow Outcome Scale (GOS) and the GOS-Extended (GOS-E), have been criticized as suffering from ceiling effects. In an attempt to develop a more useful and dynamic outcome measure, the Functional Status Examination (FSE) was developed, which grades outcome across 10 functional domains. The FSE has been demonstrated to be reliable and sensitive in monitoring recovery after TBI. This manuscript compares FSE with GOS-E in a cohort of patients with a wide range of injury severities. 177 individuals who survived at least 6 months after TBI were studied. The FSE and GOS-E were administered 6-12 months after injury. FSE and GOS-E scores correlated well with each other. FSE scores were distributed throughout the range, indicating that ceiling and floor effects were not present. Physiologic measures of injury severity (Glasgow Coma Score [GCS]) did not correlate with anatomic measures (Abbreviated Injury Scale [AIS] and Injury Severity Score [ISS]). GCS correlated weakly with both outcome measures, but AIS/ISS did not. We conclude that FSE and GOS-E are reliable outcome measures for TBI survivors, and FSE may offer some advantages over GOS-E due its ability to provide a more detailed description of deficits. The majority of the variance in outcome is not accounted for by currently available measures of injury severity.

Abbreviated Injury Scale↗
PubMed2001

Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury.

OBJECTIVE: To study the effect of hyperbaric oxy gen (HBO) treatment of severe brain injury. METHODS: Fifty-five patients were divided into a treatment group (n=35 receiving HBO therapy) and a control group (n=20 receiving dehydrating, cortical steroid and antibiotic therapy) to observe the alteration of clinic GCS (Glasgow Coma Scale), brain electric activity mapping (BEAM), prognosis and GOS (Glasgow Outcome Scale) before a nd after hyperbaric oxygen treatment. RESULTS: In the treatment group GCS, BEAM and GOS were improved obviously after 3 courses of treatment, GCS increased from 5.1 to 14.6 (P<0.01-0.001),the BEAM abnormal rate reduced from 94.3% to 38% (P<0.01-0.001), the GOS good-mild disability rate was 83.7%, and the middle-severe disability rate was 26.3% compared with the control group. There was a statistic significant difference between the two groups (P<0.01-0.001). CONCLUSIONS: Hyperbaric oxygen treatment could improve obviously GCS, BEAM and GOS of severe brain injury patients, and effectively reduce the mortality and morbidity. It is an effective method to treat severe brain injury.

Adult↗
PubMed1984

Wechsler Adult Intelligence Scale and Wechsler Adult Intelligence Scale-Revised in a neurologically impaired population.

Compared Verbal, Performance, and Full Scale IQ scores from two groups of neurologically impaired patients (N = 114) similar in age, years of education, occupation, race, sex, and etiology and location of cerebral dysfunction. One group had been given the WAIS and the other the WAIS-R. All three IQ scores were higher for the WAIS group, with Full Scale and Verbal scores significantly (p less than .05) higher. Changes in item content and standardization sample cohort effects are offered as partial possible explanation for the results. The IQ scores from the two tests cannot be considered as interchangeable for neurological patients.

Brain Damage, Chronic↗
PubMed1988

Prediction of Wechsler Intelligence Scale for Children-Revised Full Scale IQ from the Quick Test of Intelligence and the Test of Nonverbal Intelligence for a referred sample of children and youth.

As part of comprehensive psychoeducational assessment procedures, the Quick Test of Intelligence, Test of Nonverbal Intelligence, and the Wechsler Intelligence Scale for Children-Revised were administered to 89 children and youth, who varied in age from 6-4 to 16-10. The sample consisted of 61 males and 28 females, of whom 37 were Black and 52 White. Regression equations were computed that used the WISC-R Full Scale IQ as criteria and the TONI and QT as predictors. The results clearly indicated that the TONI and QT are equally good predictors of the WISC-R FSIQ. Implications for the clinician are discussed.

Adolescent↗
PubMed2003

Comparison of the Glasgow Coma Scale and the Reaction Level Scale for assessment of cerebral responsiveness in the critically ill.

