The Relationship between Cognition and Disability in Older Adults: A Systematic Review

e144 Data Sources: Medline, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published in English from 1980 to January 2016. Study Selection: Studies were included for analysis if:  50% of participants had moderate to severe ABI,  3 of the participants had an ABI, and a pharmacological intervention for agitation was provided. Data Extraction: Data extracted included participant demographics, inclusion and exclusion criteria, study design, outcome measure(s) used, and results. Study quality was assessed using the Physiotherapy Evidence Database Scale (PEDro) assessment scale for randomized controlled trials (RCTs). A level of evidence was assigned to each intervention using a modified Sackett scale. Data Synthesis: The systematic review resulted in 165 studies, of which 15 studies met inclusion criteria. The included studies consisted of 3 RCTs and 12 observational studies. Two studies demonstrated Level 1b evidence, 1 Level 2 evidence, and the remaining were Level 4. Antipsychotics had the greatest number of studies (nZ7), followed by anticonvulsants (nZ4), antidepressants (nZ2), and beta-blockers (nZ2). Beta-blockers had the highest level of evidence (Level 1b). The anti-psychotic lithium carbonate was shown to be effective but was not recommended for use due to high risk of neurotoxicity. Conclusions: Studies consistently demonstrated that pharmacological treatment was effective in reducing agitation post ABI; however, there was insufficient information to develop a conclusion due to the strength of evidence and limited number of studies. Key Words: Brain injury, rehabilitation, agitation, systematic review Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 479 The Effect of Continuous Theta Burst Stimulation (Ctbs) on Unilateral Neglect in Patients with Stroke: A Systematic Review Andreea Cotoi (Lawson Health Research Institute), Jerome Iruthayarajah, McIntyre Amanda Objectives: To evaluate the effect of continuous theta burst stimulation (cTBS) on unilateral visual neglect in individuals post stroke. Data Sources: Studies were generated by conducting a comprehensive literature search up to December of 2015 using the following electronic databases: Scopus, PubMed, ProQuest, PsycINFO, AMED, Embase, and CINAHL. Study Selection: Studies were included for analysis if (1) they were published in English, (2) consisted of an adult stroke population, and (3) treated neglect severity using cTBS. Data Extraction: Participant characteristics, study design, treatment information, outcome measures and results were extracted from each study. Methodological quality of randomized controlled studies (RCTs) was assessed using the PEDro tool, and a level of evidence was assigned to all studies using a modified Sackett scale. Data Synthesis: Of the 519 studies initially identified, eight studies met the inclusion criteria. Four RCTs (level 1B), two prospective controlled trials (level 2), one pre-post study (level 4), and one case study (level 5) were analyzed. In seven studies, cTBS was found to significantly improve neglect severity (p<0.05) on at least one of the following outcome measures: the star cancellation test (NZ3), the behavioral inattention test (NZ2), the random shape cancellation test (NZ2), the line bisection test (NZ2), the Bird cancellation task (NZ1), the Vienna Test System (NZ2), and the Catherine Bergego Scale (NZ1). One case study indicated a clinical improvement. Conclusions: Relative to sham stimulation, cTBS was shown to reduce unilateral spatial neglect in individuals post stroke. Future RCTs and intervention studies with larger sample sizes are encouraged to establish a strong evidence-based foundation for the use of cTBS in rehabilitation practices. Key Words: Stroke, transcranial magnetic stimulation, perceptual disorders Disclosures: None disclosed.

