The Spanish lower extremity functional scale: A reliable,valid and responsive questionnaire to assess musculoskeletal disorders in the lower extremity

Abstract

Purpose: The Lower Extremity Functional Scale (LEFS) is a widely used questionnaire to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It also can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. Nevertheless there is no Spanish version of the LEFS, so the aim of this study was the translation and cross-cultural adaption of the Spanish version of the LEFS and to evaluate its psychometrics properties. Methods: The questionnaire was cross cultural adapted into Spanish. The psychometric properties tested in the Spanish version of the LEFS were: internal consistency, test–retest reliability, constructs validity, discriminative validity, responsiveness, concurrent validity and floor and ceiling effects in 132 participants seeking for treatment due to lower extremity dysfunction. Results: The Spanish version of the LEFS had high internal consistency (Cronbach’s α?=?0.989), test–retest reliability (ICC?=?0.998, 95% CI: 0.996–0.999) and presented a high correlation with the SF-36 (36-Item Short-Form Health Survey) especially with the physical function and pain subscales. The construct validity showed a single factor that account for 84.95% of the variance. The standard error of measurement of the Spanish version of the LEFS was 0.88 scale points (95% CI) and the minimal detectable change was 2.18 scale points (95% CI). The sample, collected from five Spanish physical therapy centers, was divided in groups (acute, sub-acute and chronic subjects). Within group changes showed a significant improvement on the LEFS score (p?<?0.001) and effect sizes were large in all conditions. The LEFS allowed to distingue between acute and not acute conditions; for this criterion ROC curve was performed at baseline (area under the curve [AUC]?=?0.95). There was no floor or ceiling effects. Conclusions: The Spanish version of the LEFS has been shown to be a valid and reliable tool to assess musculoskeletal dysfunction in the lower extremity that could be used with Spanish speaker population.

• Implications for Rehabilitation

• Cross-cultural adaptation of a self-reported questionnaire to evaluate musculoskeletal lower extremity disorders in the Spanish population.

• To provide Spanish clinicians and physiotherapists a useful tool to assess the lower extremity function.

• To provide Spanish researchers a valid tool for research on lower extremity function: patient’s improvement due to treatment, compare results obtained between populations, treatment.

     

Effect of multi-sensory balance training for unsteady elderly people: pilot study of the “Reykjavik model”

Abstract

Purpose: To evaluate effects of combined mechano- and proprioceptive, vestibular and fall-prevention training on postural control, functional ability, confidence in activities of daily living (ADL) and frequency of falls among unsteady elderly people. Method: Subjects were 37 elderly outpatients attending physiotherapy because of instability. Treatment consisted of 18 multisensory balance training sessions. Results from Sensory Organization Test, Five-Times-Sit-to-Stand Test, 30-m normal and fast walk with a turn, Ascending–Descending 11 steps and Activities-specific Balance Confidence Scale were compared before and after training. Information was gathered about number of falls 1 year prior to training, during training period and for 6 months after completion of training. Results: Significant improvement was observed in all measured parameters (p?<?0.001). The subjects aged between 70 and 92 years (mean age 80.8 years), had considerable medical history. Thirty four of them reported 159 falls in the year prior to the study. Six subjects reported seven falls during the training period and seven subjects reported 17 falls in the 6 months follow-up period. Conclusions: Combined vestibular, proprioceptive and fall-prevention training improve postural control, functional ability, confidence in ADL and might even decrease the risk of falling among elderly people.

• Implications for Rehabilitation

• Decreased proprioception in the lower limbs and vestibular dysfunction is common among elderly people.

• Stimulation of the sensory systems and training of fall-prevention movements is essential when improving postural control among elderly people.

• Multisensory training increases functional abilities, confidence in activities of daily living and possibly reduces rate of falls among elderly individuals.

     

Cross-cultural validation of the Falls Efficacy Scale-International to assess concerns about falls among Hungarian community-living older people

Abstract

Purpose: The Falls Efficacy Scale-International (FES-I) is a reliable and valid tool for assessing concerns about falling. Our aims were to translate, culturally adapt, and evaluate the main psychometric characteristics (internal consistency, reproducibility, and convergent construct validity) of the Hungarian version of the FES-I on a sample of community-living older adults.

