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Psychometric properties of two ADHD rating scales used in children with ADHD and intellectual disability 用于多动症和智障儿童的两种多动症评分量表的心理计量特性。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-09-07 DOI: 10.1111/jir.13185
M. Palmer, Z. Fang, V. Carter Leno, E. Simonoff

Background

Attention deficit hyperactivity disorder (ADHD) is often present in people with intellectual disability (ID) and autism. However, few ADHD measures have been developed specifically for individuals with these conditions. There is little literature exploring how well ADHD measures are performing at picking up specific symptoms at the item level.

Methods

Analyses were conducted on data from 122 children aged 7–15 years old with diagnoses of both ADHD and ID enrolled in the Hyperactivity and Special Educational Needs trial. Parents and teachers completed ratings of ADHD symptoms on the Aberrant Behavior Checklist (ABC) hyperactivity subscale and the revised Conners' Rating Scales hyperactivity scale and ADHD index. Cronbach's alpha was used to examine the reliability of these measures. Item response theory explores the performance of individual items. Multiple indicators, multiple causes models were used to test for measurement invariance by ID severity, co-occurring autism traits and child age.

Results

The reliability of parent and teacher reports of ADHD symptoms on the Conners' and ABC was acceptable across the range of ID. Item performance was generally good, and information was provided across the continuum of ADHD traits. Few items on either measure were non-invariant (i.e., item endorsement generally did not differ based on other child characteristics). When non-invariance was found, the effect was small.

Conclusions

Both the parent-reported and teacher-reported versions of the Conners' hyperactivity scale and ADHD index and the ABC hyperactivity subscale appear to function well in the current sample of children with co-occurring ADHD and ID.

背景:智力障碍(ID)和自闭症患者通常会出现注意力缺陷多动障碍(ADHD)。然而,专门针对这些患者开发的注意力缺陷多动障碍测量方法却寥寥无几。很少有文献探讨注意力缺陷多动障碍测量方法在项目水平上识别特定症状的能力:对参加多动和特殊教育需求试验的 122 名 7-15 岁同时被诊断为多动症和智障的儿童的数据进行了分析。家长和教师根据异常行为核对表(ABC)多动分量表和修订版康纳斯评定量表多动量表及多动症指数对多动症症状进行评分。Cronbach's alpha 用于检验这些量表的可靠性。项目反应理论探讨了单个项目的表现。采用多指标、多原因模型来检验自闭症严重程度、共存自闭症特征和儿童年龄的测量不变量:结果:家长和教师对康纳斯多动症症状报告和 ABC 报告的可靠性在各种 ID 中都是可以接受的。项目表现总体良好,提供的信息涵盖了ADHD的所有特征。在这两种测量中,很少有项目是非变异的(即项目认可一般不会因儿童的其他特征而不同)。即使发现了非变量,影响也很小:结论:家长报告和教师报告版本的康纳斯多动量表和ADHD指数以及ABC多动分量表在目前的多动症和智障并存儿童样本中似乎效果良好。
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引用次数: 0
An exploration into self-reported inactivity behaviours of adults with an intellectual disability using physical activity questionnaires 利用体育活动调查问卷对智障成人自我报告的不活动行为进行探索。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-09-04 DOI: 10.1111/jir.13184
L. Lynch, M. McCarron, P. McCallion, E. Burke

Background

Inactivity is a correlate of adverse health. Adults with an intellectual disability (ID) are more inactive than the general population and often present with more complex health issues. Self-reported activity questionnaires such as the International Physical Activity Questionnaire – Short Form (IPAQ-SF) and Rapid Assessment of Physical Activity (RAPA) questionnaire are the predominant source of activity information because of their low cost, non-invasive nature, ease of administration and interpretation of results.

Methods

Correlates of inactivity among the general and ID populations were identified through a literature scoping review. Inactivity was measured using the RAPA and the IPAQ-SF. A multiple-imputation chained equation was used to impute missing data. Using Pearson chi-squared analyses, relationships between these correlates as well as covariates of age, sex, level of ID, body mass index (BMI) and aetiology, and RAPA and IPAQ-SF categories were explored. Logistic regression provided more detailed analyses. Results were summarised using the Systems of Sedentary Behaviour framework. Spearman correlations examined the IPAQ-SF and RAPA relationships.

