Reliability and validity of the de Morton Mobility Index in individuals with sub-acute stroke

Purpose: To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke.

Methods: This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke.

Results: The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n?=?109) and reliability (n?=?51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p?=?0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach’s alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92–0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident.

Conclusions: These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum.

• Implications for Rehabilitation

• The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke.

• The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity.

• The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points.

• The lack of any floor or ceiling effects on hospital admission indicates applicability across the whole mobility spectrum of patients with sub-acute stroke.

     

Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation

Purpose: Many patients suffer long term loss of mobility after hip fracture but there is no gold standard method for measuring mobility in this group. We aimed to validate a new mobility outcome measure, the de Morton Mobility Index (DEMMI) in a hip fracture population during inpatient rehabilitation. Method: The DEMMI was compared with the existing measures of activity limitation: 6 minute walk test, 6 metre walk test and Barthel Index on 109 consecutive patients admitted to rehabilitation after surgery for hip fracture. Patients were assessed by a physiotherapist at admission and discharge. Scale width, validity, minimal clinically important difference (MCID), responsiveness, and unidimensionality were investigated. Results: Evidence of convergent, discriminant and known groups validity were obtained for the DEMMI. Responsiveness was similar across instruments and the MCIDs were consistent with previous reports. A floor effect was identified for the 6 metre walk test and 6 minute walk test at hospital admission. Rasch analysis identified that the DEMMI maintains its unidimensional properties in this population. Conclusions: The DEMMI has a broader scale width than existing measures of activity limitation and provides a unidimensional measure of mobility for hip fracture patients during inpatient rehabilitation.

Implications for Rehabilitation

• Loss of mobility is a common and significant problem following hip fracture.

• The de Morton Mobilitiy Index (DEMMI) is an effective instrument for measuring mobility in patients with hip fracture during rehabilitation

• The DEMMI is unidimensional, has a broader scale width than existing measures and offers an interval scale for measurement of mobility in hip fracture during rehabilitation

     

Determination of the minimal clinically important difference in the FIM instrument in patients with stroke

OBJECTIVE: To define the minimal clinically important difference (MCID) for the FIM instrument in patients poststroke. DESIGN: Prospective case series discharged over a 9-month period. SETTING: Long-term acute care hospital. PARTICIPANTS: Patients with stroke (N=113). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Admission, discharge, and change scores were calculated for the total FIM, motor FIM, and cognitive FIM. Assessments of clinical change were rated at discharge on a 15-point (-7 to +7) Likert scale by attending physicians, with MCID defined at a cutoff score of 3. The FIM change scores associated with MCID were identified from receiver operating characteristic curves. Bayesian analysis was used to determine the probability of individual patients achieving MCID. RESULTS: FIM change scores associated with MCID were 22, 17, and 3 for the total FIM, motor FIM, and cognitive FIM, respectively. The accuracy of the MCID was greater when subjects were categorized based on admission FIM scores than when considering the sample as a whole. Larger FIM change scores were related to MCID in subjects with lower admission FIM scores. CONCLUSIONS: These findings will assist in the interpretation of FIM change scores relative to physicians' assessments of important clinical change.     

The Barthel Index and the Cumulated Ambulation Score are superior to the de Morton Mobility Index for the early assessment of outcome in patients with a hip fracture admitted to an acute geriatric ward

Purpose: To examine clinimetric properties of the de Morton Mobility Index (DEMMI) in patients with hip fracture in comparison with the modified Barthel Index (BI), Cumulated Ambulation Score (CAS), and 30-s Chair Stand Test (30-s CST).

Materials and methods: Two hundred and twenty two patients with a hip fracture admitted to a geriatric ward following surgery were assessed on day 1 and at discharge (mean of 9 [SD 5.1] post-surgery days).

