Magnitude and meaningfulness of change in SF-36 scores in four types of orthopedic surgery

Background: The Medical Outcomes General Health Survey (SF-36) is a widely used health status measure; however, limited evidence is available for its performance in orthopedic settings. The aim of this study was to examine the magnitude and meaningfulness of change and sensitivity of SF-36 subscales following orthopedic surgery.

Methods: Longitudinal data on outcomes of total hip replacement (THR, n = 255), total knee replacement (TKR, n = 103), arthroscopic partial meniscectomy (APM, n = 74) and anterior cruciate ligament reconstruction (ACL, n = 62) were used to estimate the effect sizes (ES, magnitude of change) and minimal detectable change (sensitivity) at the group and individual level. To provide context for interpreting the magnitude of changes in SF-36 scores, we also compared patients' scores with age and sex-matched population norms. The studies were conducted in Sweden. Follow-up was five years in THR and TKR studies, two years in ACL, and three months in APM.

Results: On average, large effect sizes (ES≥0.80) were found after orthopedic surgery in SF-36 subscales measuring physical aspects (physical functioning, role physical, and bodily pain). Small (0.20–0.49) to moderate (0.50–0.79) effect sizes were found in subscales measuring mental and social aspects (role emotional, vitality, social functioning, and mental health). General health scores remained relatively unchanged during the follow-up. Despite improvements, post-surgery mean scores of patients were still below the age and sex matched population norms on physical subscales. Patients' scores on mental and social subscales approached population norms following the surgery. At the individual level, scores of a large proportion of patients were affected by floor or ceiling effects on several subscales and the sensitivity to individual change was very low.

Conclusion: Large to moderate meaningful changes in group scores were observed in all SF-36 subscales except General Health across the intervention groups. Therefore, in orthopedic settings, the SF-36 can be used to show changes for groups in physical, mental, and social dimensions and in comparison with population norms. However, SF-36 subscales have low sensitivity to individual change and so we caution against using SF-36 to monitor the health status of individual patients undergoing orthopedic surgery.

Absolute versus relative difference measures of priming: Which is appropriate when baseline scores change with age?

It is often of theoretical interest to know if implicit memory (repetition priming) develops across childhood under a given circumstance. Methodologically, however, it is difficult to determine whether development is present when baseline performance for unstudied items improves with age. Calculation of priming in absolute (priming=studied - unstudied) or relative-to-baseline terms can lead to different conclusions. In first noting this problem, Parkin (1993) suggested using the Snodgrass (1989a) calculation of relative priming [priming=(studied - unstudied)/(maximum - unstudied)], and most developmental studies have since adopted this procedure. Here, we question the Snodgrass method because the Snodgrass method's results are not replicated in the picture identification task when baselines are equated experimentally across age groups. Instead, results support an absolute measure of priming. Theoretically, we argue against its core assumption; namely, that children and adults always lie on the same learning curve, with an equal maximum performance level and equal rate of learning.

The effects of phonological and morphological training on speech perception scores and grammatical judgments in deaf and hard-of-hearing children

Seventeen primary school deaf and hard-of-hearing children were given two types of training for 9 weeks each. Phonological training involved practice of /s, z, t, d/ in word final position in monomorphemic words. Morphological training involved learning and practicing the rules for forming third-person singular, present tense, past tense, and plurals. The words used in the two training types were different (monomorphemic or polymorphemic) but both involved word final /s, z, t, d/. Grammatical judgments were tested before and after training using short sentences that were read aloud by the child (or by the presenter if the child was unable to read them). Perception was tested with 150 key words in sentences using the trained morphemes and phonemes in word final position. Grammatical judgments for sentences involving the trained morphemes improved significantly after each type of training. Both types of training needed to be completed before a significant improvement was found for speech perception scores. The results suggest that both phonological and morphological training are beneficial in improving speech perception and grammatical performance of deaf and hard-of-hearing children and that both types of training were required to obtain the maximum benefit.

Separating the contributions of hearing, lexical knowledge and speech production to speech perception scores in children with hearing impairments.

Open-set word and sentence speech-perception test scores are commonly used as a measure of hearing abilities in children and adults using cochlear implants and/or hearing aids. These tests are usually presented auditorily with a verbal response. In the case of children, scores are typically lower and more variable than for adults with hearing impairments using similar devices. It is difficult to interpret children's speech-perception scores without considering the effects of lexical knowledge and speech-production abilities on their responses. This study postulated a simple mathematical model to describe the effects of hearing, lexical knowledge, and speech production on the perception test scores for monosyllabic words by children with impaired hearing. Thirty-three primary-school children with impaired hearing, fitted with hearing aids and/or cochlear implants, were evaluated using speech-perception, reading-aloud, speech-production, and language measures. These various measures were incorporated in the mathematical model, which revealed that performance in an open-set word-perception test in the auditory-alone mode is strongly dependent on residual hearing levels, lexical knowledge, and speech-production abilities. Further applications of the model provided an estimate of the effect of each component on the overall speech-perception score for each child.

