Reliability of the Cutting Alignment Scoring Tool (CAST) to Assess Trunk and Limb Alignment During a 45-Degree Side-Step Cut

BackgroundThree-dimensional (3D) motion analysis is considered the gold standard for evaluating human movement. However, its clinical utility is limited due to cost, operating expertise, and lengthy data processing time. Numerous qualitative scoring systems have been introduced to assess trunk and lower extremity biomechanics during functional tasks. However, the reliability of qualitative scoring systems to evaluate cutting movements is understudied. Purpose/Hypotheses: To assess the inter-rater and intra-rater reliability of the Cutting Alignment Scoring Tool (CAST) among sports medicine providers and to evaluate rater agreement of each component of the CAST. The hypotheses were: 1) there would be good–to-excellent inter-rater and intra-rater reliability among sports medicine providers, 2) there would be good to almost perfect agreement for cut width and trunk lean variables and moderate to good agreement for valgus variables of the CAST.Study DesignRepeated MeasuresMethodsTen videos of a 45-degree side-step cut performed by adolescent athletes were independently rated on two occasions by six raters (2 medical doctors, 2 physical therapists, and 2 athletic trainers). The variables assessed include trunk lean to the opposite direction of the cut, increased cut width, knee valgus at initial load acceptance (static), and knee valgus throughout the task (dynamic). Variables were scored as either present, which were given a score of “1”, or not present, which were given a score of “0”. Video sequence was randomized in each rating session, and a two-week wash out period was given.ResultsThe cumulative inter-rater and intra-rater reliabilities were good (ICC: 0.808 and ICC: 0.753). Almost perfect kappa coefficients were recorded for cut width (k=0.949). Moderate kappa coefficients were found for trunk lean (k= 0.632) and fair kappa coefficients were noted for dynamic and static valgus (k=0.462 and k= 0.533 respectively).ConclusionThese findings suggest that the CAST is a reliable tool to evaluate trunk and LE alignment during a cutting task by sports medicine providers.Level of EvidenceLevel 2 Diagnosis     

Reliability and validity of the nutritional form for the elderly (NUFFE)

AIM: The aim of this study was to test the reliability and validity of the Nutritional Form for the Elderly (NUFFE). BACKGROUND: The prevalence of undernutrition among older people in nursing homes and hospitals reaches high levels. Assessment of older patients' nutritional status is an important task for nurses in clinical care. To use a simple nutritional assessment instrument for older people is one approach for nurses. Examples of such instruments are the well validated Mini Nutritional Assessment (MNA) and the newly developed NUFFE. METHODS: A total of 114 consecutively chosen, newly admitted older patients in an elder care rehabilitation ward in western Sweden were interviewed using the NUFFE and MNA. Arm and calf circumferences, body mass index (BMI), and presence of pressure sores and skin ulcers were noted as part of the MNA on admission. Weight was monitored and BMI calculated on discharge. Serum albumin levels on admission and discharge were used if these were available in the records. Reliability of the NUFFE was measured as homogeneity. Criterion related validity, concurrent validity, construct validity, and predictive validity were assessed with different statistical methods. The regional research ethics committee approved the study. RESULTS: The results showed that the NUFFE is a fairly reliable and valid instrument for identifying actual and potential undernutrition among older patients. CONCLUSION: The NUFFE is a simple tool for nurses to use to assess older patients with the aim of detecting undernourished individuals and those at risk for undernutrition. When doing a nutritional assessment with the NUFFE, the BMI ought also to be calculated. The assessment could also be combined with food intake recording for a period of time.     

Facilitating a dedicated focus on the human dimensions of care in practice settings: Development of a new humanised care assessment tool (HCAT) to sensitise care

There is limited consensus about what constitutes humanly sensitive care, or how it can be sustained in care settings. A new humanised care assessment tool may point to caring practices that are up to the task of meeting persons as humans within busy healthcare environments. This paper describes qualitative development of a tool that is conceptually sensitive to human dimensions of care informed by a life‐world philosophical orientation. Items were generated to reflect eight theoretical dimensions that constitute what makes care feel humanly focused. An action research group process in 2014–2015 with researchers, service users, healthcare professionals in two diverse clinical settings (stroke rehabilitation and dermatology) was used. Feedback on conceptual content, transparency of meaning and readability was then gained from a panel in Sweden and third‐year student nurses in the UK. The tool can be applied to attune staff to human dimensions of care, offering items which point to concrete examples of humanising and dehumanising features of practice in ways that have not yet been fully captured in the caring literature. Based on theoretically led experiential items, with dedicated focus on what makes people feel more, or less than human, it may offer improvement on available assessments of care.     

