The multiple sclerosis work difficulties questionnaire: translation and cross-cultural adaptation to Turkish and assessment of validity and reliability

Abstract

Purpose: To linguistically and culturally adapt the Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) for use in Turkey, and to examine its reliability and validity.

Methods: Following standard forward-back translation of the MSWDQ-23, it was administered to 124 people with multiple sclerosis (MS). Validity was evaluated using related outcome measures including those related to employment status and expectations, disability level, fatigue, walking, and quality of life. Randomly selected participants were asked to complete the MSWDQ-23 again to assess test–retest reliability.

Results: Confirmatory factor analysis on the MSWDQ-23 demonstrated a good fit for the data, and the internal consistency of each subscale was excellent. The test–retest reliability for the total score, psychological/cognitive barriers, physical barriers, and external barriers subscales were high. The MSWDQ-23 and its subscales were positively correlated with the employment, disability level, walking, and fatigue outcome measures.

Conclusions: This study suggests that the Turkish version of MSWDQ-23 has high reliability and adequate validity, and it can be used to determine the difficulties faced by people with multiple sclerosis in workplace. Moreover, the study provides evidence about the test–retest reliability of the questionnaire.

• Implications for rehabilitation

• Multiple sclerosis affects young people of working age.

• Understanding work-related problems is crucial to enhance people with multiple sclerosis likelihood of maintaining their job.

• The Multiple Sclerosis Work Difficulties Questionnaire-23 (MSWDQ-23) is a valid and reliable measure of perceived workplace difficulties in people with multiple sclerosis: we presented its validation to Turkish.

• Professionals working in the field of vocational rehabilitation may benefit from using the MSWDQ-23 to predict the current work outcomes and future employment expectations.

     

The Arm Function in Multiple Sclerosis Questionnaire (AMSQ): development and validation of a new tool using IRT methods

Abstract

Purpose: We developed the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) to measure arm and hand function in MS, based on existing scales. We aimed at developing a unidimensional scale containing enough items to be used as an itembank. In this study, we investigated reliability and differential item functioning of the Dutch version. Method: Patients were recruited from two MS Centers and a Dutch website for MS patients. We performed item factor analysis on the polychoric correlation matrix, using multiple fit-indices to investigate model fit. The graded response model, an item response theory model, was used to investigate item goodness-of-fit, reliability of the estimated trait levels (θ), differential item functioning, and total information. Differential item functioning was investigated for type of MS, gender, administration version, and test length. Results: Factor analysis results suggested one factor. All items showed p-values of the item goodness-of-fit statistic above 0.0016. The reliability was 0.95, and no items showed differential item functioning on any of the investigated variables. Conclusion: AMSQ is a unidimensional 31-item questionnaire for measuring arm function in MS. Because of a well fit in a graded response model, it is suitable for further development as a computer adaptive test.

• Implications for Rehabilitation

• A new questionnaire for arm and hand function recommended in people with multiple sclerosis (AMSQ).

• Scale characteristics make the questionnaire suitable for use in clinical practice and research.

• Good reliability.

• Further development as a computer adaptive test to reduce burden of (repetitive) testing in patients is feasible.

     

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

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

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

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

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

• Implications for Rehabilitation

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

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

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

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

     

The Nordic Musculoskeletal Questionnaire: cross-cultural adaptation into Turkish assessing its psychometric properties

Purpose: The purpose of this study was to linguistically and culturally adapt the Nordic Musculoskeletal Questionnaire (NMQ) for use in Turkey, and to examine the psychometric properties of this adapted version.

Method: The cross-cultural adaptation was achieved by translating the items from the original version, with back-translation performed by independent mother-tongue translators, followed by committee review. Reliability (internal consistency and test–retest) was examined for 198 participants who completed the NMQ twice (with a 1 week interval). Construct validity was examined with data from 126 participants from the same population, who completed further four questionnaires related to the body regions described in the NMQ.

Results: The internal consistency was excellent (Cronbach’s alpha?=?0.896). The test–retest reliability was examined with the prevalence-adjusted bias-adjusted kappa (PABAK) and all items showed moderate to almost perfect reliability (PABAK?=?0.57–0.90). Participants with a musculoskeletal problem in a related region had significantly more disability/pain, as assessed by the relevant questionnaires (p?Conclusions: This study provided considerable evidence that the Turkish version of the NMQ has appropriate psychometric properties, including good test–retest reliability, internal consistency and construct validity. It can be used for screening and epidemiological investigations of musculoskeletal symptoms.

