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.

     

Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults

Spink MJ, Fotoohabadi MR, Wee E, Hill KD, Lord SR, Menz HB. Foot and ankle strength, range of motion, posture, and deformity are associated with balance and functional ability in older adults.

Objective

To determine the extent to which measures of foot and ankle strength, range of motion, posture, and deformity are associated with performance in a battery of balance and functional ability tests in older adults.

Design

Cross-sectional study of people over 65 years.

Setting

Community.

Participants

Participants (N=305; age range, 65–93y) recruited for a randomized trial investigating the efficacy of a podiatry intervention to prevent falls.

Interventions

Not applicable.

Main Outcome Measures

Clinical measures of foot and ankle strength (using hand-held dynamometry), range of motion, posture, and deformity, and a battery of balance tests (postural sway, maximum balance range, lateral stability, coordinated stability) and functional ability tests (alternate step test, sit-to-stand, timed 6-m walk).

Results

Most (67/88) of the correlations between the foot and ankle tests and performance on the balance and functional tests were statistically significant. Hierarchic linear regression analysis identified hallux plantar flexion strength and ankle inversion-eversion range of motion to be the most consistent significant and independent predictors of balance and functional test performance, explaining up to 25% of the variance in the test scores.

Conclusions

Foot and ankle characteristics, particularly plantar flexor strength of the hallux and ankle inversion-eversion range of motion, are important determinants of balance and functional ability in older people. Further research is required to establish whether intervention programs that include strengthening and stretching exercises for the foot and ankle may achieve improvements in balance and functional ability and reduce the risk of falls in older people.     

治疗性运动对功能性踝关节不稳姿势控制和踝周肌肉功能影响的Meta分析

目的 对治疗性运动对功能性踝关节不稳(FAI)患者姿势控制和踝周肌肉功能的效果进行Meta分析。方法 检索PubMed、Web of Science、Embase、SPORTdiscus、Medline、Science Direct、EBSCO、Springlink、中国知网、维普、万方数据库不同类型运动干预FAI的随机对照试验,时间范围自建库至2021年12月。由2名研究人员对纳入文献进行质量和结果证据等级评估,采用RevMan 5.4进行分析。结果 最终纳入随机对照试验14篇,共434例受试者。与无运动干预相比,治疗性运动明显减少睁闭眼下压力中心偏移(睁眼, SMD=-0.28, 95%CI-0.46～-0.09, P=0.003;闭眼, SMD=-0.24, 95%CI-0.40～-0.09, P=0.001);增强运动任务前腓骨长肌激活(SMD=0.38, 95%CI 0.05～0.71, P=0.03),运动任务后腓骨长肌(SMD=0.53, 95%CI 0.16～0.90, P=0.005)和胫骨前肌(SMD=0.47, 95%CI 0.10～0.84, P=0.01)激活...     

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

Objective

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

Design

The design of the study involved a survey instrument validation.

Participants/Patients

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

Methods

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

Results

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

Conclusion

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

Translation,cross-cultural adaptation,reliability, and validity of the Identification of Functional Ankle Instability questionnaire in Persian speaking participants with a history of ankle sprain

Purpose: To cross-culturally translate the Identification of Functional Ankle Instability (IdFAI) questionnaire into Persian and to assess its psychometric properties and factor structure.

Methods: The Persian version of IdFAI questionnaire was prepared after a forward–backward translation and cultural adaptation process. One hundred and twenty patients with a history of lateral ankle sprain completed the Persian version of this questionnaire and the Cumberland Ankle Instability Tool (CAIT), Foot and Ankle Ability Measure, Foot and Ankle Outcome Score, Fear Avoidance Belief questionnaire and the Tampa Scale of Kinesiophobia in the first test session. Afterwards, 60 randomly selected patients completed the questionnaires in the second session. Psychometric testing which included test–retest reliability, internal consistency, standard error of measurement (SEM) and minimal metric detectable change (MMDC), weighted kappa coefficient and construct validity were performed using Spearman’s correlation coefficient and confirmatory factor analysis of the three-factor structure of the IdFAI.

