Holmes and Rahe (1967) developed a questionnaire called the Social Readjustment Rating Scale (SRRS) for identifying major stressful life events.Each one of the 43 stressful life events was awarded a Life Change Unit depending on how traumatic it was felt to be by a large sample of participants.
If a person has less the 150 life change units they have a 30% chance of suffering from stress.
Procedure: 2,500 male American sailors were given the SRRS to assess how many life events they had experienced in the previous 6 months.
The researchers concluded that as Life Change Units were positively correlated with illness scores, experiencing life events increased the chances of stress-related health breakdown. Daily hassles are a€?irritating, frustrating, distressing demands that to some degree characterise everyday transactions with the environmenta€™ (Kanner 1981) a€“ i.e. Aim: Kanner et al (1981) were interested in investigating whether it is daily hassles, rather than major life events that are the most stressful. Procedure: An opportunity sample of 100 American participants, including 52 women and 48 men, all white, well-educated and middle class were asked to circle the events on both scales that they had experienced the previous month and rate each according to severity (for the hassles) and frequency (for the uplifts). Results: They found the hassles scale tended to be a more accurate predictor of stress related problems, such as anxiety and depression, than the SRRS. Life Skills is a group of programmes from Aware that are based on the principles of cognitive behavioural therapy (CBT). To find out more information about each type of programme offered please click on the relevant button below.
Key words: amputee, adaptations, falls efficacy, longitudinal, mFES, PEQ, quality of life, rehabilitation, SF-36, transtibial. Abbreviations: ADL = activity of daily living, MCS= Mental Health Component summary, mFES = Modified Falls Efficacy Scale, PCS = Physical Component summary, PEQ = Prosthesis Evaluation Questionnaire, QOL = quality of life, SF-36 = 36-Item Short Form Health Survey. Experienced transtibial prosthesis users are able to complete activities of daily living (ADLs) effectively, and the successful completion of these tasks is an integral part of regaining an independent lifestyle [1–5].
Assessment of the temporal aspects of QOL in people with lower-limb amputations has been limited [12,20].
Although a profile of lower-limb amputee QOL and falls efficacy has been presented, the literature points to a paucity of longitudinal studies in this area of research [14]. The current study had five objectives, all of which investigated changes reported from a unilateral transtibial amputee population in variables across three time points: 1 month, 3 months, and 6 months postdischarge from rehabilitation. Investigate changes in generic health-related QOL, using the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36). Investigate changes in prosthesis-related QOL, using the Prosthesis Evaluation Questionnaire (PEQ). Examine the relationship between an objective measure of mobility (walking speed) and indices of QOL (factors of SF-36) and falls efficacy. The initial approach to participate in the study was made by the physiotherapy team, and participants consented to be contacted by the principal investigator following their final physiotherapy treatment. Inclusion criteria stipulated that participants had a unilateral transtibial amputation and were at least 18 yr of age. Our stunningly high Cronbach's Alphas are published in the section related to a given scale. Edinburgh Postnatal Depression ScalePhysician instructions: Have the patient complete the scale by marking one answer for each question that comes closest to how she has felt in the past seven days, not just how she feels today. Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses.
Treating depressed primary care patients improves their physical, mental, and social functioning.
National Institute of Mental Health treatment of Depression Collaborative Research Program.
Symptom profiles of depression among general medical service users compared with specialty mental health service users.
Summary of the practice parameters for the assessment and treatment of children and adolescents with depressive disorders. Screening for depressive disorder in children and adolescents: validating the Center for Epidemiologic Studies Depression Scale for Children. Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. Development and validation of a geriatric depression screening scale: a preliminary report.
The purpose of this study was to evaluate the measurement properties of the Osteoporosis Assessment Questionnaire-Physical Functioning (OPAQ-PF).
IntroductionCommonly identified consequences associated with osteoporotic-related fractures are impaired physical functioning, disability, depression, social isolation, pain, and loss of independence.
Diagnosed with moderate to severe osteoporosis (T-score ofa€‰a‰¤a€‰a?’2.5) or a history of a nontraumatic or fragility clinical fracture (symptomatic and diagnosed by X-ray). Participants were classified into one of two subgroups: those with or without recent osteoporotic fracture.
ResultsIn total, 144 osteoporosis participants were recruited into this study: 107 without recent fracture and 37 with recent fracture. A total value for stressful life events can be worked out by adding up the scores for each event experienced over a 12 month period.
Although the positive correlation was small (a perfect positive correlation would be +1.00), it did indicate that there was a meaningful relationship between Life Change Units and health (this is often referred to as a statistically significant correlation). As the correlation was not perfect, life events cannot be the only factor in contributing to illness.
