Early experience with simulect (basiliximab) induction in living donor renal allografting in India.
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Adult↗
Biomedical subjects
R Dhanda
Publications and source records attributed to R Dhanda.
Bridging of renal arteries: a simple technique for the management of double arteries in living donor renal allograft transplantation.
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Humans↗
Concordance between the CC chemokine receptor 5 genetic determinants that alter risks of transmission and disease progression in children exposed perinatally to human immunodeficiency virus.
If CC chemokine receptor 5 (CCR5)-dependent mechanisms at the time of initial virus exposure are important determinants of virus entry and disease outcome, then the polymorphisms in CCR5 that influence risk of transmission and disease progression should be similar; this hypothesis was tested in a cohort of 649 Argentinean children exposed perinatally to human immunodeficiency virus type 1 (HIV-1). Two lines of evidence support this hypothesis. First, CCR5 haplotype pairs associated with enhanced risk of transmission were the chief predictors of a faster disease course. Second, some of the haplotype pairs associated with altered rates of transmission and disease progression in children were similar to those that we previously found influenced outcome in European American adults. This concordance suggests that CCR5 haplotypes may serve as genetic rheostats that influence events occurring shortly after initial virus exposure, dictating not only virus entry but, by extension, also the extent of early viral replication.
Acquired Immunodeficiency Syndrome↗
Global survey of genetic variation in CCR5, RANTES, and MIP-1alpha: impact on the epidemiology of the HIV-1 pandemic.
Expression of CC chemokine receptor 5 (CCR5), the major coreceptor for HIV-1 cell entry, and its ligands (e.g., RANTES and MIP-1alpha) is widely regarded as central to the pathogenesis of HIV-1 infection. By surveying nearly 3,000 HIV+ and HIV- individuals from worldwide populations for polymorphisms in the genes encoding RANTES, MIP-1alpha, and CCR5, we show that the evolutionary histories of human populations have had a significant impact on the distribution of variation in these genes, and that this may be responsible, in part, for the heterogeneous nature of the epidemiology of the HIV-1 pandemic. The varied distribution of RANTES haplotypes (AC, GC, and AG) associated with population-specific HIV-1 transmission- and disease-modifying effects is a striking example. Homozygosity for the AC haplotype was associated with an increased risk of acquiring HIV-1 as well as accelerated disease progression in European Americans, but not in African Americans. Yet, the prevalence of the ancestral AC haplotype is high in individuals of African origin, but substantially lower in non-Africans. In a Japanese cohort, AG-containing RANTES haplotype pairs were associated with a delay in disease progression; however, we now show that their contribution to HIV-1 pathogenesis and epidemiology in other parts of the world is negligible because the AG haplotype is infrequent in non-Far East Asians. Thus, the varied distribution of RANTES, MIP-1alpha, and CCR5 haplotype pairs and their population-specific phenotypic effects on HIV-1 susceptibility and disease progression results in a complex pattern of biological determinants of HIV-1 epidemiology. These findings have important implications for the design, assessment, and implementation of effective HIV-1 intervention and prevention strategies.
Africa↗
Re: Economic evaluation of the fentanyl transdermal system.
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Administration, Cutaneous↗
Anterior subannular T-tube for prolonged middle ear ventilation during tympanoplasty: evaluation of efficacy and complications.
OBJECTIVE: We previously described the use of anterior subannular T-tubes (n = 20) for long-term middle ear ventilation. In the current study, we examine a larger patient population (n = 38) and a longer follow-up interval (average >2 years) to evaluate the efficacy and safety of anterior subannular tympanostomy. STUDY DESIGN: Retrospective nonrandomized case review. SETTING: Tertiary referral hospital. PATIENTS: Our series consisted of 38 consecutive patients with a diagnosis of eustachian tube dysfunction, adhesive otitis media, or chronic otitis media with a perforation who underwent a tympanoplasty. INTERVENTION: A subannular T-tube was placed anteriorly at the time of tympanoplasty to provide long-term middle ear ventilation. MAIN OUTCOME MEASURES: The main outcomes of this study are tube position, tube patency, and middle ear ventilation. In addition, hearing was evaluated both preoperatively and postoperatively and any complications were noted. RESULTS: There were 38 patients and 38 ears that received an anterior subannular T-tube at the time of tympanoplasty. The study group consisted of 24 female patients and 14 male patents with a median age of 36 years (range, 10-75 yr). All 38 patients had eustachian tube dysfunction, 22 had adhesive otitis media, 23 had chronic otitis media, 13 had a cholesteatoma, 11 had tympanic membrane perforations, and 3 patients had a cleft palate. All patients underwent tympanoplasty. Eighteen patients had a concomitant ossiculoplasty and 7 had a mastoidectomy. Follow-up ranged from 1 month to 48 months (average, 26 mo). Three tubes had extruded within 2 years, in 1 case resulting in a persistent perforation. Postoperative complications included 1 patient with a partially extruded prosthesis, 2 patients with tipped prosthesis and persistent tympanic membrane retraction, and 1 patient with a plugged tube. All other tubes were patent and showed no evidence of migration. Furthermore, there were no cases of anterior canal blunting or ingrowth of epithelium around the tube. CONCLUSION: Anterior subannular tympanostomy is a safe and effective method for long-term middle ear ventilation in patients with chronic eustachian tube dysfunction.