• Implications for Rehabilitation

• The Nordic Musculoskeletal Questionnaire (NMQ) can be used for the screening of musculoskeletal problems.

• The NMQ allows comparison of musculoskeletal problems in different body regions in epidemiological studies with large numbers of participants.

• The Turkish version of the NMQ can be used for rehabilitation due to its appropriate psychometric properties, including good test–retest reliability, internal consistency and construct validity.

     

Adaptation of the Activity Measure Post-Acute Care (AM-PAC) from English to Mandarin using the dual-panel translation approach

Purpose: The aims of this study were to translate and adapt the Activity Measure Post-Acute Care (AM-PAC) from US English to Mandarin using the dual-panel method, and to assess its psychometric properties in an outpatient rehabilitation setting.

Methods: The AM-PAC outpatient short forms were translated using the dual-panel method. The translated AM-PAC was tested in 550 Chinese-speaking rehabilitation outpatients. Floor and ceiling effects were evaluated and internal consistency was assessed using Cronbach’s alpha. Spearman correlation was used to assess the concurrent validity of the AM-PAC with the Barthel Index and the Mini-Mental State Examination. Test–retest reliability was determined by administering the AM-PAC twice to 57 participants within a 2–7?day interval.

Results: Some ceiling effects (>20%) were observed in the Applied Cognition subscale. All subscales exhibited good internal consistency (α?>?0.70). Supportive evidence for concurrent validity was found in strong correlations between Basic Mobility subscale and Barthel Index (r?=?0.68), and Daily Activity subscale and Barthel Index (r?=?0.70); and moderate correlations between Applied Cognition subscale and Mini-Mental State Examination (r?=?0.50). Test–retest reliability for all subscales was high (intraclass correlation coefficient?=0.89–0.98).

Conclusions: The dual-panel approach was successfully used to translate the AM-PAC from English to Mandarin. Adequate reliability and validity in rehabilitation outpatients in Taiwan were established.

• Implications for Rehabilitation

• The dual-panel method is a modern translation technique, which was successfully used to adapt the Activity Measure Post-Acute Care from English to Mandarin.

• The Mandarin version of Activity Measure Post-Acute Care demonstrates adequate internal consistency, concurrent validity, and test–retest reliability in rehabilitation outpatients.

• The Activity Measure Post-Acute Care is superior to existing functional measures used to monitor activity performance for rehabilitation patients in Taiwan.

     

The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children

Purpose: To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.

Methods: The study included developmental phase and reported content, criterion validity, internal consistency and test–retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test–retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.

Results: All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26?±?1.83 and 19.5?±?11, respectively. The internal consistency was high with Cronbach’s alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p?r?=?0.77; p?r?=?0.83, respectively). A score >4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.

Conclusions: The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children.

• Implications for rehabilitation

• The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children.

• The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children.

• The Pediatric Version of the Eating Assessment Tool has good internal consistency, test–retest reliability and criterion-based validity.

• The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

     

The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version

Purpose: To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients after stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test–retest reliability. Method: TIS was translated according to international guidelines. The validity study was performed on data from 201 patients with acute stroke. Fifty patients with stroke and acquired brain injury were recruited to examine intertester and test–retest reliability. Construct validity was analyzed with exploratory and confirmatory factor analysis and item response theory, internal consistency with Cronbach’s alpha test, and intertester and test–retest reliability with kappa and intraclass correlation coefficient tests.Results: The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed. By combining items from the subscales Dynamic sitting balance and Coordination, six ordinal superitems (testlets) were constructed. The TIS-NV was renamed the modified TIS-NV (TIS-modNV). After modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. It demonstrated good construct validity, excellent internal consistency, and high intertester and test–retest reliability for the total score.Conclusions: This study supports that the TIS-modNV is a valid and reliable scale for use in clinical practice and research.

