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For patients with COPD, physical activity (PA) is recommended as the core component of pulmonary rehabilitation, but there is lack of a validated questionnaire for assessing the PA effectively. To evaluate the reliability and validity of the Chinese version of Physical Activity Scale for the Elderly (PASE-C) in patients with COPD. A cross-sectional study was conducted with 167 outpatients aged 60 years or older with COPD. Test-retest reliability and internal consistency were calculated by intraclass correlation coefficient (ICC) and Cronbach's coefficient α, respectively. Validity was evaluated by correlation with the International Physical Activity Questionnaire-Short (IPAQ-S), data of pedometer, Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6), Hospital Anxiety and Depression Scale (HADS), Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), grip strength, and disease characteristics. The PASE-C had an excellent seven-day test-retest reliability (ICC=0.98) and an acceptable internal consistency (Cronbach's α=0.71). The content validity was supported by an item-content validity index, a scale-content validity index/universal agreement, and a scale-content validity index/average value of 0.70-1, 0.70, and 0.93, respectively. Concurrent validity was tested by correlation with IPAQ-S ( =0.651). Criterion validity was confirmed by correlation with the walking steps ( =0.611) and energy expenditure ( =0.493). For construct validity, PASE-C had correlations with SES6 ( =0.396), HADS for depression ( =-0.234), seven subscales of SF-36 ( =0.182-0.525), grip strength ( =0.341), and disease characteristics including the duration of COPD ( =-0.215), modified British Medical Research Council scale ( =-0.354), forced expiratory volume in one second as percentage of predicted ( =0.307), and Global Initiative for Chronic Obstructive Lung Disease grade ( =-0.264), with a good construct validity (all <0.05). The PASE-C has acceptable reliability and validity for patients aged 60 years or older with COPD, and it can be used as a valid tool to measure the PA of patients with COPD in the People's Republic of China.

Background Physical inactivity is a major global public health issue and ranks as the fourth leading modifiable risk factor for mortality from noncommunicable diseases and a major cause of disability. One of the questionnaires used to assess levels of physical activity in older adults is the Physical Activity Scale for the Elderly (PASE). The aim of this study was to determine the cut-off value of the PASE for physical inactivity in older adults. Methods This was a cross-sectional study. The study was conducted at Hacettepe University. In the course of the study, 420 older adults were included on the basis of the established inclusion criteria. Of these, 394 voluntarily agreed to participate. Older adults’ physical activity levels were assessed via the International Physical Activity Questionnaire-Short Form (IPAQ-Short Form) and the PASE. Participants categorized as low/inactive according to the IPAQ scale were classified as physically inactive. Conversely, those categorized as moderate or high activity were classified as physically active. This classification scheme was subsequently utilized to determine the physical inactivity threshold of the PASE. Results The physical inactivity cut-off point for the PASE score in older adults was a score of 67. For identifying physical inactivity, a PASE score of ≤ 67 has a sensitivity of 0.76 and a specificity of 0.61. Among the 394 older adults who participated in the study, 163 were in the inactive group, and 231 were in the active group. The prevalence of physical inactivity was 41.37% in this study. Conclusions In the present study, the PASE was found to have moderate sensitivity and specificity in discriminating physical inactivity. It is not a sufficient stand-alone measure for physical inactivity, so it is recommended that the PASE be included as part of a comprehensive physical inactivity assessment in older adults.