Results

Three correlates for inactivity emerged from the IPAQ-SF and RAPA questionnaire. Up after 07:00 h was a correlate for both. Difficulty walking 100 yards and epilepsy were additional correlates of inactivity. Weak but significant correlations were seen between IPAQ-SF and RAPA scores.

Conclusions

High inactivity levels are present in adults with an ID. The IPAQ-SF and RAPA questionnaires are weakly correlated.

背景:不活跃是不利健康的一个相关因素。智障(ID)成年人比普通人更不活跃,而且通常会出现更复杂的健康问题。国际体力活动问卷-简表(IPAQ-SF)和体力活动快速评估(RAPA)问卷等自我报告的活动量问卷因其成本低、非侵入性、易于管理和结果解释而成为活动量信息的主要来源:方法:通过文献范围审查,确定了普通人群和智障人群中缺乏活动的相关因素。采用 RAPA 和 IPAQ-SF 测量不活跃程度。采用多重输入连锁方程对缺失数据进行补偿。通过皮尔逊卡方分析,探讨了这些相关因素以及年龄、性别、ID水平、体重指数(BMI)和病因等协变量与 RAPA 和 IPAQ-SF 类别之间的关系。逻辑回归提供了更详细的分析。使用久坐行为系统框架对结果进行了总结。斯皮尔曼相关性检验了 IPAQ-SF 和 RAPA 的关系:从 IPAQ-SF 和 RAPA 问卷中发现了三个不活动的相关因素。7:00后起床是两者的相关因素。步行 100 码有困难和癫痫也与不活动有关。IPAQ-SF和RAPA得分之间存在微弱但重要的相关性:结论:患有智障的成年人中存在较高的不活动水平。IPAQ-SF问卷和RAPA问卷之间存在弱相关性。
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引用次数: 0
Digital motor intervention effects on motor performance of individuals with developmental disabilities: a systematic review 数字运动干预对发育障碍人士运动表现的影响:系统性综述。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-29 DOI: 10.1111/jir.13169
J. Corey, J. M. Tsai, A. Mhadeshwar, S. Srinivasan, A. Bhat

Background

Individuals (i.e. children/young adults) with developmental disabilities (DDs) and intellectual disabilities (IDs) often display a variety of physical and motor impairments. It is well known that participation in motor activities can positively impact the development of children's cognitive and social skills. Recently, virtual and digital technologies (e.g. video conferencing applications, virtual reality and video gaming) have been increasingly used to promote better physical/motor outcomes. The efficacy of digital technologies in improving motor outcomes for those with DD/ID varies depending on the technology and population, and the comparative effects of various technologies are unknown. The aim of our study is to conduct a systematic review to comprehensively examine the quantitative and qualitative results of current studies reporting the efficacy of digitally based motor interventions on motor outcomes in individuals with DD/ID.

Methods

Literature published from 1900 to 2024 was searched in four health sciences databases: PubMed, PsycINFO, Scopus and CINAHL. Articles that examined the effects of gross motor/physical activity training using technologies such as exergaming (i.e. exercise through video gaming such as the Wii and Xbox Kinect), virtual reality or telehealth video conferencing applications (i.e. Zoom, Webex or mobile health apps) on the standardised or game-specific gross motor performance of individuals with DD/ID diagnoses that do not typically experience significant walking challenges using experimental or quasi-experimental study designs were included. Thirty relevant articles were retrieved from a search of the databases PubMed (914), PsycINFO (1201), Scopus (1910) and CINAHL (948).

Results

Our quantitative synthesis of this published literature suggests strong and consistent evidence of small-to-large improvements in motor skill performance following digital movement interventions.

Conclusions

Our review supports the use of digital motor interventions to support motor skill performance in individuals with DD without ID. Digital technologies can provide a more engaging option for therapists to promote motor skill development in individuals with DD or for caregivers to use as an adjunct to skilled therapy.