Systematic/Meta-Analytic Review Posters Systematic & Meta-Analytic Review Poster 482 Using Theta Burst Stimulation (TBS) to Improve Upper Limb Motor Function Following a Stroke: A Systematic Review Andreea Cotoi (Lawson Health Research Institute), Jinah Ashna, Brar Josh Objectives: To evaluate the effectiveness of theta burst stimulation (TBS) in improving upper limb motor functioning among individuals post stroke. Data Sources: A literature search for articles published up to December 2015 was conducted using the following databases: PubMed, Scopus, Embase, PsycINFO, ProQuest, AMED, and CINAHL. Study Selection: Studies meeting the following inclusion criteria were selected: (1) published in English, (2) adult population (18 years of age), and (3) TBS targeting the upper extremity cortical region was used. Data Extraction: Patient characteristics, treatment information, study design, outcome measures, and results were extracted. Randomized controlled trials (RTCs) were scored using the PEDro tool. All studies were assigned a level of evidence according to a modified Sackett scale. Data Synthesis: Of the 3350 studies found, nine studies met inclusion. Analysis was conducted on three RCTs (level 2B), four prospective controlled trials (level 2), and two pre-post studies (level 4). Four studies evaluated intermittent TBS (iTBS), two evaluated continuous TBS (cTBS), and three examined both protocols. Regarding cTBS, significant findings (p<0.05) were found on the following outcome measures: Wolf Motor Function Test, Fugl-Meyer Assessment, and preload duration. ITBS was found to be significant (p<0.05) when measuring finger tapping, muscle strength, peak torque, peak angle, and preload duration. Conclusions: Overall, findings regarding the use of cTBS and iTBS for improving upper motor function among individuals post stroke are inconclusive. Due to the large variability in the outcomes used, the low study samples, and the moderate-to-low methodological quality of the studies, there is insufficient data available to provide a concluding statement regarding cTBS or iTBS as a rehabilitative therapy for upper motor function. Key Words: Transcranial magnetic stimulation, upper extremity, stroke Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 520 The Relationship between Cognition and Disability in Older Adults: A Systematic Review Jessica Jarvis (UTMB) Objectives: To investigate the relationship between cognition and disability in adults. Data Sources: A trained reference librarian assisted the development of this search strategy. All articles were selected from an electronic database. Databases searched were CINAHL, Medline Ovid, Cochrane CENTRAL, and PsycINFO. Keywords were descriptors of cognition and disability. Included articles were not limited to a specific time frame and were accepted for publications at time of inclusion. Study Selection: Studies were selected for inclusion if their independent variable was cognition or frailty and their dependent variable was cognition or disability. Studies were excluded if they were not an experimental design, not in English, not about humans, or included children. The search strategy resulted in 1,159 articles and after systematically screening nine articles remained. Data Extraction: Articles were screened in four steps. First, by removing duplicates. Next articles were systematically screen by title, abstract, and then full text. Two reviewers conducted the screening independently. Any disagreement was settled by discussion between the reviewers. Quality of the studies was assessed using the Cochrane review risk of bias screening tool. Data Synthesis: A total of 1,159 articles were located from the search strategy, 162 duplicates were removed, and 998 were excluded for not

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Systematic/Meta-Analytic Review Posters meeting the inclusion criteria. Of the nine included articles, three were low quality and six were high quality. Two of the studies were cross sectional studies, three invested the effect of frailty on cognitive status over time, and four investigated the relationship between baseline cognition on frailty status over time. Regardless of the direction of the relationship, the studies showed cognition and frailty to be statistically, negatively correlated to each other. Conclusions: There is a statistically significant, negative correlation between cognition and disability. Further studies should investigate what factors diminish the strength of this relationship and thus find ways to reduce the development of disability over time. Key Words: Disability, Cognition, Aging Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 558 Systematic Review of the Application of Item Response Theory to Ecological Momentary Assessment Data Lauren Terhorst (University of Pittsburgh), Shannon B. Juengst, Kelly B. Beck Objectives: To investigate the application of item response theory (IRT) to data collected using ecological momentary assessment (EMA) methods. Rehabilitation researchers strive to collect accurate and objective data in real-life settings. EMA methods allow for real-time data collection over multiple occasions (hourly, daily, etc) (1). Patterns of activity over different times of day and days of the week may identify early indicators of disability. IRT modeling provides a way to examine activity patterns with EMA data by examining item-specific changes over time. Data Sources: A systematic search of PubMed, PsycINFO, Medline, and PsycArticles was performed. Additionally, reference sections of retrieved articles and peer-reviewed journals were searched. The search revealed 618 potential articles. Study Selection: The inclusion criterion was the application of IRT using EMA data. Articles that focused on methodological procedure and did not include an application were excluded. After reviewing the retrieved abstracts, 1 thesis (2), 1 book chapter (3) and two articles (4,5) were included in the data extraction phase. Data Extraction: Study characteristics such as author, year, research question, sample size, sample description, measures, IRT models, software, and relevant findings were extracted by two authors with a third as an adjudicator of any dispute. Data Synthesis: Extracted data were summarized in an evidence table. Findings revealed that all articles focused on adolescent smoking and applied different IRT models: polytomous, 2 parameter logistic, pattern mixture, and Rasch. Conclusions: We have discovered a gap in the literature for the application of IRT with EMA data, which may be particularly significant for rehabilitation research. We recommend that rehabilitation researchers apply IRT methods to identify items that are better able to characterize disability and to maximize the opportunities presented by EMA data. Key Words: Rehabilitation Research, Outcome Assessment (Health Care), Health Impact Assessment, Rehabilitation Disclosures: None disclosed. Systematic & Meta-Analytic Review Poster 581 Critical Review of Methods for Classifying Obesity In Spinal Cord Injury Stephanie Silveira (University of Houston Department of Health and Human Performance), Tracey A. Ledoux, Rachel Stough Objectives: Objective: Conduct a critical review of methods used to measure and classify obesity in individuals with spinal cord injuries (SCI). Reduced muscle mass and other SCI-related body composition variations raise questions about the validity of standard cutoffs.