BackgroundFunctional demands of patients undergoing knee arthroplasty are increasing. However, it remains unclear which patient-specific factors have an impact on postoperative activity and whether there is a difference between total and unicompartmental knee arthroplasties (TKA/UKA).Materials and methodsThis retrospective study analyzed 1907 knees with TKA (n = 1746) or UKA (n = 161), implanted for primary osteoarthritis. Pain and activity (lower extremity activity scale, LEAS) were assessed 2 years after surgery. High activity was defined as LEAS ≥ 14. Cohorts were compared using Kruskal–Wallis or Pearson-Chi-square test. A generalized least squares model was used to predict LEAS scores between cohorts adjusted for age, sex, BMI, Charlson Comorbidity Index, ASA score, and preoperative LEAS.ResultThere was no difference in pain 2 years after surgery between UKA and TKA (p = 0.952). Preoperative LEAS was similar for UKA and TKA (p = 0.994), and both groups showed significant (p < 0.001 respectively) and similar improvements after surgery (p = 0.068). LEAS 2 years after surgery was 11.1 (SD 3.2) for TKA and 11.9 (SD 3.5) for the UKA group (p = 0.004). After adjusting for preoperative LEAS, age, sex, BMI, CCI and ASA, the difference was not significant (p = 0.225). Male sex, lower BMI, higher preoperative LEAS, and younger age were associated with higher postoperative LEAS (p < 0.001, respectively).ConclusionPatients can achieve a high level of activity following both TKA and UKA. While the postoperative activity level did not depend on the type of the procedure, younger age, male sex, lower BMI, and a higher preoperative activity level were associated with a higher postoperative activity level.

Introduction Alterations in narrow‐band spectral power of electroencephalography (EEG) recordings are commonly reported in patients with schizophrenia (SZ). It is well established however that electrophysiological signals comprise a broadband scale‐free (or fractal) component generated by mechanisms different from those producing oscillatory neural activity. Despite this known feature, it has not yet been investigated if spectral abnormalities found in SZ could be attributed to scale‐free or oscillatory brain function. Methods In this study, we analyzed resting‐state EEG recordings of 14 SZ patients and 14 healthy controls. Scale‐free and oscillatory components of the power spectral density (PSD) were separated, and band‐limited power (BLP) of the original (mixed) PSD, as well as its fractal and oscillatory components, was estimated in five frequency bands. The scaling property of the fractal component was characterized by its spectral exponent in two distinct frequency ranges (1–13 and 13–30 Hz). Results Analysis of the mixed PSD revealed a decrease of BLP in the delta band in SZ over the central regions; however, this difference could be attributed almost exclusively to a shift of power toward higher frequencies in the fractal component. Broadband neural activity expressed a true bimodal nature in all except frontal regions. Furthermore, both low‐ and high‐range spectral exponents exhibited a characteristic topology over the cortex in both groups. Conclusion Our results imply strong functional significance of scale‐free neural activity in SZ and suggest that abnormalities in PSD may emerge from alterations of the fractal and not only the oscillatory components of neural activity. In this study, we separated the scale‐free (fractal) and oscillatory components of the power spectral density (PSD) of electroencephalography recordings acquired from healthy controls (HC) and patients with schizophrenia (SZ). We found increased delta band‐limited power in SZ when compared to HC in the raw PSD; however, this difference was only present in its fractal but not its oscillatory component. Our results imply strong functional significance of scale‐free neural activity in SZ and suggest that abnormalities in PSD may emerge from alterations of the fractal and not only the oscillatory components of neural activity.

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by high hetero­geneity of clinical manifestations and an uncertain prognosis. Although the mortality rate due to SLE has decreased significantly in recent decades, there is still a need to find good tools to measure disease activity for early detection of exacerbations and treatment planning. Over the decades, more than a dozen disease activity scales/indicators have been developed, with the SLE Disease Activity Index (SLEDAI) being the most popular. More recently, the new SLE Disease Activity Score (SLE-DAS) has been introduced. This paper compares the two methods of assessing SLE activity, and presents the relevance of these scales in pregnant SLE patients and their use in formulating definitions of remission and low disease activity. The results show that the SLEDAI and the SLE-DAS are of comparable value in assessing SLE activity and complement each other.