Methods: After translating and culturally adapting the original scale, 165 community-living older adults (aged 60?years or over) participated in the measurements and filled in the questionnaire. After two weeks, a subsample of 64 persons filled in the FES-I again to determine the test–retest reliability.

Results: The test–retest analysis showed excellent reliability: Intraclass Correlation Coefficient was 0.831. The FES-I Hungarian consisted of two factors that showed good internal consistency: Cronbach’s alpha 0.95 (Factor 1), 0.89 (Factor 2), and 0.93 (whole scale). The FES-I was able to discriminate the participants based on gender and fall history. It showed a significant correlation with the Timed Up and Go test (r?=?0.740) and the general health perception (r?=??0.713).

Conclusions: Translation and cultural adaptation of the original scale were successful. The Hungarian version proved to be a reliable, valid tool confirming that it can be used in future clinical and scientific work with Hungarian older people.

• Implications for rehabilitation

• Excessive concerns about falls may lead to avoidance of activities, decreasing functional abilities, increasing of risk of a future fall, ultimately premature nursing home admission.

• The Falls Efficacy Scale-International is a widespread tool for assessing concerns about falls.

• The Hungarian version of Falls Efficacy Scale-International has an excellent test–retest reliability, good internal consistency, and acceptable construct validity.

• The Hungarian version of Falls Efficacy Scale-International is a valid and reliable tool for measuring the concerns about falls among Hungarian-speaking community-living older people in everyday clinical practice and scientific studies.

     

Anxiety among individuals with visual vertigo and vestibulopathy

Abstract

Purpose: Visual vertigo (VV) is a type of dizziness triggered by visual stimuli. Despite a high incidence, its relationship with anxiety is not well-defined or understood. This study evaluated anxiety levels in subjects with VV compared to vestibulopathic subjects without VV and healthy individuals. Methods: A cross-sectional study to evaluate anxiety among individuals with VV was conducted twice. The first study included 72 participants (66 to 83 years of age) from senior residential centers. The second included 31 participants from a vestibular rehabilitation program (age range 35–82 years). Study 1 also used the Activities-Specific Balance Confidence (ABC) scale and study 2 the Dizziness Handicap Inventory (DHI). Results: Subjects were classified as VV positive (27 in study 1, 10 in study 2) or vestibulopathic without VV (30 in study 1, 11 in study 2) based on Head Impulse or Dynamic Visual Acuity Tests and the Dizziness Questionnaire. The remaining were age-matched healthy controls. The outcome of each study demonstrated significantly higher anxiety levels (p?=?0.0001) in the VV group compared to the other groups. The results of the ABC test demonstrated that subjects in the VV group had significantly lower self-confidence (p?=?0.001) than those in the Vest and Cont groups and performed fewer balance-related activities of daily life. DHI results showed that VV group expressed higher (p?<?0.001) mean scores for self-perceived feelings of dizziness and imbalance (54%), compared to the Vest (9%) and Cont groups (1%). Conclusions: Anxiety related to VV requires special attention when assessing and managing vestibulopathy, regardless of patient age.

• Implications for Rehabilitation

• Anxiety is a characteristic of subjects with visual vertigo (VV) and vestibulopathy.

• Anxiety in subjects with VV is not related to age.

• VV should be considered when subjects with anxiety complain of imbalance.

• Anxiety and vestibulopathy are often interrelated and should be considered in diagnostic evaluations.

     

Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study

Abstract

Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Independence Measure (SCIM) version III for Spain and to validate the Spanish version of the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, back-translation and assessment of cultural equivalence procedures. eSCIM version III, was administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal consistency (Cronbach’s α), (3) validation and confirmation of the correlation between eSCIM III and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The reliability of eSCIM III showed an intra-class coefficient value >0.97 in the different subscales assessed. Internal consistency of eSCIM III was shown by a Cronbach’s α value of 0.93. The validity of eSCIM III was confirmed by the close correlation with FIM (r?=?0.94, p?<?0.0001). The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be culturally equivalent to the original version, as reliability and validity of this tool were demonstrated. It can be used in Spain for functional assessment of patients with spinal cord injury.