Results: The interclass correlation coefficient, Cronbach’s alpha, SEM and MMDC were 0.91, 0.95, 2.43, and 6.73 (95% confidence interval, 0.86–0.95) for the IdFAI, respectively. The repeatability of all the questions after one week was rated good to excellent (kappa?=?0.60–0.93, p?<?0.001). The IdFAI total score had strong correlation with CAIT measure, but had moderate correlation with other questionnaires. The results of factor analysis showed an adequate fit of the model to the data and goodness-of-various fit indices.

Conclusions: The Persian version of IdFAI is a reliable and valid tool to identify patients with functional ankle instability which have a history of ankle sprain. Its original three-factor structure was replicated in this study.

• Implications for Rehabilitation

• The Persian version of the Identification of Functional Ankle Instability (IdFAI) questionnaire is a reliable and valid instrument in order to identify Iranian patients with functional ankle instability in both clinical practice and research.

• The Persian IdFAI questionnaire may be considered as a standardized clinical instrument that can be used to classify degree of ankle instability in Iranian Persian-speaking people with a history of lateral ankle sprain.

• People with a history of ankle sprain can be assessed using IdFAI questionnaire before and after rehabilitative interventions in an attempt to determine any change in their degree of ankle instability over time.

     

Observation-based assessment of functional ability in patients with chronic widespread pain: a cross-sectional study

Knowledge about functional ability, including activities of daily living (ADL), in patients with chronic widespread pain (CWP) and fibromyalgia (FMS) is largely based on self-report. The purpose of this study was to assess functional ability by using standardised, observation-based assessment of ADL performance and to examine the relationship between self-reported and observation-based measures of disability. A total of 257 women with CWP, 199 (77%) fulfilling the American College of Rheumatology tender point criteria for FMS, were evaluated with the Assessment of Motor and Process Skills (AMPS), an observation-based assessment providing linear measures of ADL motor and ADL process skill ability (unit: logits). A cutoff for effortless and independent ADL task performance is set at 2.0 for the motor scale and 1.0 for the process scale. A total of 248 (96.5%) had ability measures below the 2.00 ADL motor cutoff and 107 (41.6%) below the 1.00 ADL process cutoff, indicating increased effort and/or inefficiency during task performance as well as a potential need of assistance for community living. Mean ADL motor ability measure was 1.07 and was significantly lower in patients diagnosed with FMS than plain CWP (1.02 vs 1.27 logits, P = .001). Mean ADL process ability measure was 1.09 logits and was without difference between FMS and plain CWP (1.07 vs 1.16 logits, P = .064). Only weak to moderate correlations between self-reported functional ability and observation-based AMPS ability measures were observed. The results of the study support the notion of considerable performance difficulties in women with CWP. The everyday life problems are substantial and place the individual at risk of need of support for community living.     

French version of the Mini BESTest: A translation and transcultural adaptation study incorporating a reliability analysis for individuals with sensorimotor impairments undergoing functional rehabilitation

The Mini BESTest has been developed to comprehensively examine postural control in individuals with various pathologies treated by rehabilitation professionals. However, no formal French version of the Mini BESTest is available. This study aimed to translate and transculturally adapt the Mini BESTest to French and verify its intra- and inter-rater reliability. Translation and transcultural adaptation was performed in accordance with established guidelines, which included 2 initial translations and transcultural adaptations of the Mini BESTest to French that were then merged, a backward English translation, a subsequent adapted French version resolving discrepancies between the English versions, and pilot testing the final version by French-speaking physical therapists. In total, 20 participants with sensorimotor impairments with various etiologies and able to stand for at least 30 sec without human or technical assistance were video-recorded during evaluation with the Mini BESTest. From this video-recording, we calculated inter-rater and intrarater reliability (intraclass correlation coefficient = 0.974–0.988), internal consistency (Cronbach alpha = 0.895–0.929), standard error of measurement (1.05 and 1.63), and minimal detectable change at the 95% confidence interval (2.91 and 4.51). All values were comparable to those previously reported for the original version of the Mini BESTest. Furthermore, no significant ceiling or floor effect was detected. Therefore, the translated and transculturally adapted version of the Mini BESTest in French compares well to the original version and can be used by French-speaking rehabilitation professionals to examine postural control.     