IntroductionIt has been suggested that high activity might negatively impact implant survival following total and unicompartmental knee arthroplasty (TKA/UKA) and many surgeons advise their patients to only participate in moderate level sport activities. To date, it remains unclear whether such restraints are necessary to assure longevity of the implants.Materials and methodsWe conducted a retrospective study on 1906 knees (1745 TKA, 161 UKA) in 1636 patients aged 45–75 years who underwent primary arthroplasty for primary osteoarthritis. Lower extremity activity scale (LEAS) at a two year follow-up was assessed to define the activity level. Cases were grouped in low (LEAS ≤ 6), moderate (LEAS 7–13) and high activity (LEAS ≥ 14). Cohorts were compared with Kruskal–Wallis- or Pearson-Chi2-Test. Univariate logistic regression was conducted to test for association between activity level at two years and later revisions. Odds ratio was reported and converted to predicted probability. A Kaplan–Meier curve was plotted to predict implant survival.ResultsThe predicted implant survival for UKA was 100.0% at two years and 98.1% at five years. The predicted implant survival for TKA was 99.8% at two years, 98.1% at five years. The difference was not significant (p = 0.410). 2.5% of the UKA underwent revision, one knee in the low and three knees in the moderate activity group, differences between the moderate and high activity group were not significant (p = 0.292). The revision rate in the high activity TKA group was lower than in the low and moderate activity groups (p = 0.008). A higher LEAS two years after surgery was associated with a lower risk for future revision (p = 0.001). A one-point increase in LEAS two years after surgery lowered the odds for undergoing revision surgery by 19%.ConclusionsThe study suggests that participating in sports activity following both UKA and TKA is safe and not a risk factor for revision surgery at a mid-term follow-up. Patients should not be prevented from an active lifestyle following knee replacement.

Background: Functional or quality of life questionnaires are important tools in clinical investigations. The Lysholm Knee Scoring Scale and Tegner Activity Scale are knee-specific questionnaires that are widely used to assess knee function. Purpose: To translate both questionnaires into Thai and to assess the validity and reliability of the Thai versions of the Lysholm and adjusted Tegner scales. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The Lysholm and Tegner scales were translated into Thai by using the forward-backward translation protocol. Because cultural modifications were made to the sports used to measure activity on the Tegner scale, the authors of this study refer to the Thai version as the “Thai adjusted Tegner scale.” The reliability and validity of the translated scales were evaluated by obtaining the responses of 60 consecutive patients (mean age, 40.5 years; 34 male, 26 female); the patients also completed the Thai version of the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF). Criterion validity was tested by correlating the scores from both translated questionnaires with those from the Thai IKDC-SKF, while reliability was assessed by measuring test-retest reliability and internal consistency. Results: The Thai Lysholm scale showed a strong correlation with the Thai IKDC-SKF (r = 0.89), while the Thai adjusted Tegner scale showed a moderate correlation with the Thai IKDC-SKF (r = 0.60). The intrarater and test-retest reliability measures were excellent for the Thai Lysholm (intraclass correlation coefficient [ICC], 0.94 and 0.98, respectively) and moderate to good for the Thai adjusted Tegner (ICC, 0.73 and 0.86, respectively). The internal consistency for the Thai Lysholm was acceptable at all the time points (Cronbach alpha, 0.71-0.73). Conclusion: The Thai Lysholm and Thai adjusted Tegner scales adequately retained the characteristics of the original versions. They can be considered reliable instruments for Thai patients with knee-related problems.

