The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence

Macciocchi S, Seel RT, Thompson N, Byams R, Bowman B. Spinal cord injury and co-occurring traumatic brain injury: assessment and incidence.

Objectives

To examine prospectively the incidence and severity of co-occurring traumatic brain injury (TBI) in persons with traumatic spinal cord injury (SCI) and to describe a TBI assessment process for SCI rehabilitation professionals.

Design

A prospective, cohort design to collect and analyze clinical variables relevant for diagnosing co-occurring TBI.

Setting

An urban, single-center National Institute of Disability and Rehabilitation Research Model Spinal Cord Injury System in the Southeastern United States.

Participants

People (N=198) who met inclusion criteria and provided consent within an 18-month recruitment window.

Interventions

Not applicable.

Main Outcome Measure

FIM cognitive scale.

Results

Based on participants' presence and duration of posttraumatic amnesia, initial Glasgow Coma Scale total score, and presence of cerebral lesion documented by neuroimaging, 60% of our traumatic SCI sample also sustained a TBI (n=118). Most co-occurring TBIs were mild (34%). Co-occurring mild complicated (10%), moderate (6%), and severe TBI (10%) were less common but still occurred in a significant percentage (26%) of persons with traumatic SCI. Persons with traumatic SCI who were injured in motor vehicle collisions and falls were more likely to sustain a co-occurring TBI. Cervical level traumatic SCI was associated with greater rates of TBI but not more severe injuries. Tree analyses established a practical algorithm for classifying TBI severity associated with traumatic SCI. Analysis of variance established criterion validity for the algorithm's TBI severity classifications.

Conclusions

Findings from our prospective study provide strong support that TBI is a common co-occurring injury with traumatic SCI. Incomplete acute care medical record documentation of TBI in the traumatic SCI population remains a considerable issue, and there is a significant need to educate emergency department and acute care personnel on the TBI clinical data needs of acute rehabilitation providers. A systematic algorithm for reviewing acute care medical records can yield valid estimates of TBI severity in the traumatic SCI population.     

Construct Validity and Test-Retest Reliability of the Climbing Stairs Questionnaire in Lower-Limb Amputees

de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees.

Objective

To investigate the construct validity and test-retest reliability of the Climbing Stairs Questionnaire, a patient-reported measure of activity limitations in climbing stairs, in lower-limb amputees.

Design

A cross-sectional study.

Setting

Outpatient department of a rehabilitation center.

Participants

Lower-limb amputees (N=172; mean ± SD age, 65±12y; 71% men; 82% vascular cause) participated in the study; 33 participated in the reliability study.

Interventions

Not applicable.

Main Outcome Measure(s)

Construct validity was investigated by testing 10 hypotheses: limitations in climbing stairs according to the Climbing Stairs Questionnaire will be greater in lower-limb amputees who: (1) are older, (2) have a vascular cause of amputation, (3) have a bilateral amputation, (4) have a higher level of amputation, (5) have more comorbid conditions, (6) had their rehabilitation treatment in a nursing home, and (7) climb fewer flights of stairs. Furthermore, limitations in climbing stairs will be related positively to activity limitations according to: (8) the Locomotor Capabilities Index, (9) the Questionnaire Rising and Sitting down, and (10) the Walking Questionnaire. Construct validity was quantified by using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient (ICC).

Results

Construct validity (8 of 10 null hypotheses not rejected) and test-retest reliability were good (ICC=.79; 95% confidence interval, .57-.90).

Conclusion

The Climbing Stairs Questionnaire has good construct validity and test-retest reliability in lower-limb amputees.     

Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients

Objective

The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients’ functional capacity during cardiac rehabilitation. However, studies have only assessed its test-retest reliability in the short term. The purpose of this study was to examine long-term test-retest reliability of the ISWT in clinically stable cardiac patients.

Design

Test-retest reliability assessment.

Setting

Continuous, community-based phase IV cardiac rehabilitation centre.

Participants

Thirty patients with cardiovascular disease (15 males, 15 females; age 55 to 80 years) volunteered to participate in the study.

Interventions

Participants undertook two ISWTs, a minimum of 8 weeks apart.

Main outcome measures

ISWT performance in metres.

Results

Overall, the mean distance walked in the pre-test was 502 ± 161 m and this did not differ from test to retest. The intraclass correlation coefficient was 0.80, indicating good test-retest reliability. Using the Bland and Altman method, there was a small mean test-retest difference (−7 m). The 95% limits of agreement were large, ranging from −203 m to 189 m.

