Using the Rasch model in nursing research: An introduction and illustrative example

Objective

The purpose was to introduce the Rasch model by showing an application in nursing research.

Methods

The Rasch model was used to examine the psychometric properties of the nursing self-efficacy (NSE) scale. Data were collected among nursing students in Sweden. Two sets of items were analysed more thoroughly: an original set of nine items with eleven response categories and a revised set of seven items with seven response categories. Invariance of the item functioning and the categorisation of the items were analysed. Targeting was examined by comparisons of the items and persons locations. Differential Item Functioning across sample groups such as gender was examined using analysis of variance. The final set of seven items was also analysed more closely with respect to possible multidimensionality and response dependence.

Results

The Rasch analysis of the original set of nine items showed high reliability measured by a person separation index, but it also indicated severe problems with the targeting, the categorisation of the items as well as lack of invariance. Although the revised set comprising seven items with seven categories performed better than the original item set some items showed misfit according to formal test statistics. Graphical examination showed, however, that the items operated in the right direction. The formal test of local independence of the items indicated minor signs of multidimensionality, alternatively response dependence.

Conclusions

The Rasch model is useful for rigorous examination and development of measurement instruments in nursing research. The Rasch model facilitates disclosure of lack of invariance and other measurement problems that may not be easily detected by traditional analyses. Hence, the NSE-scale would probably have performed much better if the developmental work had been guided by Rasch analyses. In future work on the scale, priority should be given to improving the targeting and the categorisation of the items.     

Psychometric Evaluation of the Rasch-Based Depression Screening in Patients With Neurologic Disorders

Forkmann T, Norra C, Wirtz M, Gauggel S, Boecker M. Psychometric evaluation of the Rasch-based depression screening in patients with neurologic disorders.

Objectives

To provide a first evaluation of the Rasch-Based Depression Screening (DESC) in consecutive patients with neurologic disorders.

Design

Cross-sectional study.

Setting

Hospital specializing in neurologic disorders.

Participants

Eligible patients (N=323; mean age ± SD, 53.4±17.2y; 49.3% women) age 18 years and older.

Interventions

Not applicable.

Main outcome Measures

DESC with 2 parallel versions.

Results

Both versions of the DESC showed good item separation (DESC-I=4.96; DESC-II=4.94) and person separation (DESC-I=2.01; DESC-II=2.14) as well as item separation reliability (DESC-I=.96; DESC-II=.96) and person separation reliability (DESC-I=.80; DESC-II=.82). All items fit the Rasch model (infit and outfit mean squares ≤1.3). There were no signs of violation of unidimensionality. One item of DESC-I showed differential item functioning because of age and 1 item because of sex. Parallel test reliability of the 2 DESC forms was r equal to .92.

Conclusions

The DESC shows good psychometric characteristics that suggest high psychometric quality of the instrument in patients with neurologic disorders. Differential item functioning on single items needs further examination but should not substantially interfere with the valid interpretation of DESC sum scores.     

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.     

A Measure of Physical Functioning to Define Stroke Recovery at 3 Months: Preliminary Results

Finch LE, Higgins J, Wood-Dauphinee SL, Mayo NE. A measure of physical functioning to define stroke recovery at 3 months: preliminary results.

Objective

To develop a physical functioning measure through Rasch analysis conceptualized using the International Classification of Functioning, Disability and Health (ICF).

Design

Observational cohort study.

Setting

Acute-hospital and community-based study.

Participants

Subjects (N=235) hospitalized with postacute stroke and reassessed in the community at 3-months (mean age, 71.6±12.9y).

Interventions

None.

Main Outcome Measures

Functional assessments 3 months poststroke included self-report and observational indices and tests commonly used to evaluate stroke survivors. Sociodemographic information was also collected. Rasch analysis assisted in combining the items across ICF components to develop the measure. Items were retained based on fit to the model and relationship to the construct; reliability and validity were assessed.

Results

The best 44 items formed the Physical Functioning Measure at 3 months (F3m) measure of functioning evaluating limb movement, balance, activities of daily living, and participation. All Rasch model assumptions were met. Both item and person reliably (.96) indicated a stable hierarchy, while precision varied from .51 to 1.2 logits. Early evidence for construct validity is adequate.

