Easy-to-use clinical measures of walking ability in children and adolescents with cerebral palsy: a systematic review

Objective: The aims of this systematic review were to identify quick, simple and easy-to-use measures of walking ability currently used to assess children and adolescents with cerebral palsy (CP), and to evaluate the clinical utility and psychometric properties of these measures.

Data sources: The PubMed, CINAHL, SPORTDiscus and MEDLINE databases were searched up to March 2015.

Review methods: Two independent reviewers rated the methodological quality of the identified measures using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.

Results: The 1-Minute Walk Test, Timed Up and Go Test, ABILOCO-Kids, Gillette Functional Assessment Questionnaire and Functional Mobility Scale were identified. Each measure can be carried out within 5?min with limited equipment, and does not require examiner training. There was “limited” to “strong” evidence on the reliability and validity of these measurements, whereas evidence on measurement error and responsiveness was limited.

Conclusion: The identified measures in this systematic review may be considered for the clinical measurement of walking ability in children and adolescents with CP in a quick, simple and easy-to-use manner. However, there is overall a lack of evidence on the psychometric properties of these tools. The lack of evidence regarding measurement error and responsiveness might limit their value in measuring change over time.

• Implications for Rehabilitation

• The ABILOCO-Kids, 1-Minute Walk Test, Timed Up and Go Test, Gillette Functional Assessment Questionnaire, Functional Mobility Scale can be performed within 5?min with limited equipment, and do not require examiner training for measuring of walking ability in children and adolescents with cerebral palsy.

• The clinicians should use these measurement tools carefully when assessing change over time as the available evidence on measurement error and responsiveness is limited.

• When clinicians use these measurement tools, the psychometric properties reported in this systematic review should be considered in the selection of tools and subsequent interpretation of results.

     

Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality

Purpose: The aim of this systematic review was to examine the psychometric properties of published clinical sitting measurement scales containing dynamic tasks in individuals following stroke.

Method: Databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, Cochrane, PubMed and Allied and Complementary Medicine Database (AMED) were searched from inception to December 2015. The search strategy included terms relating to sitting, balance and postural control. Two reviewers independently selected and extracted data from the identified articles and assessed the methodological quality of the papers using the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist.

Results: Fourteen clinical sitting measurement scales (39 papers) containing dynamic tasks met the inclusion criteria and various measurement properties were evaluated. The methodological quality of the majority of the included studies was rated as poor to fair using the COSMIN checklist, with common limitations including small sample size and inappropriate use of statistical methods.

Conclusions: This review was unable to identify measures with sufficient psychometric properties to enable recommendation as preferred tools. However, measures were identified that warrant further specific psychometric investigations to fulfil requirements for a high quality measure.

• Implications for Rehabilitation

• Fourteen clinical sitting balance scales containing dynamic tasks are available to measure sitting balance with individuals following stroke.

• No single scale has sufficient psychometric properties to enable recommendation as a preferred tool for measuring sitting balance with stroke survivors.

• Use of a balance scale or dedicated sitting balance measure containing static and dynamic sitting items should be utilised to monitor progress for individuals following stroke with more severe deficits.

     

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

Abstract

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

• Implications for Rehabilitation

• Chronic fatigue syndrome (CFS).

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

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

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

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

     

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.

     

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

Abstract

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

• Implications for Rehabilitation

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

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

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

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

     

The psychometric properties of the cervical nonorganic signs in patients with neck pain: an assessment of pain expression

Purpose: Neck pain is a common cause of disability. This study investigated the psychometric properties of the cervical nonorganic signs (CNOS), a tool for assessing abnormal illness behaviors in patients with neck pain.

Methods: The CNOS was administered on patients with neck pain. Reliability and validity analyses were used to evaluate the psychometric properties. Exploratory factor analysis was used to investigate the dimensionality. Correlations with the Short Form-36 were used to investigate the convergent validity.

Results: The results supported the reliability (inter-rater reliability intra-class correlation: 0.920), validity (correlated with body pain (|ρ|=0.31) and vitality (|ρ|?=0.30), and two-factor dimensionality (χ²=^?5.904, p=?0.66; χ²/df?=?0.738; RMSEAConclusion: The CNOS is a reliable and valid instrument for assessing pain and vitality problems. It helps patients to express severe pain and lack of vitality. The rehabilitation discipline could use the scale to understand pain expression and to design proper rehabilitation programs.

• Implications for Rehabilitation

• The cervical nonorganic signs has two domains (pain and vitality).

• The scale is reliable and valid for patients with neck pain.

• Patients with high scores on the pain domain have severe body pain that may interfere with normal social activities.

• Clinicians should understand their suffering and try to help them to alleviate the pain.

     

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.

     

Cross-cultural adaptation,reliability and validity of the Turkish version of the Lower Limb Functional Index

Abstract

Purpose: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. Method: The LLFI was translated into Turkish and cross-culturally adapted with a double forward–backward protocol that determined face and content validity. Individuals (n?=?120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson’s r), internal consistency (Cronbachs α) and test–retest reliability (intraclass correlation coefficient – ICC_2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC₉₀), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. Results: The psychometric characteristics showed strong criterion validity (r?=?0.74–0.76), high internal consistency (α?=?0.82) and high test–retest reability (ICC_2.1?=?0.97). The SEM of 3.2% gave an MDC₉₀?=?5.8%. The factor structure was uni-dimensional. Conclusions: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population.

