Computerized cognitive remediation training for schizophrenia: An open label, multi-site, multinational methodology study Patient education methods to support quality of life and functional ability among patients with schizophrenia: a randomised clinical trial The efficacy of supported employment for middle-aged and older people with schizophrenia A longitudinal study of learning potential and rehabilitation outcome in schizophrenia. Objective evaluation of physical function in patients with advanced lung cancer: a preliminary report. Improvement in social competence in patients with schizophrenia: a pilot study using a performance-based measure using virtual reality. The reliability of determining effort level of lifting and carrying in a functional capacity evaluation. The MOS 36-Item Short Form Health Survey: reliability, validity, and preliminary findings in schizophrenic outpatients. Compensatory cognitive training for psychosis: effects in a randomized controlled trial. Planning and problem-solving training for patients with schizophrenia: a randomized controlled trial Actual reality: a new approach to functional assessment in persons with multiple sclerosis. Multimedia consent for research in people with schizophrenia and normal subjects: a randomized controlled trial. Upper limb children action-observation training (UP-CAT): a randomised controlled trial in Hemiplegic Cerebral Palsy Biosocial pathways to functional outcome in schizophrenia Learning potential and the prediction of work skill acquisition in schizophrenia. Misattributing speech and jumping to conclusions: a longitudinal study in people at high risk of psychosis. Enhancing physical function in HIV-infected older adults: A randomized controlled clinical trial.
A recent single-site study ( Fisher et al. , 2009 . Am J Psychiatry . 166 ( 7 ) 805 - 11 ) showed that repeated training with the Brain Fitness Program ( BFP )  improved performance on a battery of neuropsychological tasks . If replicated these data suggest an important non-pharmacological method for ameliorating cognitive impairment in schizophrenia . Our study evaluated the BFP training effects in an open-label , multi-site , multinational clinical trial . Fifty-five stable adult patients with schizophrenia on regular antipsychotic medication completed ≥ 32 BFP training sessions over 8 - 10 weeks . Training effects on cognitive performance and functional capacity outcome measures were measured using CogState ® schizophrenia battery , UCSD Performance based Skills Assessment ( UPSA-2 ) and Cognitive Assessment Interview ( CAI )  . BFP training showed a large and significant treatment effect on a training exercise task ( auditory processing speed ) , however this effect did not generalize to improved performance on independent CogState ® assessment . There were no significant effects on UPSA-2 or CAI scores . Our study demonstrated the feasibility of implementing BFP training in a multi-site study . However , BFP training did not show significant treatment effects on cognitive performance or functional capacity outcome measures despite showing large and significant effects on a training exercise Purpose The aim of this study was to estimate the effectiveness of patient education methods on quality of life and functional impairment of patients with schizophrenia . Methods A multicentre , r and omized controlled trial was carried out in two psychiatric hospitals in Finl and from March 2005 to October 2007 . A total of 311 patients with a diagnosis of schizophrenia , schizotypal disorder or delusional disorder were r and omly allocated to computer-based patient education ( n = 100 ) , conventional education with st and ard leaflets ( n = 106 ) and st and ard treatment ( n = 105 ) . Participants were followed up 12 months later . Primary outcome was quality of life ( Q-LES-Q-SF ) and secondary outcome was functional disability ( SDS ) . Analysis was performed by intention-to-treat . This study is registered , number IS RCT N74919979 . Results Patients ’ global quality of life improved and functional disability decreased significantly in all education groups over the follow-up time . There were no significant differences between groups in these outcomes . Conclusions In light of the findings there is no evidence to support a particular education method as the best way to improve patients ’ quality of life or improve functional ability . On the other h and , no intervention was found to be harmful . Thus computer-based patient education may be a suitable alternative for some patients . While information technology will be more widely used in societies , computer-based intervention may be beneficial for some patients with serious mental disorders OBJECTIVE Supported employment is the evidence -based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment , but few supported employment programs specifically target older clients with psychiatric