Walking tests for stroke survivors: a systematic review of their measurement properties

Purpose: To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. Method: Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). Results: Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. Conclusions: Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.

Implications for Rehabilitation

• Many tests assessing walking in stroke survivors are available in the literature. The Six Minute Walk Test, Ten Metre Comfortable Walk Test, Ten Metre Fast Walk Test, Functional Ambulation Categories and Six Metre Walk Test on parquet and carpet have been most frequently clinimetrically evaluated. These tests amongst others, have been shown to be valid, reliable and feasible for stroke survivors.

• With the wide variety of walking tests, it is important to choose an appropriate walking test suiting the specific aim of the clinician or researcher.

     

Assessment of spasticity after stroke using clinical measures: a systematic review

Abstract

Purpose: To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke. Methods: The literature search involved four databases (PubMed, CINAHL, Embase and The Cochrane Library) up to February 2014. The selected studies included those that aimed to measure spasticity using a clinical assessment tool among adult patients post-stroke. Two independent raters reviewed the included articles using a critical appraisal scale and a structured data extraction form. Results: A total of 40 studies examining 15 spasticity assessment tools in patients post-stroke were reviewed. None of the reviewed measurement tools demonstrated satisfactory results for all psychometric properties evaluated, and the majority lacked evidence concerning validity and absolute reliability. Conclusion: This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke. Future research examining the application and psychometric properties of these measures is warranted.

• Implications for Rehabilitation

• There is a need for objective clinical tools for measuring spasticity that are clinically feasible and easily interpreted by clinicians.

• This review identified various clinical measures of spasticity that have been investigated in people after stroke.

• Insufficient evidence of psychometric properties precludes recommending one tool over the others.

• Future research should focus on investigating the psychometric properties of clinical measures of spasticity.

     

Assessing advanced walking ability in people with stroke using the Groningen Meander Walking Test

Abstract

Objectives: (1) To investigate the intrarater, interrater and test–retest reliabilities of the Groningen Meander Walking Test in people with stroke; (2) to compare the performance of the Groningen Meander Walking Test between people with stroke and healthy older adults; (3) to quantify any correlations between the Groningen Meander Walking Test and other stroke-specific impairment measurements; and (4) to determine the cut off time that best discriminates between 30 people with stroke and 30 age-matched healthy elderly.

Method: Using a cross-sectional design, the Groningen Meander Walking Test was administered along with the Fugl-Meyer Motor Assessment for the lower extremities, measurement of lower limb muscle strength, Berg’s Balance Scale, comfortable walking speed, Timed up and Go test and Community Integration Measure-Cantonese version.

Results: The Groningen Meander Walking Test completion times showed excellent intrarater, interrater and test–retest reliabilities (ICC = 0.984–1.00). Our study also showed that stroke subjects took three times longer (28.8?s) than the healthy subjects (9.0?s) in completion times. Both Groningen Meander Walking Test completion times and overstep scores significantly correlated with comfortable walking speed and Timed up and Go test. The cut off time for people with stroke was 11.98 seconds (sensitivity = 0.967; specificity = 1.0) to discriminate against healthy elderly.

Conclusion: The Groningen Meander Walking Test is a highly reliable and valid tool for quantifying the advanced walking abilities of people with stroke.

• Implications for Rehabilitation

• The Groningen Meander Walking Test completion times demonstrated excellent intrarater, interrater and test–retest reliabilities.

• The Groningen Meander Walking Test completion times correlates well with Berg Balance Scale scores, comfortable walking and Timed Up and Go test times.

• The Groningen Meander Walking Test overstep scores correlates significantly to its completion times, Fugl-Myer Assessment-Lower Extremity scores, comfortable walking speed and Timed Up and Go test times.

• A cut off time of 11.98s best for Groningen Meander Walking Test completion times discriminates people with stroke from healthy elderly with sensitivity of 97% and specificity of 100%.

• The Groningen Meander Walking Test is highly reliable and easy to administer in assessing advanced walking abilities in people with stroke.

