Reliability and responsiveness of measures of pain in people with osteoarthritis of the knee: a psychometric evaluation

Purpose: To examine the fit between data from the Short Form McGill Pain Questionnaire (SF-MPQ-2) and the Rasch model, and to explore the reliability and internal responsiveness of measures of pain in people with knee osteoarthritis. Methods: Participants with knee osteoarthritis completed the SF-MPQ-2, Intermittent and Constant Osteoarthritis Pain questionnaire (ICOAP) and painDETECT. Participants were sent the same questionnaires 3 and 6 months later. Results: Fit to the Rasch model was not achieved for the SF-MPQ-2 Total scale. The Continuous subscale yielded adequate fit statistics after splitting item 10 on uniform DIF for gender, and removing item 9. The Intermittent subscale fit the Rasch model after rescoring items. The Neuropathic subscale had relatively good fit to the model. Test–retest reliability was satisfactory for most scales using both original and Rasch scoring ranging from fair to substantial. Effect sizes ranged from 0.13 to 1.79 indicating good internal responsiveness for most scales. Conclusions: These findings support the use of ICOAP subscales as reliable and responsive measure of pain in people with knee osteoarthritis. The MPQ-SF-2 subscales found to be acceptable alternatives.

• Implications for Rehabilitation

• The McGill Pain Questionnaire short version 2 is not a unidimensional scale in people with knee osteoarthritis, whereas three of the subscales are unidimensional.

• The McGill Pain Questionnaire short version 2 Affective subscale does not have good measurement properties for people with knee osteoarthritis.

• The McGill Pain Questionnaire short version 2 and the Intermittent and Constant Osteoarthritis Pain scales can be used to assess change over time.

• The painDETECT performs better as a screening measure than as an outcome measure.

     

Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial

Objectives: The aim was to evaluate an Acceptance commitment therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. Methods: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomization. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. Results: Of 87 people assessed for eligibility, 31 (36%) were randomized. The main reason for non-randomization was that participants received surgery. Of the 16 participants randomized to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with seven participants suggested the intervention was acceptable. Conclusions: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible.

• Implications for Rehabilitation

• Acceptance commitment therapy (ACT) is an effective treatment for many pain conditions andcould be a useful intervention for people with osteoarthritis who have high levels of pain.

• Rasch analysis is a measurement technique that may enable greater precision in detectingmeaningful treatment effects in routine clinical outcomes.

• The ACT intervention was successful in reducing pain and sleep difficulties and there werenotable differences in effects between standard and Rasch-transformed scales.

• In a relatively small trial, ACT may to be an acceptable intervention for people with osteoarthritisand progress to a definitive trial is warranted.

     

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions

Purpose: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions.

Materials and methods: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren’s syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test–retest reliability.

Results: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach’s α?>?0.90); concurrent validity was strong (Health Assessment Questionnaire:?r_s?=?0.60–0.92; Short-Form Health Survey v2 Physical Function:?r_s?=??0.61 to ?0.91) and test–retest reliability excellent (Intra-Class Correlation Coefficient(2,1)?=?0.77–0.96).

Conclusion: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions.

• Implications for rehabilitation

• The Evaluation of Daily Activity Questionnaire evaluates users’ ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren’s syndrome).

• Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist.

• The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility.

• The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

     

Rasch validation of the Arabic version of the lower extremity functional scale

Purpose: The purpose of this study was to examine the internal construct validity of the Arabic version of the Lower Extremity Functional Scale (20-item Arabic LEFS) using Rasch analysis.

Methods: Patients (n?=?170) with lower extremity musculoskeletal dysfunction were recruited. Rasch analysis of 20-item Arabic LEFS was performed. Once the initial Rasch analysis indicated that the 20-item Arabic LEFS did not fit the Rasch model, follow-up analyses were conducted to improve the fit of the scale to the Rasch measurement model. These modifications included removing misfitting individuals, changing item scoring structure, removing misfitting items, addressing bias caused by response dependency between items and differential item functioning (DIF).

Results: Initial analysis indicated deviation of the 20-item Arabic LEFS from the Rasch model. Disordered thresholds in eight items and response dependency between six items were detected with the scale as a whole did not meet the requirement of unidimensionality. Refinements led to a 15-item Arabic LEFS that demonstrated excellent internal consistency (person separation index [PSI]?=?0.92) and satisfied all the requirement of the Rasch model.