Conclusions

The F3m combines patient reported and observed ratings of performance items into a single measure quantifying functioning with good preliminary psychometric properties that with further testing can assist in directing and evaluating interventions and recovery.     

Rasch Analysis of the Executive Interview (The EXIT-25) and Introduction of an Abridged Version (The Quick EXIT)

Larson EB, Heinemann AW. Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick Exit).

Objectives

To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties.

Design

Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25.

Setting

A large, urban, academic free-standing rehabilitation facility.

Participants

The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27).

Interventions

Not applicable.

Main Outcome Measures

The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B.

Results

Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity.

Conclusions

The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.     

Application of Rasch Analysis to Examine Psychometric Aspects of the Activities-Specific Balance Confidence Scale When Used in a New Cultural Context

Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context.

Objective

To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context.

Design

Cross-sectional, population-based, random selection from the Icelandic National Registry.

Setting

Community-based.

Participants

Icelanders (N=183), 65 to 88 years old, and 48% women.

Interventions

Not applicable.

Main Outcome Measure

ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale.

Results

Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested.

Conclusions

Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.     

ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients

Caty GD, Arnould C, Stoquart GG, Thonnard J-L, Lejeune TM. ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients.

Objective

To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain).

Design

Prospective study and questionnaire development.

Setting

A faculty hospital.

Participants

Adult stroke patients (N=100) (age, 64±15y). The time since stroke ranged from 1 to 260 weeks.

Intervention

A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test.

Conclusions

The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.     

Rating scale analysis of the Berg Balance Scale

Kornetti DL, Fritz SL, Chiu Y-P, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85:1128-35.

Objectives

To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms.

Design

Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data.

Setting

Outpatient Veterans Affairs medical center.

Participants

One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y).

Interventions

Not applicable.

Main outcome measure

The BBS.

Results

Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item “tandem stance,” as well as passing 2 of the following 3 items: “alternating foot,” “standing on one leg,” and “look behind.”

Conclusions

Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.     

Rehabilitation of older Chinese patients with different cognitive functions: how do they differ in outcome?

Luk JK, Chiu PK, Chu LW. Rehabilitation of older Chinese patients with different cognitive functions: how do they differ in outcome?

Objective

To examine the effect of cognition on functional and motor gain in older Chinese patients undergoing geriatric inpatient rehabilitation.

Design

A retrospective cohort study.

Setting

Geriatric rehabilitation units of 2 convalescence hospitals in Hong Kong.

Participants

Older Chinese patients (N=778).

Interventions

Comprehensive geriatric assessment and inpatient rehabilitation by a multidisciplinary team.

Main Outcome Measures

Cognitive status was assessed with the Cantonese version of the Mini-Mental State Examination (C-MMSE). We measured the absolute functional gain and motor gain by using the Barthel Index and Elderly Mobility Scale (EMS) and expressed it as Barthel Index efficacy and EMS efficacy. Relative efficacy was assessed by the Montebello Rehabilitation Factor Score (MRFS). Relative efficiency was deduced by relative efficacy divided by the hospital length of stay (LOS).

Results

There were significant differences in the total Barthel Index and EMS on admission and at discharge, with lower discharge scores in low C-MMSE groups. The change of Barthel Index (Barthel Index efficacy) and EMS (EMS efficacy) during rehabilitation did not differ among different C-MMSE groups. Significant differences were observed in Barthel Index MRFS efficacy and efficiency as well as EMS MRFS efficacy and efficiency in different cognitive groups; those with better cognitive function had better results. Multivariate analysis showed that LOS (odds ratio [OR]=1.02, P=.002) and diagnosis of musculoskeletal problems (OR=2.24, P=.007) were positive predictors for a Barthel Index MRFS efficacy of .25 or higher. C-MMSE was not an independent predictor for a Barthel Index MRFS efficacy of .25 or higher. LOS (OR=1.02, P=.003), admission C-MMSE (OR=1.04, P=.001), body mass index (OR=1.05, P=.006), and diagnosis of musculoskeletal disorders (OR=1.75, P=.04) were significant positive predictors for an EMS MRFS efficacy of .25 or higher, whereas urinary incontinence was a negative predictor for EMS MRFS efficacy (OR=0.69, P=.04).

