Materials and methods: Cross-cultural adaptation of the original English version of the ABILOCO to the Brazilian–Portuguese language followed standardized procedures. The adapted version was administered to 136 stroke subjects and its measurement properties were assessed using Rash analysis. Cross-cultural validity was based on cultural invariance analyses.
Results: Goodness-of-fit analysis revealed one misfitting item. The principal component analysis of the residuals showed that the first dimension explained 45% of the variance in locomotion ability; however, the eigenvalue was 1.92. The ABILOCO-Brazil divided the sample into two levels of ability and the items into about seven levels of difficulty. The item-person map showed some ceiling effect. Cultural invariance analyses revealed that although there were differences in the item calibrations between the ABILOCO-original and ABILOCO-Brazil, they did not impact the measures of locomotion ability.
Conclusions: The ABILOCO-Brazil demonstrated satisfactory measurement properties to be used within both clinical and research contexts in Brazil, as well cross-cultural validity to be used in international/multicentric studies. However, the presence of ceiling effect suggests that it may not be appropriate for the assessment of individuals with high levels of locomotion ability.
- Implications for rehabilitation
Self-report measures of locomotion ability are clinically important, since they describe the abilities of the individuals within real life contexts.
The ABILOCO questionnaire, specific for stroke survivors, demonstrated satisfactory measurement properties, but may not be most appropriate to assess individuals with high levels of locomotion ability
The results of the cross-cultural validity showed that the ABILOCO-Original and the ABILOCO-Brazil calibrations may be used interchangeable.
Method: A non-randomized waitlist controlled design was used to compare outcome measures for the treatment group and a waitlist control group at baseline and post-waitlist/post-therapy. After the waitlist group received problem solving therapy an analysis was completed on the pooled outcome measures at baseline, post-treatment, and three-month follow-up.
Results: Changes on outcome measures between baseline and post-treatment (n?=?13) were not significantly different between the two groups, treatment (n?=?13), and the waitlist control group (n?=?16) (between-subject design). The pooled data (n?=?28) indicated that receiving problem solving therapy significantly reduced participants levels of depression and anxiety and increased quality of life levels from baseline to follow up (within-subject design), however, methodological limitations, such as the lack of a control group reduce the validity of this finding.
Conclusion: The between-subject results suggest that there was no significant difference between those that received problem solving therapy and a waitlist control group between baseline and post-waitlist/post-therapy. The within-subject design suggests that problem solving therapy may be beneficial for younger stroke survivors when they are given some time to learn and implement the skills into their day to day life. However, additional research with a control group is required to investigate this further. This study provides limited evidence for the provision of support groups for younger stroke survivors post stroke, however, it remains unclear about what type of support this should be.
- Implications for Rehabilitation
Problem solving therapy is no more effective for reducing post stroke distress than a wait-list control group.
Problem solving therapy may be perceived as helpful and enjoyable by younger stroke survivors.
Younger stroke survivors may use the skills learnt from problem solving therapy to solve problems in their day to day lives.
Younger stroke survivors may benefit from age appropriate psychological support; however, future research is needed to determine what type of support this should be.
Methods: This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke.
Results: The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n?=?109) and reliability (n?=?51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p?=?0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach’s alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92–0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident.
Conclusions: These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum.
- Implications for Rehabilitation
The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke.
The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity.
The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points.
The lack of any floor or ceiling effects on hospital admission indicates applicability across the whole mobility spectrum of patients with sub-acute stroke.
Methods: Families were recruited in Sweden and Norway and stratified according to the gross motor function classification system levels I–V for children born 2000–2011, mean age 7.9 (SD 3.2). Construct validity based on the first questionnaire (n?=?106) was evaluated for known groups, using linear regression analysis. Intraclass correlation coefficient was used to estimate test–retest reliability (n?=?64), and Cronbach’s alpha was calculated as an indicator of internal consistency.