Implications for Rehabilitation

• Trunk control is an essential part of balance and postural control, thereby an important prerequisite for daily activities and function

• Impairments of trunk control is a common problem in stroke

• The TIS-modNV is a valid and reliable measure to evaluate impairments in trunk control

• The TIS-modNV containing ordinal superitems is recommended for use in clinical practice and research

     

The psychometric properties of an Arabic numeric pain rating scale for measuring osteoarthritis knee pain

Purpose: The aims of this study were to translate the numeric rating scale (NRS) into Arabic and to evaluate the test–retest reliability and convergent validity of an Arabic Numeric Pain Rating Scale (ANPRS) for measuring pain in osteoarthritis (OA) of the knee.

Methods: The English version of the NRS was translated into Arabic as per the translation process guidelines for patient-rated outcome scales. One hundred twenty-one consecutive patients with OA of the knee who had experienced pain for more than 6 months were asked to report their pain levels on the ANPRS, visual analogue scale (VAS), and verbal rating scale (VRS). A second assessment was performed 48 h after the first to assess test–retest reliability. The test–retest reliability was calculated using the intraclass correlation coefficient (ICC_2,1). The convergent validity was assessed using Spearman rank correlation coefficient. In addition, the minimum detectable change (MDC) and standard error of measurement (SEM) were also assessed.

Results: The repeatability of ANPRS was good to excellent (ICC 0.89). The SEM and MDC were 0.71 and 1.96, respectively. Significant correlations were found with the VAS and VRS scores (p?<0.01).

Conclusions: The Arabic numeric pain rating scale is a valid and reliable scale for measuring pain levels in OA of the knee.

• Implications for Rehabilitation

• The Arabic Numeric Pain Rating Scale (ANPRS) is a reliable and valid instrument for measuring pain in osteoarthritis (OA) of the knee, with psychometric properties in agreement with other widely used scales.

• The ANPRS is well correlated with the VAS and NRS scores in patients with OA of the knee.

• The ANPRS appears to measure pain intensity similar to the VAS, NRS, and VRS and may provide additional advantages to Arab populations, as Arabic numbers are easily understood by this population.

     

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

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

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

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

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

• Implications for rehabilitation

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

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

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

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

     

Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome

Purpose: To cross-culturally adapt and validate the Greek version of the Kujala anterior knee pain scale (KAKPS). Methods: The Greek KAKPS was translated from the original English version following standard forward and backward translation procedures. The survey was then conducted in clinical settings by a questionnaire comprising the Greek KAKPS and patellofemoral pain syndrome (PFPS) severity scale. A total of 130 (62 women and 68 men) Greek-reading patients between 18 and 45 years old with anterior knee pain (AKP) for at least four weeks were recruited from physical therapy clinics. To establish test–retest reliability, the patients were asked to complete the KAKPS at initial visit and 2–3 days after the initial visit. The Greek version of the PFPS severity scale was also administered once at initial visit. Internal consistency of the translated instrument was measured using Cronbach’s α. An intraclass correlation coefficient was used to assess the test–retest reliability of the KAKPS. Concurrent validity was measured by correlating the KAKPS with the PFPS severity scale using Pearson’s correlation coefficient. Results: The results showed that the Greek KAKPS has good internal consistency (Cronbach’s α?=?0.942), test–retest reliability (ICC?=?0.921) and concurrent validity (r?>?0.7). Conclusions: This study has shown that the Greek KAKPS has good internal consistency, test–retest reliability and concurrent validity when correlated with the PFPS severity scale in adult patients with AKP for at least four weeks.

• Implications for rehabilitation

• The Greek version of the KAKPS has been found to be reliable and valid when used in adult patients with AKP for at least four weeks.

• The results of the psychometric characteristics were compatible with those of the original English version.

• The KAKPS could be applied in a Greek-speaking population to assess functional limitations and symptoms in patients aged 18–45 years old with AKP for at least four weeks.

     

2nd International Symposium on Gait and Balance in Multiple Sclerosis: interventions for gait and balance in MS

Abstract

Purpose: To provide a review of the 2nd International Symposium on Gait and Balance in Multiple Sclerosis (MS), emphasizing interventions in gait and balance for people with MS. Method: Review of current research on interventions used with people having MS and with people having other disorders that may provide novel insights into improving gait and balance and preventing falls in people with MS (pwMS). Results: Nine speakers provided evidence-based recommendations for interventions aimed at improving gait and balance dysfunction. Speaker recommendations covered the following areas: balance rehabilitation, self-management, medications, functional electrical stimulation, robotics, sensory augmentation, gait training with error feedback and fall prevention. Conclusions: The causes of gait and balance dysfunction in pwMS are multifactorial and therefore may benefit from a wide range of interventions. The symposium provides avenues for exchange of evidence and clinical experience that is critical in furthering physical rehabilitation including gait and balance dysfunction in MS.

