BackgroundThe impact of dizziness on quality of life is often assessed by the Dizziness Handicap Inventory (DHI), which is used as a discriminate and evaluative measure. The aim of the present study was to examine reliability and validity of a translated Norwegian version (DHI-N), also examining responsiveness to important change in the construct being measured.MethodsTwo samples (n = 92 and n = 27) included participants with dizziness of mainly vestibular origin. A cross-sectional design was used to examine the factor structure (exploratory factor analysis), internal consistency (Cronbach's α), concurrent validity (Pearson's product moment correlation r), and discriminate ability (ROC curve analysis). Longitudinal designs were used to examine test-retest reliability (intraclass correlation coefficient (ICC) statistics, smallest detectable difference (SDD)), and responsiveness (Pearson's product moment correlation, ROC curve analysis; area under the ROC curve (AUC), and minimally important change (MIC)). The DHI scores range from 0 to 100.ResultsFactor analysis revealed a different factor structure than the original DHI, resulting in dismissal of subscale scores in the DHI-N. Acceptable internal consistency was found for the total scale (α = 0.95). Concurrent correlations between the DHI-N and other related measures were moderate to high, highest with Vertigo Symptom Scale-short form-Norwegian version (r = 0.69), and lowest with preferred gait (r = - 0.36). The DHI-N demonstrated excellent ability to discriminate between participants with and without 'disability', AUC being 0.89 and best cut-off point = 29 points. Satisfactory test-retest reliability was demonstrated, and the change for an individual should be ≥ 20 DHI-N points to exceed measurement error (SDD). Correlations between change scores of DHI-N and other self-report measures of functional health and symptoms were high (r = 0.50 - 0.57). Responsiveness of the DHI-N was excellent, AUC = 0.83, discriminating between self-perceived 'improved' versus 'unchanged' participants. The MIC was identified as 11 DHI-N points.ConclusionsThe DHI-N total scale demonstrated satisfactory measurement properties. This is the first study that has addressed and demonstrated responsiveness to important change of the DHI, and provided values of SDD and MIC to help interpret change scores.

Patients with severe dementia and mixed dementia are at high risk to suffer from severe pain. More research and quality improvement programs are needed to increase the knowledge in pain treatment by staff, which requires competence in both pain assessment and dementia.

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (alpha=0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient=0.70-0.96), but varied between poor and excellent for pain behavior indicators (kappa=0.05-0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable and valid pain intensity scores in patients with SCI.

On the basis of pain behaviours, standardized movements and pain drawings, MOBID-2 Pain Scale was shown to be sufficiently reliable, valid and time-effective for nurses to assess pain in patients with severe dementia.

Abilities of the Short-Form McGill Pain Questionnaire to assess change have scarcely been addressed in previous studies. The aim of the present study was to examine test-retest reliability, sensitivity to change and responsiveness to clinically important change using a Norwegian version (NSF-MPQ) in different groups of patients. ICC(1,1) values for test-retest reliability (relative reliability) assessed 1-3 days apart for total, sensory and affective scores were, respectively, 0.75, 0.76 and 0.62 in patients with musculoskeletal pain (n=58), and 0.93, 0.95 and 0.79 in patients with rheumatic pain (n=25). Variability in total scores (absolute reliability) was less in patients with rheumatic pain (within-subject standard deviation, S(w)=2.70) than in patients with musculoskeletal pain (S(w)=4.28). Sensitivity to change by standardized response mean (SRM) was mostly large (>0.80) for three patient groups reporting improvement after treatment. More sensitivity to change was demonstrated by the total and sensory scores than by the affective score, and sensitivity of the total score was similarly good to capture improvement as the Visual Analogue Scale (VAS). Indication was provided that mean improvement of groups in NSF-MPQ total scores should be >5 on the 0-45 scale to demonstrate a clinically important change. Responsiveness to clinically important change by receiver operating characteristic curve analysis was modest, as area under the curve indicating ability to discriminate improved and not improved patients with musculoskeletal pain, was only 0.61. The study indicates mostly satisfactory test-retest reliability and responsiveness values of the NSF-MPQ, but shows that the measurement properties vary between groups of patients with pain.

Biochar properties vary, and characterization of biochars is necessary for assessing their potential to sequester carbon and improve soil functions. This study aimed at assessing key surface properties of agronomic relevance for products from slow pyrolysis at 250-800 °C, hydrothermal carbonization (HTC), and flash carbonization. The study further aimed at relating surface properties to current characterization indicators. The results suggest that biochar chemical composition can be inferred from volatile matter (VM) and is consistent for corncob and miscanthus feedstocks and for the three tested production methods. High surface area was reached within a narrow temperature range around 600 °C, whereas cation exchange capacity (CEC) peaked at lower temperatures. CEC and pH values of HTC chars differed from those of slow pyrolysis biochars. Neither CEC nor surface area correlated well with VM or atomic ratios. These results suggest that VM and atomic ratios H/C and O/C are good indicators of the degree of carbonization but poor predictors of the agronomic properties of biochar.

BackgroundMobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) pain scale is a staff-administered pain tool for patients with dementia. This study explores MOBID-2's test–retest reliability, measurement error and responsiveness to change.MethodsAnalyses are based upon data from a cluster randomized trial including 352 patients with advanced dementia from 18 Norwegian nursing homes. Test–retest reliability between baseline and week 2 (n = 163), and weeks 2 and 4 (n = 159) was examined in patients not expected to change (controls), using intraclass correlation coefficient (ICC2.1), standard error of measurement (SEM) and smallest detectable change (SDC). Responsiveness was examined by testing six priori-formulated hypotheses about the association between change scores on MOBID-2 and other outcome measures.ResultsICCs of the total MOBID-2 scores were 0.81 (0–2 weeks) and 0.85 (2–4 weeks). SEM and SDC were 1.9 and 3.1 (0–2 weeks) and 1.4 and 2.3 (2–4 weeks), respectively. Five out of six hypotheses were confirmed: MOBID-2 discriminated (p < 0.001) between change in patients with and without a stepwise protocol for treatment of pain (SPTP). Moderate association (r = 0.35) was demonstrated with Cohen-Mansfield Agitation Inventory, and no association with Mini-Mental State Examination, Functional Assessment Staging and Activity of Daily Living. Expected associations between change scores of MOBID-2 and Neuropsychiatric Inventory – Nursing Home version were not confirmed.ConclusionThe SEM and SDC in connection with the MOBID-2 pain scale indicate that the instrument is responsive to a decrease in pain after a SPTP. Satisfactory test–retest reliability across test periods was demonstrated. Change scores ≥ 3 on total and subscales are clinically relevant and are beyond measurement error.

Bimanual training was as effective as modified constraint-induced movement therapy in improving arm motor function. Wearing a mitt seems unnecessary for most patients in the subacute phase post stroke when focused affected arm training is provided.