Results: The questionnaire showed construct validity and the ability to discriminate between levels of gross motor function for the total score and all domain scores (p?<?0.05). Test–retest reliability was high with intraclass correlation coefficient of 0.92 for the total score and of 0.72–0.92 for the domain scores. Cronbach’s alpha was 0.96 for the total score and 0.83–0.96 for the domain scores.
Conclusions: The Scandinavian version of the CPCHILD for children with CP seems to be a valid and reliable proxy measure for health related quality of life.
- Implications for rehabilitation
Valid and reliable outcome measures are needed to evaluate whether follow-up programs enhance health related quality of life in different countries.
The Scandinavian version of the caregiver priorities and child health index of life with disabilities (CPCHILD) was evaluated for known-groups validity and test–retest reliability.
The Scandinavian version of the CPCHILD is a sound and valid measurement for evaluation and comparison of health related quality of life of children with cerebral palsy in different countries.
Materials and methods: Audio recordings of initial consultations between 24 physiotherapists and 24 patients with chronic low back pain in four hospitals in Ireland were obtained as part of a larger randomised controlled trial. Three raters, all of whom had Ph.Ds in psychology and expertise in motivation and physical activity, independently listened to the 24 audio recordings and completed the 18-item Communication Evaluation in Rehabilitation Tool. Inter-rater reliability between all three raters was assessed using intraclass correlation coefficients. Concurrent validity was assessed using Pearson’s r correlations with a reference standard, the Health Care Climate Questionnaire.
Results: The total score for the Communication Evaluation in Rehabilitation Tool is an average of all 18 items. Total scores demonstrated good inter-rater reliability (Intraclass Correlation Coefficient (ICC)?=?0.8) and concurrent validity with the Health Care Climate Questionnaire total score (range: r?=?0.7–0.88). Item-level scores of the Communication Evaluation in Rehabilitation Tool identified five items that need improvement.
Conclusion: Results provide preliminary evidence to support future use and testing of the Communication Evaluation in Rehabilitation Tool.
- Implications for Rehabilitation
Promoting patient autonomy is a learned skill and while interventions exist to train clinicians in these skills there are no tools to assess how well clinicians use these skills when interacting with a patient. The lack of robust assessment has severe implications regarding both the fidelity of clinician training packages and resulting outcomes for promoting patient autonomy.
This study has developed a novel measurement tool Communication Evaluation in Rehabilitation Tool and a comprehensive user manual to assess how well health care providers use autonomy-supportive communication strategies in real world-clinical settings.
This tool has demonstrated good inter-rater reliability and concurrent validity in its initial testing phase.
The Communication Evaluation in Rehabilitation Tool can be used in future studies to assess autonomy-supportive communication and undergo further measurement property testing as per our recommendations.
Methods: The process of cross-cultural adaptation followed standardized procedures. Construct validity of the MAS was investigated using Rasch analysis (n?=?100), whereas inter-rater and test–retest reliabilities were evaluated using Kappa coefficients and Bland and Altman plots (n?=?52).
Results: The MAS demonstrated satisfactory measurement properties. The Kappa coefficients for the inter-rater and test–retest reliabilities were 0.73 (ranging from 0.79 to 1.00) and 0.82 (ranging from 0.86 to 1.00), respectively. The Bland and Altman plots showed adequate inter-rater and test–retest agreements. No ceiling or floor effects were observed and only one item exhibited misfit to the Rasch model expectations. Item 4 “sitting to standing” exhibited marginal misfit (infit MnSq?=?1.44; Zstd?=?2.6), but it did not affect the unidimensionality of the scale.
Conclusions: The MAS demonstrated good indicators of validity and reliability to be used for the assessment of motor function of individuals with stroke within clinical and research contexts.
- Implications for rehabilitation
The Motor Assessment Scale is a performance-based scale for the assessment of motor function of individuals with stroke, based on a task-oriented approach.
The Motor Assessment Scale has shown good clinical utility indicators dues to its quick administration, objectivity, and clinical relevance as a functional predictor.