Results: Ninety eight percent and 89% of patients were not able to perform the 30-s CST at baseline and at discharge (large floor effect), respectively. Corresponding floor effects were 39% and 31% for DEMMI, 12% and 5% for BI, and 22% and 6%, respectively, for CAS. Convergent validity was strong between DEMMI and CAS (r?=?0.76, 95% CI: 0.69–0.81), and moderate between DEMMI and BI (r?=?0.58, 95% CI: 0.48–0.66) and CAS and BI (r?=?0.49, 95% CI: 0.39–0.59). Responsiveness, as indicated by the effect size was 0.76 for DEMMI, 1.78 for BI and 1.04 for CAS. Baseline scores of DEMMI, BI, and CAS showed similar properties in predicting discharge destination of patients from own home.

Conclusions: The value of using DEMMI and 30-s CST in patients with hip fracture during the acute hospitalization seems limited in comparison with BI and CAS. DEMMI and CAS seem to assess similar constructs.

• Implications for Rehabilitation

• Outcome measures used for the evaluation of patients with hip fracture should be validated in the specific time-line and rehabilitation setting following surgery, before being implemented in daily clinical practice.

• We suggest the Cumulated Ambulation Score for monitoring basic mobility during the acute hospitalization for the entire group of patients recovering from a hip fracture, while DEMMI seems more feasible for the subgroup of patients with higher functional levels.

• The modified Barthel Index seems useful for the assessment of activities of daily living in the acute care setting of patients with hip fracture. We cannot recommend the original 30-s Chair Stand Test to be used for the evaluation of patients with hip fracture in the acute hospital setting.

     

Measuring mobility limitations in children with cerebral palsy: Rasch model fit of a mobility questionnaire, MobQues28

Dallmeijer AJ, Scholtes VA, Becher J, Roorda LD. Measuring mobility limitations in children with cerebral palsy: Rasch model fit of a mobility questionnaire, MobQues28.

Objective

To develop a Rasch-based version of a mobility questionnaire (MobQues28) for children with cerebral palsy (CP).

Design

Cross-sectional study.

Setting

Private physical therapy practices and outpatient departments of hospitals and rehabilitation centers.

Participants

Parents of 323 ambulatory children with CP (Gross Motor Function Classification System [GMFCS] level I-IV; aged, 2–13y).

Interventions

Not applicable.

Main Outcome Measure

The mobility questionnaire measures mobility limitations in children with CP by rating the difficulty of executing 47 mobility activities, as reported by the parents. Items for the Rasch-based version were selected based on fit to the Rasch measurement (partial credit) model and invariance of item characteristics across GMFCS level, age group, or sex.

Results

Analysis revealed a fitting model when nonambulant and/or 2- and 3-year aged children were excluded (leaving a final sample of n=246) and answering categories were collapsed from 9 to 5. Thirteen items were removed from the questionnaire due to misfit to the model, 5 because of disordered thresholds, and 1 because of invariance across age group. Twenty-eight items out of the original 47 items showed good fit to the model.

Conclusions

The 28-item version of the mobility questionnaire (MobQues28) provides sound measurement properties for measuring mobility limitations in ambulant children with CP, aged 4 to 13 years, and shows promise as an instrument for research purposes.     

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

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

Objective

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

Design

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

Setting

Inpatient rehabilitation hospital.

Participants

Fifty-two people with hemiparesis poststroke.

Interventions

Not applicable.

Main Outcome Measures

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

Results

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

Conclusions

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

Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome

Gremeaux V, Troisgros O, Benaïm S, Hannequin A, Laurent Y, Casillas J-M, Benaïm C. Determining the minimal clinically important difference for the six-minute walk test and the 200-meter fast-walk test during cardiac rehabilitation program in coronary artery disease patients after acute coronary syndrome.

Objective

To estimate the minimal clinically important difference (MCID) for the 6-minute walk test (6MWT) and the 200-m fast-walk test (FWT) in patients with coronary artery disease (CAD) during a cardiac rehabilitation program.

Design

Prospective study using distribution- and anchor-based methods.

Setting

Outpatients from a cardiac rehabilitation unit.

Participants

Stable patients with CAD (N=81; 77 men; mean±SD age, 58.1±8.7y) enrolled 31±12.1 days after an acute coronary syndrome (ACS).

Interventions

Not applicable.

Main Outcome Measures

6MWT and 200-m FWT results before and after an 8-week cardiac rehabilitation program and at the 6th and 12th sessions. Patients and physiotherapists who supervised the training were asked to provide a global rating of perceived change in walking ability while blinded to changes in walk test performances.