Conclusions

There was a strong association between admission cognition and relative change in functional and motor efficacy and efficiency. Cognitive function was not associated with absolute functional and motor gain. Cognitive function was an independent predictor for satisfactory mobility outcome but not for functional outcome. Older patients with impaired cognitive function could still benefit from rehabilitation.     

Calibration of an item pool for assessing the disability associated with foot pain: an application of item response theory to the Manchester Foot Pain and Disability Index

Objective

To analyze the relative validity of the 17-item Manchester Foot Pain and Disability Index (MFPDI) using graded response item response theory analysis (G-IRT).

Design

The design of the study involved a survey instrument validation.

Participants/Patients

A total of 682 respondents with a history of foot pain in the last month.

Methods

Factor analysis and G-IRT were used to analyze the dimensionality and relative validity of each scale item.

Results

Exploratory factor analysis yielded a two-factor solution. G-IRT resulted in the removal of one of the original 17 items from the MFPDI. Analyses revealed that six of the nine foot and ankle function items of the MFPDI demonstrated excellent discrimination. For the seven pain and appearance items, only one item demonstrated excellent discrimination, the remaining demonstrated moderate discrimination.

Conclusion

G-IRT was successful in outlining selected items representative of disability and pain and appearance. By reducing the MFPDI to 16 items, the Modified MFPDI is multidimensional and is associated with the underlying construct of activity related foot and ankle disability and pain and appearance. By reducing the MFPDI to 16 items, a clinician can be confident that the outcome instrument accurately represents the latent construct of disability and pain and appearance.     

Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis

Khan F, Pallant JF, Turner-Stokes L. Use of goal attainment scaling in inpatient rehabilitation for persons with multiple sclerosis.

Objectives

To use goal attainment scaling (GAS) to measure clinically important functional change in persons with multiple sclerosis (MS) and to assess its responsiveness compared with standard measures used to evaluate progress in rehabilitation.

Design

Prospective, observational cohort study.

Setting

Tertiary inpatient rehabilitation unit in Victoria, Australia.

Participants

Consecutive sample of 24 persons with MS admitted for comprehensive rehabilitation program. The male-to-female ratio was 10:14, and the mean age ± standard deviation was 52.0±8.3 years (range, 37−62y). Over half (n=14 [58.3%]) had secondary progressive MS.

Interventions

Not applicable.

Main Outcome Measures

GAS scores were calculated for 5 to 10 priority goals set prospectively by each patient in agreement with the multidisciplinary treating team and compared with standard outcome measures—the FIM instrument and Barthel Index—rated on admission and discharge from the program. Patients were categorized into responders and nonresponders based on an overall clinical global impression.

Results

Of 203 selected goals, 167 were achieved at the predicted level. GAS recorded outcomes for 105 individualized goals not measured by the FIM and Barthel Index. Although all 3 measures showed statistically significant change from admission to discharge (P<.001), only GAS scores strongly correlated with the Clinical Global Impression scale (ρ=−.86, P<.001). GAS discharge scores differed significantly between the responder and nonresponder groups (Mann-Whitney, z=−3.78, P<.001). Different measures of effect size gave different results, but GAS was consistently more responsive than either the FIM or Barthel Index.

Conclusions

This preliminary study suggests that GAS is a responsive and useful outcome measure for the rehabilitation of persons with MS, providing added value to standardized outcome measurement.     

The Barthel Index: comparing inter-rater reliability between Nurses and Doctors in an older adult rehabilitation unit

Objective

To ensure accuracy in recording the Barthel Index (BI) in older people, it is essential to determine who is best placed to administer the index. The aim of this study was to compare doctors' and nurses' reliability in scoring the BI.

Methods

Sixty-five consecutive patients admitted to an older adult rehabilitation unit were assessed using the BI. Four raters recorded the BI on all patients. BI scores were compared for equivalence on the level of agreement between raters.

Results

Near-perfect correlation in the total scores between raters indicated that the final score is reliable. There was a statistically significant bias by doctors who gave a higher BI score than nurses with a mean difference of 1.2 (95% confidence interval). Nurses demonstrated good and very good agreement on all 10 items, whereas doctors demonstrated good agreement on only 5 items.

Conclusion

The BI is highly reliable when recorded by nurses with low interrater variation, whereas between doctors, there is greater variation. When assessing older adult's activities of daily living, there is greater interrater reliability in the BI score when the patient is observed performing the activities of daily living compared to the self-report method.     