The Motor Assessment Scale showed good indicators of validity and reliability to be used within clinical and research contexts for the evaluation of motor function of individuals after stroke.
Methods: The Italian version of Multiple Sclerosis Spasticity Scale was developed in accordance with international standards and subsequently administered to 232 Italian adults with multiple sclerosis. The following psychometric properties were analyzed: internal consistency through Cronbach’s α and item-to-total correlation, dimensionality with factor analysis, and convergent and criterion validity through hypotheses-testing, comparing the Multiple Sclerosis Spasticity Scale with other outcome measures (Fatigue Severity Scale, Multiple Sclerosis Quality of Life, Modified Ashworth Scale, Barthel Index, and Expanded Disability Status Scale) and analyzing related constructs. Finally, we correlated the MSSS-88 subscales with each other.
Results: The final Multiple Sclerosis Spasticity Scale version was well-understood by all subjects. The internal consistency was good (Cronbach’s α ≥0.90). Factor analysis revealed that each subscale was unidimensional. Convergent and criterion validity were supported by acceptable correlations with other disease-specific questionnaires, according to the a priori expectations.
Conclusions: The final Italian Multiple Sclerosis Spasticity Scale version showed robust psychometric properties. Therefore, it can be recommended as an assessment tool for clinical and research use to evaluate spasticity in Italian patients with multiple sclerosis.
- Implications for rehabilitation
The Multiple Sclerosis Spasticity Scale was developed to measure patients’ perception of the impact of spasticity on life of subjects with multiple sclerosis.
In a sample of Italian subjects with multiple sclerosis, the Multiple Sclerosis Spasticity Scale revealed good internal consistency and convergent and criterion validity.
Factor analysis demonstrated that each subscale was unidimensional.
Each subscale can be used to assess the impact of spasticity in Italian patients with multiple sclerosis.
Aim: Examine the predictive validity of the Occupational Therapy – Driver Off Road Assessment Battery for on-road performance among people with stroke.
Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive.
Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%).
Conclusion: The three cognitive subtests from the Occupational Therapy – Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke.
- Implications for Rehabilitation:
Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving.
The Occupational Therapy – Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment.
Scores on four of the Occupational Therapy – Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke.
Methods: Confirmatory factor analysis and hypothesis-testing was used. For 168 patients, predefined hypotheses were formulated on the correlation between the modified painDETECT and several other questionnaires, and in a subsample of 46 with pain pressure thresholds (PPTs).
Results: Two principal components were confirmed. The pain pattern item did not load on any component. Eighty per cent of the hypotheses on the correlation between modified PDQ and the questionnaires were met, as were 50% concerning PPTs measurements.
Conclusions: This study is the first to assess structural and construct validity of the modified PDQ knee/hip by using factor analysis and hypothesis-testing. This questionnaire seems to reflect neuropathic-like pain symptoms experienced by hip/knee OA-patients with adequate validity. The item on pain pattern might not reflect the construct. More than 75% of the predefined hypotheses regarding the modified PDQ and the other questionnaires were met. Only 50% of the hypotheses on PPTs measurements were met, probably due to heterogeneity and limited size of this subsample.
- Implications for rehabilitation
Pain in osteoarthritis (OA) is partly caused by modification of pain transmission in the peripheral and central nervous system, leading to sensitisation. This process seems particularly significant in a subgroup of OA patients.
Sensitisation in OA is associated with more disability in daily life, lower quality of life and more widespread pain, as well as poorer outcome of total joint surgery.
Screening for sensitisation can help to identify the subgroup of patients who could benefit from multidisciplinary treatment options focussing on desensitisation, cognitive- and behavioural therapy and reducing chronification of widespread pain. Therefore, being particularly important in the field of rehabilitation.
The Dutch modified PainDETECT-questionnaire is very useful for rehabilitation professionals as it is one of the first questionnaires specifically validated to assess neuropathic-like symptoms (indicating sensitisation) in patients with knee or hip osteoarthritis.