The assessment of functional ability in patients with Parkinson's disease: The PLM-test and three clinical tests

This study assesses functional ability of Parkinson's disease (PD) patients by means of an objective movement analysis (the PLM-test) and three clinical tests. The correlation between the tests was also studied. The main object of this study was to detect and measure relevant disabilities in Parkinson's disease to obtain a clinical test battery. Copyright © 1997 Whurr Publishers Ltd.     

Development and validation of a parsimonious and pragmatic CHARM score to predict mortality in patients with suspected sepsis

Background

We aimed to derive and validate a parsimonious and pragmatic clinical prediction rule using the concepts of Predisposition, Infection, Response, and Organ Dysfunction to predict in-hospital mortality; and to compare it with other prediction rules, as well as with conventional biomarkers for evaluating the mortality risk of patients with suspected sepsis in the emergency department (ED).

Cut point determination in the measurement of pain and its relationship to psychosocial and functional measures after traumatic spinal cord injury: a retrospective model spinal cord injury system analysis

Forchheimer MB, Richards JS, Chiodo AE, Bryce TN, Dyson-Hudson TA. Cut point determination in the measurement of pain and its relationship to psychosocial and functional measures after traumatic spinal cord injury: a retrospective Model Spinal Cord Injury System analysis.

Objective

To evaluate potential pain cutoff scores reflecting mild, moderate, and severe pain in the spinal cord injury (SCI) population and determine the relationship between the derived cutoff scores and both psychosocial and functional outcome measures.

Design

Retrospective analysis.

Setting

SCI Model Systems.

Participants

Persons (N=6096; age >18y) with traumatic SCI (American Spinal Injury Association Impairment Scale [AIS] grades A–D; injured in 1973–2008).

Interventions

Not applicable.

Main Outcome Measures

Numeric rating scale (NRS) of pain severity (11 points), NRS of pain interference (5 points), Satisfaction With Life Scale, Patient Health Questionnaire-9, Craig Handicap Assessment and Reporting Technique Short-Form (CHART-SF), motor component of the FIM (M-FIM), and employment.

Results

The best set of pain severity cutoff points are 1 to 3, 4 to 6, and 7 to 10. This was validated by randomly assigning sample members to 2 groups and replicating. There were significant differences in all outcomes as a function of pain severity grouping, although they explained little of the variance in M-FIM and CHART-SF Physical Independence scale scores. Neurologic status differed significantly between pain groups, with incongruence between pain severity and interference in people in the AIS grade D group, who reported the greatest pain interference and least pain severity.

Conclusion

Pain severity can be categorized into groups that reflect pain interference. These groupings differentiate psychosocial well-being better than activity limitations. They do not provide a comprehensive pain assessment, for which pain type, location, and interference are likely to be necessary.     

Development of an instrument to measure the responses and management of Chinese primary caregivers in caring of children with minor upper respiratory disorders

This article focuses on the development of a valid, reliable and culturally sensitive instrument to assess the responses and management of Chinese primary caregivers caring for children aged below 10 with minor upper respiratory disorders. Thirty-two semi-structured interviews were conducted as the point of saturation of qualitative data was reached. The qualitative findings contributed to the development of the instrument items. Five main categories and 29 sub-categories were identified with satisfactory inter-coder reliability. A panel of three experts judged the content validity of the instrument with a content validity index of 0.98. A test–retest procedure with 40 subjects was adopted and the correlation coefficient for the instrument was 0.850 (p0.000).     

Assessment of texture discrimination ability at the sole of the foot in subjects with chronic stroke compared with young and elderly subjects with no neurological deficits: a reliability and validity study

Purpose: To examine validity and test–retest reliability of a sensory test developed to evaluate ability of elderly subjects with/out a stroke to discriminate between textures with the sole of their foot.