Conclusion: Rasch analysis did not support the 20-item Arabic LEFS as a unidimensional measure of lower extremity function. The refined 15-item Arabic LEFS met all the requirement of the Rasch model and hence is a valid objective measure of lower extremity function. The Rasch-validated 15-item Arabic LEFS needs to be further tested in an independent sample to confirm its fit to the Rasch measurement model.

• Implications for Rehabilitation

• The validity of the 20-item Arabic Lower Extremity Functional Scale to measure lower extremity function is not supported.

• The 15-item Arabic version of the LEFS is a valid measure of lower extremity function and can be used to quantify lower extremity function in patients with lower extremity musculoskeletal disorders.

     

The PQRS-Montreal: a measure of patients’ perceptions of the quality of rehabilitation services for persons with a traumatic brain injury

Purpose To determine the factorial validity, internal consistency, criterion-related and concurrent validity of the Perception of Quality of Rehabilitation Services – Montreal (PQRS-Montreal) questionnaire for persons receiving traumatic brain injury (TBI) rehabilitation services. Design Cross-sectional study. Setting Seventeen facilities providing acute care and intensive inpatient and outpatient TBI adult rehabilitation. Participants Five-hundred thirty adults (GCS = 3–15; mean age = 41.5?±?16.9 years) who received rehabilitation were administered the questionnaire during an interview near time of discharge. Subjects responded to the 61 PQRS-Montreal items (five-point scale of agreement) and to the Client Satisfaction Question (CSQ8). Results Exploratory and confirmatory factor analyses identified three potential subscales (one- and two-factor solutions) explaining 26.1–41% of the variance (ecological approach, quality of team, service organization). The subscales’ internal structures were interpretable and their internal consistency varied from 0.51 to 0.90 (Cronbach’s α). Rehabilitation phase significantly and positively impacted factor scores and all factor scores were significantly and moderately correlated with CSQ8 scores. Conclusions The PQRS-Montreal possesses adequate psychometric properties supporting its use as a valid tool to measure patients’ perception of the quality of TBI rehabilitation services. This tool could help guide the development and monitoring of TBI rehabilitation service delivery.

• Implications for Rehabilitation

• The importance of measuring and monitoring quality of care is increasingly important in rehabilitation.

• Using the experiences and perceptions of care of service users is a valid way of assessing the quality of rehabilitation services.

• The PQRS-Montreal has adequate psychometric properties supporting its use as a valid tool to measure patients’ perception of the quality of TBI rehabilitation services.

• This tool could help guide the development and monitoring of TBI rehabilitation service delivery.

     

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

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

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

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

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

• Implications for Rehabilitation

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

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

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

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

     

Quality of life for post-polio syndrome: a patient derived,Rasch standard scale

Objective: To design a disease-specific quality of life (QoL) questionnaire for people with post-polio syndrome (PPS).

Methods: Qualitative interviews were conducted with 45 people with PPS to identify themes and derive potential items reflecting impact upon QoL. After cognitive debriefing, these were made into a questionnaire pack along with comparative questionnaires and posted to 319 patients. The 271 (85%) returned questionnaires were subjected to exploratory factor analysis (EFA) and Rasch analysis.

Results: A 25 item scale, the post-polio quality of life scale (PP-QoL), showed good fit to the Rasch model (conditional chi-square p?=?0.156), unidimensionality (% t-tests 2.0: CI 0.7–3.8), and Cronbach’s alpha of 0.87. With the latent estimate transformed to a 0–100 scale, the mean score was 56.9 (SD 18.5) with only 3.3% of respondents at the floor or ceiling of the scale. Test–retest reliability showed an intraclass correlation coefficient (ICC) (2.1) of 0.916, and correlation of 0.85.

Conclusion: The disease-specific PP-QoL demonstrated excellent reliability, appropriate concurrent validity, and satisfied the standards of the Rasch model. It enables examination of the impact of health status upon perceived QoL, and the impact of rehabilitation interventions. The scale is freely available for academic or not-for-profit users to improve research in this neglected, disabling condition.

• Implications for Rehabilitation

• In post-polio syndrome (PPS), existing work examines aspects of health-related quality of life (HRQoL), such as activity limitations.

• A disease-specific QoL measure would enable researchers to model the impact of health status, such as fatigue or mobility restrictions, upon QoL in PPS.