Materials and methods: Semi structured individual interviews were conducted with seven partners to persons who had had stroke. The interviews were recorded and then transcribed verbatim. The participants comprised two men and five women aged 60–82 years. The data were collected and analysed using a grounded theory approach.
Results: One core category Living in strained everyday circumstances and three categories Feelings of anxiety, Living a demanding day to day life, and Adjusting to a changed role emerged from the analysis. The participants had developed strategies and new ways to boost their energy level in order to find the strength needed for their everyday life.
Conclusion: This study shows that the everyday lives of partners to people who have had a stroke are characterised by feelings of strain and anxiety and that they need possibilities for different kinds of long-term support. Our findings may contribute to increased knowledge among health workers and increased readiness to offer support or referral to other meeting places such as peer support groups.
- Implications for rehabilitation
The everyday lives of partners to people who have had a stroke are characterised by feelings of strain and anxiety.
Partners to people who have had a stroke need possibilities for different kinds of long-term support.
Possibilities for relief among partners to persons after stroke may be organised for example within the municipality or by patient organisations and other voluntary networks such as peer support groups.
Method: An association between the Rosén and Lundborg Score and the Screening Activity Limitation and Safety Awareness scale for hand was evaluated in a cross-section study with 25 people of a mean age of 51?years old (SD 14), undergoing drug treatment for leprosy.
Results: The mean quantitative score in the Screening Activity Limitation and Safety Awareness scale was 27.9 (SD 10.5). Rosén and Lundborg Score for the median nerve were 2.43 (SD 0.38) on the right hand and 2.41 (SD 0.54) on the left hand whilst for the ulnar nerve, the scores observed were 2.33 (SD 0.42) for the right hand and 2.31 (SD 0.61) for the left hand. Significant correlations between the two instruments in assessment of the median and ulnar nerves on both hands were found.
Conclusions: Due to the association found between the scales, the Rosén and Lundborg Score may be used in assessment of the hand in patients diagnosed with leprosy, as a tool to assist the result evaluation after the drug treatment, surgical treatment, rehabilitation and follow-up in the hand dysfunction in leprosy.
- Implications for Rehabilitation
The leprosy inflammatory neuropathy may cause limitations and disabilities related to hand functions of patients.
Instruments with quantitative scores provide a reliable basis for therapeutic intervention prognosis.
New evaluation methods promote a better monitoring of treatment and hand function evolution of people with leprosy.
Design: General practitioners (GPs) handed out the MDI to patients aged 18–65 years on clinical suspicion of depression.
Setting: Thirty-seven general practices in the Central Denmark Region participated in the study.
Patients: Data for 363 patients (65% females, mean age: 49.8 years, SD: 17.7) consulting their GP were included in the analysis.
Main outcome measures: The overall fit to the Rasch model, individual item and person fit, and adequacy of response categories were tested. Statistical tests for local dependency, unidimensionality, differential item functioning, and correct targeting of the scale were performed. The person separation reliability index was calculated. All analyses were performed using RUMM2030 software.
Results: Items 9 and 10 demonstrated misfit to the Rasch model, and all items demonstrated disordered response categories. After modifying the original six-point to a five-point scoring system, ordered response categories were achieved for all 10 items. The MDI items seemed well targeted to the population approached. Model fit was also achieved for core symptoms of depression (items 1–3) and after dichotomization of items according to diagnostic procedure.
Conclusion: Despite some minor problems with its measurement structure, the MDI seems to be a valid instrument for identification of depression among adults in primary care. The results support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
- Key points
The Major Depression Inventory (MDI) is widely used for screening, diagnosis and monitoring of depression in general practice.
This study demonstrates misfit of items 9 and 10 to the Rasch model and a need to modify the scoring system
The findings support screening for depression based on core symptoms and dichotomization of items according to diagnostic procedure.
Minor problems with measurement structure should be addressed in future revisions of the MDI.