• Implications for Rehabilitation

• Approaches to improve Gait and Balance dysfunction in Multiple Sclerosis.

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

• Functional electrical stimulation that may provide the extra stimulation to influence coordinated leg movements needed for walking.

     

Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS)

Purpose: The present study aimed to assess the psychometric properties of the Finnish version of the Lower Extremity Functional Scale (LEFS) among foot and ankle patients.

Methods: The LEFS was translated and cross-culturally adapted to Finnish. We assessed the test–retest reliability, internal consistency, floor-ceiling effect, construct validity and criterion validity in patients who underwent surgery due to musculoskeletal pathology of the foot and ankle (N?=?166).

Results: The test–retest reliability was high (ICC = 0.93, 95% CI: 0.91–0.95). The standard error of measurement was 4.1 points. The Finnish LEFS showed high internal consistency (Cronbach’s α?=?0.96). A slight ceiling effect occurred as 17% achieved the maximum score. The LEFS correlation was strong with the 15D Mobility dimension (r?=?0.74) and overall HRQoL (r?=?0.66), pain during foot and ankle activity (r=??0.69) and stiffness (r=??0.62). LEFS correlated moderately with foot and ankle pain at rest (r=??0.50) and with physical activity (r?=?0.46).

Conclusions: The Finnish version of the LEFS showed reliability and validity comparable to those of the original version. This study indicates that the Finnish version of the LEFS serves both clinical and scientific purposes in assessing lower-limb function.

• Implications for Rehabilitation

• The Finnish version of the Lower Extremity Functional Scale (LEFS) is a reliable and valid tool for assessing lower-extremity musculoskeletal disability in Finnish-speaking population.

• Investigation of the psychometric properties of the Finnish version of the LEFS showed validity and reliability comparable to those of the original English version.

• The Finnish LEFS is easy to complete and suitable for clinical, rehabilitation and research purposes.

     

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

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

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

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

• Implications for Rehabilitation

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

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

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

     

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

Abstract

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

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

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

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

• Implications for rehabilitation

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

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

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

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

     

The Swedish Exercise Self-Efficacy Scale (ESES-S): reliability and validity in a rheumatoid arthritis population

Abstract

Purpose: The aim of the present study was to investigate aspects of reliability and validity of the Exercise Self-Efficacy Scale (ESES-S) in a rheumatoid arthritis (RA) population. Methods: A total of 244 people with RA participating in a physical activity stkudy were included. The six-item ESES-S, exploring confidence in performing exercise, was assessed for test–retest reliability over 4–6 months, and for internal consistency. Construct validity investigated correlation with similar and other constructs. Results: An intraclass correlation coefficient (ICC) of 0.59 (95% CI 0.37–0.73) was found for 84 participants with stable health perceptions between measurement occasions. Cronbach’s alpha coefficients of 0.87 and 0.89 were found at the first and second measurements. Corrected item-total correlation single ESES-S items ranged between 0.53 and 0.73. Construct convergent validity for the ESES-S was partly confirmed by correlations with health-enhancing physical activity and outcome expectations respectively (Pearson’s r?=?0.18, p?<?0.01). Construct divergent validity was confirmed by the absence of correlations with age or gender. No floor or ceiling effects were found for ESES-S. Conclusions: The results indicate that the ESES-S has moderate test–retest reliability and respectable internal consistency in people with RA. Construct validity was partially supported in the present sample. Further research on construct validity of the ESES-S is recommended.

• Implications for Rehabilitation

• Physical exercise is crucial for management of symptoms and co-morbidity in rheumatoid arthritis.

• Self-efficacy for exercise is important to address in rehabilitation as it regulates exercise motivation and behavior.

• Measurement properties of self-efficacy scales need to be assessed in specific populations and different languages.