Conclusions

Over long test-retest durations, there appears to be no learning effect in the ISWT, negating the need for a practice walk. The long-term random variation in the ISWT test is larger than in previous studies, probably due to greater physiological and psychological variation in the participants over 8 weeks compared with that seen in day-to-day testing. Factors influencing long-term test-retest reliability of the ISWT require further elucidation.     

The effects of mode of exercise instruction on compliance with a home exercise program in older adults with osteoarthritis

Objectives

To explore whether compliance with a prescribed home exercise program in elderly people with knee and/or hip osteoarthritis was influenced by mode of exercise instruction.

Design

Participants were randomised to one of three groups who received different modes of exercise instruction. Exercise performance was assessed at baseline and after 4 weeks and 8 weeks of home exercises.

Setting

Eighteen physiotherapy clinics in rural Victoria, Australia.

Participants

One hundred and fifteen males and females (mean age 70.5 years) with osteoarthritis of the knees and/or hips.

Interventions

Participants were randomised to receive verbal instructions on a home exercise program in addition to: (i) a home exercise brochure; (ii) a brochure together with an audiotape; or (iii) a brochure together with a videotape.

Main outcome measures

The Correctness of Exercise Performance scale and exercise log-sheets.

Results

Compliance with the home exercise program was good for all modes of exercise instruction where between 79% and 91% of exercises were performed correctly. Once provided with verbal instructions together with illustrated brochures, the provision of additional videotapes or audiotapes did not further enhance outcome.

Conclusions

Older people with osteoarthritis who received face-to-face instructions and a brochure on how to perform and comply with an 8-week home exercise program did not show additional benefits from other modes of instruction.

Key messages

•

Brochures can be as effective as additional audiotapes or videotapes to enhance correctness of exercise performance in older people with osteoarthritis of the knees and/or hips when given together with verbal instructions.

•

Audiotapes and videotapes may provide additional cues to maintain correctness of performance of exercises that are difficult to perform.

     

Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands

van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.

Objective

To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.

Design

A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.

Interventions

Not applicable.

Main Outcome Measure

The Life Satisfaction Questionnaire.

Results

Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).

Conclusions

Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.     

Measuring fatigue in persons with spinal cord injury

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).

Design

A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.

Setting

A tertiary spinal cord rehabilitation facility.

Participants

Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.

Interventions

Not applicable.

Main Outcome Measures

The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.

Conclusions

The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.     

Reliability and validity of the dynamic gait index in persons with chronic stroke

Jonsdottir J, Cattaneo D. Reliability and validity of the Dynamic Gait Index in persons with chronic stroke.

Objective

To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke.

Design

Cohort study.

Setting

Day hospital and ambulatory care at a rehabilitation center.

Participants

A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI.

Interventions

Not applicable.

Main Outcome Measures

The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale.

Results

ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55−.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68−.83).

Conclusions

The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke.     

Grip strength in older adults: test-retest reliability and cutoff for subjective weakness of using the hands in heavy tasks

Wang C-Y, Chen L-Y. Grip strength in older adults: test-retest reliability and cutoff for subjective weakness of using the hands in heavy tasks.

Objective

To examine the test-retest reliability of grip strength when using the mean value, the best value, and the first value of 2 grip strength measurements and to determine the cutoff value for separating those who were able or unable to perform a heavy task with their hands in a group of Taiwanese adults.

Design

Cross-sectional test-retest study.

Setting

Local community centers.

Participants

Community-dwelling older adults (N=469; age, ≥60y).

Interventions

Not applicable.

Main Outcome Measures

Self-reported measure of ability to perform heavy tasks with their hands and grip strength.

Results

The test-retest reliability of grip strength in older adults was good (intraclass correlation coefficient ≥.85) when using the mean value, the best value, or the first of 2 measurements. Optimum cutoff values were 28.5 and 18.5kg, and values with 75% sensitivity were 34 and 22kg for men and women, respectively.

Conclusions

The test-retest reliability of grip-strength measurement in a group of Taiwanese older adults was acceptable when the best value, the mean value, or the first of 2 measurements was used. The reported mean and cutoff values for grip strength also could serve as reference values for the public to monitor their grip strength performance and identify those at risk for early intervention.     

Estimating minimal clinically important differences of upper-extremity measures early after stroke

Lang CE, Edwards DF, Birkenmeier RL, Dromerick AW. Estimating minimal clinically important differences of upper-extremity measures early after stroke.