     

The Figure-of-Eight Walk test: reliability and associations with stroke-specific impairments

Abstract

Objectives: To investigate (1) the intra-rater, inter-rater and test–retest reliabilities of the Figure-of-Eight Walk (F8W) test times; (2) its correlation with other stroke-specific impairments; and (3) the cut-off scores best discriminating patients with stroke from the healthy elderly. Design: Cross-sectional study. Setting: University-based rehabilitation centre. Participants: A convenience sample of 64 subjects: 35 subjects with chronic stroke and 29 healthy elderly. Main Outcome Measures: F8W test times, Fugl–Meyer Motor Assessment for the lower extremities (FMA-LE), hand-held dynamometer measurements of bilateral hip abductor and knee extensor isometric muscle strength, Five times Sit to Stand Test (FTSTST) times, 10-Meter Walk Test (10MWT), Timed Up and Go Test (TUGT) times, Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) scores. Results: Excellent intra-rater, inter-rater and test–retest reliabilities (intra-class correlation coefficient (ICC) range 0.944–0.999) of F8W test times were found. The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT. No significant correlation was found between F8W test times and either leg strength or ABC results. A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%. Conclusions: The F8W test time is a reliable measurement tool, which is able to differentiate the patients with stroke and healthy elderly subjects and correlated well with stroke-specific impairments and walking tests. The F8W is a reliable measurement tool for assessing the advanced walking performance of subjects with chronic stroke.

• Implication for Rehabilitation

• The F8W test times have excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.

• The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT.

• A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%.

• The F8W test time is a reliable and valid measure in assessing the advanced walking skill in patients with stroke.

     

Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review

Abstract

Purpose: To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments. Method: General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et?al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et?al. Results: A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity. Conclusion: The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended.

• Implications for Rehabilitation

• Chronic fatigue syndrome (CFS).

• Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life.

• Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions.

• Currently, no measurement instrument is sufficiently evaluated with persons with CFS.

• If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use the CFS-APQ in clinical practice and scientific research.

     

Building the repertoire of measures of walking in Rett syndrome

Background: The repertoire of measures of walking in Rett syndrome is limited. This study aimed to determine measurement properties of a modified two-minute walk test (2MWT) and a modified Rett syndrome-specific functional mobility scale (FMS-RS) in Rett syndrome.

Methods: Forty-two girls and women with Rett syndrome (median 18.4 years, range 2.4–60.9 years) were assessed for clinical severity, gross motor skills, and mobility. To measure walking capacity, 27 of this group completed a 2MWT twice on two different assessment days. To assess walking performance, the FMS-RS was administered to the total sample of parents (n?=?42) on two occasions approximately one week apart.

Results: There were negative correlations between clinical severity and 2MWT (r?=??0.48) and FMS-RS (r?=??0.60–0.66). There were positive correlations between gross motor skills and mobility and 2MWT (r?=?0.51, 0.43) and FMS-RS (r?=?0.71–0.93, 0.74–0.94), respectively. Test–retest reliability for the 2MWT was good with high intraday and interday correlations (ICC?=?0.86–0.98). For the 2MWT, the standard error of measurement was 13.8 m and we would be 95% confident that changes greater than 38 m would be greater than within subject error. There was good test–retest reliability for all three distances on the FMS-RS (ICC?=?0.94–0.99).

Conclusions: Walking capacity as measured by the 2MWT showed expected but limited relationships with measures of different constructs, providing some support for concurrent validity. Walking performance as measured with the FMS-RS was more strongly consistent with other clinical measures supporting its concurrent validity. Test–retest reliability was good for both the FMS-RS and the 2MWT. Therefore, these measures have the potential to be used in clinical practice and research.

• Implications for Rehabilitation

• Walking is one of the commonest daily physical activities in ambulant girls and women with RTT. Comprehensive knowledge about the walking abilities in this population is limited.

• Evidence of validity and test–retest reliability have been demonstrated for the modified two-minute walk test (2MWT) and the Rett syndrome-specific functional mobility scale (FMS-RS).

• The 2MWT and FMS-RS offer detailed information of the capacity and performance of walking, respectively, in girls and women with RTT

     

Role of ankle foot orthoses in functional stability of individuals with stroke

Purpose: Ankle foot orthoses (AFOs) are frequently prescribed to improve ambulation in individuals with stroke. However, the role of AFOs in balance control is not completely understood. The aim of the study was to evaluate the contribution of the AFOs in functional stability of individuals with stroke. Methods: Twenty three individuals with unilateral hemiparesis due to stroke were assessed using the Functional Reach Test. The subjects performed reaches forward, left and right while standing with or without an AFO. Results: When provided with AFO, individuals with stroke improved the maximal reaching distance in all the directions (p?<?0.05). Conclusions: The study found that individuals with unilateral stroke clearly demonstrated improvements in functional stability when they were provided with AFOs. This outcome could be used in the optimization of balance rehabilitation of individuals with stroke.