Psychometric Properties of the Community Integration Questionnaire Adjusted for People With Aphasia

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia.

Objectives

To describe the feasibility of the Community Integration Questionnaire (CIQ) adjusted for use in people with aphasia and to report its psychometric properties in people with aphasia (internal consistency, factor analysis, test-retest reliability, convergent validity).

Design

A cross-sectional, interview-based psychometric study. Test-retest reliability was evaluated in 20 people (minimal to severe aphasia) by 2 different interviewers within a 2-week period.

Setting

Community.

Participants

In total 490 stroke survivors with (minimal to severe) aphasia were approached, of which 165 (34%) participants returned the answering letter. Participants (N=150) agreed to take part and were interviewed using a structured interview format.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire (CIQ), Frenchay Aphasia Screening Test, Barthel Index, Dartmouth Coop Functional Health Assessment Charts (COOP)-World Organisation of Family Doctors (WONCA) Charts, Life Satisfaction Questionnaire.

Results

A total of 150 stroke survivors with aphasia completed the CIQ adjusted for people with aphasia. The CIQ adjusted for people with aphasia was a feasible instrument. Results showed good internal consistency for the CIQ total (standardized Cronbach α=.75), excellent test-retest reliability (intraclass correlation coefficient=.96), moderate correlations with the Barthel Index, the COOP-WONCA, and the Life Satisfaction Questionnaire with regard to construct validity. Significant relations were found with regard to age and aphasia severity.

Conclusions

The CIQ adjusted for people with aphasia seems to be an adequate instrument to assess participation in people with aphasia.     

Mobility rating scale for elderly people with dementia: preparation of a Japanese-language version of the Southampton Mobility Assessment

Objectives

Improving the mobility of elderly people with dementia appears to be of significant value in maintaining and enhancing their activities of daily living and quality of life. However, a literature search revealed no scales for rating the mobility of elderly people with dementia currently available in Japan. A Japanese-language version of a rating scale for the mobility of elderly people with dementia, the Southampton Mobility Assessment (SMA), was prepared and its reliability and validity were evaluated.

Participants

Eighty-five elderly people with dementia.

Methods

Reliability was assessed using limits of agreement based on the analysis by Bland and Altman. Validity was evaluated using Spearman's rank correlation coefficients to assess associations between the scores on the Japanese-language version of the SMA and the scores on the subscales of the Barthel Index.

Results

The limits of agreement between two raters were −1.2 and 1.2, and the evaluation of repeatability revealed that 98% of the differences were within two standard deviations (−0.3 and 0.3). A high correlation was found between the scores on the Japanese-language version of the SMA and the Barthel Index.

Conclusions

These results demonstrate that the Japanese-language version of the SMA possesses high reliability and validity, suggesting its suitability in the assessment of mobility when developing physiotherapy approaches intended to enhance the mobility and quality of life of elderly people with dementia.     

A Method for Standardizing Procedures in Rehabilitation: Use in the Extremity Constraint Induced Therapy Evaluation Multisite Randomized Controlled Trial

Morris DM, Taub E, Macrina DM, Cook EW, Geiger BF. A method for standardizing procedures in rehabilitation: use in the Extremity Constraint Induced Therapy Evaluation multisite randomized controlled trial.

Objective

An enduring problem in the field of rehabilitation has been the lack of standardization in the protocols of treatments and tests. To develop a process evaluation method to standardize the administration of rehabilitation procedures used in the Extremity Constraint Induced Therapy Evaluation (EXCITE) Trial, a randomized controlled trial of upper-extremity constraint-induced therapy implemented across 7 sites.

Design

Process evaluation.

Setting

Research laboratory.

Participants

Convenience sample or research personnel.

Interventions

Not applicable.

Main Outcome Measures

Checklist scoring sheets were developed to rate videotapes using systematic application of prescribed steps for each of 5 procedures across 3 time periods. Time periods were immediately after training, and 1 and 2 years later. A performance score of at least 90% was required before individual research personnel were allowed to participate in the trial.

Results

Overall performance scores ranged from 85.8% to 95% of performance items correctly executed. There was a significant improvement in standard performance of procedures between the first time period (immediately after training) and each of the subsequent time periods for all but 1 procedure. The scoring of standardized performance when carried out with routine participant testing and training did not differ significantly from scoring from videotaped sessions submitted for standardization rating for 2 of the procedures, suggesting adequate validity of scoring from videotape.