• Implications for Rehabilitation

• Development of the Spanish version of the Spinal Cord Independence Measure version III.

• The importance of the adaptation of Spinal Cord Independence Measure (SCIM) is that it guarantees the possibility of measuring the same concept in different cultures and countries.

• The eSCIM III is the first, specific assessment tool in patients with spinal cord injury adapted for its use in Spain.

• The eSCIM III is a tool conceptually equivalent to the original version. It has the reliability and validity of SCIM III in order to be used by clinicians.

     

A simple test of choice stepping reaction time for assessing fall risk in people with multiple sclerosis

Purpose To determine (a) the discriminant validity for established fall risk factors and (b) the predictive validity for falls of a simple test of choice stepping reaction time (CSRT) in people with multiple sclerosis (MS). Method People with MS (n?=?210, 21–74y) performed the CSRT, sensorimotor, balance and neuropsychological tests in a single session. They were then followed up for falls using monthly fall diaries for 6 months. Results The CSRT test had excellent discriminant validity with respect to established fall risk factors. Frequent fallers (≥3 falls) performed significantly worse in the CSRT test than non-frequent fallers (0–2 falls). With the odds of suffering frequent falls increasing 69% with each SD increase in CSRT (OR?=?1.69, 95% CI: 1.27–2.26, p?=?<0.001). In regression analysis, CSRT was best explained by sway, time to complete the 9-Hole Peg test, knee extension strength of the weaker leg, proprioception and the time to complete the Trails B test (multiple R² = ^?0.449, p?Conclusions A simple low tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS. This test may prove useful in documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions.

• Implications for rehabilitation

• Good choice stepping reaction time (CSRT) is required for maintaining balance.

• A simple low-tech CSRT test has excellent discriminative and predictive validity in relation to falls in people with MS.

• This test may prove useful documenting longitudinal changes in fall risk in relation to MS disease progression and effects of interventions

     

The validity and reliability of the Thai version of the Kujala score for patients with patellofemoral pain syndrome

Purpose: To develop a Thai version of the Kujala score and show the evaluation of the validity and reliability of the score.

Method: The Thai version of the Kujala score was developed using the forward–backward translation protocol. The 49 PFPS patients answered the Thai version of questionnaires including the Kujala score, Short Form-36 (SF-36) and International Knee Documentation Committee (IKDC) Subjective Knee Form. The validity between the scores has been tested. The reliability was assessed using test–retest reliability and internal consistency.

Results: The Thai version of the Kujala score showed a good correlation with Thai IKDC Subjective Knee Form (Pearson’s correlation coefficient; r?=?0.74: p?r?=?0.586, 0.571 and 0.524, respectively: p?p?p?Conclusion: The Thai version of the Kujala score has shown good validity and reliability. This score can be effectively used for evaluating Thai patients with patellofemoral pain syndrome.

• Implications for Rehabilitation

• The Kujala score is a self-administered questionnaire for patients with patellofemoral pain syndrome (PFPS).

• The validity and reliability of the Thai version of Kujala are compatible with other versions (Turkish, Chinese and Persian version).

• The Thai version of Kujala has been shown to have validity and reliability in Thai PFPS patients and can be used for clinical evaluation and also in the research work.