• Implications for Rehabilitation

• Functional stability is impaired in individuals with stroke.

• Functional Reach Test (FRT) was used to assess the role of ankle foot orthoses (AFOs) in balance control.

• Individuals with stroke improved their functional stability while they were provided with AFOs.

• Functional Reach Test could assist clinicians in the evaluation of postural stability associated with the use of AFOs.

     

Content and psychometric evaluations of questionnaires for assessing physical function in people with neck disorders: a systematic review of the literature

Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders (MSD) in the neck. Specifically, we aimed to determine: (1) Which questionnaires are used to assess physical function in people with MSD in the neck? (2) What do those questionnaires measure? (3) What are the measurement properties of the questionnaires?

Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations. The content of the questionnaires was categorized according to the International Classification of Function, Disability and Health, and the psychometric properties were quality-rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

Results: Ten questionnaires and 32 articles evaluating measurement properties were analyzed. Most questionnaires covered only the components body functions and activity and participation, more often activity participation than body function. Internal consistency was adequate in most questionnaires, whereas responsiveness was generally low. Neck Disability Index was most evaluated, but the evaluations of all questionnaires tended to cover most properties in the checklist.

Conclusions: The questionnaires differed substantially in items and extent to which their psychometric properties had been evaluated. Focus of measurement was on activities in daily life rather than physical function as such.

• Implications for Rehabilitation

• To provide early diagnostics and effective treatment for patients with neck disorders, valid and reliable instruments that measure relevant aspects of the disorders are needed.

• This paper presents an overview of content and quality of questionnaires used to assess physical function in neck disorders, which may facilitate informed decisions about which measurement instruments to use when evaluating the course of neck disorders.

• Most of the questionnaires need more testing to judge the quality, however the NDI was the most frequently tested questionnaire.

• The COnsensus-based Standards for the selection of health Measurement INstruments checklist is a useful tool in relation to psychometric testing of questionnaires, but clear definitions of interpretation of the quality criteria in each study would enhance comparability of results.

     

Italian adaptation of the functional outcome questionnaire – aphasia: initial psychometric evaluation

Abstract

Purpose: To evaluate the psychometric properties of the Italian version of Functional Outcome Questionnaire – Aphasia.

Methods: Two hundred and five persons with stroke-related aphasia and right hemiparesis who received ongoing assistance from a family caregiver were assessed using the Functional Outcome Questionnaire – Aphasia, Aachener Aphasie Test, Token Test, Raven’s Coloured Progressive Matrices, Functional Independence Measure (FIM), Functional Assessment Measure (FAM), and Quality of Life Questionnaire for Aphasics (QLQA). The Functional Outcome Questionnaire – Aphasia was translated into the Italian language using a translation and back-translation method. Reliability and construct validity of the Functional Outcome Questionnaire – Aphasia were evaluated.

Results: The Italian version of the Functional Outcome Questionnaire – Aphasia showed good internal consistency and test–retest reliability for the overall scale (α?=?0.98; ICC?=?0.95) and subscales (α?=?0.89 for the communicating basic needs (CBN), α?=?0.92 for the making routine requests (MRR), α?=?0.96 for the communicating new information (CNI), α?=?0.93 for the attention/other communication skills (AO); ICC?=?0.95 for CBN, ICC?=?0.96 for MRR, ICC?=?0.97 for CNI and ICC?=?0.92 for AO). Significant correlations were found between the Functional Outcome Questionnaire – Aphasia and Token Test, QLQA, Aachener Aphasie Test scores, and FAM linguistic scores, indicating good convergent validity. Low correlations were found between Functional Outcome Questionnaire – Aphasia and Raven’s Coloured Progressive Matrices and FIM motor scores, showing good discriminant validity.

Conclusions: The overall findings of this study supported the reliability and construct validity of the Italian version of the Functional Outcome Questionnaire – Aphasia. This measure holds considerable promise in assessing the functional outcomes of aphasia rehabilitation in Italian-speaking persons with aphasia.

• Implications for Rehabilitation

• Functional Outcome Questionnaire – Aphasia is a reliable and valid questionnaire in assessing functional communication of Italian-speaking people with aphasia.