     

Validity and reliability of the multidimensional assessment of fatigue scale in Iranian patients with relapsing-remitting subtype of multiple sclerosis

Purpose: The purpose of this study is to investigate the validity and reliability of the Persian version of the Multidimensional Assessment of Fatigue Scale (MAFS) in an Iranian population with multiple sclerosis.

Method: A self-reported survey on fatigue including the MAFS, Fatigue Impact Scale and demographic measures was completed by 130 patients with multiple sclerosis and 60 healthy persons sampled with a convenience method. Test–retest reliability and validity were evaluated 3 days apart. Construct validity of the MAFS was assessed with the Fatigue Impact Scale.

Results: The MAFS had high internal consistency (Cronbach’s alpha >0.9) and 3-d test–retest reliability (intraclass correlation coefficient?=?0.99). Correlation between the Fatigue Impact Scale and MAFS was high (r?=?0.99). Correlation between MAFS scores and the Expanded Disability Status Scale was also strong (r?=?0.85). Questionnaire items showed acceptable item-scale correlation (0.968–0.993).

Conclusions: The Persian version of the MAFS appears to be a valid and reliable questionnaire. It is an appropriate short multidimensional instrument to assess fatigue in patients with multiple sclerosis in clinical practice and research.

• Implications for Rehabilitation

• The Persian version of Multidimensional Assessment of Fatigue is a valid and reliable instrument for the assessment and monitoring the fatigue in Persian-language patients with multiple sclerosis.

• It is very easy to administer and a time efficient scale in comparison to other instruments evaluating fatigue in patients with multiple sclerosis.

     

Cross-cultural adaptation and psychometric evaluation of the Singapore version of the Chedoke Arm and Hand Activity

Abstract

Purpose: To develop a Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to estimate the construct validity and inter-rater reliability.

Materials and methods: The Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure was used to systematically adapt the CAHAI. We recruited 56 adults admitted to an inpatient stroke facility to evaluate the psychometric properties of the Singapore version of the CAHAI. The Singapore version of the CAHAI, Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and the Action Research Arm Test (ARAT) were administered to all participants. We used Spearman’s rank correlation coefficients to estimate convergent and discriminative validity, and reliability was estimated using the intra-class correlation coefficient and standard error of measurement.

Results: Implementation of the Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure resulted in the modification to two test items. The Singapore version of the CAHAI demonstrated convergent validity with the FMA-UE (r_s =?0.87; 95% CI: 0.76, 0.92) and ARAT (r_s?=?0.80; 95% CI: 0.63, 0.9). Discriminative validity between the Singapore version of the CAHAI and FMA-UE pain subscale was r_s=?0.42 (95% CI: 0.22, 0.59). Reliability of the Singapore version of the CAHAI was 0.97 (95% CI: 0.94, 0.99) and standard error of measurement of 4.80 points (95% CI: 4.23, 5.55).

Conclusion: The Singapore version of the CAHAI demonstrated good validity and reliability, similar to the properties of the original CAHAI.

• Implications for rehabilitation

• The Singapore version of the Chedoke Arm and Hand Activity Inventory demonstrates evidence of construct validity and inter-rater reliability.

• The Singapore version of the Chedoke Arm and Hand Activity Inventory can be used by clinicians and researchers to evaluate function in the affected upper extremity for persons with stroke in Singapore.

     

Reliability,validity, and responsiveness of the Persian version of Shoulder Activity Scale in a group of patients with shoulder disorders

Abstract

Purpose: The aim of this methodological study was to cross-culturally translate the Shoulder Activity Scale (SAS) into the Persian and determine its clinimetric properties including reliability, validity, and responsiveness in patients with shoulder disorders. Method: Persian version of the SAS was obtained after standard forward-backward translation. Three questionnaires were completed by the respondents: SAS, shoulder pain and disability index (SPADI), and Short-Form 36 Health Survey (SF-36). The patients completed the SAS, 1 week after the first visit to evaluate the test–retest reliability. Construct validity was evaluated by examining the associations between the scores on the SAS and the scores obtained from the SPADI, SF-36, and age of the patients. To assess responsiveness, data were collected in the first visit and then again after 4 weeks physiotherapy intervention. Test–retest reliability and internal consistency were assessed using Intra-class Correlation Coefficient (ICC) and Cronbach’s alpha, respectively. To evaluate construct validity, Spearman’s rank correlation was used. The ability of the SAS to detect changes was evaluated by the receiver-operating characteristics method. Results: No problem or language difficulties were reported during translation process. Test–retest reliability of the SAS was excellent with an ICC of 0.98. Also, the marginal Cronbach’s alpha level of 0.64 was obtained. The correlation between the SAS and the SPADI was low, proving divergent validity, whereas the correlations between the SAS and the SF-36/age were moderate proving convergent validity. A marginally acceptable responsiveness was achieved for the Persian SAS. Conclusions: The study provides some evidences to support the test–retest reliability, internal consistency, construct validity, and responsiveness of the Persian version of the SAS in patients with shoulder disorders. Therefore, it seems that this instrument is a useful measure of shoulder activity level in research setting and clinical practice.