     

Psychometric properties of the Spanish version of the Cumberland Ankle Instability Tool

Abstract

Purpose: To estimate the psychometric properties of the Spanish version of the Cumberland Ankle Instability Tool (CAIT-Sv). Method: One hundred and seventy-one subjects participated. The psychometric properties tested for CAIT-Sv were internal consistency with Cronbach’s α (n?=?171) in the first measurement; test–retest reliability using the intraclass correlation coefficient (ICC_2,1) (n?=?171) in two measurements separated by one week; criterion validity by ICC_2,1 between the original CAIT and CAIT-Sv in two measurements separated by two weeks for a subgroup of 54 bilingual subjects; ceiling and floor effects (n?=?78 subjects with a history of at least one ankle sprain), and responsiveness using Cohen’s d in a subgroup of 25 subjects with a history of at least one ankle sprain and a score ≤24 points on the CAIT-Sv and treated with a rehabilitation program during four weeks. Results: Internal consistency was excellent (Cronbach’s α: 0.8–0.84). Test–retest reliability was high (ICC_2,1: 0.95). Criterion validity was high (ICC_2,1: 0.91; 95% CI: 0.84–0.94; p?<?0.001 for dominant ankle). There were no ceiling (9%) and floor (0%) effects. Responsiveness was moderate (Cohen’s d: 0.6995; CI: 0.11–1.27). Conclusions: CAIT-Sv is a reliable instrument with high criterion validity to measure the presence and severity of chronic ankle instability (CAI) in the Spanish population.

• Implications for Rehabilitation

• Chronic ankle instability is the most prevalent complication after ankle injuries.

• CAIT is a widely used tool for clinical detection of subjects with chronic ankle instability (CAI).

• In this study, CAIT-Sv has shown good phsychometric properties for using with Spanish speaking individuals.

     

Bladder function and falls in individuals with multiple sclerosis

Purpose: To examine the association between bladder function and falls while controlling for mobility in individuals with multiple sclerosis (MS).

Methods: A total of 92 ambulatory individuals with MS (mean age?±?SD?=?59.1?±?7.3 years, female n?=?69) were divided into two groups based on self-reported bladder function (none-mild n?=?43 versus moderate-severe n?=?49). The main outcome measure was a number of self-reported falls in the previous 3 months. Participants’ demographic information (age, type of MS, gender, use of the assistive device) was also collected. The balance was quantified with the Berg balance scale, and walking speed was indexed with the timed 25-foot walk test. Negative binomial regression analysis was used to examine the association between bladder function and falls in individuals with MS while controlling for balance and walking.

Results: The median number of self-reported falls in the previous 3 months was 2 (interquartile range, 0–4). The severe bladder dysfunction group was more likely (incidence rate ratio?=?1.84) to have a greater number of self-reported falls compared to mild bladder dysfunction group when balance and walking were taken into account.

Conclusion: Bladder dysfunction is related to falls history independently of mobility in individuals with MS. Future research examining whether bladder management programmes have an impact on fall incidence in MS is warranted.

• Implications for rehabilitation

• Bladder dysfunction and falls are common health concerns in individuals with multiple sclerosis.

• Bladder dysfunction was associated with the number of falls in individuals with MS, and this association was independent of mobility.

• Bladder management should be included in fall prevention strategies in individuals with MS.

     

Is walking symmetry important for ambulatory patients with spinal cord injury?

Purpose: To assess and compare the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI) who had different degrees of lesion severity, levels of walking ability, and fall history. In addition, the study explored the relationship between the levels of walking symmetry and variables related to the ability of well-controlled walking of the participants.

Study design: Cross-sectional study.

Methods: Sixty-six eligible participants were assessed and interviewed for levels of walking symmetry, walking speed, functional endurance, symmetrical lower limb support ability, balance control, and fall history over the last 6 months.

Results: Participants walked asymmetrically (85%) similar to those with unilateral impairments (i.e., patients with stroke and amputee, 79–93%). The levels of walking symmetry were significantly correlated to walking speed, functional endurance and balance ability of the participants (p?r?=?0.613–0.765, p?Conclusions: The findings confirm problems of asymmetrical walking and the importance of walking symmetry for the ability of well-controlled walking and a risk of multiple falls in ambulatory participants with SCI. Therefore, apart from the levels of independence, the improvement of walking symmetry is crucial for these individuals.

• Implications for Rehabilitation:

• Ambulatory individuals with spinal cord injury walked asymmetrically at the same level as those with unilateral impairments such as patients with stroke and amputee.

• Their levels of walking symmetry were significantly related to the ability of well-controlled walking, particularly in those with the history of multiple falls.