Results

Mean change in 6MWT distance (6MWD) in patients who reported no change was −6.5m versus 23.3m in those who believed their performance had improved (P<.001). This result was consistent with the MCID determined by using the distribution method (23m). Considering a 25-m cutoff, positive and negative predictive values were 0.9 and .63, respectively. Conversely, there was no difference in 200-m FWT performance between these 2 groups (0.1 vs −1.4s, respectively). There was poor agreement with the physiotherapist's perceived change.

Conclusions

The MCID for 6MWD in patients with CAD after ACS was 25m. This result will help physicians interpret 6MWD change and help researchers estimate sample sizes in further studies using 6MWD as an endpoint.     

Determining the minimal clinically important difference of the hand function sort questionnaire in vocational rehabilitation

ObjectiveTo estimate the Minimal Clinically Important Difference (MCID) of the French version of the Hand Function Sort questionnaire (HFS-F). As a comparison, the MCID of the Disabilities of the Arm, Shoulder, and Hand (DASH) was also estimated.Materials and methodsWe included French-speaking patients hospitalized in a multidisciplinary rehabilitation program for chronic pain of the upper limb after an accident. HFS-F and DASH scores were collected at admission and discharge; the Patient Global Impression of Change measure (PGIC; 7 levels) was collected at discharge. The MCID was estimated by 2 methods: the anchor-based method (receiver operating characteristic [ROC], delta (Δ) mean of scores) and the objective method based on the distribution of scores (standard error of measurement, SEM).ResultWe included 225 patients. By the anchor-based method, the MCID for the HFS-F and DASH was +26 (SD 35) (P < 10⁻⁴) and −13 (SD 13) (P < 10⁻⁴), respectively, and by the ROC curve, it was +10 to +12 for the Δ-HFS-F and −7.5 to −5 for the Δ-DASH. The area under the ROC curve (AUC) was 0.726 [0.638–0.781] for Δ-HFS-F and 0.768 [0.701–0.83] for Δ-DASH. The correlations between the anchor and delta scores were > 0.38 (P < 10⁻⁴). The SEM was 16.2 for the HFS-F and −4.3 for the DASH.ConclusionsValues below the SEM must be rejected. Our anchor was significantly correlated with the outcome. Therefore, we propose an MCID for the HFS-F of 26, corresponding to approximately 10% progression of the score.     

Relationships between mortality,morbidity, and physical function in adults who survived a period of prolonged mechanical ventilation

Purpose

This study aimed to report mortality, morbidity, and the relationship between these outcomes with physical function in patients who survived prolonged mechanical ventilation during an intensive care unit (ICU) admission.

Methods and Materials

Records were reviewed for Western Australian residents admitted to an ICU in 2007 or 2008 who were ventilated for 7 days or longer and survived their acute care stay. Records were linked with data maintained by the Department of Health.

Results

A total of 181 patients (aged 52 ± 19 years) were included in this study. In the 12 months after discharge, 159 (88%) survived and 148 (82%) had been hospitalized. Compared with those who were ambulating independently when discharged from acute care, those who were not had more admissions (incident rate ratio, 1.81; 95% confidence interval, 1.28-2.57) and a greater cumulative length of hospital stay (10 [37] vs 57 [115] days, P < .001) over the first 12 months after discharge. Time between admission to ICU and when the patient first stood correlated with the number of admissions (R_s = 0.320, P < .001) and cumulative length of stay (R_s = 0.426, P < .001) in the 12 months after discharge.

Conclusions

For survivors of prolonged mechanical ventilation, physical function during acute care was associated with hospitalization over the following 12 months.     