• Implications for Rehabilitation

• Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life.

• Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care.

• The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

     

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

Abstract

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

• Implications for Rehabilitation

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

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

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

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

     

The extremity function index (EFI), a disability severity measure for neuromuscular diseases: psychometric evaluation

Objective: To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease severity in neuromuscular diseases.

Design: A cross-sectional postal survey study was performed among patients diagnosed with a neuromuscular disease.

Methods: Patients completed both adapted extremity function scales, questionnaires for psychometric evaluation, and disease-specific questions. Confirmatory factor analysis was performed, and reliability and validity were examined.

Results: Response rate was 70% (n?=?702). The Extremity Function Index model with a two-factor structure – for upper and lower extremities – showed an acceptable fit. The Extremity Function Index scales showed good internal consistency (alphas: 0.97–0.98). The known-groups validity test confirmed that Extremity Function Index scales discriminate between categories of “Extent of limitations” and “Quality of Life.” Convergent and divergent validity tests confirmed that Extremity Function Index scales measure the physical impact of neuromuscular diseases. Relative validity tests showed that the Extremity Function Index scales performed well in discriminating between subgroups of patients with increasing “Extent of limitations” compared to concurrent measurement instruments.

Conclusion: The Extremity Function Index proved to be a sound and easy to apply self-report disability severity measurement instrument in neuromuscular diseases.

• Implications for rehabilitation

• The Extremity Function Index reflects the functioning of all muscles in the upper and lower extremities involved in activities of daily living.

• The Extremity Function Index is an easy to administer and patient-friendly disability severity measurement instrument that has the ability to evaluate differences in disability severity between relevant neuromuscular disease subgroups.

• The Extremity Function Index is a valid and reliable disability severity measurement instrument for neuromuscular diseases.

     

Psychometric properties of the performing arts module of the Disabilities of the Arm,Shoulder, and Hand questionnaire

Abstract

Background: The Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) offers an optional performing arts module. The goal was to examine the psychometric properties of this module in musicians.

Methods: This study is a secondary analysis of a randomized controlled trial on the effectiveness of a biopsychosocial intervention to prevent or reduce playing-related disability in conservatory students. Baseline data were used to examine internal consistency and discriminative validity of the performing arts module of the DASH questionnaire. Construct validity was analyzed by hypotheses testing. The performing arts module outcomes were compared to scores from the general DASH questionnaire, pain disability index, Short-Form 36, playing-related musculoskeletal disorder (PRMD) intensity, and pain intensity.

Results: Questionnaires completed by 130 conservatory students were analyzed, 55% of the population was female. Median age was 20 years (IQR 4). The performing arts module showed good internal consistency (Cronbach’s alpha 0.893). Discriminative validity between students with and without PRMDs was good. Three out of six hypotheses were accepted, indicating moderate construct validity.

Conclusions: The performing arts module showed good internal consistency, good discriminative validity and moderate construct validity in a population of conservatory students.

• Implications for Rehabilitation

• Musicians suffer frequently from musculoskeletal disorders, mostly in the upper extremity.

• The Disabilities of the Arm, Shoulder, and Hand questionnaire is a well-known outcome measure, which also includes a performing arts module.

• This study is the first to explore psychometric properties of the performing arts module.

• The performing arts module of the Disabilities of the Arm, Shoulder, and Hand questionnaire showed good internal consistency, good discriminative validity, and moderate construct validity.

     

The measurement of psychological constructs in people with osteoarthritis of the knee: a psychometric evaluation

Purpose To examine the measurement properties of measures of psychological constructs in people with knee osteoarthritis. Method Participants with osteoarthritis of the knee completed the beck depression inventory (BDI-II), state-trait anxiety inventory (STAI), arthritis helplessness index (AHI), fatigue severity scale (FSS), coping strategies questionnaire (CSQ), beliefs about pain control questionnaire (BPCQ), illness perceptions questionnaire-revised (IPQ-R), pain self-efficacy questionnaire (PSEQ) at home as part of a set of measures covering different aspects of osteoarthritis pain. The questionnaires were returned by pre-paid envelope. Rasch analysis was used to check the psychometric properties of the scales in people with osteoarthritis. Results The STAI-SF was an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue, with removal of items 1 and 2. The BDI subscales were acceptable for measuring negative thoughts and behaviours related to depressive symptomatology with some modifications to the scale. The helplessness scale of the AHI was acceptable as a measure of helplessness. The PSEQ was an acceptable measure of self-efficacy and the CSQ as a measure of cognitive coping strategies. The BPCQ and IPQ-R did not fit the Rasch model. Conclusions These findings indicate that questionnaires need to be checked for their ability to measure psychological constructs in the clinical groups to which they will be applied.