Adolescent↗
Modeling impairment: using the disablement process as a framework to evaluate determinants of hip and knee flexion.
Elders often present to health care providers with multiple inter-related conditions that determine an individual's ability to function. The disablement process provides a generalized sociomedical framework for investigating the complex pathways from chronic disease to disability. At each stage of the main pathway, associations may exist among primary physical factors and modifying variables that ultimately have downstream effects on the progression toward disability. The purpose of the present analysis is to examine the inter-relationships between a cohesive set of variables primarily at the level of impairment that may affect hip and knee flexion range of motion (ROM). The San Antonio Longitudinal Study of Aging enrolled 833 community dwelling Mexican (MA) and European American (EA) elders aged 64-78 years between 1992 and 1996. Of these, 647 had complete data from both a home-based and performance-based battery of assessments for these analyses. Concerning impairments, hip ROM was measured using an inclinometer, and knee ROM using a goniometer. Pain location and intensity were assessed using the McGill Pain Questionnaire. Peripheral vascular disease was assessed using doppler brachial and ankle systolic blood pressures. Ankle and knee reflexes, and vibratory sensation were assessed by a standardized neurological examination. As to diseases, diabetes was assessed using a combination of blood glucose levels and self-report, and arthritis by self-report. Concerning modifying variables, height and weight were directly measured and used to calculate BMI. Activity level was assessed with the Minnesota Leisure Time Questionnaire. Analgesic use was assessed by direct observation of medications taken within the past two weeks. We used structural equation modeling to test associations between the variables that were specified a priori. These analyses demonstrate the central role of BMI as a determinant of hip and knee flexion ROM. For an increase in level of BMI, the coefficients [SEM] for changes in levels of hip and knee ROM were -0.38 [0.05] and -0.26 [0.05], respectively. A higher BMI resulted in lower hip and knee ROM. BMI was also directly associated with prevalent diabetes (0.10 [0.05]) and arthritis (0.17 [0.05]). However, after adjustment for BMI, diabetes and arthritis did not have direct independent associations with either hip or knee ROM. BMI was also indirectly associated with knee, but not hip, ROM through paths including lower-leg pain, pain intensity, and neurosensory impairments. Diabetes had an indirect association with hip, but not knee ROM, through a path including peripheral vascular disease. In conclusion, BMI is a primary direct determinant of hip and knee ROM. The paths by which diabetes and arthritis lead to physical disability may be mediated, in part, at the level of impairment by BMI's association with joint range of motion. Interventions designed to decrease the impact of diabetes and arthritis on disability should track changes in BMI and joint ROM to measure the paths that account for the intervention's success. The observed associations suggest that interventions targeted to decrease BMI itself may lead to improved function in part through improved joint ROM.
Aged↗
Race-specific HIV-1 disease-modifying effects associated with CCR5 haplotypes.
Genetic variation in CC chemokine receptor 5 (CCR5), the major HIV-1 coreceptor, has been shown to influence HIV-1 transmission and disease progression. However, it is generally assumed that the same CCR5 genotype (or haplotype) has similar phenotypic effects in different populations. To test this assumption, we used an evolutionary-based classification of CCR5 haplotypes to determine their associated HIV-1 disease-modifying effects in a large well-characterized racially mixed cohort of HIV-1-seropositive individuals. We demonstrate that the spectrum of CCR5 haplotypes associated with disease acceleration or retardation differs between African Americans and Caucasians. Also, we show that there is a strong interactive effect between CCR5 haplotypes with different evolutionary histories. The striking population-specific phenotypic effects associated with CCR5 haplotypes emphasize the importance of understanding the evolutionary context in which disease susceptibility genes are expressed.