Content validity to support the use of a computer-based phonological awareness screening and monitoring assessment (Com-PASMA) in the classroom

Abstract

Purpose. This study investigated the content validity of a computer-based phonological awareness (PA) screening and monitoring assessment (Com-PASMA) designed to evaluate school-entry PA abilities. Establishing content validity by confirming that test items suitably ‘fit’ and sample a spectrum of difficulty levels is critical for ensuring educators can deduce accurate information to comprehensively differentiate curricular reading instruction.

Method. Ninety-five children, inclusive of 21 children with spoken language impairment, participated in a 1-year longitudinal study whereby the Com-PASMA was administered at the start, middle and end of the school year.

Result. Estimates of content validity using Rasch Model analysis demonstrated that: (1) rhyme oddity and initial phoneme identity tasks were most appropriate at school-entry and sampled a spectrum of difficulty levels, (2) more challenging phoneme level tasks (e.g. final phoneme identity, phoneme blending, phoneme deletion and phoneme segmentation) became increasingly appropriate and differentiated between high- and low-ability students by the middle and end of the first year of school and (3) letter-knowledge tasks were appropriate but declined in their ability to differentiate student ability as the year progressed.

Conclusion. Findings demonstrate that the Com-PASMA has sufficient content validity to measure and differentiate between the PA abilities of 5-year-old children on entry to school.     

Convergent Validation of the Kohlman Evaluation of Living Skills as a Screening Tool of Older Adults' Ability to Live Safely and Independently in the Community

Burnett J, Dyer CB, Naik AD. Convergent validation of the Kohlman Evaluation of Living Skills as a screening tool of older adults' ability to live safely and independently in the community.

Objective

To evaluate the convergent validity of the Kohlman Evaluation of Living Skills (KELS) to screen older adults' ability to live safely and independently.

Design

Cross-sectional study correlating KELS with components of a Comprehensive Geriatric Assessment.

Setting

Participants' homes.

Participants

Community-dwelling older adults (N=200) 65 years and older including 100 persons referred by Adult Protective Services (APS) and 100 ambulatory patients matched on age, race, sex, and socioeconomic status.

Interventions

In-home comprehensive assessment.

Main Outcome Measures

KELS, Geriatric Depression Scale (GDS), modified Physical Performance Test (mPPT), Mini-Mental State Examination (MMSE), Knee Extensor Break Test, Executive Cognitive Test (EXIT25), executive clock-drawing test (CLOX) 1 and 2, and an 8-foot walk test.

Results

Older adults with abnormal KELS scores performed significantly worse on all tests except for the Knee Extensor Break Test. Accordingly, among the entire group, the KELS correlated with measures of executive function (EXIT25, r=.705, P<.001; CLOX 1, r=−.629, P<.001), cognitive function (MMSE, r=−.508, P<.001), affect (GDS, r=.318, P<.001), and physical function (mPPT, r=−.472, P<.001) but did not correlate with the Knee Extensor Break Test (r=−.068, P=.456). Among those referred by APS, the KELS failed to correlate with only the 8-foot walk test (r=.175, P=.153) and GDS (r=.080, P=.450).

Conclusions

This study demonstrated the convergent validity of KELS with a battery of cognitive, affective, executive, and functional measures often used to determine older adults' ability to live safely and independently in the community. KELS may be a valid and pragmatic alternative to screen for the capacity to live safely and independently among older adults.     