OBJECTIVE: The Glasgow Coma Scale (GCS) is a well-known source of error in outcome prediction models. We compared assessment of cerebral responsiveness with the GCS and the Reaction Level Scale (RLS) in two otherwise similar outcome prediction models. DESIGN AND SETTING: Prospective, observational study in a general intensive care unit. PATIENTS AND PARTICIPANTS: All admissions of patients with or at risk of developing impaired brain function between 1997 and 1998 ( n=534). MEASUREMENTS AND RESULTS: Admissions were scored by RLS and APACHE II (includes scoring with the GCS). The RLS scores were transformed to APACHE II central nervous system scores according to a predetermined protocol. APACHE II estimated probability of death was calculated conventionally with the GCS and the RLS. Vital status 90 days after admission was secured from a national database. Bias and precision was 0.5% and 16.6%, respectively. The area under receiver operating characteristic curves was slightly but significantly greater with the RLS-based APACHE II model than with the GCS-based model (0.92 vs. 0.90). Discrimination was improved primarily in admissions with low and intermediate probability of death. CONCLUSIONS: Scoring of cerebral responsiveness with the RLS instead of the GCS was associated with minimal bias of the APACHE II probability of death estimate. Assessment of consciousness in critically ill with the RLS deserves further evaluation

APACHE↗
PubMed2004

Comparison of the posttraumatic stress disorder scale versus the clinician-administered posttraumatic stress disorder scale in domestic violence survivors.

The posttraumatic diagnostic scale (PDS) is a self-report instrument for PTSD that is simple to administer and has demonstrated good psychometric properties. We compared the PDS with the gold standard clinician administered PTSD scale (CAPS) diagnostic interview for PTSD. We assessed 138 women who were victims of domestic violence using both the PDS and the CAPS. Findings confirmed that PTSD develops at a high base rate in this sample. The PDS generally performed well in relation to the CAPS although with a tendency to overdiagnose PTSD. The findings lend further support to the use of the PDS as a diagnostic tool for PTSD but indicate that it is better at identifying survivors with PTSD than those without the disorder.

Adolescent↗
PubMed1985

Use of the Hamilton Rating Scale for Depression and the Carroll Self-Rating Scale in adolescents.

The relationship of clinicians' ratings of depression in adolescents to self-rating is important to clinical research. The Hamilton Rating Scale for Depression (HRSD) and the Carroll Self-Rating Scale (CSRS) were compared in a study of 81 psychiatrically hospitalized adolescents. The correlation of CSRS and HRSD total scores in adolescents with melancholic major depression was 0.46, lower than the correlation reported in adults (0.80). Higher correlations were seen in females and in nonmelancholic and nondepressed subgroups. While the comparison of the two rating methods suggests some characteristics of depressed adolescents' presentation of their illness, it does not appear that the self-rating instrument can be used as an alternative to clinicians' ratings.

Adaptation, Psychological↗
PubMed1992

The Pain Anxiety Symptoms Scale: development and validation of a scale to measure fear of pain.

Fear of pain has been implicated in the development and maintenance of chronic pain behavior. Consistent with conceptualizations of anxiety as occurring within three response modes, this paper introduces an instrument to measure fear of pain across cognitive, overt behavioral, and physiological domains. The Pain Anxiety Symptoms Scale (PASS) was administered to 104 consecutive referrals to a multidisciplinary pain clinic. The alpha coefficients were 0.94 for the total scale and ranged from 0.81 to 0.89 for the subscales. Validity was supported by significant correlations with measures of anxiety and disability. Regression analyses controlling for measures of emotional distress and pain showed that the PASS made a significant and unique contribution to the prediction of disability and interference due to pain. Evidence presented here supports the potential utility of the PASS in the continued study of fear of pain and its contribution to the development and maintenance of pain behaviors. Factor analysis and behavioral validation studies are in progress.

Adult↗
PubMed2000

Discriminant validity of the Social Phobia and Anxiety Inventory (SPAI), the Social Phobia Scale (SPS) and the Social Interaction Anxiety Scale (SIAS).

Three measures commonly used in assessment of social phobia, the Social Phobia and Anxiety Inventory (SPAI [Turner, S. M., Beidel, D. C. & Dancu, C. V. (1996). Social phobia and anxiety inventory: manual. Toronto, Ont.: Multi-Health Systems Inc.), the Social Phobia Scale (SPS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470] and the Social Interaction Anxiety Scale (SIAS [Mattick, R. P. & Clarke, J. C. (1998). Development and validation of measures of social phobia scrutiny fear and social interaction anxiety. Behaviour Research and Therapy, 36, 455-470], were compared for their ability to discriminate between social phobia and other anxiety disorders (panic disorder with or without agoraphobia). Participants were 117 patients attending a specialized anxiety disorders unit for treatment. While all three measures were able to detect differences between social phobic patients and patients with panic disorder with or without agoraphobia, a logistic regression analysis showed that the SPAI, but not the SPS and SIAS, was a significant predictor of membership of the social phobia group. Receiver operating characteristic (ROC) analysis also showed that the SPAI was the better measure for discriminating between social phobia and panic disorder with and without agoraphobia. Analysis of the sensitivity, specificity and positive and negative predictive power of the measures at the optimum cutoff scores produced by the ROC analysis are presented.