• The post-polio quality of life scale (PP-QoL) is based on the patients’ lived experience, meets Rasch standards and is free for use for academic and not-for-profit researchers.

• The raw score is reliable for individual use in clinical settings, and interval scale transformation is available for parametric applications and the calculation of change scores.

     

Rasch analysis of the Chedoke–McMaster Attitudes towards Children with Handicaps scale

Aim To assess whether the Chedoke–McMaster Attitudes towards Children with Handicaps (CATCH) 36-item total scale and subscales fit the unidimensional Rasch model. Method The CATCH was administered to 1881 children, aged 7–16 years in a cross-sectional survey. Data were used from a random sample of 416 for the initial Rasch analysis. The analysis was performed on the 36-item scale and then separately for each subscale. The analysis explored fit to the Rasch model in terms of overall scale fit, individual item fit, item response categories, and unidimensionality. Item bias for gender and school level was also assessed. Revised scales were then tested on an independent second random sample of 415 children. Results Analyses indicated that the 36-item overall scale was not unidimensional and did not fit the Rasch model. Two scales of affective attitudes and behavioural intention were retained after four items were removed from each due to misfit to the Rasch model. Additionally, the scaling was improved when the two most negative response categories were aggregated. There was no item bias by gender or school level on the revised scales. Items assessing cognitive attitudes did not fit the Rasch model and had low internal consistency as a scale. Conclusion Affective attitudes and behavioural intention CATCH sub-scales should be treated separately. Caution should be exercised when using the cognitive subscale.

• Implications for Rehabilitation

• The 36-item Chedoke–McMaster Attitudes towards Children with Handicaps (CATCH) scale as a whole did not fit the Rasch model; thus indicating a multi-dimensional scale.

• Researchers should use two revised eight-item subscales of affective attitudes and behavioural intentions when exploring interventions aiming to improve children’s attitudes towards disabled people or factors associated with those attitudes.

• Researchers should use the cognitive subscale with caution, as it did not create a unidimensional and internally consistent scale. Therefore, conclusions drawn from this scale may not accurately reflect children’s attitudes.

     

The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis – a mixed methods study

Purpose: Understanding motivational factors related to physical activity (PA) maintenance is essential in promoting long-term exercise benefits. This study explored the impact of self-efficacy (SE) on post-intervention PA maintenance in patients with hip osteoarthritis. Method: An SE-theory based mixed-methods sub-study of a trial investigating the effects of 4 months supervised exercise in patients with hip osteoarthritis. Questionnaire data (n?=?52; baseline and 12 months) on PA and SE (Arthritis Self-Efficacy Scale, ASES, score-range 10–100) were analysed (Mann–Whitney test) for differences in characteristics of maintainers and non-maintainers. Semi-structured individual interviews (n?=?15; at 12-months follow-up) were analysed using directed content analysis. Results: Compared to non-maintainers (n?=?9; 17%) maintainers (n?=?31; 60%) had improved (p?Conclusion: SE contributes to understanding of post-intervention PA maintenance in patients with hip osteoarthritis. However, disease-related factors and clinical trial participation appears significant too.

• Implications for Rehabilitation

• Patients’ perceived self-efficacy for physical activity contributes to the understanding of post-intervention physical activity maintenance in patients with hip osteoarthritis.

• Practitioners may benefit from incorporating the self-efficacy theory in the planning and execution of exercise interventions to promote post-intervention physical activity maintenance and long term health benefits.

• Post-intervention physical activity maintenance may be increased by focussing on the patients’ exercise self-efficacy through verbal persuasion and support, disease-specific information and information on normal physiological responses to exercise combined with an individualised training progression to support experiences of success and achievement of desired outcomes.

     

WOMAC-pf as a measure of physical function in patients with Parkinson’s disease and late-onset sequels of poliomyelitis: unidimensionality and item behaviour

Purpose: To assess psychometric properties of the Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC)-pf, an osteoarthritis (OA)-specific questionnaire used to establish the level of physical functioning in patients with late-onset sequels of poliomyelitis (LOSP) and Parkinson’s disease (PD). Study design and setting: Unidimensionality (using principal component analyses [PCA] and Rasch analyses) was separately established for three diagnostic groups: OA (n = 288), LOSP (n = 168) and PD (n = 200). Additionally, differential item functioning (DIF) among the three diagnostic groups was assessed using ordinal regression (Polytomous Universal Model) analyses. Baseline data were used from an ongoing cohort study of these three patient populations. Results: Unidimensionality was adequate, with all items loading on the first principal component. The Rasch analyses revealed that item fit was generally good. Uniform and non-uniform DIF were found to be present among the three diagnostic groups in three and one of the 17 physical functioning subscale (WOMAC-pf) items, respectively. Conclusion: The WOMAC-pf is a unidimensional measure of physical functioning in patients with LOSP and PD, in addition to its established use in OA.