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e145 Data Sources: Data Sources: PubMed, 1975-2015. Search terms (“obesity” or “weight status” and “spinal cord injury”) yielded 186 articles. Filters: adults, English, and human. Study Selection: Study Selection: Studies were retained that 1) included participants at least 18 years old with SCI; 2) took place in inpatient, outpatient, or community-based settings, and 3) measured obesity or weight status. Data Extraction: Data Extraction: Using independent extraction by three reviewers, we required two reviewers agree the article met inclusion criteria. Reasons for exclusion included no classification of obese status, no explanation of how obesity was defined, or review article. Data Synthesis: Data Synthesis: Of 41 publications extracted, 9 used multiple methods, 23 used World Health Organization body mass index (BMI) cutoff 30kg/m2, 8 used a BMI cutoff 25-29kg/m2, and 6 used a SCI-specific BMI cutoff 23kg/m2. Six studies used waist circumference cutoff (women>102cm, men>88cm). Four studies used percent body fat cutoffs 22%, three used Bioelectrical Impedance Analysis (BIA) cutoffs, and one used Dual-energy X-ray absorptiometry (DXA). One study used Computerized Tomography scan (CT) visceral fat area 100cm2 and another used percentage of ideal body weight (IBW). We outline strengths and weaknesses of each method and summarize purpose of obesity classification in articles. Conclusions: Conclusions: BMI is the most widely used measure of obesity in the SCI population. Although some studies identified alternative cutoffs or other metrics, there is no standardized obesity classification in SCI. Research is needed to determine and validate obesity classification specific to SCI. Key Words: Spinal Cord Injuries, Obesity, Body Composition, Body Mass Index, Adipose Tissue Disclosures: None Disclosed. Systematic & Meta-Analytic Review Poster 585 The Experience Of Patients with ABI and Their Families During The Hospital Stay: A Systematic Review of Qualitative Literature Tolu Oyesanya (University of Wisconsin-Madison) Objectives: Patients with acquired brain injury (ABI) and their families have unique experiences and needs during the hospital stay; yet, limited literature exists on this topic. The purpose of this systematic review was to compile and synthesize qualitative literature on the experience of patients with ABI and their families during the hospital stay. Data Sources: A systematic review of qualitative studies was conducted by searching for studies from seven databases (CINAHL, PsycInfo, PubMed, SocIndex, Academic Search Premier, Family Studies Abstracts, and Family and Society Studies Worldwide). Study Selection: The initial search provided 2,871 records. Ultimately, eleven studies relevant to the research question were included in this review. No studies were excluded based on critical quality appraisal. The author used the QualSyst Tool for Qualitative Studies to assess the quality of each study in this review. The QualSyst tool contains an individual checklist detailing criteria specific to qualitative studies. Data Extraction: After deciding which studies met inclusion criteria, data extraction was performed. All studies were read and coded deductively for the stated: a) author(s); b) year of publication; c) country; d) study purpose; e) study design; f) sample strategy; g) sample characteristics; h) data collection techniques; i) data analysis techniques; j) findings for patients’ and families’ experience relevant to the review. The author entered all studies information into a table to allow for comparison across articles. Data Synthesis: Content analysis was used to analyze and synthesize studies’ findings separately for the patient and family experience. Findings on the patient experience showed patients had negative perceptions of the rehabilitation environment and a perceived need for information. Findings on the family experience included difficulty adjusting after the patient’s injury, desire to be involved in the patient’s