• The finding confirmed the importance of walking symmetry as a crucial parameter to detect walking improvement and fall risk reduction.

• Apart from the levels of independence, rehabilitation professionals also need to emphasize on the improvement of symmetrical walking for these patients.

     

Cross-cultural adaptation and validation of the Arabic version of the knee outcome survey-activities for daily living scale

Purpose: The purpose of this study is to cross-culturally adapt the Knee Outcome Survey-Activities of Daily Living Scale into Arabic and to assess its psychometric properties (internal consistency, reliability, validity, and responsiveness) in patients with knee disorders.

Methods: The cross-cultural adaptation process for the Knee Outcome Survey-Activities of Daily Living Scale into Arabic was performed consistent with the published guidelines. The psychometric properties of this Arabic version were then evaluated. Participants completed this version three times: at baseline, 2–4 days later, and 4?weeks later. Correlations between the Arabic version of Knee Outcome Survey-Activities of Daily Living Scale and the Arabic version of the Short Form-36 Health Survey, Get Up and Go, and Ascending/Descending stairs tests were evaluated.

Results: Linguistic and cultural issues were addressed. The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale demonstrated excellent internal consistency (Cronbach’s alpha?=?0.97) and excellent test–retest reliability (intraclass correlation coefficient?=?0.97). Construct validity of the Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale with the Arabic version of Short Form-36 Health Survey subscales ranged from r?=?0.28 to 0.53, p?r?=??0.47 to ?0.60, p?Conclusions: The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale is a reliable, valid and responsive measure for assessing knee-related symptoms and functional limitations

• Implications for rehabilitation

• The Knee Outcome Survey-Activities of Daily Living Scale-Arabic is a reliable, valid and responsive measure for assessing knee-related functional limitations.

• This Arabic version can be used in clinical practice and for research purposes to assess symptoms and functional limitations in Arabic-speaking patients with knee disorders.

• This scale is responsive to track therapeutic outcome of Arabic-speaking patients with knee disorders.

     

Transcultural adaptation and validation of Hindi version of Quebec Back Pain Disability Scale

Abstract

Purpose: To transculturally adapt the Quebec Back Pain Disability Scale for Hindi-speaking population and examine its psychometric properties in patients with low back pain.

Materials and methods: The Quebec Back Pain Disability Scale was translated and cross-culturally adapted into Hindi following international guidelines. Hindi version of the scale was completed by 120 patients with low back pain and 60 healthy controls. Patients with low back pain were also administered the Hindi-Roland Morris Disability Questionnaire and Visual Analog Scale. Psychometric evaluation included test–retest reliability, convergent and discriminative validity. Exploratory factor analysis was carried out to determine the factor structure.

Results: The factorial analysis revealed a four-factor solution (bending/carrying, ambulation/reach, prolonged postures and rest). Convergent validity was confirmed by high correlation of Hindi Quebec Back Pain Disability Scale to the Hindi version of Roland Morris Disability Questionnaire (r?=?0.77 and p?<?0.001) as well as Visual Analog Scale (r?=?0.682 and p?<?0.001) scores. Discriminative validity was established by significantly different scores for patients with low back pain and the healthy controls (35.36?±?18.6 vs. 9.13?±?6.08 and p?<?0.001). The translated version of the scale showed remarkable internal consistency (Cronbach α?=?0.98) and the intraclass correlation coefficient of test–retest reliability was excellent (ICC_2,1=0.96). MDC₉₅ and SEM scores obtained were 10.28 and 3.71, respectively.

Conclusion: The Hindi version of Quebec Back Pain Disability Scale has good test–retest reliability, discriminative and convergent validity and is appropriate for clinical and research use in Hindi-speaking low back pain patients.

• Implications for rehabilitation

• Linguistically and culturally adapted questionnaires help researchers make adequate inferences about instruments measuring health and quality of life.

• The translated version would serve as a valid research tool allowing comparability of data across cultures thus, providing opportunities for large multicenter, multicountry trials.