Objective

To estimate minimal clinically important difference (MCID) values of several upper-extremity measures early after stroke.

Design

Data in this report were collected during the Very Early Constraint-induced Therapy for Recovery of Stroke trial, an acute, single-blind randomized controlled trial of constraint-induced movement therapy. Subjects were tested at the prerandomization baseline assessment (average days poststroke, 9.5d) and the first posttreatment assessment (average days poststroke, 25.9d). At each time point, the affected upper extremity was evaluated with a battery of 6 tests. At the second assessment, subjects were also asked to provide a global rating of perceived changes in their affected upper extremity. Anchor-based MCID values were calculated separately for the affected dominant upper extremities and the affected nondominant upper extremities for each of the 6 tests.

Setting

Inpatient rehabilitation hospital.

Participants

Fifty-two people with hemiparesis poststroke.

Interventions

Not applicable.

Main Outcome Measures

Estimated MCID values for grip strength, composite upper-extremity strength, Action Research Arm Test (ARAT), Wolf Motor Function Test (WMFT), Motor Activity Log (MAL), and duration of upper-extremity use as measured with accelerometry.

Results

MCID values for grip strength were 5.0 and 6.2kg for the affected dominant and nondominant sides, respectively. MCID values for the ARAT were 12 and 17 points, for the WMFT function score were 1.0 and 1.2 points, and for the MAL quality of movement score were 1.0 and 1.1 points for the 2 sides, respectively. MCID values were indeterminate for the dominant (composite strength), the nondominant (WMFT time score), and both affected sides (duration of use) for the other measures.

Conclusions

Our data provide some of the first estimates of MCID values for upper-extremity standardized measures early after stroke. Future studies with larger sample sizes are needed to refine these estimates and to determine whether MCID values are modified by time poststroke.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

Objective

To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).

Design

Longitudinal study (20-y follow-up).

Setting

Laboratory setting.

Participants

Persons with SCI (N=7).

Interventions

Not applicable.

Main Outcome Measures

Maximum oxygen consumption V?o₂max) measured in 1986-1988 and in 2006.

Results

Subjects with SCI maintained stable V?o₂max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o₂max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o₂max by 43% and 45% after 20 years.

Conclusion

The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.     

The Validity and Reliability of the Motor Point Detection System: A Preliminary Investigation of Motor Points of the Triceps Surae Muscles

Lee NG, You JH, Park HD, Myoung HS, Lee SE, Hwang JH, Kim HS, Kim SS, Lee KJ. The validity and reliability of the motor point detection system: a preliminary investigation of motor points of the triceps surae muscles.

Objective

To investigate the validity and reliability of the motor point detection system in cadavers and healthy young adults.

Design

Correlation statistics.

Setting

University research laboratory.

Participants

Sixty-two lower limbs of 31 healthy young adults (mean age, 22.3±1.8) and 10 size-matched lower limbs from cadavers were used.

Interventions

Not applicable.

Main Outcome Measures

The validity of the motor point detection system's motor point measure was determined by comparing the motor point locations of the lower-leg muscles obtained from the motor point detection system with the established anatomic motor point locations from our previous cadaveric dissection study. The anatomic motor points were determined by tracing the terminal motor nerve branches on soleus, medial, and lateral gastrocnemius muscles through the dissection of adult cadavers. The test-retest reliability was determined by repeatedly measuring the locations of motor points in healthy young adults on 2 separate occasions, approximately 24 hours apart. The intraclass correlation coefficient (ICC) was computed to determine correlation, and an independent t test was used to determine the difference between the demographic and clinical variables at the significance level (P<.05).

Results

Correlation analysis revealed relatively high validity between the motor point detection system and cadaver-dissected motor point location measurements (ICC_2,1=.71-.92, P<.05). The test-retest reliability showed excellent correlation between the repeated measures (range, ICC_1,2=.90-.95 at P<.05).

Conclusions

Our results showed that the motor point detection system was accurate and consistent in the measurement of motor point locations of the lower-leg muscles. This system can be considered as an alternative device to localize motor points in clinical settings. Our motor point detection system warrants further investigation in pathologic population.     

Reliability of a test measuring transversus abdominis muscle recruitment with a pressure biofeedback unit

Background

There are indications that segmental stabilising exercises (SSEs) are effective in the treatment of low back pain. The evaluation of successful training in SSE performance in patients requires a reliable outcome measure. The PRONE test gives an indication of the activity of the transversus abdominis muscle. Performed in prone lying using a pressure biofeedback unit, it has been used as an aid to training and to assess the subject's ability to perform SSEs correctly.