背景:发育障碍(DDs)和智力障碍(IDs)患者(即儿童/青少年)通常表现出各种身体和运动障碍。众所周知,参与运动活动会对儿童认知和社交技能的发展产生积极影响。最近,虚拟和数字技术(如视频会议应用、虚拟现实和视频游戏)越来越多地被用于促进更好的身体/运动效果。数字技术在改善残疾/智障人士运动能力方面的功效因技术和人群而异,各种技术的比较效果尚不清楚。我们的研究旨在开展一项系统性综述,以全面检查当前报告基于数字技术的运动干预对残疾/智障人士运动效果的定量和定性研究结果:在四个健康科学数据库中检索了 1900 年至 2024 年间发表的文献:PubMed、PsycINFO、Scopus 和 CINAHL。纳入了采用实验性或准实验性研究设计,研究了使用外游戏(即通过Wii和Xbox Kinect等视频游戏进行锻炼)、虚拟现实或远程医疗视频会议应用程序(即Zoom、Webex或移动医疗应用程序)等技术进行粗大运动/体力活动训练对患有DD/ID诊断且通常没有明显行走困难的个体的标准化或特定游戏粗大运动表现的影响的文章。在PubMed(914篇)、PsycINFO(1201篇)、Scopus(1910篇)和CINAHL(948篇)数据库中检索到30篇相关文章:结果:我们对已发表的文献进行了定量综合,结果表明,有有力且一致的证据表明,在进行数字运动干预后,运动技能表现会有小幅到大幅的提高:我们的综述支持使用数字运动干预来提高无智障的残疾人士的运动技能表现。数字技术可为治疗师提供更具吸引力的选择,以促进残疾人士的运动技能发展,也可作为熟练治疗的辅助手段供护理人员使用。
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引用次数: 0
Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service 接受记忆专科服务的智障和认知障碍老年人的药物负担指数。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-26 DOI: 10.1111/jir.13180
R. M. Vaughan, M. O'Dwyer, J. Tyrrell, S. P. Kennelly, M. McCarron

Background

Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints.

Methods

We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed.

Results

The study population was 58.6% female with a median age of 55 years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1.

Conclusions

People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.

背景:对于有认知障碍的患者,应慎用具有镇静或抗胆碱能特性的药物。这一点对于患有智力障碍(ID)的老年人尤为重要。药物负担指数(DBI)得分越高,老年人体弱、跌倒和生活质量下降的情况就越多,智障人士出现不良反应(白天嗜睡、便秘)的风险也越高。以往的研究表明,与普通人群相比,智障人群的药物负担率更高,被处方抗精神病药物的倾向性也更高,但还没有专门针对智障和认知障碍患者的药物负担程度进行过评估:我们评估了一组连续转诊至国家记忆服务机构的智障人士的药物负担。所有转诊患者均接受了认知症状评估(自我报告或护理人员报告的记忆或认知问题)。对每位参与者的 DBI 进行单独计算,并评估智障病因、智障程度、年龄、精神/神经系统合并症和诊断结果对 DBI 分数的影响:研究对象中 58.6% 为女性,中位年龄为 55 岁,71.3% 的 ID 病因是唐氏综合征(DS)。40.2%的人被确诊为阿尔茨海默氏痴呆症,29.9%的人被确诊为轻度认知障碍,25.3%的人被确诊为基线认知功能未受损。药物使用率很高,95.4% 的人在服药,药物中位数为 4 种(四分位间范围为 4),多药(≥5 种药物)率为 51.7%。总体而言,65.5%的患者服用镇静剂或抗胆碱能药物,39.1%的患者服用具有临床意义的DBI评分>1:结论:患有智障和初期认知障碍的患者的药物负担很重,超过了普通人群的药物负担,令人担忧。
{"title":"Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service","authors":"R. M. Vaughan,&nbsp;M. O'Dwyer,&nbsp;J. Tyrrell,&nbsp;S. P. Kennelly,&nbsp;M. McCarron","doi":"10.1111/jir.13180","DOIUrl":"10.1111/jir.13180","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study population was 58.6% female with a median age of 55 years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score &gt;1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score &gt;1.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16163,"journal":{"name":"Journal of Intellectual Disability Research","volume":"68 12","pages":"1386-1395"},"PeriodicalIF":2.1,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142073042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Age and sex-specific risk in fractures with Down syndrome in a retrospective case–control study from Germany 德国一项回顾性病例对照研究中唐氏综合征患者骨折的年龄和性别风险。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-25 DOI: 10.1111/jir.13183
S. Krieg, A. Krieg, K. Kostev