Methods: Children with mild (n?=?18, 11 males, 7 females, mean age?=?9.5?±?2.9 years, Gross Motor Function Classification System I–II) and moderate-to-severe (n?=?18, 11 males, 7 females, mean age?=?9.2?±?229, Gross Motor Function Classification System III–IV) CP were tested using the TIS and the GMFM, and during static sitting on force-plate.
Results: Children with mild CP showed better trunk (median; 95% confidence interval?=?22.5; 21.29–22.59 vs. 13; 11.97–14.8; p?<?0.001) and gross motor (60; 57.73–59.3 vs. 40; 38.96–46.25; p?<?0.001) scores, and better postural control (lower center of pressure (CoP) displacement [anterior–posterior: (0.42; 0.32–1.11 vs. 0.89; 0.70–1.65; p?=?0.022); medial–lateral: (0.42; 0.31–1.08 vs. 0.91; 0.65–1.17; p?=?0.044)], and lower area of sway, (0.05; ?0.15–0.97 vs. 0.44; 0.23–0.90; p?=?0.008) than the moderate-to-severe group. Trunk control and gross motor function explained 81.5% of the variance in the severity of motor condition. Correlations between the TIS and the GMFM were excellent (ρ?=?0.944, p?<?0.001); correlations between the TIS and CoP variables were low (anterior–posterior displacement: ρ?=??0.411, p?<?0.05; medial–lateral displacement: ρ?=??0.327, p?<?0.05); area of sway: ρ?=??0.430, p?<?0.05; velocity of sway: ρ?=??0.308, p?<?0.05).
Conclusions: The TIS is able to differentiate levels of trunk control across various levels of motor impairments in CP. It is a valid tool to assess trunk control, showing very high concurrent validity with the GMFM sitting dimension.
- Implications for Rehabilitation
Trunk Impairment Scale (TIS) can be used by rehabilitation professionals to differentiate levels of trunk control across levels of motor impairment.
TIS showed concurrent validity with Gross Motor Function Measure and should be used to assess trunk control in children with cerebral palsy (CP) in clinical settings.
The use of TIS allows a reliable assessment of postural control in children with CP in clinical settings.
Methods: Using a cross sectional observational design, measures of somatosensation (Erasmus MC modifications to the (revised) Nottingham Sensory Assessment), walking ability (10?m walk test, Walking Impact Scale, Timed “Get up and go”), balance (Functional Reach Test and Centre of Force velocity), and falls (reported incidence and Falls Efficacy Scale-International), were obtained.
Results: Complete somatosensory data was obtained for 163 ambulatory chronic stroke survivors with a mean (SD) age 67(12) years and mean (SD) time since stroke 29 (46) months. Overall, 56% (n?=?92/163) were impaired in the most affected lower limb in one or more sensory modality; 18% (n?=?30/163) had impairment of exteroceptive sensation (light touch, pressure, and pin-prick), 55% (n?=?90/163) had impairment of sharp-blunt discrimination, and 19% (n?=?31/163) proprioceptive impairment. Distal regions of toes and foot were more frequently impaired than proximal regions (shin and thigh). Distal proprioception was significantly correlated with falls incidence (r?=?0.25; p?<?0.01), and centre of force velocity (r?=?0.22, p?<?0.01). The Walking Impact Scale was the only variable that significantly contributed to a predictive model of falls accounting for 15–20% of the variance.
Conclusion: Lower limb somatosensory impairments are present in the majority of chronic stroke survivors and differ widely across modalities. Deficits of foot and ankle proprioception are most strongly associated with, but not predictive, of reported falls. The relative contribution of lower limb somatosensory impairments to mobility in chronic stroke survivors appears limited. Further investigation, particularly with regard to community mobility and falls, is warranted.
- Implications for Rehabilitation
Somatosensory impairments in the lower limb were present in approximately half of this cohort of chronic stroke survivors.
Tactile discrimination is commonly impaired; clinicians should include an assessment of discriminative ability.
Deficits of foot and ankle proprioception are most strongly associated with reported falls.
Understanding post-stroke lower limb somatosensory impairments may help inform therapeutic strategies that aim to maximise long-term participation, minimise disability, and reduce falls.