• A Hindi Quebec Back Pain Disability Scale version will help to improve the quality and efficacy of assessment of low back pain by developing in patients, a better understanding of the items which can be easily correlated with the activities of daily living.

     

Persian version of the Moorong Self-Efficacy Scale: psychometric study among subjects with physical disability

Purpose: Self-efficacy plays a key role in varying areas of human conditions which can be measured by different scales. The present study was aimed to evaluate the psychometric properties of Moorong Self-Efficacy Scale (MSES) in Iranian Subjects with Physical Disability (SWPD).

Method: Data were collected by face-to-face interviews and self-report surveys from 214 subjects. The face and content validity, and reliability were evaluated. Discriminates were evaluated between the sub-groups of disability levels, physical activity, and health condition levels. The concurrent, convergent, divergent, and construct validity were assessed by short form health survey scale (SF-36), general self-efficacy scale (GSES), hospital anxiety and depression scale (HADS), respectively. Replaceable exploratory factor analysis was evaluated. SPSS software was used for statistical analysis.

Results: There were acceptable face and content validity, and reliability. Furthermore, significant correlation was found between PSES and SF-36 (p?p?=?0.02), physical activity levels (p?p?=?0.001). The correlation of Persian Self-Efficacy Scale (PSES) scores with GSES (r?=?0.61, p?R?=??0.53, p?Conclusions: The PSES is a valid, reliable and sensitive tool to measure the self-efficacy among SWPD for planning and managing of disability problems.

• Implications for rehabilitation

• Psychometric properties of the Persian version of self-Efficacy scale (PSES) appear to be similar to original, English version.

• The PSES has been shown to have validity and reliability in Persian physical disables and can be used for patients with more different types of physical disability than individuals suffering from only Spinal Cord Injury (SCI).

• The PSES can be used in clinical practice and research work to evaluate the patients’ confidence in performing daily activities.

     

The Wheelchair Use Confidence Scale: Italian translation,adaptation, and validation of the short form

Objective: We developed an Italian version of the Wheelchair Use Confidence Scale for Manual Users-Short Form (WheelCon-M-I-short form) and examined its reliability and validity.

Methods: The original scale was translated from English to Italian using the “Translation and Cultural Adaptation of Patient Reported Outcomes Measures–Principles of Good Practice” guidelines. The WheelCon-M-I-short form was administered to experienced manual wheelchair users who had a variety of diagnoses. Its internal consistency and test–retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair Outcome Measure (WhOM-I) and the Italian version of the Barthel index (BI).

Results: The WheelCon-M-I-short form was administered to 31 subjects. The mean?±?SD of the WheelCon-M-I-short form score was 7.5?±?1.9. All WheelCon-M-I-short form items were either identical or similar in meaning to the WheelCon-M-short form items. Cronbach’s α for the WheelCon-M-I-short form was 0.95 (p?p?p?p?Conclusions: The WheelCon-M-I-short form was found to be reliable and a valid outcome measure for assessing manual wheelchair confidence in the Italian population.

• Implication for Rehabilitation

• The WheelCon-M-I-short form is a valid outcome measure available for assessing wheelchair confidence, according to Bandura’s social cognitive theory, self-efficacy is a better predictor of future behavior than skill itself.

• Translation of the WheelCon-M-short form into the WheelCon-M-I-short form provides a new tool for Italian professionals.

• Clinicians now have a method to measure this invisible barrier to wheelchair use, and they will be able to make informed decisions when prescribing the use of manual wheelchairs and when training clients in their use.

• The WheelCon-M-I-short form also provides researchers with a tool in an important and relevant area of study for future research.

     

Chinese cross-cultural adaptation and validation of the Foot Function Index as tool to measure patients with foot and ankle functional limitations

Purpose: To perform a cross-cultural adaptation and validation of the Foot Function Index (FFI) questionnaire to develop the Chinese version.

Materials and methods: Three hundred and six patients with foot and ankle neuromusculoskeletal diseases participated in this observational study. Construct validity, internal consistency and criterion validity were calculated for the FFI Chinese version after the translation and transcultural adaptation process.