Reliability,validity and factor structure of the Appraisal of Self‐Care Agency Scale – Revised (ASAS‐R)

Rationale, aims and objectives Self‐care agency is a fundamental concept in nursing and health care research. Having self‐care agency enhances an individual's health‐promoting behaviours and/or specific capabilities for chronic disease self‐management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self‐Care Agency – Revised (ASAS‐R). Methods A cross‐sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS‐R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n = 240) and a confirmatory factor analysis (CFA; n = 389) of the scale. A demographic questionnaire, the ASAS‐R and the Health‐Promoting Lifestyle Profile (HPLP‐II) were the measures used to collect the data. Results The final 15‐item three‐factor ASAS‐R had an overall Cronbach's alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self‐care, developing power for self‐care and lacking power for self‐care. All inter‐items and item‐to‐total correlations met recommended criteria of r = 0.30 to r = 0.70, except for one of the items that had an item‐to‐total correlation of 0.71, slightly exceeding the maximum recommended item‐to‐total correlation. The three factors had Cronbach's alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15‐item ASAS‐R had a very good fit (χ²/d.f. = 1.97, GFI = 0.94, AGFI = 0.92, CFI = 0.96, TLI = 0.95, RMSEA = 0.05, RMR = 0.05 and the PCLOSE = 0.48). Conclusions The 15‐item three‐factor ASAS‐R is a short, reliable and valid instrument to measure self‐care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.     

Reliability and validity of the Spanish version of the TAPQOL: a health-related quality of life (HRQOL) instrument for 1- to 5-year-old children

Objectives

To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL).

Methods

A consecutive sample of children (3 months to 5 years old) was recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their child's health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instrument's structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup.

Results

A total of 228 children participated in the study (response rate = 95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbach's alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup.

Conclusions

Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaire's structure and assess its sensitivity to change.     

Adaptation of the person centered therapeutic relationship patient version (PCTR-PT) to a version for physiotherapists (PCTR-PHYS) and evaluation of its psychometric properties

Background and Purpose

The therapeutic relationship is a central component for developing person-centered care within physiotherapy services. However, it is necessary to understand how this relationship is perceived by both parties involved. The Person Centered Therapeutic Relationship-Patient scale (PCTR-PT) was constructed to identify patients' perceptions. No instruments are currently available to correlate patients' and physiotherapists' perceptions of the therapeutic relationship. This study sought to adapt the PCTR-PT to develop a version for physiotherapists, the Person Centered Therapeutic Relationship Scale for Physiotherapists (PCTR-PHYS) and to determine its psychometric properties.

Methods

A three-stage study was performed: (1) item generation, (2) pretesting of the questionnaire, (3) analysis of psychometric properties. Factor validity and psychometric properties were analyzed by confirmatory factor analysis (CFA). Convergent validity was calculated. Internal consistency was verified using the Cronbach's alpha coefficient. The intraclass correlation coefficient (ICC) was used to examine temporal stability.

Results

Thirty-three physiotherapists participated in two rounds of cognitive interviews and 343 participated in the analysis of psychometric properties. The CFA confirmed the four-structure model. Reliability of the tool was confirmed by Cronbach's alpha (α = 0.863) for all four dimensions, as all were above 0.70, ranging from 0.704 (relational bond) and 0.898 (therapeutic communication). Test-retest was performed with 2-week intervals, indicating an appropriate stability for the scale (ICC = 0.908).

Discussion

The Person Centered Therapeutic Relationship Scale for Physiotherapists is a useful, valid and applicable instrument to evaluate the person-centered therapeutic relationship during physiotherapy interventions. It will enable the comparison of patients' and physiotherapists' perceptions. To provide person-centered care in physiotherapy services, there is a clear need to incorporate specific resources into clinical practice to evaluate the quality of the therapeutic relationship from the perspective of both the persons being treated and the professionals providing care.     

Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation

Purpose: To develop and validate parallel short forms for the assessment of activities of daily living in cardiac rehabilitation patients (PADL-cardio I & II).

Method: PADL-cardio I & II were developed based on a sample of 106 patients [mean age = 57.6; standard deviation (SD)?=?11.1; 72.6% males] using Rasch analysis and validated with a sample of 81 patients (mean age = 59.1; SD = 11.1; 88.9% males). All patients answered PADL-cardio and the Short Form 12 Health Survey.