A head-to-head comparison of the de Morton Mobility Index (DEMMI) and Elderly Mobility Scale (EMS) in an older acute medical population

Abstract

Purpose: To compare the clinimetric properties of the de Morton Mobility Index (DEMMI®) and the Elderly Mobility Scale (EMS). Method: A head-to-head comparison of the EMS and DEMMI® with 120 consecutive older acute medical patients. The DEMMI® and EMS were administered within 48?h of hospital admission and discharge. Results: At admission, 6% and 15% of participants scored the lowest scale score for the DEMMI® and EMS, respectively. For the DEMMI®, 17% of participants scored within the minimal detectable change of the lowest scale score compared to 20% for the EMS at admission. At hospital discharge, DEMMI® scores were normally distributed and the EMS had a ceiling effect. Similar evidence of convergent, discriminant and known groups validity were obtained for the DEMMI® and EMS. There was no significant difference in responsiveness to change between the DEMMI® and EMS. The EMS was significantly quicker to administer compared to the DEMMI®. Conclusion: The DEMMI® and EMS are both valid measures of mobility for older acute medical patients. The DEMMI® has a broader scale width than the EMS with interval level measurement and therefore provides a more accurate method for measuring and monitoring changes in mobility for older acute medical patients.

• Implications for Rehabilitation

• Mobility of older acute medical patients.

• Hospitalised older acute medical patients are at “high risk” of mobility decline.

• Accurate measurement of mobility is essential for preventing and treating mobility decline.

• Many existing mobility measures have significant measurement limitations.

• The DEMMI® is a more accurate measure of mobility than the EMS in an older acute medical population.

     

A virtual reality environment for evaluation of a daily living skill in brain injury rehabilitation: reliability and validity

OBJECTIVE: To establish the stability and validity of information collected in a virtual reality environment from persons with traumatic brain injury (TBI). DESIGN: Prospective correlation design to examine 3-week test-retest results for equivalence reliability between computer-simulated and natural environments. SETTING: A residential rehabilitation center for brain injury. PARTICIPANTS: Fifty-four consecutive patients with TBI who received comprehensive rehabilitation services and who were at different stages of recovery. INTERVENTION: An immersive virtual kitchen was developed in which a meal preparation task involving multiple steps was performed. The subjects completed meal preparation both in a virtual reality kitchen and an actual kitchen twice over a 3-week period. MAIN OUTCOME MEASURES: Time and errors on task completion using virtual reality assessment, actual kitchen performance (analogous to the virtual reality environment), occupational therapy (OT) evaluation, and neuropsychologic tests. RESULTS: The stability of performance using the simulated virtual environment was estimated with intraclass correlation coefficients (ICCs). The ICC value for total performance, based on all steps involved in the meal preparation task, was.76 (P<.01). The construct validity of the simulated environment was examined by correlating performance in the virtual environment with that in the actual kitchen (r=.63, P<.01), the OT evaluation (r=.30, P=.05 for meal preparation; r=.40, P=.01 for cognitive subskills), and neuropsychologic tests (r=.56, P<.01 for the full-scale intelligence quotient [IQ]; r=.40, P<.01 for the verbal IQ; r=.56, P<.01 for the performance IQ). Finally, a multiple regression analysis revealed that the virtual reality environment test was a good predictor for the actual assessment kitchen (beta=.35, P=.01). CONCLUSION: The virtual reality system showed adequate reliability and validity as a method of assessment in persons with brain injury.     

Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke

OBJECTIVE: To determine the reliability, concurrent and predictive validity, and responsiveness of the Functional Ambulation Category (FAC) in hemiparetic patients after stroke. DESIGN: Prospective cohort. SETTING: An early rehabilitation center for patients with neurologic disorders. PARTICIPANTS: Fifty-five nonambulatory patients after first-ever stroke, with duration of illness between 30 and 60 days, were included. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FAC, Rivermead Mobility Index (RMI), walking velocity, step length, and six-minute walking test (6MWT) were assessed at the beginning, after 2 and 4 weeks of rehabilitation, and again 6 months later. After 6 months, community ambulation was also assessed. Test-retest and interrater reliability, concurrent, discriminant, and predictive validity and responsiveness of the FAC were calculated. RESULTS: Based on video examinations, high test-retest reliability (Cohen kappa=.950) and interrater reliability (kappa=.905) were found. FAC scores at the beginning and after 2 weeks, 3 weeks, and 6 months correlated highly with the RMI (Spearman rho=.686, rho=.787, rho=.825, rho=.893, respectively), distance walked in the 6MWT (rho=.949, rho=.937, rho=.931, rho=.906, respectively), walking velocity (rho=.952, rho=.939, rho=.902, rho=.901, respectively), and step length (rho=.952, rho=.932, rho=.896, rho=.877, respectively) at the same time points (all P<.001). The RMI, walking velocity, step length, and distance walked in the 6MWT differed for each FAC category (P<.001). After 4 weeks of rehabilitation, an FAC score of 4 or higher predicted community ambulation at 6 months with 100% sensitivity and 78% specificity. FAC scores changed significantly between the first 2 and second 2 weeks (Wilcoxon z=8.7, z=7.9, respectively; both P<.001) of the inpatient rehabilitation program. CONCLUSIONS: The FAC has excellent reliability, good concurrent and predictive validity, and good responsiveness in patients with hemiparesis after stroke.     