Scores on the dietary guideline index for children and adolescents are associated with nutrient intake and socio-economic position but not adiposity 1-3

Diet quality indices reflect overall dietary patterns better than single nutrients or food groups. The study aims were to develop a measure of adherence with dietary guidelines applicable to child and adolescent populations in Australia and determine the association between index scores and food and nutrient intake, socio-demographic characteristics, and measures of adiposity. Data were analyzed from 4- to 16-y-old participants of the 2007 Australian Children’s Nutrition and Physical Activity Survey (n = 3416). The Dietary Guideline Index for Children and Adolescents (DGI-CA) comprises 11 components: 5 core food groups, wholegrain bread, reduced-fat dairy foods, extra foods (nutrient poor and high in fat, salt, and added sugar), healthy fats/oils, water, and diet variety (possible score of 100). The index criteria were age specific. The mean DGI-CA score was low (53.6 ± 0.4), similar between boys and girls, and differed by age; the youngest children scored higher than the oldest children (P < 0.0001). Higher DGI-CA scores were associated with lower energy intake, energy density, total and saturated fat, and sugar intake; higher protein, carbohydrate, fiber, calcium, iron, vitamin C, vitamin A, folate, phosphorous, magnesium, zinc, and iodine intakes; and a higher polyunsaturated:saturated fat ratio (P < 0.0001). DGI-CA scores were associated with socio-economic characteristics and measures of family circumstance. Weak positive associations were observed between DGI-CA score and BMI or waist circumference Z-scores in the 4- to 10-y and 12- to 16-y age groups only. This index is the first validated index in Australia and one of the few international indices to describe the diet quality of children and adolescents.

Sharing good NEWS across the world: developing comparable scores across 12 countries for the neighborhood environment walkability scale (NEWS)

Background: The IPEN (International Physical Activity and Environment Network) Adult project seeks to conduct pooled analyses of associations of perceived neighborhood environment, as measured by the neighborhood Environment Walkability Scale (NEWS) and its abbreviated version (NEWS-A), with physical activity using data from 12 countries. As IPEN countries used adapted versions of the NEWS/NEWS-A, this paper aimed to develop scoring protocols that maximize cross-country comparability in responses. This information is also highly relevant to non-IPEN studies employing the NEWS/NEWS-A, which is one of the most popular measures of perceived environment globally.
Methods: The following countries participated in the IPEN Adult study: Australia, Belgium, Brazil, Colombia, Czech Republic, Denmark, Hong Kong, Mexico, New Zealand, Spain, the United Kingdom, and the United States. Participants (N = 14,305) were recruited from neighborhoods varying in walkability and socio-economic status. Countries collected data on the perceived environment using a self- or interviewer-administered version of the NEWS/NEWS-A. Confirmatory Factor Analysis (CFA) was used to derive comparable country-specific measurement models of the NEWS/NEWS-A. The level of correspondence between standard and alternative versions of the NEWS/NEWS-A factor-analyzable subscales was determined by estimating the correlations and mean standardized difference (Cohen’s d) between them using data from countries that had included items from both standard and alternative versions of the subscales.
Results: Final country-specific measurement models of the NEWS/NEWS-A provided acceptable levels of fit to the data and shared the same factorial structure with six latent factors and two single items. The correspondence between the standard and alternative versions of subscales of Land use mix – access, Infrastructure and safety for walking/cycling, and Aesthetics was high. The Brazilian version of the Traffic safety subscale was highly, while the Australian and Belgian versions were marginally, comparable to the standard version. Single-item versions of the Street connectivity subscale used in Australia and Belgium showed marginally acceptable correspondence to the standard version.
Conclusions: We have proposed country-specific modifications to the original scoring protocol of the NEWS/NEWS-A that enhance inter-country comparability. These modifications have yielded sufficiently equivalent measurement models of the NEWS/NEWS-A. Some inter-country discrepancies remain. These need to be considered when interpreting findings from different countries.

