Conceptualisation and development of the arm activity measure (ArmA) for assessment of activity in the hemiparetic arm

Abstract

Purpose: To develop a patient reported outcome measure of active and passive function in the hemiparetic upper limb. Methods: Potential items for inclusion were identified through (a) systematic review and analysis of existing measures and (b) analysis of the primary goals for treatment in a spasticity service. Item reduction was achieved through consultation with a small, purposively selected multi-disciplinary group of experienced rehabilitation professionals (n?=?10) in a three-round Delphi process. This was followed by a confirmatory survey with a larger group of clinicians (n?=?36) and patients and carers (n?=?13 pairs). Results: From an initial shortlist of 75 items, 23 items were initially identified for inclusion in the arm activity measure (ArmA), and subsequently refined to a 20-item instrument comprising 7 passive and 13 active function. In common with the six measures identified in the systematic review, a five-point ordinal scaling structure was chosen, with ratings based on activity over the preceding 7?days. Conclusions: The ArmA is designed to measure passive and active function following focal interventions for the hemiparetic upper limb. Content and face validity have initially been addressed within the development process. The next phase of development has involved formal evaluation of psychometric properties.

• Implications for Rehabilitation

• In clinical practice or research, outcome measures in rehabilitation need to have face and content validity.

• Following stroke or brain injury, goals for rehabilitation of the hemiparetic upper limb may be: to restore active function, if there is return of motor control or to improve passive function making it easier to care for the limb (e.g. maintain hygiene) if no motor return is possible, measurement of both constructs should be considered.

• This study describes the systematic development of the ArmA, a measure of active and passive function in the hemiparetic upper limb.

     

Effects of the Dietary Approaches to Stop Hypertension (DASH) on Pregnancy/Neonatal Outcomes and Maternal Glycemic Control: A Systematic Review and Meta-analysis of Randomized Clinical Trials

Background & objectiveNo systematic review to date has appraised the impact of the Dietary Approaches to Stop Hypertension (DASH) eating plan on maternal glycemic control and pregnancy outcomes. Thus, we conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) to ascertain whether the DASH diet in pregnant women ameliorates their glycemic control and neonatal outcomes when compared to standard diets.MethodsWe performed a comprehensive systematic review and meta-analysis of RCTs on PubMed/MEDLINE, Web of Science, SCOPUS, and Embase from the inception until October 2019.ResultsSix studies met the eligibility criteria and were included in the quantitative meta-analysis. The pregnant women had cardiometabolic disorders such as gestational diabetes, obesity, and hypertension. The meta-analysis suggested a significant effect of DASH diet on fasting plasma levels of glucose (WMD = -6.239 mg/dl; 95% CI: -11.915, -0.563, p = 0.031), but not for the homeostasis model assessment of insulin resistance (WMD = -1.038; 95% CI: -2.704, 0.627, p = 0.22). Following the DASH diet during pregnancy decreased the risk of gestational preeclampsia (RR = 0.667; 95% CI: 0.451, 0.987, p = 0.043), macrosomia (birth weight >4000 g) (RR = 0.294; 95% CI: 0.120, 0.721, p = 0.043), and large for gestational age (RR = 0.452; 95% CI: 0.211, 0.969, p = 0.041). Consuming DASH diet during pregnancy neither increased nor decreased the risk of cesarean section, polyhydramnios, preterm birth (<37 weeks), and small for gestational age. The mean newborn head circumference (cm) (WMD = -0.807; 95% CI: -1.283, -0.331, p = 0.001) and ponderal index (kg/m³) (RR = -0.396; 95% CI: -0.441, -0.350, p = 0.000) in the group receiving the DASH diet were lower than in the control group.ConclusionThe adherence of pregnant women with cardiometabolic disorders to DASH eating pattern has a significant effect on decreasing fasting plasma glucose levels, ponderal index, incidence of preeclampsia, fetal macrosomia, large for gestational age, and newborn head circumference.     

Cultural adaptation and validation of the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure

OBJECTIVE: To translate and validate the Persian version of the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure (Persian DASH). DESIGN: Cultural translation and psychometric testing. SETTING: Outpatient departments of orthopaedics surgery, primary care settings, rehabilitation medicine and physical therapy. SUBJECTS: Two hundred and seventy-one consecutive Persian-speaking patients with upper extremity disorders including subacromial impingement syndrome, rotator cuff disease, epicondylitis, ulnar nerve entrapment, bursitis, instability, carpal tunnel syndrome, tenosynovitis and adhesive capsulitis. METHODS: The translation and cultural adaptation of the original questionnaire was carried out in accordance with published guidelines. The participants were asked to complete a questionnaire booklet including the Persian DASH, the Short Form General Health Survey (SF-36) and a visual analogue scale (VAS) of pain. In addition, 31 randomly selected patients were asked to complete the questionnaire 48 hours later for the second time. RESULTS: Cronbach's alpha coefficient for the Persian DASH was 0.96. The Persian DASH showed excellent test-retest reliability with intraclass correlation coefficient equal to 0.82 (P<0.01). The correlation between the Persian DASH and the functional scales of the Iranian SF-36 showed desirable results indicating a good convergent validity (Pearson's coefficients ranged from -0.25 to -0.72; P<0.001). The correlation between the Persian DASH and the visual analogue scale was 0.52 (P<0.01). CONCLUSIONS: The Persian DASH is a reliable and valid instrument to measure functional status in Persian-speaking patients with upper extremity disorders in Iran. It is simple and easy to use and now can be applied in clinical settings and future outcome studies in Iran and other Persian-speaking communities.     