Results: Internal consistency ranged from 0.996 to 0.998. Test–retest analysis ranged from 0.985 to 0.994; minimal detectable change 90: 2.270; standard error of measurement: 0.973. Load distribution of the three factors had an eigenvalue greater than 1. Chi-square value was 9738.14 (p?r?=??0.634 (Factor 2) and r?=??0.191 (Factor 1). Foot Function Index (Taiwan Version), Short-Form 12 (Version 2) and EuroQol-5D were used for criterion validity. Factors 1 and 2 showed significant correlation with 15/16 and 14/16 scales and subscales, respectively.

Conclusions: Foot Function Index Chinese version psychometric characteristics were good to excellent. Chinese researchers and clinicians may use this tool for foot and ankle assessment and monitoring.

• Implications for rehabilitation

• A cross-cultural adaptation of the FFI has been done from original version to Chinese.

• Consistent results and satisfactory psychometric properties of the Foot Function Index Chinese version have been reported.

• For Chinese speaking researcher and clinician FFI-Ch could be used as a tool to assess patients with foot disease.

     

Cross cultural adaptations and psychometric domains of Brazilian version of PROFILE PD for Parkinson’s disease

Purpose: The PROFILE PD scale was developed specifically to evaluate patients with Parkinson’s disease (PD) within the context of the International Classification of Functioning, Disability and Health, directly applied to physical therapy practice. The study aimed to translate and cross-culturally adapt the PROFILE PD scale to Portuguese-Brazil, and to analyze its psychometric domains.

Methods: Fifty participants with PD participated in the study. We assessed the clarity of the Brazilian version of the scale by physiotherapists, presence of floor and ceiling effects, interrater and test–retest reliabilities, in addition to discriminant, concurrent (UPDRS) and construct validity, internal consistence, minimal detectable change (MDC), and responsiveness.

Results: The scale was considered highly clear for physical therapists. The interrater ICC was 0.74 and Wk was 0.89 for the total score. For test–retest reliability, the total ICC score was 0.99. The analysis of concurrent validity showed the Spearman correlation between Brazilian version of PROFILE PD and UPDRS (ρ?=?0.77; p?α?=?0.99). MDC was 2.41 points and there were no floor and ceiling effects. Also, the scale was responsive to physical therapy intervention, with improvement in 8 points after two months (effect size = 0.85).

Conclusion: The Brazilian version of PROFILE PD is an instrument reliable, valid, and responsive to physical therapy intervention, that can be used to quantify impairments and limitations in patients with PD and can provide an overall summary of the impact of disease, useful for physiotherapy practice.

• Implications for Rehabilitation

• PROFILE PD is a reliable and valid instrument to be applied in Brazilian Parkinson disease patients.

• This scale is design specially to be used in physical therapy practice within the contexts surrounding the International Classification of Functioning, Disability and Health.

• PROFILE PD was able to discriminate between patients in mild and moderate stages of disease which is difficult in clinical practice mainly because the scale used for this relies on balance and gait rather than a global profile.

     

Factors impacting the household and recreation participation of older adults living in the community

Abstract

Purpose: To identify demographic, physical and psychosocial determinants associated with participation in daily activities of community-dwelling older adults. Methods: A cross-sectional design of older adults (≥70 years) from Victoria, Australia, residing in their homes was drawn from a convenience sample. The outcomes were recent participation in household and recreational activities as measured by the Phone-FITT. Explanatory variables included demographics, physical and mental health functioning (Short Form-12 version 2, Geriatric Depression Scale 15). Associations were analyzed through linear regression. Results: There were 244 participants (60% female), with a mean age of 77.5 years (SD 5.7). Higher levels of depression and fewer falls (during the previous year) were independently associated with restrictions in household participation (p?<?0.001, p?<?0.001). For recreational participation, higher levels of depression were associated with restricted participation (p?<?0.001). Conclusion: Screening for depression should be a key component of health assessments with older adults. Untreated depression may lead to lower participation rates in daily activities potentially resulting in social isolation. Fewer falls and restricted household participation were associated, but no association was observed between falls and recreational participation. Further studies are required to explore this association in more detail.