Adult↗
PubMed2000

Comparison of clinical outcomes following treatment of chronic adult periodontitis with subgingival scaling or subgingival scaling plus metronidazole gel.

BACKGROUND, AIMS: Conventional treatment of chronic periodontitis involves mechanical debridement of periodontal pockets. Recently, subgingival antimicrobials have been used adjunctively following such debridement. This 2-centre study compared the clinical effects of subgingival scaling (SRP) with SRP plus subgingival application of 25% metronidazole gel, Elyzol (SRP+gel), in patients with chronic adult periodontitis. METHOD: Voluntary informed written consent was obtained from 45 subjects at the Eastman (mean age 46, range 34-63) and 43 subjects at RAF Halton (mean age 47, range 34-71) who participated in this blind, randomised split-mouth design study. All had at least 2 sites in each quadrant with probing pocket depth (PPD) > or = 5 mm. PPD, bleeding on probing (BOP), and clinical probing attachment levels (CAL) measured using a stent, were recorded at baseline and at 1, 3, 6 and 9 months post-therapy. After subgingival scaling of all quadrants, 2 quadrants were randomly selected to be treated with metronidazole gel. RESULTS: A paired t-test on baseline values showed no bias between groups. Both treatments effectively reduced the signs of periodontitis. At each follow-up visit, reduction in PPD, CAL and BOP after the combined treatment was greater than for SRP alone. Paired t-tests showed that the improvement in the SRP+gel group was statistically significantly better (p<0.001) than for SRP alone (mean 0.5 +/- 0.6 mm. 95% CI 0.4-0.6 mm.) Similarly, the % of sites which improved to a final pocket depth of < or = 3 mm and the % of sites which improved over the 9 months of the study by as much as > or = 2 mm were greater for SRP+gel than for SRP alone. CONCLUSIONS: At the end of the study, the mean reductions for PPD were 1.0 mm (SRP) compared to 1.5 mm (SRP+gel), and for CAL they were 0.4 mm (SRP) compared to 0.8 mm (SRP+gel), with mean difference for CAL between treatments of 0.4 +/- 0.6 mm (95% confidence intervals of 0.3-0.6 mm). The combination therapy of SRP+gel was superior to the conventional treatment of SRP alone, and these differences were maintained for 9 months.

Adult↗
PubMed1989

Psychometric evaluation of the Geriatric Depression Scale and the Zung Self-Rating Depression Scale using an elderly community sample.

In this study the psychometric properties of the Geriatric Depression Scale (GDS) and the Zung Self-Rating Depression Scale (SDS) were evaluated and compared, using a relatively large elderly community sample. The GDS generally performed well, replicating earlier findings from a different population. Also, as hypothesized, the SDS, which has a multiple-choice format, had a higher non-completion rate than the GDS, which has a true-false format. Finally, no significant differences between the responses of young-old and old-old subjects were observed.

Aged↗
PubMed2004

Education-stratified base-rate information on discrepancy scores within and between the Wechsler Adult Intelligence Scale--Third Edition and the Wechsler Memory Scale--Third Edition.

The Wechsler Adult Intelligence Scale--Third Edition (WAIS-III; D. Wechsler, 1997a) and the Wechsler Memory Scale--Third Edition (WMS-III; D. Wechsler, 1997b) are 2 of the most frequently used measures in psychology and neuropsychology. To facilitate the diagnostic use of these measures in the clinical decision-making process, this article provides information on education-stratified, directional prevalence rates (i.e., base rates) of discrepancy scores between the major index scores for the WAIS-III, the WMS-III, and between the WAIS-III and WMS-III. To illustrate how such base-rate data can be clinically used, this article reviews the relative risk (i.e., odds ratio) of empirically defined "rare" cognitive deficits in 2 of the clinical samples presented in the WAIS-III--WMS-III Technical Manual (The Psychological Corporation, 1997).

Educational Status↗
PubMed2001

Assessment of the convergent validity of the Questions About Behavioral Function scale with analogue functional analysis and the Motivation Assessment Scale.