Acquired Immunodeficiency Syndrome↗
Determinants of hip and knee flexion range: results from the San Antonio Longitudinal Study of Aging.
OBJECTIVE: We analyzed data from the San Antonio Longitudinal Study of Aging, a neighborhood-based study of community-dwelling elderly people, to identify factors that determine the flexion range (FR) of hips and knees. METHODS: The FR of hips and knees was measured in a cohort of 687 subjects aged 65 to 79 years. We used multivariate models to examine the associations among the FR of hips and knees, and between these and age, gender, ethnicity, body mass index (BMI), pain and its location, self-reported arthritis, and diabetes mellitus. The functional relevance of hip and knee FR was tested by measuring its association with 50-foot walking velocity. RESULTS: More than 90 degrees of flexion in both hips and both knees was observed in 619 subjects (90.1%). Correlations among the FR of hips and knees ranged from 0.54 to 0.80 (P < 0.001 for Spearman r values). Multivariate analysis revealed a pattern of significant associations between each of the joints and its contralateral mate and ipsilateral partner joints that was consistent for both hips and both knees. Using each individual joint as the unit of analysis, the following variables were independently associated with hip or knee FR in multivariate models: rising BMI and female sex with reduced FR of both hips and knees, a Mexican American ethnic background with decreased hip FR, and knee pain with decreased knee FR. The functional importance of the FR of these two important joints was supported by its significant association with walking velocity in a model that adjusted for age, gender, ethnic background, BMI, and hip or knee pain. CONCLUSIONS: Most community-dwelling elderly people have a FR of hips and knees that can be considered functional. The ipsilateral and contralateral hip or knee are significant independent determinants of the FR of each of these joints. Obesity, a health problem potentially amenable to preventive and therapeutic interventions, is a factor significantly associated with decreased FR of hips and knees.
Aged↗
Case-finding for depression in primary care: a randomized trial.
PURPOSE: Depression is a highly prevalent, morbid, and costly illness that is often unrecognized and inadequately treated. Because depression questionnaires have the potential to improve recognition, we evaluated the accuracy and effects on primary care of two case-finding instruments compared to usual care. SUBJECTS AND METHODS: The study was conducted at three university-affiliated and one community-based medical clinics. Consecutive patients were randomly assigned to be asked a single question about mood, to fill out the 20-item Center for Epidemiologic Studies Depression Screen, or to usual care. Within 72 hours, patients were assessed for Diagnostic and Statistical Manual of Mental Disorders Third Revised Edition (DSM-III-R) disorders by an assessor blinded to the screening results. Process of care was assessed using chart audit and administrative databases; patient and physician satisfaction was assessed using Likert scales. At 3 months, depressed patients and a random sample of nondepressed patients were re-assessed for DSM-III-R disorders and symptom counts. RESULTS: We approached 1,083 patients, of whom 969 consented to screening and were assigned to the single question (n = 330), 20-item questionnaire (n = 323), or usual care (n = 316). The interview for DSM-III-R diagnosis was completed in 863 (89%) patients; major depression, dysthymia, or minor depression was present in 13%. Both instruments were sensitive, but the 20-item questionnaire was more specific than the single question (75% vs 66%, P = 0.03). The 20-item questionnaire was less likely to be self-administered (54% vs 90%) and took significantly more time to complete (15 vs 248 seconds). Case-finding with the 20-item questionnaire or single question modestly increased depression recognition, 30/77 (39%) compared with 11/38 (29%) in usual care (P = 0.31) but did not affect treatment (45% vs 43%, P = 0.88). Effects on DSM-III-R symptoms were mixed. Recovery from depression was more likely in the case-finding than usual care groups, 32/67 (48%) versus 8/30 (27%, P = 0.03), but the mean improvement in depression symptoms did not differ significantly (1.6 vs 1.5 symptoms, P = 0.21). CONCLUSIONS: A simple question about depression has similar performance characteristics as a longer 20-item questionnaire and is more feasible because of its brevity. Case-finding leads to a modest increase in recognition rates, but does not have consistently positive effects on patient outcomes.
Aged↗
Disaggregating pain and its effect on physical functional limitations.