Methods: Semi-structured interviews were conducted in Singapore with community-dwelling stroke survivors with a previous fall (n?=?9), family caregivers (n?=?4), and domestic helpers (n?=?4) who have cared for a stroke survivor with a previous fall. Purposive sampling was used for recruitment; all interviews were audio-recorded with permission and transcribed. Thematic analysis was conducted using NVivo (v10) software.
Results: All participants shared their self-perceived intrinsic and extrinsic fall risk factors and main challenges after a fall. For stroke participants and family caregivers, motivational factors in developing safety strategies after a previous fall(s) include social connectedness, independent living and community participation. For family caregivers and domestic helpers, the stroke survivor’s safety is their top priority, however this can also lead to over-protective behavior outside of the rehabilitation process.
Conclusions: Reducing the risk of falls in community-dwelling stroke survivors seems to be more important than promoting community participation among caregivers. The study findings highlight that a structured and client-centered fall prevention program targeting stroke survivors and caregivers is needed in Singapore.
- Implications for rehabilitation
Falls after stroke can lead to functional decline in gait and mobility and restricted self-care activities.
Community-dwelling stroke survivors develop adaptive safety strategies after a fall and want to be socially connected. However, caregivers see the safety of the stroke survivors as their top priority and demonstrate over-protective behaviors.
Fall prevention programs for community-dwelling stroke survivors should target both stroke survivors and their caregivers.
A structured and client-centered fall prevention program targeting at multiple risk factors post-stroke is needed for community-living stroke survivors.
Materials and Methods: Participants were 591 parents (89.2% females; aged 25–69) of children treated as outpatients in 14 centers of “Istituto Medea – La Nostra Famiglia”, an Italian rehabilitation institution. They completed: Adult Carer Quality of Life Questionnaire, a 40-item scale assessing care-related challenges, resources, and benefits; Caregiver Burden Inventory; Resilience Scale for Adults; Satisfaction With Life Scale; Health Survey SF-36. The psychometric properties of the Adult Carer Quality of Life Questionnaire were investigated through exploratory and confirmatory factor analyses and reliability evaluation; correlation coefficients assessed convergent and discriminant validity with burden and well-being measures.
Results: The original eight-factor structure of the Adult Carer Quality of Life Questionnaire showed good adequacy and internal consistency; convergent and discriminant validity with measures of burden, resilience, satisfaction, physical and mental health were satisfactory.
Conclusions: The Italian version of the Adult Carer Quality of Life Questionnaire is a reliable and valid instrument to assess caregivers’ perceived challenges and resources. As a parsimonious and easily administrable tool, it can be used to evaluate caregivers’ quality of life and related interventions.
- Implications for Rehabilitation
Family caregivers are essential assets for the rehabilitation process, and their challenges and resources need to be considered by healthcare services.
Information on caregivers’ frailties to be reduced and strengths to be empowered allows to design interventions promoting well-being and social integration of people with disabilities and their families.
The Adult Carer Quality of Life is a comprehensive measure of burden and well-being dimensions that can be easily administered to caregivers of any age.
Methods: The Trunk Impairment Scale was culturally adapted in accordance with international standards. The psychometric testing included: internal consistency (Cronbach’s alpha), inter- and intra-rater reliability (intraclass correlation coefficient; standard error of measurement and minimal detectable change), construct validity by comparing Trunk Impairment Scale score with Barthel Index, motor subscale of Functional Independence Measure, and Trunk Control Test (Pearson’s correlation), and responsiveness (Effect Size, Effect Size with Guyatt approach, standardized response mean, and Receiver Operating Characteristics curves).