• This measure provides critical information about people with aphasia’s functional and pragmatic communication in home and community settings, contributing significantly to overall quality of life.

• Since the use of measures of functional communication is recommended in the clinical evaluation of language disease, the Italian version of Functional Outcome Questionnaire – Aphasia may be effective in tailoring rehabilitation treatment to the presenting communication problems of people with aphasia and their caregivers.

     

Psychometric evidence of self-reported questionnaires for patellofemoral pain syndrome: a systematic review

Abstract

Purpose: To conduct a systematic review of psychometric properties of self-reported questionnaires used to assess the level of symptoms and disability in individuals with patellofemoral pain syndrome (PFPS). Methods: A structured search was conducted in four databases (Medline, Embase, CINAHL, SportDiscus). A total of 24 studies about five different self-reported questionnaires were analyzed. A pair of independent raters extracted data on validity, reliability and responsiveness to change, and performed critical appraisal (0–100%). Results: Activities of Daily Living Scale (ADLS), Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) and Lysholm Scale (LS) present excellent test–retest reliability (weighted average intraclass correlation coefficients [ICC]?>?0.80), whereas Functional Index Questionnaire (FIQ) is moderately reliable (ICC?=?0.61). Minimal detectable change is 8.3% for ADLS, 9.0% for AKPS, 19% for FIQ, 8.5% for IKDC and 30% for LS. ADLS, AKPS, IKDC and LS are highly responsive (effect size/standardized response mean >0.95) in individuals with PFPS, while FIQ is lowly responsive (effect size?=?0.49). Conclusion: Based on available evidence, ADLS presents the best psychometric properties and should be preferred when evaluating patients with PFPS. AKPS and IKDC are also adequate, while FIQ and LS are not recommended for individuals with PFPS.

• Implications for Rehabilitation

• While several questionnaires have been developed to assess symptoms and functional limitations caused by knee pain, their psychometric properties can vary depending on the condition presented by the patient.

• The Activities of Daily Living Scale of the Knee Outcome Survey should be preferred by clinicians when evaluating a patient with PFPS.

• The Anterior Knee Pain Scale and International Knee Documentation Committee Subjective knee evaluation are also adequate for use with this population.

• The Functional Index Questionnaire and Lysholm Scale are not recommended for PFPS.

     

A comparison of performance on the Keitel Functional Test by persons with systemic sclerosis and rheumatoid arthritis

Purpose: The purpose of this study is to compare lower extremity impairments in persons with systemic sclerosis, rheumatoid arthritis, and healthy controls.

Methods: The participants were a convenience sample of 64 persons with systemic sclerosis, 58 persons with rheumatoid arthritis, and 30 healthy controls. The Keitel Functional Test was used to assess lower extremity joint motion and strength. Demographic information on age, disease duration, employment, and perceived overall health was also collected.

Results: Significant differences were found between the healthy control group and both the systemic sclerosis and rheumatoid arthritis groups in rising from a chair, squatting, walking 30?m, walking up and downstairs, and the total score. For hip external rotation, there were significant differences between all three groups for the right hip; for the left hip, the systemic sclerosis group had significantly less motion than the other two groups. For standing on toes, there was only a significant difference between the systemic sclerosis and the healthy control groups.

Conclusions: Persons with systemic sclerosis and rheumatoid arthritis have similar levels of lower extremity impairments but greater impairments compared to the healthy controls. These impairments may lead to decreased mobility paired with difficulties with activities of daily living such as lower extremity dressing, bathing, and feet care.

• Implications for Rehabilitation

• Persons with systemic sclerosis and rheumatoid arthritis have similar levels of lower extremity impairments but greater impairments compared to the healthy controls.

• Findings from this study indicate a need for rehabilitation for persons with systemic sclerosis and rheumatoid arthritis as the lower extremity impairments may lead to decreased mobility paired with difficulties with daily living activities such as lower extremity dressing, bathing, and feet care.

• The Keitel Functional Test could be used as a quick screening test for lower extremity impairments.

     

Cross-cultural adaptation,reliability, and validation of the Korean version of the identification functional ankle instability (IdFAI)

Abstract

Purpose: To cross-culturally adapt the Identification Functional Ankle Instability for use with Korean-speaking participants.

Methods: The English version of the IdFAI was cross-culturally adapted into Korean based on the guidelines. The psychometric properties in the Korean version of the IdFAI were measured for test-retest reliability, internal consistency, criterion-related validity, discriminative validity, and measurement error 181 native Korean-speakers.