Background There is a need for a validated simple Dutch paediatric activity scale. The purpose was to translate and transculturally validate the Dutch Hospital for Special Surgery Paediatric Functional Activity Brief Scale (HSS Pedi-FABS) questionnaire in healthy children and adolescents. Methods The original HSS Pedi-FABS was translated forward and backward and was transculturally adapted after performing a pilot study among children and professionals. The final version of the Dutch HSS Pedi-FABS was validated in healthy children and adolescents aged 10 to 18 years old. Children who had any condition or injury limiting their normal physical activity were excluded. The interval between the first questionnaire T0 (HSS Pedi-FABS, Physical Activity Questionnaire for children or adolescents (PAQ-C/A) and Tegner activity scale) and the second questionnaire T1 (HSS Pedi-FABS) was 2 weeks. Construct validity, interpretability and reliability were evaluated. Content validity was evaluated through cognitive interviews among a smaller group of children and through a questionnaire among professionals. Results To evaluate content validity, 9 children and adolescents were interviewed, and 30 professionals were consulted. Content validity among professionals showed a relevance of less than 85% for most items on construct. However, content validity among children was good with a 92% score for item relevance. Readability was scored at a reading level of 11- to 12-year-olds. The validation group consisted of 110 healthy children and adolescents (mean age of 13.9 years ±2.6). Construct validity was considered good as 8 out of 10 hypotheses were confirmed. The Dutch HSS Pedi-FABS showed no floor or ceiling effect. Analysis of the internal consistency in the validation group resulted in a Cronbach’s alpha of 0.82. Test-retest reliability was evaluated among 69 children and adolescents and revealed an Intraclass Correlation Coefficient (ICC) of 0.76. Conclusion The Dutch HSS Pedi-FABS showed good psychometric properties in a healthy Dutch paediatric and adolescent population. Limitations of the current Dutch HSS Pedi-FABS are content validity on construct of items reported by professionals.

Purpose Adequate dietary protein intake is required to postpone and treat sarcopenia in elderly people. Insight into dietary protein intake in this heterogeneous population segment is needed to locate dietary inadequacies and to identify target populations and feeding strategies for dietary interventions. Therefore, we assessed dietary protein intake, distribution of protein intake throughout the day, and the use of protein-containing food sources in community-dwelling, frail, and institutionalized elderly people in the Netherlands. Methods Secondary analyses were carried out using dietary data collected from studies among community-dwelling, frail, and institutionalized elderly people to evaluate protein intake characteristics. Results Dietary protein intake averaged 1.1 ± 0.3 g/kg-bw/day in community-dwelling, 1.0 ± 0.3 g/kg-bw/day in frail, and 0.8 ± 0.3 g/kg-bw/day in institutionalized elderly men. Similar protein intakes were found in women. Ten percent of the community-dwelling and frail elderly and 35% of the institutionalized elderly people showed a protein intake below the estimated average requirement (0.7 g/kg-bw/day). Protein intake was particularly low at breakfast in community-dwelling (10 ± 10 g), frail (8 ± 5 g), and institutionalized elderly people (12 ± 6 g) with bread and dairy products as predominant protein sources. Conclusions Whereas daily protein intake is generally well above the recommended dietary allowance in community-dwelling and frail elderly people, a significant proportion of institutionalized elderly showed an intake below the current protein requirement, making them an important target population for dietary interventions. Particularly at breakfast, there is scope for improving protein intake.

Background: The Tegner activity scale is a patient-reported questionnaire that is frequently used to measure activity levels in patients with anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to translate, cross-culturally adapt, and validate the Tegner activity scale into Arabic. Methods: The Tegner activity scale–Arabic version (TAS-Ar) was forward and backward translated, cross-culturally adapted, and validated according to established guidelines. Seventy-five patients who underwent ACLR were instructed to complete the TAS-Ar, the International Knee Documentation Committee (IKDC) subjective knee evaluation form, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) scale. The test-retest reliability of the TAS-Ar was assessed in 39 patients. Statistical tests were conducted to test the reliability and construct validity of the TAS-Ar. Results: The TAS-Ar showed excellent test-retest reliability, with intraclass correlation coefficients of 0.836 (p < 0.001). The TAS-Ar was significantly correlated with the IKDC (Spearman’s rho = 0.476, p < 0.001), all KOOS subscales (Spearman’s rho = 0.195–0.497, p < 0.05), and the KOOS total score (Spearman’s rho = 0.469, p < 0.001). Conclusions: The Arabic version of the Tegner activity scale is a reliable and valid measure that can be used to evaluate the activity level of Arabic-speaking patients following ACLR.