Exploring the capacity to ambulate after a period of prolonged mechanical ventilation

Purpose

The purposes were to assess the functional recovery of those who survived a prolonged intensive care unit (ICU) stay by reporting the proportion who were able to ambulate independently at hospital discharge and also to examine if the time duration between admission and when the patient first stood impacted on their capacity to ambulate at discharge.

Materials and Methods

A retrospective review was conducted of medical records of ICU patients in 2007 to 2008, who were mechanically ventilated for 168 hours or more, and survived their acute care stay. Main outcome measures were (1) ambulation status before admission and at time of hospital discharge and (2) time between admission to the ICU and when the patient first stood.

Results

A total of 190 patients were included. Before admission, 189 (99%; 95% confidence interval [CI], 98%-100%) were ambulating independently, of whom 180 (95%) did not require a gait aid. On discharge from acute care, 89 (47%; 95% CI, 40%-54%) were ambulating independently, of whom 54 (61%) did not require a gait aid. Compared with those who stood within 30 days of ICU admission, a delay in standing of between 30 and 60 days increased the odds 5-fold (95% CI, 2-11) of being unable to ambulate independently at the time of discharge.

Conclusions

After a prolonged ICU admission, more than 50% of patients were unable to ambulate independently by hospital discharge, with the time between admission and first stand, being an important predictor of this outcome.     

Reproducibility and validity of the Dutch translation of the de Morton Mobility Index (DEMMI) used by physiotherapists in older patients with knee or hip osteoarthritis

Jans MP, Slootweg VC, Boot CR, de Morton NA, van der Sluis G, van Meeteren NL. Reproducibility and validity of the Dutch translation of the de Morton Mobility Index (DEMMI) used by physiotherapists in older patients with knee or hip osteoarthritis.

Objective

To examine the reproducibility, construct validity, and unidimensionality of the Dutch translation of the de Morton Mobility Index (DEMMI), a performance-based measure of mobility for older patients.

Design

Cross-sectional study.

Setting

Rehabilitation center (reproducibility study) and hospital (validity study).

Participants

Patients (N=28; age >65y) after orthopedic surgery (reproducibility study) and patients (N=219; age >65y) waiting for total hip or total knee arthroplasty (validity study).

Intervention

Not applicable.

Main Outcome Measures

Not applicable.

Results

The intraclass correlation coefficient for interrater reliability was high (.85; 95% confidence interval, 71–.93), and minimal detectable change with 90% confidence was 7 on the 100-point DEMMI scale. Rasch analysis identified that the Dutch translation of the DEMMI is a unidimensional measure of mobility in this population. DEMMI scores showed high correlations with scores on other performance-based measures of mobility (Timed Up and Go test, Spearman r=−.73; Chair Rise Time, r=−.69; walking test, r=.74). A lower correlation of .44 was identified with the self-report measure Western Ontario and McMaster Universities Osteoarthritis Index.

Conclusions

The Dutch translation of the DEMMI is a reproducible and valid performance-based measure for assessing mobility in older patients with knee or hip osteoarthritis.     

Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults

Davenport SJ, de Morton NA. Clinimetric properties of the de Morton Mobility Index in healthy, community-dwelling older adults.

Objective

To investigate the clinimetric properties of the de Morton Mobility Index (DEMMI) in healthy, community-dwelling older adults.

Design

Cohort study.