Cross-cultural adaptation of wheelchair skills test (version 4.3) for wheelchair users and caregivers to the Portuguese language (Brazil)

Abstract

Objective: To perform cross-cultural adaptation of the Wheelchair Skills Test of manual wheelchair users and their caregivers into the Brazilian Portuguese language.

Methods: The study was composed of translation, synthesis of translations, back-translation, review by an expert committee and pre-test, when the test was applied in the target population. Included were translators, subject specialists and coordinators to carry out the cross-cultural adaptation process, and manual wheelchair users and their caregivers with at least six months of wheelchair experience for the pre-test.

Results: Forty-three people participated in the study, 30 for the pre-test and 13 for the stages that preceded the pre-test. The mean age of manual wheelchair users was 40.2 (±10.7) years and of caregivers was 44.2 (±15.7) years. Of the 47 phrases translated in the first stage, 36 discrepancies were found and resolved. During the analysis by the committee of experts the instrument underwent 13 modifications in order to achieve the best possible equivalence between the original version and the final version and was understandable by the people evaluated. The total pre-test scores of wheelchair users and their caregivers were 66.2 (±24.6) and 88.7 (±14.2), respectively.

Conclusions: This instrument was able to evaluate the abilities of wheelchair users and their caregivers in Brazil, as well as being useful for training in rehabilitation programs.

• Implications for rehabilitation

• The need to use wheelchair (WC) properly has made clinicians and rehabilitation professionals more concerned with assessing and training users' abilities with their WC.

• Cross-cultural adaptation allows for the linguistic modification of the original language of the evaluation tool into a new language and enables the comparison of research results in different countries.

• Immediate use of the instrument for WC users and caregivers in Brazil, both for evaluation and for training, is necessary and may be a means for rehabilitation professionals to improve their evaluations, their treatments and optimize the skills that aim at independence.

     

Validity,reliability and ease of use of the disabilities of arm,shoulder and hand questionnaire in adults following stroke

Purpose: The Disabilities of Arm, Shoulder and Hand (DASH) questionnaire is a patient reported outcome measure for evaluating upper limb function in people with musculoskeletal conditions. While the DASH has good psychometric properties when used with people with musculoskeletal conditions, it has not been tested with adults after stroke.

Methods: Data for n?=?61 adults following stroke (aged 32–93 years, 44% male) were analyzed to test validity and reliability of the DASH for use with a stroke population. Data included demographic and clinical attributes, DASH scores (baseline and four weeks later) and Patient Rated Wrist Evaluation (PRWE) measures.

Results: Internal consistency was good (Cronbach alpha 0.92, SEM 6.65). Factor analysis and Rasch modeling suggested that the questionnaire comprised three subscales: pain, impact and function. Concurrent validity between the DASH and PRWE (Spearman’s Rho r_s?=_?0.41) was moderate. The scale was perceived by clinicians to be useful, quick and simple to administer. The DASH had low four-week test-retest reliability (ICC 0.56 [95% Cl 0.05–0.79]).

Conclusions: The DASH is considered to have acceptable validity when used with adults following stroke. Test–retest reliability was low but further research is needed to establish whether this is a result of condition-related change or the stability of the measure.

• Implications for Rehabilitation

• The DASH questionnaire examines upper limb function in task performance and appears to be a useful tool, which is simple to administer in the clinical setting with adults following stroke.

• Upper limb function post stroke can be meaningfully assessed using the DASH as it has good internal consistency and moderate concurrent validity.

• Rasch analysis and factor analysis suggests that the tool appears to consist of three subscales: pain, impact and function. The total score of the DASH may be less meaningful than the totals of these subscales.

• The test–retest reliability of the DASH requires further research; over a four-week period DASH stability was poor in a group of people with moderate to severe upper limb impairment.