Results: Intra-class correlation coefficients (ICC_2,1) between the English and Korean versions of the IdFAI for test–retest reliability was 0.98 (standard error of measurement?=?1.41). The Cronbach’s alpha coefficient was 0.89 for the Korean versions of IdFAI. The Korean versions of the IdFAI had a strong correlation with the SF-36 (r_s?=??0.69, p?<?.001) and the Korean version of the Cumberland Ankle Instability Tool (r_s?=??0.65, p?<?.001). The cutoff score of >10 was the optimal cutoff score to distinguish between the group memberships. The minimally detectable change of the Korean versions of the IdFAI score was 3.91.

Conclusion: The Korean versions of the IdFAI have shown to be an excellent, reliable, and valid instrument. The Korean versions of the IdFAI can be utilized to assess the presence of Chronic Ankle Instability by researchers and clinicians working among Korean-speaking populations.

• Implications for rehabilitation

• The high recurrence rate of sprains may result into Chronic Ankle Instability (CAI).

• The Identification of Functional Ankle Instability Tool (IdFAI) has been validated and recommended to identify patients with Chronic Ankle Instability (CAI).

• The Korean version of the Identification of Functional Ankle Instability Tool (IdFAI) may be also recommend to researchers and clinicians for assessing the presence of Chronic Ankle Instability (CAI) in Korean-speaking population.

     

Effects of different exercise modalities on ataxia in multiple sclerosis patients: a randomized controlled study

Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS).

Method: A total of 42?MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3–5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions.

Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p?p?p?>?0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly.

Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation.

• Implications for rehabilitation

• Multiple sclerosis is a chronic inflammatory and autoimmune disease of central nervous system and ataxia is one of the most challenging symptoms of this disease.

• Different exercise modalities are commonly employed to control ataxic symptoms in MS patients.

• Lumbar stabilization exercises or task-oriented training should be considered as complementary approach to improve balance and coordination in ataxic multiple sclerosis patients.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

A study of physical activity comparing people with Charcot-Marie-Tooth disease to normal control subjects

Purpose: Charcot Marie Tooth disease (CMT) describes a group of hereditary neuropathies that present with distal weakness, wasting and sensory loss. Small studies indicate that people with CMT have reduced daily activity levels. This raises concerns as physical inactivity increases the risk of a range of co- morbidities, an important consideration in the long-term management of this disease. This study aimed to compare physical activity, patterns of sedentary behavior and overall energy expenditure of people with CMT and healthy matched controls.

Methods: We compared 20 people with CMT and 20 matched controls in a comparison of physical activity measurement over seven days, using an activity monitor. Patterns of sedentary behavior were explored through a power law analysis.

Results: Results showed a decrease in daily steps taken in the CMT group, but somewhat paradoxically, they demonstrate shorter bouts of sedentary activity and more frequent transitions from sedentary to active behaviors. No differences were seen in energy expenditure or time spent in sedentary, moderate or vigorous activity.

Conclusion: The discrepancy between energy expenditure and number of steps could be due to higher energy requirements for walking, but also may be due to an over-estimation of energy expenditure by the activity monitor in the presence of muscle wasting. Alternatively, this finding may indicate that people with CMT engage more in activities or movement not related to walking.

• Implications for Rehabilitation

• Charcot-Marie-Tooth disease:

• ??People with Charcot-Marie-Tooth disease did not show a difference in energy expenditure over seven days compared to healthy controls, but this may be due to higher energy costs of walking, and/or an over estimation of energy expenditure by the activity monitor in a population where there is muscle wasting. This needs to be considered when interpreting activity monitor data in people with neuromuscular diseases.

• ??Compared to healthy controls, people with Charcot-Marie-Tooth disease had a lower step count over seven days, but exhibited more frequent transitions from sedentary to active behaviors

• ??High Body Mass Index and increased time spent sedentary were related factors that have implications for general health status.

• ??Understanding the profile of physical activity and behavior can allow targeting of rehabilitation interventions to address mobility and fitness.

     

Reliability,validity and responsiveness of the Arabic version of the Disability of Arm,Shoulder and Hand (DASH-Arabic)

Purpose: To investigate the psychometric properties (reliability, validity and responsiveness) of the DASH-Arabic in a cohort of Arabic patients presenting with various upper extremity conditions.