Conclusions

The present method was successful in assessing protocol fidelity for the EXCITE research personnel and represents 1 means of addressing the longstanding problem in rehabilitation of the lack of standardization in administering different treatments and tests.     

Clinimetric evaluation of the physical mobility scale supports clinicians and researchers in residential aged care

Barker AL, Nitz JC, Low Choy NL, Haines TP. Clinimetric evaluation of the Physical Mobility Scale supports clinicians and researchers in residential aged care.

Objective

To investigate the interrater agreement and the internal construct validity of the Physical Mobility Scale, a tool routinely used to assess mobility of people living in residential aged care.

Design

Prospective, multicenter, external validation study.

Setting

Nine residential aged care facilities in Australia.

Participants

Residents (N=186). Phase 1 cohort (99 residents; mean age, 85.22±5.1y); phase 2 cohort (87 residents; mean age, 81.59±10.69y).

Interventions

Not applicable.

Main Outcome Measures

Kappa statistics, minimal detectable change (MDC₉₀) scores, and Bland-Altman plots were used to assess interrater agreement. Scale unidimensionality, item hierarchy, and person separation were examined with Rasch analysis for both cohorts.

Results

Agreement between raters on 6 of the 9 Physical Mobility Scale items was high (κ>.60). The MDC₉₀ value was 4.39 points, and no systematic differences in scores between raters were found. The Physical Mobility Scale showed a unidimensional structure demonstrated by fit to the Rasch model in both cohorts (phase 1: χ²=23.90, P=.16, person separation index=0.96; phase 2: χ²=22.00, P=.23, person separation index=0.96). Standing balance was the most difficult item in both cohorts (phase 1: logit=2.48, SE, 0.16; phase 2: logit=2.53, SE, 0.15). The person-item threshold map indicated no floor or ceiling effects in either cohort.

Conclusions

The Physical Mobility Scale demonstrated good interrater agreement and internal construct validity with good fit to the Rasch model in both cohorts. The comparative results across the 2 cohorts indicate generality of the findings. The Physical Mobility Scale total raw scores can be converted to Rasch transformed scores, providing an interval measure of mobility. The Physical Mobility Scale may be suited to a range of clinical and research applications in residential aged care.     

A 1-Year Follow-Up After Shortened Constraint-Induced Movement Therapy With and Without Mitt Poststroke

Brogårdh C, Lexell J. A 1-year follow-up after shortened constraint-induced movement therapy with and without mitt poststroke.

Objective

To explore the long-term benefits of shortened constraint-induced movement therapy (CIMT) in the subacute phase poststroke.

Design

A 1-year follow-up after shortened CIMT (3h training/d for 2wk) where the participants had been randomized to a mitt group or a nonmitt group.

Setting

A university hospital rehabilitation department.

Participants

Poststroke patients (N=20, 15 men, 5 women; mean age 58.8y; on average 14.8mo poststroke) with mild to moderate impairments of hand function.

Interventions

Not applicable.

Main Outcome Measures

The Sollerman hand function test, the modified Motor Assessment Scale, and the Motor Activity Log test. Assessments were made by blinded observers.

Results

One year after shortened CIMT, participants within both the mitt group and the nonmitt group showed statistically significant improvements in arm and hand motor performance and on self-reported motor ability compared with before and after treatment. No significant differences between the groups were found in any measure at any time.

Conclusions

Shortened CIMT seems to be beneficial up to 1 year after training, but the restraint may not enhance upper motor function. To determine which components of CIMT are most effective, larger randomized studies are needed.     

Conceptualizing and measuring confidence in older drivers: development of the day and night driving comfort scales

Myers AM, Paradis JA, Blanchard RA. Conceptualizing and measuring confidence in older drivers: development of the Day and Night Driving Comfort Scales.

Objective

To examine and measure driving confidence from the perspective of older adults.

Design

Used focus groups for construct examination, item generation, and ratings; conducted psychometric testing using Rasch analysis for scale refinement; examined test-retest reliability and associations with driver characteristics and driving habits.

Setting

Retirement complexes and seniors’ housing and centers in Ontario, Canada.