Background

The increasing life expectancy of individuals with Down syndrome has led to a growing awareness of mid- and late-life conditions.

Methods

Based on the Disease Analyser database (IQVIA), this retrospective cohort study compared adults ≥18 years of age with Down syndrome (ICD-10: Q90) in general practices in Germany with a propensity score-matched cohort without Down syndrome. The outcome was the first diagnosis of a fracture within 5 years of the index date. The cumulative incidence of fractures over a 5-year period was presented using Kaplan–Meier curves. Univariable Cox regression analyses by age group and sex were performed to assess the association between Down syndrome and fractures.

Results

A total of 2547 individuals with Down syndrome and 12 735 individuals without Down syndrome were included in the study. A significantly higher cumulative fracture incidence within 5 years was observed in the age group 51–60 years (9.3% Down syndrome vs. 4.8% without Down syndrome, P = 0.003) as well as in the age group >60 years (20.3% Down syndrome vs. 8.6% without Down syndrome, P < 0.001) compared with the cohort without Down syndrome. Regression analysis showed a significant association between Down syndrome and fracture risk in women with Down syndrome aged 51–60 years (hazard ratio [HR] = 1.60; 95% confidence interval [CI]: 1.13–2.26), and in those aged 51–60 years (HR = 2.08; 95% CI: 1.27–3.41) and >60 years (HR = 2.98; 95% CI: 1.87–4.73)), but not in men. When comparing fractures in individuals with and without Down syndrome, shoulder and arm fractures were most common in the Down syndrome cohort.

Conclusion

The results of our study indicate a positive association between individuals with Down syndrome and subsequent fractures in women and those aged >50 years. Prevention of falls appears to be particularly important in these populations. However, future studies should clarify the extent to which socio-economic factors, such as housing, play a role in this context.

背景:随着唐氏综合征患者预期寿命的延长,他们对中年和晚年状况的认识也在不断提高:随着唐氏综合征患者预期寿命的延长,人们对中晚期疾病的认识也在不断提高:这项回顾性队列研究以 Disease Analyser 数据库(IQVIA)为基础,比较了德国全科医生中年龄≥18 岁的唐氏综合征成人(ICD-10:Q90)与无唐氏综合征的倾向得分匹配队列。研究结果是在索引日期后的 5 年内首次诊断出骨折。5 年内骨折的累积发生率采用 Kaplan-Meier 曲线表示。按年龄组和性别进行单变量 Cox 回归分析,以评估唐氏综合征与骨折之间的关系:研究共纳入了 2547 名唐氏综合征患者和 12 735 名非唐氏综合征患者。在 51-60 岁年龄组(9.3% 的唐氏综合征患者与 4.8% 的非唐氏综合征患者,P = 0.003)和大于 60 岁年龄组(20.3% 的唐氏综合征患者与 8.6% 的非唐氏综合征患者,P 60 岁(HR = 2.98;95% CI:1.87-4.73))中观察到,5 年内累积骨折发生率明显较高,但在男性中没有观察到。在比较有唐氏综合征和无唐氏综合征患者的骨折情况时,肩部和手臂骨折在唐氏综合征人群中最为常见:结论:我们的研究结果表明,患有唐氏综合症的人与女性和年龄大于 50 岁的人随后发生骨折之间存在正相关。在这些人群中,预防跌倒似乎尤为重要。不过,未来的研究应明确住房等社会经济因素在这方面的作用。
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引用次数: 0
SSBP 26th International Research Symposium, Bali, Indonesia: Abstracts for presentation 第 26 届 SSBP 教育日暨国际研究研讨会:遗传和神经发育障碍的早期识别和治疗。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-22 DOI: 10.1111/jir.13174
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引用次数: 0
Early identification and treatment of genetic and neurodevelopmental disorders 遗传和神经发育障碍的早期识别和治疗。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-22 DOI: 10.1111/jir.13175
T. I. Winarni, A. Utari, N. Maharani, T. A. Sumekar, N. R. B. Sihombing, R. J. Hagerman
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引用次数: 0
SSBP 26th International Research Symposium, Bali, Indonesia: Keynote Abstracts for presentation 第 26 届 SSBP 教育日暨国际研究研讨会:遗传和神经发育障碍的早期识别和治疗。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-22 DOI: 10.1111/jir.13173
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引用次数: 0
Immersive virtual reality is more effective than non-immersive devices for developing real-world skills in people with intellectual disability 与非沉浸式设备相比,沉浸式虚拟现实在开发智障人士的真实世界技能方面更为有效。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-21 DOI: 10.1111/jir.13177
A. Franze, T. Loetscher, N. C. Gallomarino, A. Szpak, G. Lee, S. C. Michalski

