Mobility decline is a symptom of advanced dementia that impacts function, safety, caregiving, and quality of life. The causes of mobility decline in dementia are multi-factorial, including cognitive, physical, and neurological changes. Many of these factors are progressive in nature, leading to a loss of independent mobility and increased numbers of falls. Monitoring mobility status is essential for preventing excess disability in people with dementia however, the cognitive and behavioral symptoms of dementia present unique challenges for mobility assessment. The goals of this review were to identify and describe existing measures of mobility for people with dementia and to determine their feasibility for use in advanced stages of the disease. Electronic searches of Medline, Embase, CINAHL and PsychInfo databases were conducted using key words related to dementia, mobility, measurement, and validation. Descriptive characteristics (e.g. tool purpose, type, reporting method, number of items) were extracted and measures coded for elements of mobility targeted. Study features such as setting and disease severity were also charted. Tools were evaluated for feasibility of use in advanced dementia according to practical details including the need for communication, attention, motivation, and complex motor skills. Tools deemed feasible were screened for psychometric strength. 38 measures were included. 36% of studies included people with advanced dementia. 68% of tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%) and wheeled mobility (3%). Only 18% of tools received high scores for feasibility. Four of the 14 tools screened for psychometric strength showed both good reliability and good external validity. Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most tools are not feasible for individuals with advanced dementia and the psychometric evaluation of these tools is limited. More work is needed to develop a comprehensive, dementia-specific, assessment tool that considers the unique symptoms of dementia. Importantly, such a tool should be designed to identify transitions in mobility through the progression of the disease.
Mobility decline is a symptom of advanced dementia that affects function, safety, caregiving, and quality of life. Monitoring mobility status is essential for initiating timely and targeted interventions aimed at preventing excess disability in people with dementia (PWD). The physical, cognitive, and behavioral symptoms of dementia however, present unique challenges for mobility assessment. The goals of this review were to (a) identify and describe measures of mobility used for PWD and (b) assess measures' feasibility for use in people with advanced dementia; a group whose degree of cognitive impairment results in severe functional deficits.Electronic searches of Medline, Embase, CINAHL, and PsychInfo databases were conducted using keywords related to dementia, mobility, measurement, and validation. Descriptive characteristics were extracted and measures coded for mobility components. Tools were also evaluated for feasibility of use in advanced dementia and those deemed feasible, screened for psychometric strength.Thirty-eight measures were included and 68% of these tools were performance-based. Elements of mobility evaluated were walking (53% of measures), postural transitions (42%), standing (40%), mobility-related behavioral/psychological symptoms (24%), transfers (10%), bed mobility (5%), and wheeled mobility (3%). 36% of studies included people with advanced dementia. Only 18% of tools received high scores for feasibility.Existing measures provide only partial information regarding mobility and few target elements that become relevant as dementia progresses. Most measures are not feasible for people with advanced dementia, and the psychometric evaluation of these measures is limited. Further research is needed to develop a comprehensive, dementia-specific, mobility assessment tool.
To evaluate studies assessing the effectiveness of teaching critical appraisal of the literature to medical students.French and English articles published between 1980 and 1990 indexed on MEDLINE or FAMLI as well as articles identified from the bibliographies.Studies were evaluated if the subjects were undergraduate or postgraduate medical students and if the teaching intervention was aimed at improving one or more of the following areas: knowledge in clinical epidemiology and biostatistics, reading habits and ability to critically appraise a scientific article.The methodologic quality of the articles was assessed by three evaluators, who used a modified version of Poynard's checklist to assign a score. Articles with a score of 60% or more were considered satisfactory. The reliability of the checklist was evaluated by means of the kappa (kappa) coefficient and a coefficient of intraclass correlation.For the three evaluators the mean kappa coefficient was 0.33 and the coefficient of intraclass correlation 0.70. Five of the 10 studies had an overall score of 60% or higher. The quality of the individual sections of the articles varied: purpose of the study 85%, description of the population 58%, methods 44%, analysis of results 50%, and conclusions 90%.The effectiveness of teaching critical appraisal of the literature remains uncertain. More rigorous methods are needed in research in this area.
To identify the most commonly used biostatistical concepts and tests in three journals read by family physicians.Descriptive study of the biostatistical content of 12 issues of the Canadian Medical Association Journal (CMAJ), Canadian Family Physician (CFP), and the New England Journal of Medicine (NEJM).Frequency of citations of concepts and tests, and Spearman's correlation coefficients comparing the biostatistical profiles of the three journals.Biostatistical content of NEJM was diverse (on average, 39 concepts and 21 tests per issue). In CFP, we found 10 concepts and four tests per issue. In CMAJ, there were, on average, nine concepts and five tests per issue.The journals' profiles (order of importance of concepts and tests) were fairly similar.
Abstract Introduction Loss of mobility is common in advanced dementia and has important negative consequences related to fall risk, loss of independence, and lack of participation in meaningful activities. The causes of decline are multifactorial, including disease‐specific changes in motor function, behavior, and cognition. To optimize clinical management of mobility, there is a need to better characterize capacity for safe and independent mobility. This study aimed to identify key factors that impact on mobility in dementia. Methods Expert input was gathered using a modified Delphi consensus approach. The primary criterion for participation was specialist knowledge in mobility or dementia, either as a clinician or a researcher. Participants rated elements of mobility for importance and feasibility of assessment in advanced dementia and prioritized items for inclusion in a mobility staging tool. Descriptive statistics and qualitative content analysis were used to summarize responses. Results Thirty‐six experts completed the first survey with an 80% retention rate over three rounds. One‐third of 61 items reached consensus for being both important and feasible to assess, representing five categories of elements. Items reaching agreement for a staging tool included walking, parkinsonism, gait, impulsivity, fall history, agitation, transfers, and posture control. Discussion This study highlights the need for a multidimensional, dementia‐specific approach to mobility assessment. Results have implications for development of assessment methods and management guidelines to support the clinical care of mobility impairment in people with dementia.