Results: The Trunk Impairment Scale was administered to 125 and 116 acute and chronic stroke patients, respectively. Internal consistency was acceptable (α?>?0.7), inter- and intra-rater reliability (ICC >?0.9, Minimal Detectable Change for total score <?1.6 in cohort 1 and <?1.1 in cohort 2) were excellent. The construct validity showed acceptable correlations (r?>?0.4) with all scales but the motor Functional Independence Measure in cohort 2. Distribution-based methods showed large effects in cohort 1 and moderate to large effects in cohort 2. The Minimal Important Difference was 3.5 both from patient’s and therapist’s perspective in cohort 1 and 2.5 and 1.5 from patient’s and therapist’s perspective, respectively, in cohort 2.
Conclusion: The Trunk Impairment Scale was successfully translated into Italian and proved to be reliable, valid, and responsive. Its use is recommended for clinical and research purposes.
- Implications for Rehabilitation
Trunk control is an essential part of balance and postural control, constituting an important prerequisite for daily activities and function.
The TIS administered in subjects with subacute and chronic stroke was reliable, valid and responsive.
The TIS is expected to help clinicians and researchers by identifying key functional processes related to disability in people with subacute and chronic stroke.
Materials/methods: Analysis of a large multicentre cohort of patients (n?=?5396) from the national clinical dataset representing 63 specialist rehabilitation services across England. Structural validity was examined using exploratory and confirmatory factor analysis. Concurrent and criterion-validity were tested through a priori hypothesized relationships with other validated measures of resource requirements and dependency.
Results: All but two items loaded strongly onto a single principal component with Cronbach’s alpha 0.88. A total score of ≥30 identified patients with complex (category A) needs with sensitivity 76% and specificity 75%. However, confirmatory factor analysis provided a better fit when the scale was split into two subscales – a 'Cognitive/psychosocial' and a 'Physical' sub-scale (alpha 0.83 and 0.84, respectively). Moderate convergent and discriminant correlations were consistent with hypothesized relationships.
Conclusions: The findings provide some overall support for the Patient Categorisation Tool as a unidimensional tool for measuring complexity of needs for neurorehabilitation, but the subscales may be more suitable for certain groups of patients. Further analysis is now required to evaluate its performance in different conditions.
- Implications for Rehabilitation
A psychometrically robust tool for measuring the complexity of rehabilitation needs has potential value, both at an individual level for treatment planning, and at a population level for planning and commissioning rehabilitation services.
The Patient Categorisation Tool now forms part of the United Kingdom national clinical dataset mandated by the National Health Service in England
This psychometric analysis from a large national multicentre cohort representing a diverse range of conditions, provides evidence for its validity as a means to identity patients with complex rehabilitation needs requiring specialist rehabilitation.
Methods: Stroke survivors receiving in-patient rehabilitation were randomised to receive eight art participation sessions (n?=?41) or usual care (n?=?40). Recruitment, retention, preference for art participation and change in selected outcomes were evaluated at end of intervention outcome assessment and three-month follow-up.
Results: Of 315 potentially eligible participants 81 (29%) were recruited. 88% (n?=?71) completed outcome and 77% (n?=?62) follow-up assessments. Of eight intervention group non-completers, six had no preference for art participation. Outcome completion varied between 97% and 77%. Running groups was difficult because of randomisation timing. Effectiveness cannot be determined from this feasibility study but effects sizes suggested art participation may benefit emotional wellbeing, measured on the positive and negative affect schedule, and self-efficacy for Art (d?=?0.24–0.42).
Conclusions: Undertaking a RCT of art participation within stroke rehabilitation was feasible. Art participation may enhance self-efficacy and positively influence emotional wellbeing. These should be outcomes in a future definitive trial. A cluster RCT would ensure art groups could be reliably convened. Fewer measures, and better retention strategies are required.
- Implications for Rehabilitation
This feasibility randomised controlled trial (RCT) showed that recruiting and retaining stroke survivors in an RCT of a visual arts participation intervention within stroke rehabilitation was feasible.
Preference to participate in art activities may influence recruitment and drop-out rates, and should be addressed and evaluated fully.
Art participation as part of rehabilitation may improve some aspects of post-stroke wellbeing, including positive affect and self-efficacy for art.
A future definitive cluster RCT would facilitate full evaluation of the value art participation can add to rehabilitation.