Implications for Rehabilitation

• Disability in physical functioning related to mobility (walking, stair climbing, etc.) is a common feature of many chronic diseases, including osteoarthritis, late-onset sequels of poliomyelitis and Parkinson’s disease.

• In this study, the Western Ontario and MacMasters Universities Osteoarthritis Index-pf was shown to be a useful and adequate tool to assess physical functioning in these patient groups.

• The study highlighted that, despite differences in diagnosis, history and course of the disease, patients with different conditions experience similar disabilities in their physical functioning.

     

Improving the utility of the fine motor skills subscale of the comprehensive developmental inventory for infants and toddlers: a computerized adaptive test

Abstract

Aim: This study aimed at improving the utility of the fine motor subscale of the comprehensive developmental inventory for infants and toddlers (CDIIT) by developing a computerized adaptive test of fine motor skills.

Methods: We built an item bank for the computerized adaptive test of fine motor skills using the fine motor subscale of the CDIIT items fitting the Rasch model. We also examined the psychometric properties and efficiency of the computerized adaptive test of fine motor skills with simulated computerized adaptive tests.

Results and conclusions: Data from 1742 children with suspected developmental delays were retrieved. The mean scores of the fine motor subscale of the CDIIT increased along with age groups (mean scores?=?1.36–36.97). The computerized adaptive test of fine motor skills contains 31 items meeting the Rasch model’s assumptions (infit mean square?=?0.57–1.21, outfit mean square?=?0.11–1.17). For children of 6–71 months, the computerized adaptive test of fine motor skills had high Rasch person reliability (average reliability >0.90), high concurrent validity (rs?=?0.67–0.99), adequate to excellent diagnostic accuracy (area under receiver operating characteristic?=?0.71–1.00), and large responsiveness (effect size?=?1.05–3.93). The computerized adaptive test of fine motor skills used 48–84% fewer items than the fine motor subscale of the CDIIT. The computerized adaptive test of fine motor skills used fewer items for assessment but was as reliable and valid as the fine motor subscale of the CDIIT.

• Implications for Rehabilitation

• We developed a computerized adaptive test based on the comprehensive developmental inventory for infants and toddlers (CDIIT) for assessing fine motor skills.

• The computerized adaptive test has been shown to be efficient because it uses fewer items than the original measure and automatically presents the results right after the test is completed.

• The computerized adaptive test is as reliable and valid as the CDIIT.

     

Trajectories of health-related quality of life after stroke: results from a one-year prospective cohort study

Purpose: To identify trajectories of physical and psychosocial health-related quality of life (HRQoL) from two months to one-year post stroke and to determine the factors that are associated with trajectory membership.

Method: Multicenter prospective cohort study in which 351 stroke patients were followed up at 2, 6, and 12?months post stroke. Latent class growth mixture modeling was used to determine trajectories of physical and psychosocial HRQoL. Multinomial regression analyses were performed to predict trajectory membership. Potential predictors were demographic, stroke-related, and psychological factors.

Results: Four trajectories were identified for both physical and psychosocial HRQoL: high, low, recovery, and decline. Comparing the low and recovery trajectories, the groups with low HRQoL were more likely to have higher scores for neuroticism. Comparison of the decline and high trajectories yielded the following predictors of physical HRQoL: discharged to a rehabilitation setting, less acceptance and more neuroticism, pessimism, helplessness, and passive coping. Predictors of psychosocial HRQoL were: discharged to a rehabilitation setting, less self-efficacy, and proactive coping, and more helplessness and passive coping.

Conclusions: The present study identified four distinct trajectories of physical and psychosocial HRQoL. The findings indicate that psychological factors are the most important factors in identifying stroke patients at risk of unfavorable HRQoL trajectories. Using these factors will help to identify vulnerable patients and guide rehabilitation in the early stages post stroke.

• Implications for rehabilitation

• Clinicians should be aware that health-related quality of life follows distinct trajectories stable high, stable low, recovery, or decline, after onset of stroke.