Background

People with intellectual disability (ID) demonstrate persistent challenges around developing life skills. Immersive virtual reality (IVR) is gaining interest as a tool for training life skills as it enables individuals to engage in hands-on learning in a safe, controlled and repeatable environment. However, there are concerns about the potential drawbacks of IVR, such as cybersickness and practical challenges with using the equipment, which may hinder its widespread adoption in educational settings. The current study aimed to compare the effectiveness of training in IVR and a non-immersive virtual environment for improving real-world skills in people with ID.

Methods

In the present study, 36 adults (16 female, 20 male) with ID were recruited from a disability organisation. Participants completed a real-world assessment of waste management skills before and after training in either the IVR or non-immersive group.

Results

Consistent with our hypotheses, the IVR group scored significantly higher in the real-world assessment after virtual training (d = 1), and at the 1-week follow-up (d = 1.12), compared with the non-immersive group. Further analyses showed that the IVR group, but not the non-immersive group, significantly improved performance in the real-world assessment across timepoints.

Conclusions

The findings indicate that IVR was more effective for improving and retaining real-world waste management skills. This study supports IVR as a viable tool for professionals and caregivers to develop skills for independent living among people with ID.

背景:智障人士在发展生活技能方面一直面临挑战。沉浸式虚拟现实(IVR)作为一种训练生活技能的工具正受到越来越多的关注,因为它能让个人在安全、可控和可重复的环境中进行实践学习。然而,IVR 的潜在缺点也令人担忧,例如晕网和使用设备时的实际困难,这可能会阻碍其在教育环境中的广泛应用。本研究旨在比较 IVR 培训和非沉浸式虚拟环境对提高智障人士实际技能的效果:本研究从一家残疾人组织招募了 36 名成年智障人士(16 名女性,20 名男性)。参加者在 IVR 或非沉浸式组培训前后完成了对废物管理技能的真实世界评估:结果:与我们的假设一致,与非浸入式组相比,IVR 组在虚拟培训后(d = 1)和一周随访时(d = 1.12)的真实世界评估中得分明显更高。进一步的分析表明,IVR 组(而非沉浸式组)在不同时间点的真实世界评估中的表现都有显著提高:结论:研究结果表明,IVR 对提高和保持真实世界中的废物管理技能更为有效。这项研究支持将 IVR 作为一种可行的工具,供专业人员和护理人员培养智障人士的独立生活技能。
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引用次数: 0
Feasibility and findings of electrocardiogram recording in older adults with intellectual disabilities: results of the Healthy Ageing and Intellectual Disabilities study 智障老年人心电图记录的可行性和结果:健康老龄化和智障研究的结果。
IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL Pub Date : 2024-08-15 DOI: 10.1111/jir.13181
M. J. de Leeuw, M. N. Böhmer, M. J. G. Leening, J. A. Kors, P. J. E. Bindels, A. Oppewal, D. A. M. Maes-Festen