Participants

Convenience samples of current drivers (n=143) (range, 66-92y) and 7 counselors.

Interventions

Not applicable.

Main Outcome Measure

The Day (DCS-D) and Night (DCS-N) Driving Comfort Scales developed inductively with older drivers.

Results

Older drivers believed that it was important to consider confidence in their own abilities and discomfort caused by other drivers, to separate day and night driving, and to specify the driving context (eg, traffic flow, speed). Rasch analysis showed that the final 13-item DCS-D and 16-item DCS-N were both hierarchic and unidimensional, with good person (.89, .96) and item (.98, .97) reliabilities, respectively. Test-retest reliability was adequate for the DCS-D (intraclass correlation coefficient [ICC]=.7) and good for the DCS-N (ICC=.88). Scores were significantly associated with reported driving frequency, situational avoidance, and perceived abilities (P<.001).

Conclusions

The Driving Comfort Scales are promising new tools for research and practice.     

Light Touch Cue Through a Cane Improves Pelvic Stability During Walking in Stroke

Boonsinsukh R, Panichareon L, Phansuwan-Pujito P. Light touch cue through a cane improves pelvic stability during walking in stroke.

Objective

To examine the effect of a light touch cue provided through a cane on mediolateral (ML) pelvic stability during walking in subjects poststroke.

Design

Crossover trial examining ML pelvic stability during walking using a cane with the force contact and touch contact methods.

Setting

Physical therapy clinic, tertiary care center.

Participants

Subacute patients (N=40) with stroke with a mean age of 59.6 years and mean stroke duration of 46.8 days. The average gait speed with a cane was .13m/s (.05-.29m/s).

Intervention

Using a cane with the force contact and touch contact methods during walking.

Main Outcome Measures

ML pelvic stability as measured by averaged peak-to-peak pelvic acceleration, muscle activation of bilateral tensor fascia latae (TFL), semitendinosus (ST), and vastus medialis (VM) using an electromyography system, and vertical cane force.

Results

The average amount of cane force during touch contact and force contact cane use conditions was 2.3N and 49.3N, respectively. A light touch cue through a cane was required only when the paretic leg accepted the body weight, and this cue can provide ML pelvic stability (.16g of average pelvic acceleration) during walking to the same degree as the force contact method of cane use. However, significant increases in single-limb support duration with higher activations of TFL, VM, and ST muscles on the paretic leg were found during the paretic stance phase when using a cane in the touch contact fashion (P<.05).

Conclusions

A light touch cue can be provided during walking through the use of a cane. This augmented somatosensory information provides lateral stability during walking for subjects with stroke by facilitating the activations of weight-bearing muscles on the paretic leg during the stance phase.     

Validity of a Functional Dynamic Walking Test for the Elderly

Lark SD, Pasupuleti S. Validity of a functional dynamic walking test for the elderly.

Objective

To determine the validity of a safe, quick, and simple method of measuring dynamic balance in the elderly during gait called the parallel walk test.

Design

Control study.

Setting

Outpatient clinic, community.

Participants

Twenty-seven elderly fallers (age 82±6y) registered at a falls clinic and 34 elderly nonfallers (age 76±7y) were recruited to this study based on Mini Mental State Examination and Barthel Index scores.

Interventions

Subjects were timed as they walked 6m between 2 parallel lines on the floor at 3 different widths (20, 30.5, 38cm) in their own footwear. They were scored for foot placement on the line (1 point) or outside the lines (2 points). Participants also performed a timed 6-m tandem walk test, a 30-second tandem stance, and a 30-second parallel stance.

Main Outcome Measures

Scores and time to complete the parallel walk test and tandem walk test along with the time of standing for tandem and parallel stance. Validity coefficients were calculated for the sensitivity and specificity of the parallel walk test.

Results

All subjects completed the parallel walk test, but few attempted and completed the tandem walk test. The fallers had significantly greater scores at 20 and 30.5cm and took significantly longer to complete the 6m at all widths. The 20-cm width was most discriminatory. The parallel walk test showed a significant correlation with the tandem stance.

Conclusions

All subjects attempted and completed the parallel walk test but not the tandem walk test. The time to completion and scoring accurately measures dynamic balance during gait in elderly fallers. The parallel walk test could be a useful tool in the clinical setting for assessing balance in gait pre- and postintervention.