Setting

Retirement village and Returned and Services League (RSL) club in Melbourne, Australia.

Participants

All participants were 65 years or older, healthy, and living within the community. The validation study included participants recruited from a retirement village (n=61), and the reliability studies included participants recruited from an RSL club and a subset of participants from the retirement village.

Interventions

Not applicable.

Main Outcome Measures

Mobility was assessed using the DEMMI. The percentage of participants who scored the highest and lowest possible score on the DEMMI was calculated to determine whether a floor or ceiling effect occurred. The minimal clinically important difference (MCID) was estimated using a distribution-based method. Reliability was assessed independently and concurrently using the minimal detectable change at 90% confidence (MDC₉₀).

Results

Evidence of convergent and discriminant validity was obtained for the DEMMI by examining correlations with measures of related constructs, the Lower Extremity Functional Scale (r=.69) and Quality of Life Scale scores (r=.28), respectively. Participants who ambulated without a gait aid (82.62±10.63) had significantly higher (P<.0) DEMMI scores than those who ambulated with an aid (64.1±12.40), providing evidence of known groups validity. No floor or ceiling effect was identified. The MCID was 7 points. The MDC₉₀ was 13 (95% CI, 8.76–17.05) points on the 100-point scale.

Conclusion

DEMMI scores in healthy, community-dwelling older adults are both valid and reliable.     

The lower-limb tasks questionnaire: an assessment of validity, reliability, responsiveness, and minimal important differences

OBJECTIVES: To develop a questionnaire that focuses only on physical tasks related to lower-limb function and, within that questionnaire, to explore the psychometric properties of a series of questions that are related specifically to activities of daily living (ADLs) and a series of activities more often associated with recreation. DESIGN: Inception cohort. SETTING: Private practice. PARTICIPANTS: Data were primarily from patients who had experienced a lower-limb injury that would typically involve rehabilitation up to 6 weeks. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Through 5 studies, the following psychometric qualities were evaluated: content and factor validity, construct and concurrent validity, test-retest reliability (intraclass correlation coefficient [ICC], typical error), responsiveness (effect size, standardized response mean, Guyatt's responsiveness statistic), and the minimum important difference (distribution, anchor-based approaches). RESULTS: Factor analysis supported the theoretical perspective that ADLs and recreational activities can be treated as different domains within the construct of function. Internal consistency was high (Cronbach alpha: ADLs, .91; recreational activities, .95) and the 2 domains explained a moderate level of the response variance (61%). In the ADL domain, 7 tasks had greater than 80% of participants regarding them as having some importance. For recreational activities, 6 tasks had 79% or more of participants regarding them as having some importance. Both domains were moderately correlated to actual performance of tasks (r = .62, r = .72), and to other questionnaires used for lower-limb injuries (r range, .51-.86). The floor and ceiling effects of the domains followed an expected pattern that could be related to the loading forces experienced on the injured limb during activities. The reliability of the 2 domains was high (ICCs >.95), and the Bland-Altman plots showed that the distribution of error across the range of scores was random with low bias scores (<1.0 point). Typical error scores were 2 points for each domain. All measures of responsiveness were high (1.2-6.7). Measures of the minimal important difference varied (3-10 points) according to the methodologic approach used. CONCLUSIONS: The questionnaire possesses good factor structure and composition, relates well with other measures of function, differentiates patients with regard to certain characteristics or processes known to occur after injury, shows high levels of reliability and responsiveness, and shows evidence of good minimal important difference scores. The findings support the use of the questionnaire in both clinical scenarios and in research.     

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.

     

The reliability and validity of assessment of sagittal plane deviations in children who have spastic diplegia