Objectives

To evaluate inter-observer and test-retest reliability of the PRONE test.

Design

Repeated measures by three observers on 2 days.

Setting

Department of Physical Medicine and Rehabilitation, Ludwig-Maximilian University, Munich, Germany.

Participants

Forty nurses (39 females and one male), aged between 24 and 62 years, with at least one episode of low back pain.

Main outcome measures

During the test, movement of the abdominal wall was monitored by measuring a change in pressure during muscle contraction termed ‘abdominal hollowing’. Defined observation and palpation criteria were verified by the observers to ensure correct execution of the test.

Methods

Participants were tested on two separate days. On the first day, Observer A performed two similar test sets, each with four exercises. On the second test day, Observers B and C conducted one test set each.

Results

This study found an intra-class correlation coefficient (ICC) of 0.47 [95% confidence interval (CI) 0.20 to 0.67] for inter-observer reliability, and an ICC of 0.81 (95% CI 0.67 to 0.90) for test-retest reliability. Kappa values and the limits of agreement were also calculated with similar results.

Conclusions

For this subject group, the PRONE test had relatively low inter-observer reliability but, as may be expected, higher test-retest reliability. It is suggested that by providing visual feedback, the PRONE test may enhance patients’ insight into their deep abdominal muscle recruitment and thereby increase their motivation to exercise.     

Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury

Hussain R, Cevallos ME, Darouiche RO, Trautner BW. Gram-negative intravascular catheter-related bacteremia in patients with spinal cord injury.

Objective

To determine whether the prevalence of gram-negative catheter-related bloodstream infection (CRBSI) is higher in patients with spinal cord injury (SCI) than in patients without SCI.

Design

Retrospective chart review from August 1998 to August 2006.

Setting

A Veterans Affairs medical center, which serves as a tertiary care medical center to over 500 veterans with SCI and is the primary source of health care for veterans in southeast Texas.

Participants

All hospitalized patients who had an International Classification of Diseases, Ninth Revision, code for bacteremia associated with their hospital stay.

Interventions

Not applicable.

Main Outcome Measure

The proportion of CRBSI caused by gram-negative organisms in the SCI patients to the proportion of CRBSI caused by gram-negative organisms in the non-SCI patients.

Results

Eight (42%) of 19 episodes of CRBSI in the SCI were caused by a gram-negative organism as compared with 4 (11%) of 36 infections in the non-SCI group (P<.01). Factors associated with having a gram-negative organism rather than a gram-positive organism as the causative agent of CRBSI were SCI, femoral catheter site, prolonged hospitalization, decubitus ulcer, and urinary catheter.

Conclusions

In our medical center, patients with SCI who develop CRBSI are more likely to have an infection with a gram-negative organism than are patients without SCI. This knowledge may guide initial empirical therapy of suspected bloodstream infection.     

Reliability of Center of Pressure Measures for Assessing the Development of Sitting Postural Control in Infants With or at Risk of Cerebral Palsy

Kyvelidou A, Harbourne RT, Shostrom VK, Stergiou N. Reliability of center of pressure measures for assessing the development of sitting postural control in infants with or at risk of cerebral palsy.

Objective

To establish the test-retest reliability of linear and nonlinear measures, including intra- and intersession reliability, when used to analyze the center of pressure (COP) time series during the development of infant sitting postural control in infants with or at risk for cerebral palsy (CP).

Design

Longitudinal study.

Setting

University hospital laboratory.

Participants

Infants with or at risk for CP (N=18; mean age ± SD at entry into the study, 13.7±3.6mo).

Interventions

Not applicable.

Main Outcome Measures

Infant sitting COP data were recorded for 3 trials at each session (2 sessions for each month within 1 week) for 4 consecutive months. The linear COP parameters of the root mean square, the range of sway for both the anterior-posterior and the medial-lateral directions, and the sway path were calculated. In addition, the nonlinear parameters of approximate entropy, Lyapunov exponent (LyE), and the correlation dimension for both directions were also calculated. Intra- and intersession reliability was computed by the intraclass correlation coefficient (ICC).

Results

Regarding nonlinear measures, LyE showed high intra- and intersession ICC values in comparison with all other parameters evaluated. Intrasession and intersession reliability increased overall in the last 2 months of data collection and as sitting posture improved.