Methods: Participants were 139 patients with various upper extremity conditions, who completed the DASH-Arabic at the baseline, 2–5 days later and 30–36 days later. Participants completed demographic data forms, the SF-36 and VAS at baseline, and a Global Rating of Change scale at first and second follow-ups.

Results: Cronbach’s alpha of the DASH-Arabic was 0.94. Test–retest reliability was excellent with an ICC of 0.97. The SEM was 3.50 and the MDC₉₅ was 9.28. Construct validity of the DASH-Arabic with the SF-36 subscales and VAS scores ranged from r??0.32 to??0.57, all statistically significant (p?CI?=?0.72–0.92, p?Conclusions: The DASH-Arabic is a reliable, valid and responsive upper extremity outcome measure for patients whose primary language is Arabic; it can be used to document patient status and outcomes and support evidence-based practice.

• Implications for Rehabilitation

• The DASH-Arabic demonstrated sound psychometric properties of reliability, validity and responsiveness.

• It is an effective patient status and outcome tool that will support evidence-based practice.

• This tool is recommended for evaluating upper extremity work-related injuries and tracking therapeutic outcomes.

     

Rehabilitation professionals’ perceptions of the use of new visualisation software tools with people with stroke

Purpose: The envisage programme of research was funded to explore and evaluate the use of visualisation software tools using biomechanical data within rehabilitation. Three work packages were developed to evaluate the impact of the tools within stroke rehabilitation. The research presented here aimed at exploring the perceptions of rehabilitation therapists about the use of the visualisation software tools in the context of future randomised controlled trials and stroke rehabilitation practice. Methods: Sixteen therapists working in a range of stroke rehabilitation contexts participated in semi-structured interviews. Interview questions explored their current practice, and the perceived impact of the new visualisation technologies on their workplace environment and practice. Framework analysis was used to analyse the textual data. Results: In general, the stroke therapists were enthusiastic about the potential application of the visualisation software tools. Three themes were identified through qualitative framework analysis: potential uses of the visualisation tools; integration within current service provision; and trial involvement. Conclusions: The study highlights important contextual considerations which may impact significantly on the success of novel technologies in stroke rehabilitation. Normalisation process theory was proposed as a useful process evaluation methodology to optimise both trial evaluation and future service implementation.

• Implications for Rehabilitation

• There is limited research exploring the use of visual software technologies featuring biomechanical data within stroke rehabilitation.

• The perspectives of stroke rehabilitation therapists about the potential of such tools are useful both in terms of planning trial evaluations, and implementation.

• Therapists were generally positive about the contribution of visual software tools in stroke rehabilitation, but highlighted a number of practical constraints which required addressing.

• Normalisation process theory provides a useful process evaluation methodology which can support both trial evaluation and implementation of such novel technologies within stroke rehabilitation.

     

Evaluation of the clinical utility of the Home Falls and Accidents Screening Tool (HOME FAST)

Purpose: The HOME FAST was developed and trialled in Australia as a screening tool designed to be used by any health professional to identify older people at increased risk of falls and to facilitate referral for more detailed assessment and intervention. This study aimed to evaluate the clinical utility of the HOME FAST from the perspective of users.

Method: A mixed-methods approach using survey data (n?=?32), focus group data (n?=?46) and interview data (n?=?5) from occupational therapists, physiotherapists, community nurses and other health professionals working in hospitals, community services and private practice, located in the UK, Canada and Australia. Data were integrated using a matrix of quantitative and qualitative data that aligned the findings with established theoretical constructs of clinical utility.

Results: Findings across the data sources provide evidence of the clinical utility of the HOME FAST, and these findings align with theoretical constructs about how a tool such as the HOME FAST is adopted in practice.

Conclusion: The HOME FAST can be used in a variety of international setting in developed countries and by different health professionals as a screening tool. A manual would assist in the consistent application of the HOME FAST.

• Implications for Rehabilitation

• Hazards in the home environment are a key contributor to falls risk for older people

• The Home Falls and Accidents Screening Tool (HOME FAST) was designed for any health professional to screen older people at increased risk of falling because of home hazards.

• Even with psychometric evidence of the reliability and validity of a tool, it is critical that the tool can be easily adopted by clinicians (clinical utility), otherwise its applicability to practice and research is limited.

• An international mixed-method study has provided evidence of the clinical utility of the HOME FAST.