Methods: Subjects poststroke, old adults and young subjects were tested twice. Twelve materials relevant to foot function (e.g., gravel, sand) were used. Blindfolded subjects were requested to discriminate with the sole of each foot one outstanding texture among three textures presented in each of 12 subtests. ANOVA, ICC and Bland–Altman tests were used to determine group/leg differences and test-retest reliability.

Results: Discrimination ability of the involved lower extremity poststroke is significantly reduced. Ability in individuals with no neurological impairment is age related. Good test–retest (ICC?=?0.81) reliability was demonstrated for the impaired foot of subjects poststroke. The 95% repeatability ranges were age related with the highest range demonstrated for the involved foot poststroke. A significant fair negative correlation was demonstrated between texture discrimination ability and tactile detection threshold measured by Semmes–Weinstein monofilaments for the involved foot in poststroke subjects.

Conclusion: This newly developed assessment tool demonstrates concurrent and known-groups validity and is reliable for determining texture discriminative ability of the foot in individuals post-stroke and in older adults with no neurological impairment.

• Implications for rehabilitation

• The texture discrimination test presented here is a valid and reliable tool, providing quantitative assessment of sensory function at the sole of the foot in older adults with no neurologic deficits and in subjects poststroke.

• Lower extremity texture discrimination test is easy to administer in the clinic and might suggest directions for individually tailored, lower extremity, sensory retraining protocols.

     

Brain regions associated with Brunnstrom and functional independence measure scores in patients after a stroke: a tract-based spatial statistics study

[Purpose] We aimed to assess diffusion tensor fractional anisotropy to outline the brain regions associated with the long-term motor and cognitive functional outcomes of patients with stroke. [Participants and Methods] Eighty patients from our previous study were enrolled. Fractional anisotropy maps were acquired on days 14–21 after stroke onset, and tract-based spatial statistics were applied. Outcomes were scored using the Brunnstrom recovery stage and Functional Independence Measure motor and cognition components. Fractional anisotropy images were assessed in relation to outcome scores using the general linear model. [Results] For both the right (n=37) and left (n=43) hemisphere lesion groups, the corticospinal tract and the anterior thalamic radiation were most strongly associated with the Brunnstrom recovery stage. In contrast, the cognition component involved large regions encompassing the anterior thalamic radiation, superior longitudinal fasciculus, inferior longitudinal fasciculus, uncinate fasciculus, cingulum bundle, forceps major, and forceps minor. The results for the motor component were intermediate between those for the Brunnstrom recovery stage and those for the cognition component. [Conclusion] Motor-related outcomes were associated with fractional anisotropy decreases in the corticospinal tract, whereas cognitive outcomes were related to broad regions of association and commissural fibers. This knowledge will help scheduling appropriate rehabilitative treatments.     

Psychometric properties of the HI-FI problem checklist in a sample of adults with neurological and neuropsychiatric disorders: factors contributing to life satisfaction after long-term disability

Purpose To assess psychometric properties of the problem checklist (PCL) in a sample of individuals with neurological and neuropsychiatric disorders many years after trauma; to identify factors that impact life satisfaction and promote functional competence after long-term disability. Method Cross-sectional, interview- and assessment-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?53), who participated in a pre-vocational readiness and social skills training program. The Problem Checklist from the New York University Head Injury Family Interview (PCL), a battery of self-rated and clinician-rated measures of social/emotional status, and neuropsychological tests were main outcome measures. Results PCL is a valid and reliable instrument with acceptable psychometric properties (reliability coefficients for two scales and the total score are above (0.795). Use of maladaptive coping strategies in our sample was reflected in inverse relationship between depression and denial of disability, and in the tendency to overrate self-reported symptoms by participants with acquired trauma. Considerably lower self-ratings of symptoms across all PCL scales were seen in those of our participants who live with parents. Conclusions The study offers initial support for the use of PCL as a measure of long-term functional outcome in individuals with neurological and neuropsychiatric diagnoses. The goal of rehabilitation in patients with long-term disabilities is increase in life satisfaction.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with long-term disabilities due to dysfunction of the central nervous system is to improve their quality of life.