illness . The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia . METHOD Participants included 58 out patients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic . Participants were r and omly assigned to receive Individual Placement and Support ( IPS ; the manualized version of supported employment ) or conventional vocational rehabilitation ( CVR ) for one year , and completed assessment s at baseline , six months , and twelve months . RESULTS IPS was superior to CVR on nearly all work outcome measures , including attainment of competitive employment , weeks worked , and wages earned . Fifty-seven percent of IPS participants worked competitively , compared with 29 % of CVR participants ; 70 % of IPS participants obtained any paid work , compared with 36 % of CVR participants . Within the IPS group , better baseline functional capacity ( as measured by the UCSD Performance Based Skills Assessment ) and more recent employment were modestly associated with better work outcomes . CONCLUSIONS Middle-aged and older adults with schizophrenia are good c and i date s for supported employment services OBJECTIVE The study examined whether a measure of learning potential is prospect ively related to the success of a vocational rehabilitation program for patients with severe mental illness in Germany . METHODS At rehabilitation intake ( November 2002 to January 2004 ) , 41 persons with schizophrenia or schizoaffective disorders completed a test-train-test version of the Wisconsin Card Sorting Test as a measure of learning potential . Research participants were classified as high scorers , learners , or nonlearners . Rehabilitation outcome was assessed with measures of work capability during the rehabilitation program , level of functioning during rehabilitation and at three-month follow-up , and level of vocational integration at three-month follow-up . RESULTS Individual learning potential was associated with the improvement of work-related learning ability during rehabilitation and with the level of functioning and the level of vocational integration at three-month follow-up ( about 15 months after the initial testing ) . Generally , high scorers had better rehabilitation outcome at all assessment points regarding all outcome measures . Even though learners and nonlearners started at comparable levels at the beginning of the rehabilitation , learners benefited more from the program , whereas nonlearners showed a rather unfavorable rehabilitation outcome . CONCLUSIONS Findings supported the assumption that learning potential is an informative predictor of rehabilitation outcome and may add information beyond static cognitive measures . Learning potential should be considered in the further development of vocational rehabilitation programs PURPOSE This prospect i ve study was design ed in order to compare the most common subjective measurements of physical function in patients with advanced lung cancer with an objective physical functional test ( Simmonds Functional Assessment Tool [ SFA ] ) . PATIENTS AND METHODS One hundred patients agreed to participate and complete the study before or after their outpatient medical oncology appointment . Patients underwent assessment using the  Karnofsky , the Brief fatigue Inventory , The Functional Assessment of Cancer Therapy-Lung patients ( FACT-L ) and the  Edmonton Symptom Assessment Scale ( ESAS ) . These results were compared to the SFA tool . The SFA consists of six tasks : tying a belt , putting coins in a cup , reaching above head , st and ing up/sitting down , reaching forward and walking 50 feet . RESULTS Ninety-nine patients completed the study over 8 months : median Karnofsky performance status was 85 ( 70 to 100 ) , Edmonton Symptom Assessment Scale ( ESAS ) score ( 0 to 10 ) was generally low ( 0.5 to 2.8 ) . SFA scores were significantly different in patients compared to a control group . The correlation between the subscales of the SFA and the Karnofsky , the Brief Fatigue Inventory , The FACT-L and the ESAS was generally low to moderate ( r values : 0.22 to 0.38 ) . There was generally a moderate correlation between the different subjective scales ( r values : 0.3 to 0.62 ) . CONCLUSION Adherence to the SFA tool was excellent . The low to moderate correlation between the abnormalities found in the objective SFA and the subjective fatigue tests suggest that objective evaluation of the functional capacity provides a potentially useful and independent end-point for clinical trials and therapeutic interventions . These assessment tools should be used complementary to each other to better assess the functional status of patients with advanced lung cancer . Large trials of objective functional assessment are justified OBJECTIVE The objective of this study was to explore the possibility of the use of Virtual Reality Functional Skills Assessment ( VRFSA ) in a future regular clinical trial , as well as to report a preliminary result about effectiveness of atypical antipsychotics to social competence in schizophrenia . METHODS We developed the VRFSA that measured subjects ' performances automatically and used analogue scale rather than Likert scale .  