Background

Older adults with intellectual disabilities (ID) have a high risk of cardiovascular diseases (CVD). At the same time, challenging diagnostic work-up increases the likelihood of underdiagnosis of CVD in this population. To limit this underdiagnosis, it would be beneficial to use objective measures such as the electrocardiogram (ECG). However, little is known about the feasibility of ECG recording and the prevalence of ECG abnormalities in this population. Therefore, the aims of this study were to investigate the feasibility of resting ECG recording, to study the prevalence of ECG abnormalities, and to compare the frequency of ECG abnormalities with medical records in older adults with ID.

Method

A cross-sectional study was performed within a cohort of older adults (≥60 years) with ID as part of the Healthy Ageing and Intellectual Disabilities (HA-ID) study. A resting 12-lead ECG was attempted, and the ECG recording was considered feasible if the recording could be made and if the ECG could be interpreted by a cardiologist and the Modular ECG Analysis System (MEANS). ECGs were assessed for the presence of ECG abnormalities and medical record review was performed. If the cardiologist or MEANS concluded that there was evidence of myocardial infarction, atrial fibrillation or QTc prolongation on the ECG in the absence of this ECG diagnosis in the participant's medical record, this was classified as a previously undiagnosed ECG diagnosis.

Results

ECG recording was feasible in 134 of the 200 participants (67.0%). Of these 134 participants (70.6 ± 5.8 years; 52.2% female), 103 (76.9%) had one or more ECG abnormality, with the most prevalent being prolonged P-wave duration (27.6%), QTc prolongation (18.7%), minor T-wave abnormalities (17.9%), first degree atrioventricular block (12.7%) and myocardial infarction (6.7%). Eight out of 9 (88.9%) myocardial infarctions and all cases of (significant) QTc prolongation (100%) were previously undiagnosed.

Conclusions

This study showed that ECG recording is feasible in the majority of older adults with ID and revealed a substantial underdiagnosis of ECG abnormalities. These results stress the importance of ECG recording and warrant further research into the yield of opportunistic ECG screening in older adults with ID.

背景:智障老年人罹患心血管疾病(CVD)的风险很高。同时,高难度的诊断工作增加了这一人群心血管疾病诊断不足的可能性。为了限制这种漏诊,使用心电图(ECG)等客观测量方法将是有益的。然而,人们对心电图记录的可行性以及该人群心电图异常的发生率知之甚少。因此,本研究的目的是调查静息心电图记录的可行性,研究心电图异常的发生率,并将智障老年人心电图异常的频率与医疗记录进行比较:方法:作为健康老龄化和智力残疾(HA-ID)研究的一部分,在一组患有智障的老年人(≥60 岁)中进行了一项横断面研究。研究人员尝试了静息 12 导联心电图,如果心电图能够记录,并且心电图能够由心脏病专家和模块化心电图分析系统 (MEANS) 进行解读,则认为心电图记录是可行的。评估心电图是否存在异常,并对病历进行审查。如果心脏病专家或模块化心电图分析系统(MEANS)认为心电图上存在心肌梗死、心房颤动或 QTc 延长的证据,而参与者的医疗记录中没有该心电图诊断,则将其归类为先前未诊断的心电图诊断:200 名参与者中有 134 人(67.0%)可以进行心电图记录。在这 134 名参与者(70.6 ± 5.8 岁;52.2% 为女性)中,103 人(76.9%)有一种或多种心电图异常,其中最常见的是 P 波持续时间延长(27.6%)、QTc 延长(18.7%)、轻微 T 波异常(17.9%)、一级房室传导阻滞(12.7%)和心肌梗死(6.7%)。9例心肌梗死中的8例(88.9%)和所有(明显)QTc延长的病例(100%)以前都未被诊断出来:这项研究表明,对大多数患有智障的老年人进行心电图记录是可行的,并揭示了心电图异常的严重漏诊。这些结果强调了心电图记录的重要性,值得进一步研究对患有智障的老年人进行机会性心电图筛查的收益。
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Journal of Intellectual Disability Research
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