They developed a 117 item hassles scale and a 135 uplifts scale to examine the relationship between hassles and health. Each participant was tested once a month for ten consecutive months using the two stress measures together with another two psychometric tests for psychological well-being.
Seven male unilateral transtibial amputees completed the Medical Outcomes Study 36-Item Short Form Health Survey, the Prosthesis Evaluation Questionnaire, and the Modified Falls Efficacy Scale at 1, 3, and 6 months postdischarge from rehabilitation. However, psychological issues, such as how an amputee feels about his or her amputation and prostheses, are also important factors. Studies have linked physical functioning with QOL and reported stable levels of QOL across rehabilitation [12,20].


Falls efficacy is reportedly reduced in people with amputations when compared with a community-dwelling elderly population [21–23].
Understanding the changes that occur in QOL and falls efficacy over time following discharge from rehabilitation is important for this population. Seven male unilateral transtibial amputees participated in the current study, having followed a course of rehabilitation within a National Health Service physiotherapy department (Table 1).
Such prosthetic components indicate Medicare Functional Classification Level K2 activity level. Primary care physicians, not mental health professionals, treat the majority of patients with symptoms of depression.
Preventive Services Task Force (USPSTF) recently reviewed new evidence finding that patients fared best when physicians recognized the symptoms of depression and made sure that they received appropriate treatment.8 Based on this evidence, the USPSTF issued new depression screening recommendations last May, encouraging primary care physicians to routinely screen their adult patients for depression. Although each measure has a unique scoring system, higher scores consistently reflect more severe symptoms.
Signs of depression that are more common in the elderly than in other populations include diminished self-care, irritability, and psychomotor retardation. Geriatric Depression Scale–Short FormReprinted with permission from Sheikh JI, Yesavage JA.
Patients completed three patient reported outcome (PRO) measures and four performance-based measures (PBMs) at baseline to enable an evaluation of construct validity.
These impacts of osteoporosis on a patienta€™s life are often measured in clinical trials using patient-reported outcome (PRO) instruments assessing overall health-related quality of life (HRQL) [1-3]. Participants without fracture were expected to experience stability in their ability to perform daily activities of physical functioning for evaluation of testa€“retest reliability of the OPAQ-PF. The OPAQ-PF was expected to correlate positively with the SF-36 physical functioning, role functioning, bodily pain, vitality, and PCS domain scores.
Then over the following six-month tour of duty, detailed records were kept of each sailora€™s health status. Previous reports have suggested that in order to provide a complete assessment of the benefits of an intervention, evidence of its effect on health-related quality of life (QOL) must be reported [6–8].
This finding has been attributed to the fact that people with lower-limb amputations expect to fall because of their physical constraints or while attempting tasks of increasing difficulty [22]. This may have long-term implications with regards to mobility and social reintegration as well as participation in future physical activity and employment. Initially, participants had the study explained to them by physiotherapists and agreed to be contacted by the principal investigator.
Persons who are depressed have feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt that may be accompanied by an array of physical symptoms. All measures have a statistically predetermined cutoff score at which depression symptoms are considered significant. Early diagnosis and treatment of depression in the elderly improve quality of life and functional status, and may help prevent premature death.When using screening instruments with elderly patients, it is important to consider their level of cognitive impairment along with visual deficits.
Once depression is diagnosed and treatment is initiated, repeated administration of these measures provides an excellent means of tracking response to pharmacotherapy or psychotherapy.Depression measures should be selected based on the patient population (Table 4).
Patients without a recent fracture completed the OPAQ-PF 2 weeks after baseline to enable an evaluation of testa€“retest reliability. However, specific aspects of HRQL need to be well measured in the development of new health technologies as a means to demonstrate and meet patient expectations to maintain and live an active, healthy life with the ability to independently perform activities of daily living, even after experiencing a fracture event [4].New treatments in development for osteoporosis are subject to regulatory review of demonstrated effectiveness and safety, evaluated using measures and methods that conform to published regulatory guidance.
Participants with recent fracture reported greater impairment on the OPAQ-PF than those with no recent fracture (mean score 57.0 vs. The recorded number of Life Change Units were correlated with the sailorsa€™ illness scores.
Health-related QOL measures displayed increases, resulting in large effect sizes though not reaching statistical significance. People with recent lower-limb amputations will continue to adapt to using a prosthetic limb during ADLs as they rejoin the work place and participate in recreational activities including sport and exercise [9–10].