• Determining relevant psychological factors, in particular helplessness and passive coping, in stroke patients early after stroke is important because these are predictors of unfavorable health-related quality of life trajectories.

     

Validation of the Participation Strategies Self-Efficacy Scale (PS-SES)

Purpose: To develop and examine the psychometric properties of a newly developed Participation Strategies Self-Efficacy Scale (PS-SES) designed to assess self-efficacy in using participation strategies following a stroke.

Method: One hundred and sixty-six subjects with mild to moderate stroke were recruited and interviewed using the PS-SES. The principal axis factoring analysis was run to examine the factor structure, and internal consistency was assessed by computing Cronbach’s alpha coefficient.

Results: The final measure is a 35-item scale with six subscales: (1) managing home participation, (2) staying organized, (3) planning and managing community participation, (4) managing work/productivity, (5) managing communication, and (6) advocating for resources. The instrument demonstrated high internal consistency.

Conclusion: The PS-SES is a reliable measure offering unique information regarding self-efficacy in managing participation.

• Implications for Rehabilitation

• Post-stroke participation requires complex management of resources, information, and strategies.

• There is a gap in instruments that can assess self-efficacy in managing participation following a stroke.

• The PS-SES is a valid tool measuring self-efficacy in using participation strategies in home, work, and community contexts.

     

Evaluating change in virtual reality adoption for brain injury rehabilitation following knowledge translation

Purpose: To evaluate the impact of knowledge translation (KT) on factors influencing virtual reality (VR) adoption and to identify support needs of therapists. Hypotheses: Intervention will be associated with improvements in therapists' perceived ease of use and self-efficacy, and an associated increase in intentions to use VR. Method: Single group mixed-methods pre-test–post-test evaluation of convenience sample of physical, occupational and rehabilitation therapists (n=37) from two brain injury rehabilitation centres. ADOPT-VR administered pre/post KT intervention, consisting of interactive education, clinical manual, technical and clinical support. Results: Increases in perceived ease of use (p=0.000) and self-efficacy (p=0.001), but not behavioural intention to use VR (p=0.158) were found following KT, along with decreases in the frequency of perceived barriers. Post-test changes in the frequency and nature of perceived facilitators and barriers were evident, with increased emphasis on peer influence, organisational-level supports and client factors. Additional support needs were related to clinical reasoning, treatment programme development, technology selection and troubleshooting. Conclusions: KT strategies hold potential for targeting therapists’ perceptions of low self-efficacy and ease of use of this technology. Changes in perceived barriers, facilitators and support needs at post-test demonstrated support for repeated evaluation and multi-phased training initiatives to address therapists’ needs over time.

• Implications for Rehabilitation

• Therapists’ learning and support needs in integrating virtual reality extend beyond technical proficiency to include clinical decision-making and application competencies spanning the entire rehabilitation process.

• Phased, multi-faceted strategies may be valuable in addressing therapists’ changing needs as they progress from novice to experienced virtual reality users.

• The ADOPT-VR is a sensitive measure to re-evaluate the personal, social, environmental, technology-specific and system-level factors influencing virtual reality adoption over time.

     

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke

Purpose: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. Methods: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM^?). Results: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed “activities” and “participation” components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach’s α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM^?. Conclusions: WHODAS-II provides a reliable and valid instrument for measuring disability and components of “activities” and “participation” in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.

Implications for Rehabilitation

• The impact of stroke on patients’ functioning in terms of activities and participation is important in the postacute and long-term rehabilitation phase.

• The World Health Organization Disability Assessment Schedule (WHODAS-II) was developed specifically to measure activities and participation.

• Psychometric properties of the WHODAS-II in stroke have received some attention recently, mostly using classical approaches.

• This study has tested the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis and it has been found that WHODAS-II provides a reliable and valid instrument for measuring functioning and components of “activities” and “participation” in stroke survivors.