Twenty-four female patients with paranoid schizophrenia and 15 healthy females were recruited . This was a 6-week , r and omized , open-label , and flexible dose study , and 2 treatments ( baseline versus post-treatment ) x 2 skills phases ( receptive versus expressive ) x 2 patient groups ( aripiprazole versus risperidone ) analysis of variance was used in the final analysis . RESULTS There was a significant difference in the VRFAS between the patients and the healthy subjects ( p < 0.05 ) . Eighteen patients were included in the final analysis . We found larger treatment effect than those found in previous studies , and significant treatment x skills phase x group interaction effect on the VRFAS . CONCLUSIONS Our results suggest that the VRFAS is strongly sensitive to changes in social competence and thus especially beneficial in short-term clinical trials . In addition , atypical antipsychotics can improve social competence and differentially improve receptive skills and expressive skills in schizophrenia OBJECTIVES To establish inter- and intra-rater reliability of observations in a functional capacity evaluation . BACKGROUND Functional capacity evaluations are used to assess a person 's functional capacity as it relates to work . Lifting and carrying are important aspects of a functional capacity evaluation . An evaluator determines the patient 's levels of effort through st and ardized observations . Questions remain with regards to the reliability of these observations . METHODS Four healthy subjects were videotaped while performing two lifts and four carries with progressive loads . The videotape was scrambled r and omly and viewed twice by 3 physical therapists and 2 occupational therapists . The evaluators determined the amount of effort it required ( light , medium , heavy , and maximum ) . The inter- and intra-rater reliability of the observations was expressed by means of percentage agreement . RESULTS Inter-rater reliability ranged 87 - 96 % , intra-rater reliability ranged 93 - 97 % . CONCLUSION The results indicate that by means of st and ardized observations , therapists can reliably determine effort level during lifting and carrying in healthy subjects , and thus affirm the findings of other studies of similar design OBJECTIVES The authors test the reliability and validity of the Medical Outcomes Study Short Form 36-Item Health Survey ( SF-36 ) as a written , self-administered survey in out patients with chronic schizophrenia . METHODS Thirty-six schizophrenic out patients completed a written and oral form of the SF-36 . A psychiatrist rated the patients using the Brief Psychiatric Rating Scale to determine severity of psychopathology . Cognitive functioning and academic achievement were also assessed . Internal consistency , test-retest reliability , concurrent and discriminative validity of the oral and written versions were determined . RESULTS The SF-36 in both forms was shown to have good internal consistency , stability , and concurrent validity . The mental health SF-36 subscales had poor discriminant validity , compared with the physical functioning scale that demonstrated good discriminant validity . CONCLUSIONS The validity of using the written form of the SF-36 on a sample of patients with chronic mental illness was demonstrated . The SF-36 appears to be an appropriate outcome measure for changes in physical and role functioning in consumers of outpatient mental health programs OBJECTIVE Treatments for the cognitive impairments of schizophrenia are urgently needed . We developed and tested a 12-week , group-based , manualized , compensatory cognitive training intervention targeting prospect i ve memory , attention , learning/memory , and executive functioning . The intervention focused on compensatory strategies , such as calendar use , self-talk , note taking , and a 6-step problem-solving method , and did not require computers . METHOD In a r and omized controlled trial , 69 out patients with DSM-IV primary psychotic disorders were assigned to receive st and ard pharmacotherapy alone or compensatory cognitive training + st and ard pharmacotherapy for 12 weeks . Assessment s of neuropsychological performance and functional capacity ( primary outcomes ) and psychiatric symptom severity , quality of life , social skills performance , cognitive insight , and self-reported everyday functioning ( secondary outcomes ) were administered at baseline , posttreatment , and 3-month follow-up . Data were collected between September 2003 and August 2009 . RESULTS Hierarchical linear modeling analyses demonstrated significant compensatory cognitive training-associated effects on attention at follow-up ( P = .049 ) , verbal memory at posttreatment and follow-up ( P values ≤ .039 ) , and functional capacity ( University of California , San Diego Performance-based Skills Assessment ) at follow-up ( P = .004 ) . The compensatory cognitive training group also differentially improved in negative symptom severity at posttreatment and follow-up ( P values ≤ .025 ) and subjective quality of life at follow-up ( P = .002 ) . CONCLUSIONS Compensatory cognitive training , a low-tech , brief intervention , has the potential to improve not only cognitive performance but also functional skills , negative symptoms , and self-rated quality of life in people with psychosis . TRIAL REGISTRATION Clinical Trials.gov identifier : NCT01521026 Background The purpose of this study was to assess whether planning and problem-solving training is more effective in improving functional capacity in patients with schizophrenia than a training program addressing basic cognitive functions . Methods Eighty-nine patients with schizophrenia were r and omly assigned either to a computer assisted training of planning and problem-solving or a training of basic cognition . Outcome variables included planning and problem-solving ability as well as functional capacity , which represents a proxy measure for functional outcome . Results Planning and problem-solving training improved one measure of planning and problem-solving more strongly than basic cognition training , while two other measures of planning did not show a differential effect . Participants in both groups improved over time in functional capacity . There was no differential effect of the interventions on functional capacity . Conclusion A differential effect of targeting specific cognitive functions on functional capacity could not be established . Small differences on cognitive outcome variables indicate a potential for differential effects . This will have to be addressed in further research including longer treatment programs and other setting s . Trial registration Clinical Trials.gov OBJECTIVE To examine the use of an innovative approach for assessing everyday life activities of people with multiple sclerosis ( MS ) :  Actual Reality . Actual Reality is a performance-based assessment approach that involves the use of the internet to perform real , everyday life activities . DESIGN A between-subjects design . SETTING Outpatient rehabilitation institute . PARTICIPANTS Persons ( n=21 ) with clinical ly definite MS and healthy controls ( HCs ) ( n=18 ) without any reported neurologic disabilities participated in this study . Participants were between the ages of 21 to 60 years , and the sample consisted of volunteer sample . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Participants were asked to  access the internet to purchase airline tickets for a round trip flight  and were administered the  Minimal Assessment of Cognitive Functioning in Multiple Sclerosis .  Participants also completed question naires to assess quality of life ( Functional Assessment of Multiple Sclerosis ) , functional status ( Functional Behavior Profile ) , and prior Internet experience . RESULTS The MS group displayed significantly more difficulties than the HC group in accurately and independently completing the Actual Reality task primarily because of cognitive impairment . Self-report of quality of life and functional status were not correlated with Actual Reality performance in the group of people with MS . However , the self-report measures were significantly associated with affective symptomatology . CONCLUSIONS These results provide initial evidence supporting the use of the Actual Reality approach in assessing persons with MS performing everyday life activities .  Actual Reality is a significant step forward in increasing the sensitivity , accessibility , and relevancy of functional assessment s in people with cognitive and physical disabilities Limitations of printed , text-based , consent forms have long been documented and may be particularly problematic for persons at risk for impaired decision-making capacity , such as those with schizophrenia . We conducted a r and omized controlled comparison of the effectiveness of a multimedia vs routine consent procedure ( augmented with a 10-minute control video presentation ) as a means of enhancing comprehension among 128 middle-aged and older persons with schizophrenia and 60 healthy comparison subjects . The primary outcome measure was manifest decisional capacity ( underst and ing , appreciation , reasoning , and expression of choice ) for participation in a ( hypothetical ) clinical drug trial , as measured with the MacArthur Competence Assessment Tool for Clinical Research ( MacCAT-CR ) and the University of California San Diego ( UCSD ) Brief Assessment for Capacity to Consent ( UBACC ) . The MacCAT-CR and UBACC were administered by research assistants kept blind to consent condition . Additional assessment s