• Implications for Rehabilitation

• Depression is significantly correlated with the level of participation in daily activities for older adults.

• Health professionals need to screen for depression when working with older adults.

     

Further validation of the Multiple Sclerosis Self-Efficacy Scale

Abstract

Purpose: This study examined the factorial and construct validity of the Multiple Sclerosis Self-Efficacy (MSSE) Scale in two samples of people with multiple sclerosis (MS). Method: Two samples (n's?=?292, 275) of participants with MS were recruited from across the United States. Participants in both studies completed a questionnaire battery that included the MSSE and measures of symptoms, dysfunction, disability, psychosocial aspects, mental/emotional well-being, and quality of life. Factorial validity was tested using confirmatory factor analysis (CFA), whereas construct validity was examined based on bivariate correlations with scores from other measures. Results: The two-factor measurement model provided a poor fit for the 18 items on the MSSE in both the samples. This model provided a good fit for a modified, 10-item scale in both samples. The 10-item version of the MSSE was highly correlated with the original MSSE (r?=?0.97, p?<?0.001) and related constructs (e.g. disability, r?=?0.69, p?<?0.0001). The standardized Cronbach's αs of the two subscales (function and control) of the 10-item version ranged between 0.78 and 0.94 for both samples. Conclusions: Scores from the modified, 10-item version of the MSSE provide a valid and reliable measure of MS-specific self-efficacy among persons with MS.

• Implications for Rehabilitation

• The importance of self-efficacy in managing the consequences of multiple sclerosis (MS) has increased.

• The Multiple Sclerosis Self-Efficacy (MSSE) Scale was developed and validated for measuring self-efficacy in function maintenance and control over MS from patients' perspectives. In the past almost 20 years, this scale has not undergone additional validation of its factor structure and construct validity in large-scale samples of persons with MS.

• The original two-factor construct did not provide a good fit for the 18 items on the MSSE in two independent samples. We modified the MSSE and found the 10 items fitted by the two-factor construct well with one sample and demonstrated cross-validity of the 10 items in the second sample.

• The 10-item version of the MSSE has good reliability and construct validity in both independent samples. Researchers and clinicians should adopt these 10 items when examining MS self-efficacy of patients.

     

Validity and reliability of the French translation of the VISA-A questionnaire for Achilles tendinopathy

Purpose: The Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire (VISA-A) evaluates the clinical severity of Achilles tendinopathy. The aim of this study was to translate the VISA-A into French and to study the reliability and validity of this French version, the VISA-AF.

Method: The VISA-A was translated into French to produce the VISA-AF using a validated methodology in six steps. Thereafter, several psychometric properties of this French version such as test–retest reliability, internal consistency, construct validity and floor and ceiling effects were evaluated. Therefore, we recruited 116 subjects, distributed into 3 groups: pathological patients (n?=?31), at-risk athletes (n?=?63) and healthy people (n?=?22).

Results: The final version of the VISA-AF was approved by an expert committee. On a scale ranging from 0 to 100, the average scores of the VISA-AF obtained were 59 (±?18) for the pathological group, 99 (±?1) for the healthy group and 94 (±?7) for the at-risk group. The VISA-AF shows excellent reliability, low correlations with the discriminant subscales of the SF-36 and moderate correlations with the convergent subscales of the SF-36.

Conclusions: The French version of the VISA-A is equivalent to its original version and is a reliable and valid questionnaire for French-speaking patients with Achilles tendinopathy.

• Implication for Rehabilitation

• The VISA-AF questionnaire is a reliable translation of the original VISA-A, from English into French, which is one of the most widespread languages in the world.

• The VISA-AF questionnaire is now a valid instrument that can be used by clinicians and researchers to assess the severity of pain and disability of French-speaking subjects with Achilles tendinopathy.

• The VISA-AF is a questionnaire to assess the severity of Achilles tendinopathy symptoms but is not a diagnostic tool.