BACKGROUND: Pain is a common impairment that limits the abilities of older persons. The purposes of this article are to: (i) describe the distribution of pain location using the McGill Pain Map (MPM) in a community-based cohort of aged subjects; (ii) investigate whether individual areas of pain could be sensibly grouped into regions of pain; (iii) determine whether intensity, frequency, and location constitute independent dimensions of pain; and (iv) determine whether these three pain dimensions make differential contributions to the presence of self-reported physical functional limitations. METHODS: A total of 833 Mexican American and European American subjects, aged 65-79 years, were enrolled in the San Antonio Longitudinal Study of Aging and were interviewed in their homes between 1992 and 1996. A total of 373 (46%) of the subjects reported having pain in the past week. Physical functional limitations were ascertained using the nine items from the Nagi scale. Three composite scales were created: upper extremity, lower extremity, and total. Pain intensity and frequency were ascertained using the McGill Pain Questionnaire. Pain location was ascertained by using the MPM. RESULTS: Pain was reported in every area of the MPM. Using multiple groups confirmatory factor analysis, the 36 areas were grouped into 7 regions of pain: head, arms, hands and wrists, trunk, back, upper leg, and lower leg. Among persons with pain, pain frequency, intensity, and location were weakly associated with each other. Pain regions were primarily independent of each other, yet weak associations existed between 6 of the 21 pair-wise correlations between regions. Pain regions were differentially associated with individual physical functional limitations. Pain in the upper leg was associated with 8 of the 9 physical tasks. In multivariate analyses, age, gender, and ethnic group accounted for only 2-3% of the variance in physical tasks. In multivariate analyses, age, gender, and ethnic group accounted for only 2-3% of the variance in physical functional limitations. Pain intensity accounted for 5-6% of the variance in the composite scores of functional limitation. Pain frequency accounted for 4-5% of the variance in upper extremity limitations but did not contribute to the modeling of lower extremity limitations. In contrast, pain location accounted for 9-14% of the variance in physical functional limitations. CONCLUSIONS: We tested a method for ascertaining pain location and clearly demonstrated that pain location is an important determinant of self-reported physical functional limitations. The MPM methodology may be used in population-based studies or in clinical samples that focus on specific impairments and seek to control for pain frequency and intensity. Future studies can link specific diseases with the common impairment of pain and tease out the pathways that lead to other impairments (e.g., weakness), functional limitations, and disability.
Aged↗
Body fatness and increased injury rates in high school football linemen.
OBJECTIVE: To determine whether associations exist between body fatness and injury rates in high school football linemen. DESIGN: Prospective, injury surveillance study during a 2-week preseason and 10-week regular season. SETTING: 10 public high schools in Texas. PARTICIPANTS: Two hundred fifteen varsity and junior varsity high school football linemen. MAIN OUTCOME MEASURES: Injury rates (injuries per 1000 hours of playing time) for groups of players above a given body fat level and at or below a given body fat level. Rates were computed as the number of injuries per group divided by the group's aggregate playing time (practice + game time). The null hypothesis was that there is no difference in injury rates between players above a given level of body fat and those at or below that level of body fat. Body fat was determined from chest, abdomen, and thigh skinfold measurements using standard conversion equations. Body mass index (BMI) (kg/m2) was also calculated for each player. RESULTS: The overall injury rate was 5.66 injuries per 1000 hours of playing time. Percent body fat ranged from 9.3% to 40.2%. BMI ranged from 19.9 to 46.6 kg/m2. Sixty-seven players sustained 86 injuries, the most common of which were ankle sprains and medial collateral ligament sprains. No difference in overall injury rates between higher and lower fat groups was seen at any body fat level. Players in higher body fat groups, however, had significantly greater lower extremity injury rates than did players in lower fat groups between 18% and 27% body fat and again 32% to 33%, but not at intermediate levels or >33%. Players in higher BMI groups had significantly greater lower extremity injury rates than did players in lower BMI groups throughout the range from 24 to 36 kg/m2, except at 34 kg/m2. CONCLUSION: Both higher body fatness and BMI were associated with increased rates of lower extremity injury among high school football linemen. BMI appears to be associated more consistently with increased lower extremity injury rates than is body fat.
Adipose Tissue↗
Preoperative spirometry and laparotomy: blowing away dollars.