Factors affecting mental health include depression, which is considered an important predictor of QOL [11], as well as the aesthetics of the prosthesis [13,16] and employment status [8].
Although a fear of falling has been linked with reduced QOL, the longitudinal aspects of falls efficacy in people with lower-limb amputations have not been thoroughly investigated, nor has an amputation-??specific measure of falls efficacy been developed [22–23]. The validity of certain depression screening instruments is significantly decreased in patients with a Mini-Mental State Examination score of 15 or less.42A  Table 2 includes information on the BDI, CES-D, and Geriatric Depression Scale (GDS)22 specific to their use in persons older than 60 years. The Pediatric Symptom Checklist may serve as a general psychosocial screen for children and adolescents.
Ability to detect change and interpretation of change were investigated following completion of the OPAQ-PF 12 and 24 weeks postbaseline by patients with a recent fracture. The US Food and Drug Administration (FDA) requires evidence of a specific treatment benefit, defined as a favorable effect on a meaningful aspect of how a patient feels, functions, or survives [5].
Participants with a recent fracture had to have been able to ambulate independently prior to the fracture and to be able to ambulate with or without a walking aid at their baseline visit. Negative correlations were hypothesized between the OPAQ-PF and (i) the WOMAC total and domain scores and (ii) the QUALEFFO-41 pain, physical function, and total scores, in line with their reversed scoring schemes.
Prosthesis-related QOL measures indicated that scales relating to the participants– prostheses improved and the support of significant others was the most positively scored variable. These adaptations may lead to changes in an amputee's physical abilities and will likely have an effect on self-reported QOL.
Coupled with the links between walking ability and QOL [20], results have suggested that as people with amputations regain mobility, there is a positive effect on QOL.
Identifying patients with depression can be difficult in busy primary care settings where time is limited, but certain depression screening measures may help physicians diagnose the disorder.
An interview is necessary because many conditions have symptoms that are common to depression.
The GDS is unique in that it was specifically developed for use in geriatric patients, and it contains fewer somatic items. In adult patient populations, screening with the BDI, CES-D, or Zung measures is recommended in targeted, high-risk populations. Ability to detect change was established with high correlations between changes in OPAQ-PF score and changes in global concept scores in recent fracture patients (ra€‰a‰?a€‰0.6, 24-week change).


No relationships were expected between the OPAQ-PF and the social function, general health perception, and mental function QUALEFFO-41 domains.
Patients who score above the predetermined cut-off levels on the screening measures should be interviewed more specifically for a diagnosis of a depressive disorder and treated within the primary care physician's scope of practice or referred to a mental health subspecialist as clinically indicated. In addition, screening measures do not address important diagnostic features such as duration of symptoms, degree of impairment, and comorbid psychiatric disorders.
Edinburgh Postnatal Depression ScaleReprinted with permission from Cox JL, Chapman G, Murray D, Jones P.
In postpartum women, the Edinburgh Postnatal Depression Scale is the preferred measure.The use of depression screening measures in elderly patients varies with their cognitive status and clinical presentation. Generic measures most commonly used to evaluate patient-reported aspects of HRQL include the Short Form 36 (SF-36 and the EQ-5D [6-12]. The 10MWT and the TUG were expected to correlate negatively with the OPAQ-PF, in line with the revered scoring schemes.
Targeted screening in high-risk patients such as those with chronic diseases, pain, unexplained symptoms, stressful home environments, or social isolation, and those who are postnatal or elderly may provide an alternative approach to identifying patients with depression. An evaluation is critical in ruling out conditions that may present with symptoms of depression, such as hypothyroidism and pancreatic cancer.
In cognitively intact patients older than 65 years, the GDS or one-item screen are currently the preferred instrument because the psychometric data on the BDI and CES-D are mixed in this population.44In patients who have cognitive deficits, interviewer-administered instruments such as the Cornell Scale for Depression in Dementia (Figure 4)24 or the Hamilton Rating Scale for Depression45 are preferred. Use of the GDS is limited to cognitively intact or mildly impaired elderly patients and interviewer-administered instruments, such as the Cornell Scale for Depression in Dementia or the Hamilton Rating Scale, are preferable when cognitive deficits are present. Anchor-based methods identified an OPAQ-PF change of 10 at an individual patient level and 20 at a group level as meaningful to patients.