Results: Both versions of PADL-cardio are composed of 10 items. The fit to the Rasch model was given documented by a non-significant Item-trait interaction score (PADL-cardio I: χ²?=?31.08, df =??30, p = 0.41; PADL-cardio II: χ²?=?45.6, df??=??40, p??=??0.25). The two versions were free of differential item functioning. Person-separation reliability was 0.72/0.78 and unidimensionality was given. The two versions correlated with r?=?0.98 and the correlation between PADL-cardio and the underlying item bank was 0.99 for both versions. Concurrent validity is indicated through correlations with the Short Form 12 Health Survey (r =??0.37 to ?0.40).

Conclusion: PADL-cardio provides a short and psychometrically sound option for the assessment of activities of daily living in cardiovascular rehabilitation patients. The two versions of PADL-cardio are equivalent. Hence, they can be used to reduce practice and retest effects in repeated measurement, facilitating the longitudinal assessment of activities of daily living.

• Implications for Rehabilitation

• New parallel test forms for the assessment of activities of daily living in cardiac rehabilitation (PADL-cardio I & PADL-cardio II) are available.

• PADL-cardio I & II consist of 10 items and are therefore especially timesaving. Concurrent validity is given through correlations with the Short Form Health Survey 12.

• Therapeutic success could be determined more precisely by the parallel forms reducing practice and retest effects.

     

Test-retest and interobserver reliability of quantitative sensory testing according to the protocol of the German Research Network on Neuropathic Pain (DFNS): a multi-centre study

Quantitative sensory testing (QST) is an instrument to assess positive and negative sensory signs, helping to identify mechanisms underlying pathologic pain conditions. In this study, we evaluated the test-retest reliability (TR-R) and the interobserver reliability (IO-R) of QST in patients with sensory disturbances of different etiologies. In 4 centres, 60 patients (37 male and 23 female, 56.4 ± 1.9 years) with lesions or diseases of the somatosensory system were included. QST comprised 13 parameters including detection and pain thresholds for thermal and mechanical stimuli. QST was performed in the clinically most affected test area and a less or unaffected control area in a morning and an afternoon session on 2 consecutive days by examiner pairs (4 QSTs/patient). For both, TR-R and IO-R, there were high correlations (r = 0.80-0.93) at the affected test area, except for wind-up ratio (TR-R: r = 0.67; IO-R: r = 0.56) and paradoxical heat sensations (TR-R: r = 0.35; IO-R: r = 0.44). Mean IO-R (r = 0.83, 31% unexplained variance) was slightly lower than TR-R (r = 0.86, 26% unexplained variance, P < .05); the difference in variance amounted to 5%. There were no differences between study centres. In a subgroup with an unaffected control area (n = 43), reliabilities were significantly better in the test area (TR-R: r = 0.86; IO-R: r = 0.83) than in the control area (TR-R: r = 0.79; IO-R: r = 0.71, each P < .01), suggesting that disease-related systematic variance enhances reliability of QST. We conclude that standardized QST performed by trained examiners is a valuable diagnostic instrument with good test-retest and interobserver reliability within 2 days. With standardized training, observer bias is much lower than random variance.     

A qualitative description of falls in a neuro-rehabilitation unit: the use of a standardised fall report including the International Classification of Functioning (ICF) to describe activities and environmental factors

Abstract

Purpose: Falls are a recognised problem for people with long-term neurological conditions but less is known about fall risk in young adults. This study describes fallers’ and falls’ characteristics in adults less than 60 years old, in a neuro-rehabilitation unit. Methods: This single-centre, longitudinal, observational study included 114 consecutive admissions to a UK neuro-rehabilitation unit over 20 months. The demographic and clinical characteristics of eligible patients included age, sex, diagnosis, hospital length of stay and the Functional Independence Measure (FIM). Falls were recorded prospectively in a fall report, using the activities and environmental domains of the International Classification of Functioning (ICF). Results: A total of 34 (30%) patients reported a fall, with 50% experiencing more than one fall. The majority of falls (60%) occurred during the first 2 weeks, during day-time (90%) and during mobile activities (70%). Overall, falls rate (95% confidence interval) was 1.33 (1.04 to 1.67) per 100?d of patient hospital stay. Factors associated with increased falls included becoming a walker during admission or being cognitively impaired. There were no serious fall-related injuries. Conclusion: The first 2 weeks of admission is a high risk time for fallers, in particular those who become walkers or are cognitively impaired. Prevention policies should be put in place based on fall characteristics.