STUDY OBJECTIVE: Increasing evidence indicates that routine preoperative diagnostic spirometry (pulmonary function tests [PFTs]) before elective abdominal surgery does not predict individual risk of postoperative pulmonary complications and is overutilized. This economic evaluation estimates potential savings from reduced use of preoperative PFTs. DESIGN: Analyses of (1) real costs (resource consumption to perform tests) and (2) reimbursements (expenditures for charges) by third-party payers. SETTING: University-affiliated public and Veterans Affairs hospitals. PATIENTS: Adults undergoing elective abdominal operations. MEASUREMENTS AND RESULTS: Average real cost of PFTs was $19.07 (95% confidence interval [CI], $18.53 to $19.61), based on a time and motion study. Average reimbursement expenditure by third-party payers for PFTs was $85 (range, $33 to $150; 95% CI, $68 to $103), based on Medicare payment of $52 and a survey of nine urban US hospitals with a spectrum of bed sizes and teaching status. Estimates from published literature included the following: (1) annual number of major abdominal operations, 3.5 million; and (2) proportion of PFTs not meeting current guidelines, 39% (95% CI, 0.31 to 0.47). Local data were used when estimates were not available in the literature: (1) proportion of laparotomies that are elective, 76% (95% CI, 0.73 to 0.79); and (2) frequency of PFTs before laparotomy, 69% (95% CI, 0.54 to 0.84). Estimated annual national real costs for preoperative PFTs are $25 million to $45 million. If use of PFTs were reduced by our estimate for the proportion of PFTs not meeting current guidelines, potential annual national cost savings would be $7,925,411 to $21,406,707. National reimbursement expenditures by third-party payers range from more than $90 million to more than $235 million. If use were reduced, potential annual savings in reimbursements would be $29,084,076 to $111,345,440. Potential savings to Medicare approach $8 million to $20 million annually. CONCLUSION: Reduced use of PFTs before elective abdominal surgery could generate substantial savings. Current evidence indicates reduced use would not compromise patients' outcomes.
Abdomen↗
Testing of bone-biomaterial interfacial bonding strength: a comparison of different techniques.
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Animals↗
Appendicitis: higher risk in Mexican Americans?
OBJECTIVES: Mexican Americans (MAs), compared to white non-Hispanics (WNHs), have higher rates of biliary disease, noninsulin dependent diabetes, and endstage renal disease but lower rates of lung cancer, hip fractures, and mortality from coronary heart disease. Relatively little research has been done to identify other ethnic differences in disease incidence. We used surgical procedure rates to confirm known ethnic differences and to explore our clinical suspicion that MAs have higher rates of appendectomy than WNHs. METHODS: We used a registry of surgical procedures at two teaching hospitals in South Texas to calculate proportional operation ratios (PORs) for MAs versus WNHs. These two hospitals are the primary source of acute hospital care for the indigent in the area. The POR is arithmetically identical to proportional incidence and mortality ratios. RESULTS: MAs underwent appendectomy proportionally more often than WNHs at both hospitals (POR = 1.41 and 1.75, p < 0.0001). Other significant PORs were consistent with known ethnic disease differences in biliary tract operations, vascular access for chronic hemodialysis, lung cancer, and coronary artery bypass. CONCLUSIONS: These findings support the hypothesis that MAs may undergo appendectomy more often than WNHs and so may be at higher risk of appendicitis.
Adolescent↗
Risk of pulmonary complications after elective abdominal surgery.
STUDY OBJECTIVE: Intra-abdominal operations are relatively high risk for pulmonary complications. Previous research has more intensely investigated cardiac operative risk, but recent work suggests that significant pulmonary complications may be more common than cardiac complications and associated with longer length of stay. This study identified risk indicators for pulmonary complications after elective abdominal operations. DESIGN: Nested case-control. SETTING: University affiliated Veterans Affairs hospital. PATIENTS: We used a computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991. Ascertainment and verification of pulmonary and cardiac complications were systematic and explicit. Charts of all 116 patients identified by the registry as having complications and 412 (19%) randomly selected from 2,175 remaining patients were reviewed to verify complications, using explicit criteria and independent abstraction of preoperative and postoperative components of charts. From 528 validated subjects (23% of the cohort), 82 cases and 82 control subjects were closely matched by operation type and age, +/- 10 years. MEASUREMENTS AND RESULTS: The primary outcome measure was postoperative pulmonary complications. Among 82 cases with pulmonary complications, 27 (33%) also had cardiac complications. Preoperative variables independently associated with pulmonary complications by multivariable analysis (p < or = 0.05) included the following: Charlson comorbidity index (per point odds ratio [OR], 1.6; 95% confidence interval [CI], 1.004 to 2.6), Goldman cardiac risk index (per point OR, 2.04; 95% CI, 1.17 to 3.6), abnormal chest radiograph (OR, 3.2; 95% CI, 1.07 to 9.4), and abnormal findings on lung examination (OR, 5.8; 95% CI, 1.04 to 32). Equal proportions of cases and control subjects had preoperative diagnostic spirometry. No component of spirometry predicted complications, including severity of obstructive lung disease. CONCLUSIONS: For pulmonary operative risk, abnormal results of lung examination and chest radiography plus cardiac and overall comorbidity were important. Spirometry was not helpful. Because 33% of cases had both cardiac and pulmonary complications, future studies should prospectively examine comparative incidence, outcomes, and predictors of both type of complications.