Types of fracture considered difficult to classify as fragility, versus traumatic, not to result in sufficient physical impairment for OPAQ-PF validation purposes, or to have unpredictable healing rates were excluded. These results provide a novel insight into how QOL and falls efficacy develop in people with lower-limb amputations, alongside changes in mobility, after discharge from rehabilitation. These instruments require more time to administer; however, they are more appropriate than self-report instruments for cognitively impaired patients. However, older patients with depression may also present with unexplained somatic symptoms and may deny sadness or loss of pleasure.
The Osteoporosis Assessment Questionnaire-Physical Functioning (OPAQ-PF) has been developed specifically to meet the requirements of evaluating osteoporosis treatment effectiveness [20].
The existence of observed relationships with a correlation coefficienta€‰a‰?a€‰0.3 and greater than correlations, where no relationship was hypothesized, were taken to support the convergent validity of the OPAQ-PF. Further improvements in physical health following discharge may be required to elicit subsequent increases in overall QOL and concurrent improvements in falls efficacy.
It manifests as a combination of feelings of sadness, loneliness, irritability, worthlessness, hopelessness, agitation, and guilt, accompanied by an array of physical symptoms (Table 1).6 Recognizing depression in patients in a primary care setting may be particularly challenging because patients, especially men, rarely spontaneously describe emotional difficulties. This new 15-item measure captures impact of osteoporosis on patients ability to perform daily activities of physical function and was previously adapted from the OPAQ v 2.0 [13] through a process of item reduction based on item response theory, input from key thought leaders on quality of life issues and measurement in osteoporosis, concept elicitation, and cognitive debriefing interviews conducted with osteoporotic patients with and without experience of fracture [20]. Items are rated on a six-point Likert response scale ranging from no difficulty to completely avoided doing this.
The aim of this current study was to evaluate the measurement properties of the OPAQ-PF following published psychometric standards [21-23]. First, the changes in OPAQ-PF scores and global concept scores at each follow-up point were calculated and Spearmana€™s correlation coefficients used to assess their degree of association. The WOMAC [24] was designed to assess pain, disability, and joint stiffness in osteoarthritis during the last 48 hours. Second, patients were then classified into change categories based on changes in the global concept items.
Comparison of two modes of stress measurement: Daily hassles and uplifts versus major life events. The SF-36 [25] was designed to measure health status in a wide range of conditions as well as in the general population. Finally, the patterns of mean change, and the associated effect sizes, in OPAQ-PF score by global change category were then evaluated. Eight SF-36 domain scores provide a health profile (bodily pain, general health perceptions, mental health, physical functioning, role limitations due to emotional problems, role limitations due to physical problems, social functioning, and vitality), as well as two component summary scores for physical (PCS) and mental health (MCS). The QUALEFFO-41 [26, 27] was designed to measure HRQL in patients with vertebral fractures and produces five domain scores (pain, physical function, social function, general health perception, mental function) and a total score.Three global concept items were developed to evaluate the ability of the OPAQ-PF to detect change and to evaluate interpretation of change [28]. Individual level change, receiver operator characteristic (ROC) curves were used to identify the OPAQ-PF change score (the best cut point), which best distinguishes patients who change to a minimal extent from those who do not. Global concept items were self-completed by participants to reflect overall difficulty in the last 7 days with mobility, physical positions, and transfer activities due to osteoporosis. The area under the curve (AUC) indicates the overall usefulness of the prediction (the observed AUC is compared with the AUC of 0.5 expected from a a€?uselessa€? test), and the best cut point is identified as the value which maximizes the values of sensitivity (proportion of true a€?positivesa€? detected) and specificity (proportion of true a€?negativesa€? detected) [33, 34]. FR is a test of balance impairment and change in balance performance: the maximal forward reach by the participant is measured, using a fixed base of support. Distance is recorded in centimeters, with a shorter reach reflecting a worse health status. Each test was repeated three times with the score being the average of the three attempts.ProceduresSite staff received in-person training to ensure familiarity with protocol requirements, study procedures, and materials.
Clinical site staff screened for eligibility using chart review and discussion with individual patients.Baseline visitAll participants (with and without recent fracture) attended the clinical site for a baseline visit.
Participants completed all PROs and PBMs and provided sociodemographic and other background information.
Individual item scores were correlated with the OPAQ-PF total score further to assess the homogeneity of the items (item-total correlation).
It was hypothesized that patients who have had a recent fracture, had osteoarthritis, or had high WOMAC scores (0 indicates better WOMAC health status) would have poorer OPAQ-PF scores than comparator groups. In addition, patients in the no-recent-fracture group but who had experienced fractures at some point previously were expected to have poorer OPAQ-PF scores if fracture was experienced more recently than patients experiencing fractures longer ago (split at the median).



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