     

上肢微型游离皮瓣在外伤性手指创面修复中的效果及对手部功能改善价值分析

目的探讨上肢微型游离皮瓣在外伤性手指创面修复中的效果及对手部功能的改善价值.方法选取我院2016年1月至2019年9月收治的100例手指外伤患者为研究对象,根据手术方式分为肢微型游离皮瓣修复组(试验组n=50例)和腹部皮瓣修复组(对照组n=50例).比较两组术后皮瓣存活情况、手部功能改善情况及术后并发症的发生率.结果术后试验组的皮瓣存活良好率为为94%高于对照组80%(P<0.05),手部功能优良率试验组为98%高于对照组86%(P<0.05),术后试验组的并发症发生率为12%,对照组为16%,但组间比较,差异无统计学意义(P>0.05).结论上肢微型游离皮瓣能提高外伤性手指创面修复效果,有效改善患者手部功能,且不增加术后并发症的发生率.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

Reliability,validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke

Purpose:?The upper limb items of the Motor Assessment Scale (MAS) have been shown to be a sensitive, valid and reliable measure of upper limb function for adults following stroke, however the validity and reliability of summing these items into an independent subscale has not yet been evaluated. The stability, internal consistency and construct validity of the upper limb MAS subscale (UL-MAS) was assessed in this study.

Method:?Twenty-seven inpatients following stroke (mean age?=?67 years, range?=?40?–?80) were sampled from an acute, inpatient rehabilitation setting. Patients were evaluated with ‘Upper Arm Function’, ‘Hand Movements’, and ‘Advanced Hand Activities’ items of the MAS by masked physiotherapists who had received standardized training in administration of the MAS.

Results:?All items were explained by one factor on confirmatory factor analysis and correlated significantly with one another and with the composite (summed total) score. Internal consistency analysis produced a Cronbach's alpha of 0.83 which did not benefit from removal of any items.

Conclusions:?The acceptable internal consistency score obtained verifies the validity and reliability of using the UL-MAS as an independent scale. This study has also verified the construct validity of the UL-MAS subscale and provides a valuable extension of previous work, which together demonstrates the value of the UL-MAS as a responsive, valid and reliable measure of upper limb function in adults following stroke. The UL-MAS produced a single, composite score that could be interpreted as a total score for upper limb function in this population.     

Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture

Purpose: To examine the validity and reliability of an activity monitor to estimate upper limb activity.

Methods: Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test–retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences.

Results: There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r?=?0.82, r?=?0.73, respectively] and floor sweeping activities [r?=?0.54, r?=?0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC_(2,1)?=?0.91, ICC_(2,1)?=?0.88, respectively], grocery shelving [ICC_(2,1)?=?0.83, ICC_(2,1)?=?0.89, respectively], and table dusting activities [ICC_(2,1)?=?0.77, ICC_(2,1)?=?0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed.

Conclusions: There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture.

• Implications for Rehabilitation

• Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions.

• After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels.

• Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence.

• Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.

     

Responsiveness,minimal importance difference and minimal detectable change scores of the shortened disability arm shoulder hand (QuickDASH) questionnaire

The aim of this study was to determine the responsiveness, Minimal Important Difference (MID) and Minimal Detectable Change (MDC) scores of the shortened Disability Arm Shoulder Hand (QuickDASH) questionnaire. Participants (n = 35) were recruited from private physiotherapy practices. Participants completed the QuickDASH questionnaire on two occasions; the first prior to treatment and the second at discharge or at six weeks post baseline, whichever event occurred first. The participants also completed a Global Change in Status Questionnaire (GSCQ). Responsiveness across treatment to discharge or at six weeks post initial visit was analysed by calculating the Effect Size (ES) and Standardised Response Mean (SRM). The MID was calculated using an anchor based approach and the MDC score was based upon calculations of the standard error of measurement (SEM). The results indicated that responsiveness was high (ES = 1.02, SRM = 1.1). The MID was 19 points while the MDC was 11 points.These results provide evidence that the QuickDASH is a responsive instrument when utilised in patients seen in private practice over a typical treatment interval.     

康复机器人辅助训练对偏瘫患者上肢功能及日常生活活动能力的影响

目的:探讨上肢康复机器人辅助训练对脑卒中偏瘫患者上肢运动功能及日常活动能力的影响。方法:将44例符合入组标准的患者随机分成治疗组(n=22)和对照组(n=22),对所有患者进行为期4周的康复治疗,对照组患者采用传统作业训练40min/次,1次/天,6天/周;治疗组每天在20min传统作业训练的基础上增加上肢机器人辅助训练20min/次,1次/天,6天/周。采用简式Fugl-Meyer量表上肢部分(FMA-UE)、香港手功能评估(FTHUE-HK)和改良Barthel指数(MBI)分别于治疗前和治疗后对两组患者进行评估。结果:两组患者治疗前后的FMA-UE、FTHUE-HK评分和MBI评分比较均有显著性差异(P0.01);治疗后两组间对比无显著性差异(P0.05)。结论:上肢康复机器人辅助治疗对脑卒中偏瘫患者上肢运动功能及ADL能力的提高和传统的作业治疗一样有效。     