Abdomen↗
Incidence and hospital stay for cardiac and pulmonary complications after abdominal surgery.
OBJECTIVE: Internists frequently evaluate preoperative cardiopulmonary risk and co-manage cardiac and pulmonary complications, but the comparative incidence and clinical importance of these complications are not clearly delineated. This study evaluated incidence and length of stay for both cardiac and pulmonary complications after elective laparotomy. DESIGN: Nested case-control. SETTING: University-affiliated Department of Veterans Affairs Hospital. PATIENTS: Computerized registry of all 2,291 patients undergoing elective abdominal operations from 1982 to 1991. MEASUREMENT AND MAIN RESULTS: Strategy for ascertainment and verification of complications was systematic and explicit. The charts of all 116 patients identified by the registry as having complications and 412 (19%) randomly selected from 2,175 remaining patients were reviewed to verify presence or absence of cardiac or pulmonary complications, using explicit criteria and independent abstraction of pre- and postoperative components of charts. From these 528 validated cases and controls (23% of the cohort), 96 cases and 96 controls were matched by operation type and age within ten years. Hospital and intensive care unit stays were significantly longer (p < 0.0001) for the cases than for the controls (24.1 vs 10.3 and 5.6 vs 1.5 days, respectively). All 19 deaths occurred among the cases. Among the cases, pulmonary complications occurred significantly more often than cardiac complications (p < 0.00001) and were associated with significantly longer hospital stays (22.7 vs 10.4 days, p = 0.001). Combined cardiopulmonary complications occurred among 28% of the cases. Misclassification-corrected incidence rates for the entire cohort were 9.6% (95% CI 7.2-12.0) for pulmonary and 5.7% (95% CI 3.6-7.7) for cardiac complications. CONCLUSIONS: For noncardiac surgery, previous research has focused on cardiac risk. In this study, pulmonary complications were more frequent, were associated with longer hospital stay, and occurred in combination with cardiac complications in a substantial proportion of cases. These results suggest that further research is needed to fully characterize the clinical epidemiology of postoperative cardiac and pulmonary complications and better guide preoperative risk assessment.
Abdomen↗
Classifying change with the Sickness Impact Profile for Nursing Homes (SIP-NH).
The aim of this cohort study was to evaluate the concordance of the Sickness Impact Profile for Nursing Homes (SIP-NH) and Sickness Impact Profile (SIP) in classifying change. Subjects consisted of 194 consecutive long-stay nursing home residents at one academic department of the V.A. and in 8 community proprietary nursing homes in San Antonio, Texas. They were to have more than 3 months residency; to be > or = 61 years; and to be dependent in at least 2 ADLs with an MMSE score of > or = 15. Subjects were administered a 128-item SIP and a reduced 66-item SIP-NH at baseline and 4, 8, and 12-month follow-up. At each follow-up, subjects were classified into 3 mutually exclusive change categories using a change score of > or = 5 points. Concordance of the classification of subjects by the SIP-NH and SIP was evaluated. The misclassification rate as well as its direction was also assessed. Both instruments classified a little over one-quarter of the subjects as better, over a third as being unchanged, and another third as being worse at the four-month follow-up. More subjects were classified as worse by both instruments at 8 and 12 months. All kappas ranged from 0.52 to 0.78, indicating good to excellent agreement. Overall, the SIP-NH characterized persons as changed more often than the SIP with no systematic directional bias. In conclusion, the SIP-NH was concordant with the SIP in classifying change in subjects. However, we cannot say which of the two is better for detecting change. Future research must focus on defining a change score which has clinical meaning, and evaluate responsiveness to change.
Activities of Daily Living↗