The present study examined the convergent validity of the Questions About Behavioral Function (QABF) scale, a behavioural checklist for assessing variables maintaining aberrant behaviour, with analogue functional analyses and the Motivation Assessment Scale (MAS). The two checklists were more highly correlated with each other than either checklist with results from the analogue sessions, and the QABF was more highly correlated with analogue sessions than the MAS. Using analogue sessions, the experimenters failed to ascertain behavioural function for a number of subjects because the behaviour problems in question were low frequency/high intensity and failed to appear during the course of the analysis, pointing out a limitation of this technology. These findings, taken together with recent research outlining the psychometric properties of the QABF, seem to support the use of the QABF in a hierarchical model of functional analysis. The implications of the findings are discussed.

Adult↗
PubMed1982

[Comparison of the Hamilton Depression Rating Scale and the Self Rating Scale BS (v. Zerssen) within a double blind study on the antidepressant effects of trazodone verus amitriptyline (author's transl)].

From October 1977 until March 1978 a prospective study was performed on 30 depressive patients of both sexes, age 20 to 60 years. In a double-blind design patients received either amitriptyline or trazodone for 28 days. The course of therapy was controlled six times by means of the Hamilton Rating Scale for Depression (HRS) and the Zerssen-Contentment Scale (BS). The following results were obtained: By the statistical analysis of the HRs scores no difference in the antidepressant properties of trazodone and amitriptyline can be demonstrated. The same result is obtained by use of the BS scores. Therefore the antidepressant efficacy of the two medications can be called equal. When comparing day 10 to day 0, a correlation between the two data pools of RSp = 0.719 (p less than 0.01) according to Spearmen was found. Upon comparing the 28th day with the pre-treatment day, RSp comes out to be 0.809. When applying Anova no significant correlation for the pre-treatment day can be demonstrated (RL = 0.260); yet at the end of the study the correlation comes out to be extremely high (RL = 0.940, p less than 0.1). When considering each day of the study, RL results to be 0.808 (p less than 0.001). Thus, a high correlation can be demonstrated for the HRS and BS.

Administration, Oral↗
PubMed1983

Factor analysis of the WAIS and Wechsler Memory Scale: an analysis of the construct validity of the Wechsler Memory Scale.

The WAIS and Wechsler Memory Scale subtest scores of 256 neurologic and nonneurologic subjects were factor analyzed. The results supported the construct validity of the Wechsler Memory Scale as a measure of verbal learning and memory, attention and concentration, and orientation. Construct validity was not demonstrated for the Visual Reproduction subtest as a measure of visual memory. Suggestions are offered for future development and research on measures of visual memory.

Attention↗
PubMed2006

Fine tuning recommendations for older adults with memory complaints: using the Independent Living Scales with the Dementia Rating Scale.

The purpose of this study was to describe how functional test performance changed as global cognitive functioning dropped, as well as to examine the relationship of demographic variables and depression with functional test results. We found that level of performance on the Independent Living Scales (ILS) correlated highly with Dementia Rating Scale (DRS) scores in 83 older adults presenting for clinical neuropsychological assessment, while correlations with demographic factors and depression were nonsignificant or modest. Based on DRS scores, we divided our sample into four groups: normal cognitive status, borderline cognitive impairment, likely mild dementia, and likely moderate dementia. ILS profiles of the borderline impairment and mild dementia groups were similar and reflected particularly poor performance on subscales tapping financial management and everyday memory. Individuals with likely moderate dementia were markedly impaired on all subscales.

Activities of Daily Living↗
PubMed2001

The relation between acute physiological variables and outcome on the Glasgow Outcome Scale and Disability Rating Scale following severe traumatic brain injury.

The relation between outcome and duration of adverse physiological events was studied, using suggested critical physiological values. Subjects were 184 patients with severe traumatic brain injury who received continuous monitoring of intracranial pressure (ICP), mean arterial pressure (MAP), cerebral perfusion pressure (CPP), and jugular venous oxygen saturation. Longer durations of adverse physiological events were significantly related to Glasgow Outcome Scale (GOS) scores and Disability Rating Scale (DRS) scores for all variables at all timepoints postinjury. When analyses excluded patients who died, the relation between adverse physiological events and GOS was nonsignificant; however, duration of ICP, MAP, and CPP still accounted for a significant portion of the variance in DRS scalres. The relative sensitivity of the GOS and DRS is discussed.

Acute Disease↗