中文版上肢技巧质量量表在脑性瘫痪患儿上肢功能评定中的信度和效度

目的:评估中文版上肢技巧质量量表(quality of upper extremity skills test,QUEST)在痉挛型脑瘫患儿上肢功能评定中的信度和效度。方法:将英文版QUEST翻译并完善成中文版,研究对象为75例在我院就诊的痉挛型脑瘫儿童,检测其重测信度及评定者间信度。同时进行Peabody运动发育量表的精细运动部分(peabody developmental motor scale fine motor,PDMS-FM),精细运动能力(fine motor function measure scale,FMFM),分析PDMS-FM原始分、FMFM各区分数与中文版QUEST各分测试项原始分之间的相关性,评估量表的平行效度。结果:中文版QUEST分测试项得分及总分具有优良的重测信度及评估者间信度(ICC值均0.890),中文版QUEST分测试项原始分与PDMS-FM、FMFM各区原始分间具有较好的平行效度(Pearson/Spearson秩相关系数分别为r1=0.563—0.816、r2=0.389—0.830)。结论:中文版QUEST量表具有良好的信度和效度,可以作为评估痉挛型脑瘫患儿上肢运动功能的首选方法。     

Towards a short questionnaire for stepwise assessment of upper limb function,pain and stiffness in Duchenne muscular dystrophy

Purpose: Duchenne muscular dystrophy can lead to upper extremity limitations, pain and stiffness. In a previous study, these domains have been investigated using extensive questionnaires, which are too time-consuming for clinical practice. This study aimed at gaining insight into the underlying dimensions of these questionnaires, and to construct a short questionnaire that can be used for clinical assessment.

Methods: Exploratory factor analysis was performed on the responses of 213 participants to a web-based survey to find the underlying dimensions in the Capabilities of Upper Extremity questionnaire, the ABILHAND questionnaire, and questionnaires regarding pain and stiffness. Based on these underlying dimensions, a stepwise approach was formulated. In addition, construct validity of the factors was investigated.

Results: In total, 14 factors were identified. All had high internal consistency (Cronbach's alpha >0.89) and explained 80–88% of the variance of the original questionnaires. Construct validity was supported, because participants in the early ambulatory stage performed significantly better (pConclusion: The factors identified from the set of questionnaires provide a valid representation of upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on the factor commonalities, the Upper Limb Short Questionnaire was formulated.

• Implications for Rehabilitation

• New insights into the underlying dimensions of upper extremity function, pain and stiffness in Duchenne muscular dystrophy are gained.

• Fourteen factors, with good internal consistency and construct validity, are identified regarding upper extremity function, pain and stiffness in Duchenne muscular dystrophy. Based on these factors, the Upper Limb Short Questionnaire is presented.

• The Upper Limb Short Questionnaire can be used as an identifier of arm-hand limitations and the start of more thorough clinical investigation.

     

Prevalence and characteristics of complaints of the arm, neck, and/or shoulder (CANS) in the open population

OBJECTIVE: To study the prevalence of upper extremity disorders (UEDs) and neck as a total and complaints of the arm, neck and/or shoulder (CANS) not caused by acute trauma or any systemic disease as defined in the CANS model in the open population and to assess sociodemographic and health characteristics of chronic symptoms. METHODS: Data were obtained from the DMC3-study, a Dutch questionnaire survey on musculoskeletal conditions (>25 y, n=3664). Data on four anatomic sites were assessed: neck, shoulder, elbow, and wrist. Various health characteristics were measured including the Short Form-36. Rectangle diagrams were used to illustrate cooccurrence of pain in the four anatomic sites. RESULTS: The 12-month prevalence of CANS was 36.8%, the point prevalence was 26.4%, and 19.0% patients reported chronic CANS. Women, aged 45 to 64 years, with the lowest education level and working were the most affected. Within those with UEDs, around 25% of cases were caused by an acute trauma or by some systemic disease. Of those with chronic CANS, 58% reported use of healthcare. Healthcare users scored worse on general health, limitations in daily living, pain, and sickness absence than nonhealthcare users; >43% reported symptoms in more than 1 anatomic site. DISCUSSION: UEDs and CANS frequently occur in the open population. Excluding acute traumas and systemic diseases reduced the prevalence of CANS and resulted in a relatively healthier population. A compound definition of CANS seems indicated because of the large overlap of affected anatomic sites.     

基于虚拟现实技术的上肢康复训练系统发展现状

本文对基于虚拟现实技术的上肢功能康复训练系统的国内外现状进行概述,重点介绍几款发展相对比较成熟的康复系统,针对软件设计部分做出主要说明,分析虚拟场景、虚拟物体及网络远程在上肢康复中的应用,并对虚拟训练技术在康复应用中的问题做出总结,对其发展前景做出展望。