included st and ardized measures of psychopathology and cognitive functioning . Relative to patients in the routine consent condition , schizophrenia patients receiving multimedia consent had significantly better scores on the UBACC and on the MacCAT-CR underst and ing and expression of choice subscales and were significantly more likely to be categorized as being capable to consent than those in the routine consent condition ( as categorized with several previously established criteria ) . Among the healthy subjects , there were few significant effects of consent condition . These findings suggest that multimedia consent procedures may be a valuable consent aid that should be considered for use when enrolling participants at risk for impaired decisional capacity , particularly for complex and /or high-risk research protocol Background Rehabilitation for children with hemiplegic cerebral palsy ( HCP ) aim ed to improve function of the impaired upper limb ( UL ) uses a wide range of intervention programs . A new rehabilitative approach , called Action-Observation Therapy , based on the recent discovery of mirror neurons , has been used in adult stroke but not in children . The purpose of the present study is to design a r and omised controlled trial ( RCT ) for evaluating the efficacy of Action-Observation Therapy in improving UL activity in children with HCP . Methods / Design The trial is design ed according to CONSORT Statement . It is a r and omised , evaluator-blinded , match-pair group trial . Children with HCP will be r and omised within pairs to either experimental or control group . The experimental group will perform an Action-Observation Therapy , called UP-CAT ( Upper Limb-Children Action-Observation Training ) in which they will watch video sequences showing goal -directed actions , chosen according to children UL functional level , combined with motor training with their hemiplegic UL . The control group will perform the same tailored actions after watching computer games . A careful revision of psychometric properties of UL outcome measures for children with hemiplegia was performed . Assisting H and Assessment was chosen as primary measure and , based on its calculation power , a sample size of 12 matched pairs was established . Moreover , Melbourne and ABILH AND -Kids were included as secondary measures . The time line of assessment s will be T0 ( in the week preceding the onset of the treatment ) , T1 and T2 ( in the week after the end of the treatment and 8 weeks later , respectively ) . A further assessment will be performed at T3 ( 24 weeks after T1 ) , to evaluate the retention of effects . In a subgroup of children enrolled in both groups functional Magnetic Resonance Imaging , exploring the mirror system and sensory-motor function , will be performed at T0 , T1 and T2 . Discussion The paper aims to describe the methodology of a RCT for evaluating the efficacy of  Action-Observation Therapy  in improving UL activity in children with hemiplegia . This study will be the first to test this new type of treatment in childhood . The paper presents the theoretical background , study hypotheses , outcome measures and trial methodology .Trial Registration UNLABELLED Biosocial models are preeminent in the study of schizophrenia , yet there has been little empirical testing of these models . OBJECTIVE This study provided the first test of a biosocial causal model of functional outcome in schizophrenia , using neurocognition , social cognition , social competence and social support as predictors of both global and specific domains of functional outcome . METHOD The design used baseline variables to predict both concurrent functional status and prospect i ve 12-month functional outcome . Subjects were recruited upon admission to outpatient community-based psychosocial rehabilitation programs shown in previous studies to be effective in improving functional outcomes . 139 individuals diagnosed with schizophrenia or schizoaffective disorder participated in the study ; 100 participants completed the 12-month assessment s.  Face-to-face interviews assessed neurocognitive functioning ( with five neuropsychological measures ) , social cognition ( as perception of emotion ) , social competence , social support , and functional outcome which consisted of items covering the domains of social , independent living , and work functioning . RESULTS Path analysis modeling showed that the proposed biosocial models had strong fit with the data , for both concurrent and 12-month global functional outcomes , with fit indices ranging from .95 to .98 . The model explained 21 % of the variance in concurrent global functional outcome , and 14 % of the variance in 12-month prospect i ve outcome . CONCLUSIONS The support for this model was strong , and it has implication s for underst and ing the causal factors related to functional outcome , as well as for intervention strategies for improving functional outcomes in schizophrenia This study examined whether a measure of learning potential could predict work skill acquisition in schizophrenia beyond the prediction offered by a single administration assessment . Fifty-seven out patients with schizophrenia or schizoaffective disorder completed a test-train-test version of the Wisconsin Card Sorting Test as a measure of their learning potential . The out patients were r and omly assigned to training by errorless learning or conventional instruction on two work skills ( index card filing and toilet tank assembly ) .  