• Implications for Rehabilitation

• The shoulder activity scale (SAS) is a reliable, valid, and responsive measure of shoulder activity level in Persian-speaking patients with different shoulder disorders.

• The results on clinimetric properties of the Persian SAS are comparable with its original, English version.

• Persian version of the SAS can be used in “clinical” and “research” settings of patients with shoulder disorders.

     

Development of a Tablet-based symbol digit modalities test for reliably assessing information processing speed in patients with stroke

Purpose: To develop a Tablet-based Symbol Digit Modalities Test (T-SDMT) and to examine the test–retest reliability and concurrent validity of the T-SDMT in patients with stroke.

Methods: The study had two phases. In the first phase, six experts, nine college students and five outpatients participated in the development and testing of the T-SDMT. In the second phase, 52 outpatients were evaluated twice (2 weeks apart) with the T-SDMT and SDMT to examine the test–retest reliability and concurrent validity of the T-SDMT.

Results: The T-SDMT was developed via expert input and college student/patient feedback. Regarding test–retest reliability, the practise effects of the T-SDMT and SDMT were both trivial (d=0.12) but significant (p≦0.015). The improvement in the T-SDMT (4.7%) was smaller than that in the SDMT (5.6%). The minimal detectable changes (MDC%) of the T-SDMT and SDMT were 6.7 (22.8%) and 10.3 (32.8%), respectively. The T-SDMT and SDMT were highly correlated with each other at the two time points (Pearson’s r=0.90–0.91).

Conclusions: The T-SDMT demonstrated good concurrent validity with the SDMT. Because the T-SDMT had a smaller practise effect and less random measurement error (superior test–retest reliability), it is recommended over the SDMT for assessing information processing speed in patients with stroke.

• Implications for Rehabilitation

• The Symbol Digit Modalities Test (SDMT), a common measure of information processing speed, showed a substantial practise effect and considerable random measurement error in patients with stroke.

• The Tablet-based SDMT (T-SDMT) has been developed to reduce the practise effect and random measurement error of the SDMT in patients with stroke.

• The T-SDMT had smaller practise effect and random measurement error than the SDMT, which can provide more reliable assessments of information processing speed.

     

Measurement properties of the WheelCon for powered wheelchair users

Purpose: To evaluate the measurement properties of the Wheelchair Use Confidence Scale for power wheelchair users (WheelCon-P).

Design: One-month test–retest design, using data from a longitudinal study of power wheelchair use.

Participants: Volunteer sample of 73 community dwelling, older adult experienced power wheelchair users who had a mean age of 60.5?±?7.1 years.

Methods: Participants completed the WheelCon-P twice to assess retest reliability. Concurrent validity was assessed by evaluating hypothesized relationships between the WheelCon-P and relevant variables.

Results: The baseline mean (standard deviation) WheelCon-P score was 78.8?±?14.5. Cronbach’s α was 0.92. The one-month test–retest intraclass correlation coefficient was 0.85 (CI 0.77–0.90). Correlations ranging from r?=?0.26 (social support) to r?=?0.49 (wheelchair skills) were found between the WheelCon-P and the validation outcome measures.

Conclusion: The WheelCon-P has high internal consistency, strong retest reliability and evidence supporting its validity. Although further work is needed, the WheelCon-P may serve as a useful clinical and research tool for measuring power wheelchair confidence.

• Implications for rehabilitation

• The WheelCon-P is a reliable and valid outcome measure for assessing wheelchair confidence.

• This tool can be used to identify individuals with low power wheelchair confidence who require a confidence-enhancing intervention.