OBJECTIVE: To assess the reliability and validity of a newly described classification of sagittal plane alignment in spastic diplegic gait. DESIGN: Twenty split-screen videos of children with spastic diplegia, Gross Motor Function Classification System levels I to III, were viewed on 2 occasions, 6 weeks apart, by 5 raters. The sagittal plane alignments of the right and left lower limbs in gait were classified separately as true equinus, jump knee, apparent equinus, or crouch, based on the published classification. A fifth category, nonclassifiable, was used if classification was not possible. We then used sagittal plane kinematic data to confirm the classification for each subject and these were compared with rater classification scores, which used the video information only. SETTING: Tertiary-level children's hospital. PARTICIPANTS: Three pediatric orthopedic surgeons and 2 pediatric orthopedic residents. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gait classification scores derived from visual observation were compared among and within raters. The gait classification scores derived from visual observation were compared with the scores derived from sagittal plane kinematic data to assess validity. RESULTS: A moderate correlation was found among the 5 raters within each session, with an interrater weighted kappa score of .45 in session 1 and .49 in session 2. The intrarater, weighted kappa scores showed a moderate to substantial level of agreement between sessions, ranging from .50 to .68. The classification scores of individual raters had moderate validity when compared with classifications derived from the sagittal plane kinematic data. However, there was a substantial level of agreement between the consensus opinion and the classification obtained using the kinematic data as well as the video recordings (weighted kappa=0.8). CONCLUSIONS: This classification has only moderate reliability and validity when a single experienced rater views the 2-dimensional gait videos. However, the consensus opinion derived from the scores of 5 raters considerably improves the validity of the assessment.     

Applicability of a toolkit for geriatric rehabilitation outcomes

Purpose. To field test the applicability of a multidimensional toolkit for geriatric rehabilitation outcomes which includes nine standardized tools. Applicability is defined as context- and population-specific pragmatic qualities of an assessment tool such as respondent and examiner burden, score distribution and format compatibility.

Method. A sample of 48 older adults representing four diagnostic groups, as well as 26 caregivers, were assessed at home in the first month after discharge from intensive rehabilitation (T1) and 2 months later (T2). Pre-determined qualitative and quantitative applicability criteria were coded and compared at T1 and T2, as well as responsiveness.

Results. A higher respondent burden was found for three self-report tools, as well as a ceiling effect on social functioning tools. Respondent burden, examiner burden and score distribution remained stable or diminished at T2. Format compatibility deteriorated only for the mobility test due to a higher proportion of non ambulatory participants (17%). Low to moderate associations between the tools corroborated that they were not redundant (r_Pearson ≤ 0.77). Responsiveness estimates confirmed that mean scores were stable between T1 and T2.

Conclusion. Overall, the toolkit was found to be applicable at home after geriatric rehabilitation. Modifications are proposed to further improve its applicability. This study highlighted practical aspects that could alleviate the burden on research participants and facilitate the use of those tools for community follow-up for clinical and research purposes.     

Reliability of the de Morton mobility index (DEMMI) in an older acute medical population

Background. The de Morton Mobility Index (DEMMI) is an instrument that accurately measures the mobility of older people across clinical settings. Purpose. To report the multiple reliability studies conducted during the development and validation of the DEMMI. Methods. Intra‐rater and inter‐rater reliability studies were conducted for the DEMMI in two independent samples (development and validation samples) of older acute medical patients (aged 65 years or older). Inter‐rater reliability studies were conducted between the test developer (a physiotherapist) and another experienced physiotherapist. Order of assessor administration was randomized by a coin toss. Patients who were fatigued after the first assessment were excluded from the inter‐rater reliability study. Intra‐rater reliability studies included participants with ‘unchanged’ mobility status between hospital admission and discharge. Scale reliability estimates were expressed as the minimal detectable change with 90% confidence (MDC₉₀). Item reliability was calculated using Kappa statistics and absolute percentage agreement. Results. The MDC₉₀ for the DEMMI development sample was 9.51 points (95% confidence interval [95% CI], 5.04–13.32; n = 21) and 7.84 (95% CI, 4.34–11.65; n = 16) on the 100‐point interval DEMMI scale for the inter‐rater and intra‐rater reliability studies, respectively. Similar estimates were obtained for the DEMMI validation samples of 8.90 (95% CI, 6.34–12.69; n = 35) and 13.28 points (95% CI, 8.08–20.87; n = 19). Items were not excluded from the DEMMI based on the results of item reliability. Conclusion. Reliability estimates for the DEMMI were consistent across independent samples of older acute medical patients using different reliability study methodology. Error represents approximately 9% of the DEMMI scale width. Copyright © 2010 John Wiley & Sons, Ltd.