Conclusions

Our results suggested that the methodology presented is a reliable way of examining the development of sitting postural control in infants with or at risk for CP, and the reliability results generally parallel values found in sitting postural behavior in typical infants. Therefore, this methodology may be helpful in examining efficacy of therapy protocols directed at advancing sitting postural control in infants with motor developmental delays.     

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility

Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.

Objective

To determine the measurement properties and diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R).

Design

Analysis of interrater and test-retest reliability, internal consistency, concurrent validity, and diagnostic accuracy.

Setting

Acute inpatient brain injury rehabilitation hospital.

Participants

Convenience sample of 80 patients with severe acquired brain injury admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS).

Interventions

Not applicable.

Main outcome measures

The CRS-R, the JFK Coma Recovery Scale (CRS), and the Disability Rating Scale (DRS).

Results

Interrater and test-retest reliability were high for CRS-R total scores. Subscale analysis showed moderate to high interrater and test-retest agreement although systematic differences in scoring were noted on the visual and oromotor/verbal subscales. CRS-R total scores correlated significantly with total scores on the CRS and DRS indicating acceptable concurrent validity. The CRS-R was able to distinguish 10 patients in an MCS who were otherwise misclassified as in a VS by the DRS.

Conclusions

The CRS-R can be administered reliably by trained examiners and repeated measurements yield stable estimates of patient status. CRS-R subscale scores demonstrated good agreement across raters and ratings but should be used cautiously because some scores were underrepresented in the current study. The CRS-R appears capable of differentiating patients in an MCS from those in a VS.     

The experience of spinal cord injury: using Frank's narrative types to enhance physiotherapy undergraduates’ understanding

Objectives

To consider physiotherapy students’ responses to three illness narratives common in rugby players who have suffered a spinal cord injury (SCI).

Design

A narrative vignette was provided to first and third year students reading for a Batchelor of Science degree in physiotherapy.

Setting

A university in the West Midlands during a year cohort meeting.

Participants

Seventy-seven first year students and 45 third year students took part in the study. All students were attending the university at the time of the study. None of the first year students had completed any clinical placement hours, and all of the third year students had completed the required number of clinical hours for a physiotherapy degree.

Main outcome measures

The narrative vignette consisted of nine questions relating to the vignette. Thematic content analysis was applied to the results.

Results

The role of experience appeared to influence students’ responses. The third year students’ reactions to each narrative appeared more consistent and unified as a medical voice. This appeared to support their preference for an ideal type of story and patient. Problems with each narrative were identified, although often not critiqued.

Conclusions

Students need more time to consider different illness narratives in order to accept and understand them.     

Posttraumatic Stress Disorder and Spinal Cord Injury

Krause JS, Saunders LL, Newman S. Posttraumatic stress disorder and spinal cord injury.

Objectives

To identify the prevalence of posttraumatic stress disorder (PTSD) after spinal cord injury (SCI) in a sample averaging over 2 decades postinjury at assessment. Related objectives are to confirm the factor structure, compare subscales with those reported in a nonclinical sample, and identify the relationship of PTSD with depression.

Design

Survey.

Setting

A medical university in the Southeastern United States.

Participants

Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States. A cohort of adults (N=927) with traumatic SCI of at least 1 year duration at enrollment in 2002 to 2003 and a minimum of 7 years at the time of assessment completed the study materials.

Interventions

Not applicable.

Main Outcomes Measures

PTSD was measured by the Purdue Posttraumatic Stress Disorder Scale-Revised, and depression was measured by the Patient Health Questionnaire 9-item.

Results

PTSD was reported by less than 10% of the participants. Item endorsement decreased as a function of years postinjury, primarily because of low rates of endorsement among those 21 or more years postinjury. Confirmatory factor analysis did not result in an acceptable fit for subscales, item sets, or factors previously reported in the literature. Participants scored higher than a nonclinical sample (reported in the literature) on the arousal and avoidance subscales but lower on the re-experiencing subscale. Item endorsements were lower for the first set of items that relate directly to the SCI itself, with the highest item endorsement for “have difficulty remembering important aspects of event.” PTSD rarely occurred in the absence of a depressive disorder.

Conclusions

PTSD does not appear to be highly prevalent in long-term SCI survivors, and endorsement of items related to re-experiencing and even recalling the injury are rare. Because SCI often is accompanied by mild traumatic brain injury, difficulty recalling the event may have an organic rather than psychologic component.