Work skills were assessed both immediately and 3 months after training . Generally , patients with high learning potential performed better on the work skill tasks . Learning potential explained an additional 15 percent of variance beyond single administration assessment in participants ' accuracy immediately after work skill training and an additional 13 percent of variance in participants ' accuracy 3 months after training . These findings indicate that measures of learning potential contribute to the prediction of work skill acquisition , going beyond the predictive power of single administration assessment Biases in cognition such as Jumping to Conclusions ( JTC ) and Verbal Self-Monitoring ( VSM ) are thought to underlie the formation of psychotic symptoms . This prospect i ve study in people with an At Risk Mental State ( ARMS ) for psychosis examined how these cognitive biases changed over time , and predicted clinical and functional outcomes .  Twenty-three participants were assessed at clinical presentation and a mean of 31 months later .  Performance on a  JTC and VSM tasks  were measured at both time points . Relationships to symptom severity , level of function and the incidence of psychotic disorder were then examined . The levels of symptoms , function and VSM all improved over time , while JTC was stable . Five participants ( 22 % ) developed a psychotic disorder during the follow-up period , but the risk of transition was not related to performance on either task at baseline , or to longitudinal changes in task performance . JTC performance correlated with symptom severity at baseline and follow-up . Similarly , performance on the two tasks was not related to the level of functioning at follow-up . Thus , while the ARMS is associated with both VSM and JTC biases , neither predict the onset of psychosis or the overall functional outcome OBJECTIVE HIV-infected older adults ( HOA ) are at risk of functional decline . Interventions promoting physical activity that can attenuate functional decline and are easily translated into the HOA community are of high priority . We conducted a r and omized , controlled clinical trial to evaluate whether a physical activity counseling intervention based on self-determination theory ( SDT ) improves physical function , autonomous motivation , depression and the quality of life ( QOL ) in HOA . METHOD In total , 67 community-dwelling HOA with mild-to-moderate functional limitations were r and omized to 1 of 2 groups : a physical activity counseling group or the usual care control group . We used SDT to guide the development of the experimental intervention . Outcome measures that were collected at baseline and final study visits included a battery of physical function tests , levels of physical activity , autonomous motivation , depression , and QOL . RESULTS The study participants were similar in their demographic and clinical characteristics in both the treatment and control groups . Overall physical performance , gait speed , measures of endurance and strength , and levels of physical activity improved in the treatment group compared to the control group ( p < .05 ) . Measures of autonomous regulation such as identified regulation , and measures of depression and QOL improved significantly in the treatment group compared with the control group ( p < .05 ) . Across the groups , improvement in intrinsic regulation and QOL correlated with an improvement in physical function ( p < .05 ) . CONCLUSION Our findings suggest that a physical activity counseling program grounded in SDT can improve physical function , autonomous motivation , depression , and QOL in HOA with functional limitations . ( PsycINFO Data base
Conclusion The SLOF was the most often used functional measure and had the strongest observed correlation with the UPSA .
Although knowledge gaps remain , evidence from this review indicates that there is a quantitative relationship between functional capacity and real-world outcomes in individuals with schizophrenia
Objective To perform a systematic review of the published literature to evaluate how functional capacity , as measured by the University of California at San Diego ( UCSD ) Performance-based Skills Assessment ( UPSA ) , relates to other functional measures and real-world outcomes among individuals with schizophrenia .