Improvements in fundamental movement skill competency mediate the effect of the SCORES intervention on physical activity and cardiorespiratory fitness in children

Numerous studies have identified a positive association between fundamental movement skill (FMS) competency and physical activity in children; however, the causal pathways have not been established. The aim of this study is to determine if changes in FMS competency mediated the effect of the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention on physical activity and cardiorespiratory fitness in children. Eight primary schools (25 classes) and 460 children (aged 8.5 ± 0.6, 54% girls) were randomised to the SCORES intervention or control group for the 12-month study. The outcomes were accelerometer-determined moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness. The hypothesised mediators were actual FMS competency and perceived sport competence. Mediation analyses were conducted using multilevel linear analysis in MPlus. From the original sample, 138 (30.0%) and 370 (80.4%) children provided useable physical activity and cardiorespiratory fitness data at post-test assessments. There were significant treatment effects for locomotor skills and overall FMSs. Changes in MVPA were associated with changes in object-control skills, overall FMSs and perceived competence. The overall FMSs had a significant mediating effect on MVPA (AB = 2.09, CI = 0.01-4.55). Overall FMSs (AB = 1.19, CI = 0.002-2.79) and locomotor skills (AB = 0.74, CI = 0.01-1.69) had a significant mediating effect on cardiorespiratory fitness. The results of this study conclude that actual but not perceived movement skill competency mediated the effect of the SCORES intervention on physical activity and cardiorespiratory fitness.

Using Patient Health Questionnaire-9 item parameters of a common metric resulted in similar depression scores compared to independent item response theory model reestimation

Objectives: To investigate the validity of a common depression metric in independent samples. Study Design and Setting: We applied a common metrics approach based on item-response theory for measuring depression to four German-speaking samples that completed the Patient Health Questionnaire (PHQ-9). We compared the PHQ item parameters reported for this common metric to reestimated item parameters that derived from fitting a generalized partial credit model solely to the PHQ-9 items. We calibrated the new model on the same scale as the common metric using two approaches (estimation with shifted prior and StockingeLord linking). By fitting a mixed-effects model and using BlandeAltman plots, we investigated the agreement between latent depression scores resulting from the different estimation models. Results: We found different item parameters across samples and estimation methods. Although differences in latent depression scores between different estimation methods were statistically significant, these were clinically irrelevant. Conclusion: Our findings provide evidence that it is possible to estimate latent depression scores by using the item parameters from a common metric instead of reestimating and linking a model. The use of common metric parameters is simple, for example, using a Web application (http://www.common-metrics.org) and offers a long-term perspective to improve the comparability of patient-reported outcome measures.

What’s the score? Using scores in dance improvisation

This paper explores the use of scores or verbal propositions inimprovising dance. Examining my use of scores in my own improvisationpractice it discusses what scores might be and might do and how theyrelate to the real time composition of dance in the present of its making.To help explore these ideas I refer to the theory of Nelson Goodman anddiscuss the use of scores by other dance practitioners including StevePaxton, Yvonne Meier and Anna Halprin.

An extended approach to adjust inconsistent minority peer- and self-assessment scores of teamwork using assessor’s reliability

Teamwork is generally assessed either solely by academic staff or by both academic staff andstudents themselves confidentially as well as collaboratively. Peer- and self-assessments have beenused primarily to assess teamwork process and teacher assessment to assess teamwork product.Peer- and self-assessments are useful to elicit team members’ contribution towards teamwork and toconvert team mark into individual marks, provided the scores are reliable (the extent to which thescores are consistent). However, not all peer- and self-assessment scores are reliable. Anecdotal andliterature evidence suggest that there are several cases of inconsistencies in these scores. Individualcontribution scores given by teammates to an assessee (including himself/herself) can sometimesvary significantly due to both intentional and unintentional reasons. Simply using total individual ratingscores without considering an assessor’s reliability to estimate individual contribution factors cansometime results unfair grades and becomes hindrance to learning through teamwork.PURPOSEThis study proposes an extended approach to adjust inconsistent and/or distorted minority peer andself-assessment scores of teamwork using standard normal probability concept.APPROACHIn order to adjust inconsistent and/or distorted minority peer-and self-assessment scores of teamwork,an extended approach has been proposed. The approach uses the reliability of assessor’s scores ofan assessee using standard normal probability curve. The evaluation of the extended approach isconducted by comparing with the existing approaches using two case examples of peer- and selfassessmentof teamwork where minority team members’ scores are inconsistent.RESULTSThe evaluation of the extended approach shows that the proposed method is superior to the availableapproaches in order to adjust inconsistent peer- and self-assessment scores for special cases wherescores of minority team members are inconsistent. The extended approach helps both to automaticallydetect such scoring anomalies and to adjust the scores so that the fairer contributions to the teamworkwould be obtained and utilised.CONCLUSIONSThe extended approach is useful in that it helps both to automatically detect scoring anomalies and todevise the methods to adjust them. However, the approach does not address the issue of scoringinconsistencies by majority of team members as it uses average score as a basis for identifyinginconsistencies. Moreover, the approach needs to be implemented in the real teamwork environmentin order to identify the impacts of these scoring adjustments in teamwork process and teamworkproduct.