     

Predictors of depressed mood 12 months after injury. Contribution of self-efficacy and social support

Abstract

Purpose: There is evidence that depressed mood and perception of pain are related in patients with chronic illness. However, how individual resources such as self-efficacy and social support play a role in this association remains unclear. The aim of this study was to investigate the influence of both variables as either moderator or mediator. Method: In a longitudinal study, 274 injured workers (M?=?43.24 years) were investigated. Data were collected on sociodemographics, depressed mood, pain, social support, and self-efficacy at three months post-injury, and depressed mood one year post-injury. Results: Hierarchical multiple linear regression analyses revealed that pain (β?=?0.14; p?<?0.01) and social support (β?=??0.18; p?<?0.001) were significant predictors of depressed mood. Self-efficacy moderated the relationship of pain (β?=??0.12; p?<?0.05) and depressed mood after one year. Lower self-efficacy in combination with pain had a stronger impact than higher self-efficacy and pain on depressed mood. Social support did not moderate the association. Conclusions: Self-efficacy for managing pain is important in the development of depressed mood. According to the results of this study, we suggest that the detection of low social support and low self-efficacy might be important in long-term rehabilitation process.

• Implications for Rehabilitation

• Risk for depressed mood one year after an accident is high: One in five workers report depressed mood.

• Protective factors for depressed mood in injured workers needs to be considered in the rehabilitation.

• Focusing on resources like social support and self-efficacy could be protective against depressed mood.

• The early detection of low social support and low self-efficacy might be important in long-term rehabilitation processes.

     

Child engagement in daily life: a measure of participation for young children with cerebral palsy

Abstract

Purpose: The objectives of this study were to determine the: (1) internal consistency and test–retest reliability of the Child Engagement in Daily Life measure; (2) construct validity of the measure (known groups methods), that is, the ability of the measure to discriminate participation in family and recreational activities and self-care among young children of varying age and motor ability and between children with and without cerebral palsy, and (3) stability and hierarchical ordering of the items for young children with CP to devise an interval-level scoring system. Methods: 429 children with CP and their parents and 110 parents of children without CP participated in this methodological study. Parents completed the Child Engagement in Daily Life measure and therapists assessed the children's gross motor function. Rasch analysis was used to create an interval-level measure. Results: Children's frequency in and enjoyment of participation in family and recreational activities and self-care varied by age and gross motor ability. Internal consistency of the domains of the measure was high, Cronbach alpha values ranging from 0.86 to 0.91; test–retest for participation in family and recreational activities was acceptable, ICC?=?0.70, and in self-care was high, ICC?=?0.96. The items in the measure had a good fit and a logical hierarchical ordering. Conclusion: Study results support the validity and reliability of the Child Engagement in Daily Life measure as an assessment of participation in family and recreational activities and self-care for young children with CP.

• Implications for Rehabilitation

• Participation in family and recreational activities and self-care for young children with cerebral palsy can be reliably and validly assessed using the Child Engagement in Daily Life measure.

• Service providers are encouraged to support young children's participation in family and recreational activities and self-care.

     

Rasch measurement: the Arm Activity measure (ArmA) passive function sub-scale

Purpose: To evaluate the conformity of the Arm Activity measure (ArmA) passive function sub-scale to the Rasch model. Methods: A consecutive cohort of patients (n?=?92) undergoing rehabilitation, including upper limb rehabilitation and spasticity management, at two specialist rehabilitation units were included. Rasch analysis was used to examine scaling and conformity to the model. Responses were analysed using Rasch unidimensional measurement models (RUMM 2030). The following aspects were considered: overall model and individual item fit statistics and fit residuals, internal reliability, item response threshold ordering, item bias, local dependency and unidimensionality. Results: ArmA contains both active and passive function sub-scales, but in this analysis only the passive function sub-scale was considered. Four of the seven items in the ArmA passive function sub-scale initially had disordered thresholds. These items were rescored to four response options, which resulted in ordered thresholds for all items. Once the items with disordered thresholds had been rescored, item bias was not identified for age, global disability level or diagnosis, but with a small difference in difficulty between males and females for one item of the scale. Local dependency was not observed and the unidimensionality of the sub-scale was supported and good fit to the Rasch model was identified. The person separation index (PSI) was 0.95 indicating that the scale is able to reliably differentiate at least two groups of patients. Conclusions: The ArmA passive function sub-scale was shown in this evaluation to conform to the Rasch model once disordered thresholds had been addressed. Using the logit scores produced by the Rasch model it was possible to convert this back to the original scale range.

• Implications for Rehabilitation

• The ArmA passive function sub-scale was shown, in this evaluation, to conform to the Rasch model once disordered thresholds had been addressed and therefore to be a clinically applicable and potentially useful hierarchical measure.

• Using Rasch logit scores it has be possible to convert back to the original ordinal scale range and provide an indication of real change to enable evaluation of clinical outcome of importance to patients and clinicians.