• The HI-FI Problem Checklist (PCL) is a brief and efficient instrument for assessing functional outcomes after long-term disability.

• This study demonstrated acceptable psychometric properties of the PCL in a sample of 53 individuals participating in a pre-vocational training program and provided initial support for its utility for patients with various diagnoses.

     

Life dissatisfaction in the pre-operative and early recovery phase predicts low functional ability and coping among post-operative patients with lumbar spinal stenosis: a 2-year prospective study

Purpose.?We examined the significance of life dissatisfaction in pre-operative and early recovery phases with respect to functional ability, pain and coping on 2-year follow-up of patients with lumbar spinal stenosis (LSS).

Methods.?Patients (n?=?90, mean age, 62 years, men 40%) with symptomatic LSS underwent decompressive surgery. Data collection took place with the same set of questionnaires before surgery and 3 months, 6 months and 2 years postoperatively. Life dissatisfaction was assessed with the four-item life satisfaction (LS) scale. In addition, a life dissatisfaction burden, comprising the sum of preoperative, 3-month and 6-month LS scores, was calculated. Physical functioning (Oswestry disability index), pain (VAS and pain drawing) and coping (sense of coherence, SOC) were assessed. Logistic regression analysis was used to examine life dissatisfaction as a predictor of the 2-year functional ability, pain and coping (SOC).

Results.?In these analyses, pain was not predicted by either pre-operative life dissatisfaction or life dissatisfaction burden. However, both disability and poor coping on 2-year follow-up were independently associated with both pre-operative and early recovery phase life dissatisfaction.

Conclusions.?Our results show the importance of both pre-operative and early post-operative well-being regarding subsequent functioning. Thus, monitoring of the subjective well-being throughout the pre-operative and post-operative period may indicate those patients at risk of poorer post-operative recovery.     

Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease

Background  Cardiac output is the fundamental determinant of peripheral blood flow however; optimal regional tissue perfusion is ultimately dependant on the integrity of the arterial conduits that transport flow. A complete understanding of tissue perfusion requires knowledge of both cardiac and peripheral blood flow. Existing noninvasive devices do not simultaneously assess the cardiac and peripheral circulations. Multi-channel electrical bioimpedance (MEB) measures cardiac output and peripheral flow simultaneously. Objectives  Assessment of the accuracy of MEB to measure cardiac output in patients with clinical heart failure (group 1) and to measure regional arterial limb flow in patients with exertional leg pain clinically thought to have peripheral arterial disease (group 2). Methods  Cardiac output was measured by MEB in 44 patients with moderate to severe clinical heart failure (group 1) and was compared to a cardiac output measured by 2D-Echo Doppler. Peripheral blood flow (regional ankle and arm flow) was measured by MEB in another group of 25 patients with exertional leg pain clinically thought to be claudication (group 2). The MEB ankle/arm flow ratio (AAI index) was then compared to a conventional ankle/brachial pressure ratio (ABI index). Results  There was excellent correlation between the mean cardiac index by MEB (2.01 l/min/m²) and by 2D-Echo Doppler (2.06 l/min/m²) and bias and precision was 0.05 (2.4%) and ±0.48 l/min/m² (±23%), respectively. The correlation was maintained for each measurement over a wide range of cardiac indices. There was good correlation between AAI and ABI measurements (P < 0.05). Conclusions   MEB accurately measures cardiac output in patients with moderate to severe clinical heart failure and accurately measures regional arterial limb flow in patients with peripheral arterial disease. Stanley AWH, Herald JW, Athanasuleas CL, Jacob SC, Bartolucci AA, Tsoglin AN. Multi-channel electrical bioimpedance: a non-invasive method to simultaneously measure cardiac output and individual arterial limb flow in patients with cardiovascular disease