• Implications for Rehabilitation

• The ICF is a valuable instrument for describing subject and environmental factors during a fall-event.

• Falls are frequent events but do not usually cause serious injuries during inpatient rehabilitation.

• There is an increased fall risk for subjects with cognitive impairments or those relearning how to walk.

     

Representing and organizing information to describe the lived experience of health from a personal factors perspective in the light of the International Classification of Functioning,Disability and Health (ICF): a discussion paper

Purpose: To discuss the representation and organization of information describing persons’ lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health, using spinal cord injury as a case in point for disability.

Methods: The scientific literature was reviewed, discussion rounds conducted, and qualitative secondary analyses of data carried out using an iterative inductive–deductive approach.

Results: Conceptual considerations are explicated that distinguish the personal factors perspective from other components of the International Classification of Functioning, Disability and Health. A representation structure is developed that organizes health-related concepts describing the internal context of functioning. Concepts are organized as individual facts, subjective experiences, and recurrent patterns of experience and behavior specifying 7 areas and 211 concept groups.

Conclusions: The article calls for further scientific debate on the perspective of personal factors in the light of the International Classification of Functioning, Disability and Health. A structure that organizes concepts in relation to a personal factors perspective can enhance the comprehensiveness, transparency and standardization of health information, and contribute to the empowerment of persons with disabilities.

• Implications for rehabilitation

• The present study collected data from scientific literature reviews, discussion rounds and qualitative secondary analyses in order to develop a representation and organization of information describing persons’ lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health.

• The following representation structure for health-related information from a personal factors perspective was developed: (i) Individuals facts (i.e., socio-demographical factors, position in the immediate social and physical context, personal history and biography), (ii) subjective experience (i.e., feelings, thoughts and beliefs, motives), and (iii) recurrent patterns of experience (i.e., feelings, thoughts and beliefs) and behavior.

• With this study, we aim to stimulate further scientific discussion about the personal factors component in the International Classification of Functioning, Disability and Health, including its application and subsequent validation for potential implementation into clinical practice.

     

The ENGAGE-2 study: Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes in a randomized controlled trial (Phase 2)

Despite evidence for effective integrated behavior therapy for treating comorbid obesity and depression, treatment response is highly variable and the underlying neurobiological mechanisms remain unknown. This hampers efforts to identify mechanistic targets in order to optimize treatment precision and potency. Funded within the NIH Science of Behavior Change (SOBC) Research Network, the 2-phased ENGAGE research project applies an experimental precision medicine approach to address this gap. The Phase 1 study focused on demonstrating technical feasibility, target engagement and potential neural mechanisms of responses to an integrated behavior therapy. This therapy combines a video-based behavioral weight loss program and problem-solving therapy for depression, with as-needed intensification of antidepressant medications, and its clinical effectiveness was demonstrated within a parent randomized clinical trial. Here, we describe the ENGAGE Phase 2 (ENGAGE-2) study protocol which builds on Phase 1 in 2 ways: (1) pilot testing of an motivational interviewing-enhanced, integrated behavior therapy in an independent, primarily minority patient sample, and (2) evaluation of a priori defined neural targets, specifically the negative affect (threat and sadness) circuits which demonstrated engagement and malleability in Phase 1, as mediators of therapeutic outcomes. Additionally, the Phase 2 study includes a conceptual and methodological extension to explore the role of microbiome-gut-brain and systemic immunological pathways in integrated behavioral treatment of obesity and depression. This protocol paper documents the conceptualization, design and the transdisciplinary methodologies in ENGAGE-2, which can inform future clinical and translational research in experimental precision medicine for behavior change and chronic disease management.Trial registration: ClinicalTrials.gov #NCT 03,841,682.