• Implications for Rehabilitation

• For people with osteoarthritis, the STAI-SF is an acceptable measure of anxiety and the revised FSS an acceptable measure of fatigue with removal of items 1 and 2.

• The BDI subscales, but not the total score, are acceptable for measuring depressive symptomatology with some modifications to the scoring of the scale. And helplessness can be measured using the Helplessness subscale of the AHI.

• The PSEQ was an acceptable measure of self-efficacy and cognitive coping strategies can be measured with the CSQ.

• Rasch analysis highlighted lack of unidimensionality, disordered response thresholds and poor targeting in some measures commonly used for people with osteoarthritis

     

Methodological quality of studies on the measurement properties of neck pain and disability questionnaires: a systematic review

Objective

The aim of this study was to obtain an overview of the methodological quality of studies on the measurement properties of neck pain and disability questionnaires and to describe how well various aspects of the design and statistical analyses of studies on measurement properties are performed.

Methods

A systematic review was performed of published studies on the measurement properties of neck pain and disability questionnaires. Two reviewers independently rated the quality of the studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. This checklist was developed in an international Delphi consensus study.

Results

A total of 47 articles were included on the measurement properties of 8 different questionnaires. The methodological quality of the included studies was adequate on some aspects (often, adequate statistical analyses are used for assessing reliability, measurement error, and construct validity) but can be improved on other aspects. The most important methodological aspects that need to be improved are as follows: assessing unidimensionality in internal consistency analysis, stable patients and similar test conditions in studies on reliability and measurement error, and more emphasis on the relevance and comprehensiveness of the items in content validity studies. Furthermore, it is recommended that studies on construct validity and responsiveness should be based on predefined hypotheses and that better statistical methods should be used in responsiveness studies.

Conclusion

Considering the importance of adequate measurement properties, it is concluded that, in the field of measuring neck pain and disability, there is room for improvement in the methodological quality of studies measurement properties.     

Cross-cultural translation and validation of the Greek version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in patients with total knee replacement

Abstract

Purpose: Aim of this study is to assess the psychometric properties of the developed Greek version of the Knee Injury and Osteoarthritis Outcome Score (KOOS) in total knee replacement (TKR) patients. Methods: Psychometric properties of the Greek version of KOOS were evaluated according to the Consensus-based Standards Measurements Instruments (COSMIN) checklist. Patients’ pre-operative clinical status and post-operative outcomes at two occasions (at discharge and 10–12 days post-operatively) were evaluated using the KOOS, KOS-ADL and SF-12 Health Survey. Results: A comprehensive Greek KOOS was piloted and well accepted by patients and therefore administered to 60 consecutive TKR patients (mean age 72.2?±?7.2 years, 39 women). Excellent Internal consistency, good test–retest reliability of KOOS and KOOS 5 subdomains, respectively [ICC(2-1) 0.76, 95% CI?=?0.235–0.902 and 0.89, 95% CI?=?0.843–0.927] was yielded. A priori hypotheses for construct validity were confirmed with KOOS score and subdomains for pain, symptoms and Everyday Living function (ADL) correlating moderately with KOS-ADL. Responsiveness for KOOS subdomains of Pain and Symptoms yielded moderate effect size (ES?=?0.4). Conclusion: The Greek KOOS was found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties. It is therefore, recommendable for usage in future clinical trials and clinical practice.

• Implications for Rehabilitation

• The Greek version of KOOS is an essential assessment scale to evaluate not only acute injuries but also chronic knee associated conditions in a holistic perspective.

• The Greek KOOS has been found to be a practical and comprehensible self-reported measure for TKR patients with acceptable psychometric properties, recommendable for usage in future clinical trials and clinical practice.

• KOOS Greek version (downloadable at the official site http://www.koos.nu/koosgreek.pdf) was used in the validity study.

     

Self-management: a systematic review of outcome measures adopted in self-management interventions for stroke

Purpose: To systematically review the psychometric properties of outcome measures used in stroke self-management interventions (SMIs) to (1) inform researchers, clinicians and commissioners about the properties of the measures in use and (2) make recommendations for the future development of self-management measurement in stroke. Methods: Electronic databases, government websites, generic internet search engines and hand searches of reference lists. Abstracts were selected against inclusion criteria and retrieved for appraisal and systematically scored, using the COSMIN checklist. Results: Thirteen studies of stroke self-management originating from six countries were identified. Forty-three different measures (mean 5.08/study, SD 2.19) were adopted to evaluate self-SMIs. No studies measured self-management as a discreet concept. Six (46%) studies included untested measures. Eleven (85%) studies included at least one measure without reported reliability and validity in stroke populations. Conclusions: The use of outcome measures which are related, indirect or proxy indicators of self-management and that have questionable reliability and validity, contributes to an inability to sensitively evaluate the effectiveness of stroke self-SMIs. Further enquiry into how the concept of self-management in stroke operates, would help to clarify the nature and range of specific self-management activities to be targeted and aid the selection of existing appropriate measures or the development of new measures.

Implications for Rehabilitation

• The evaluation of complex interventions such as self-management interventions is aided by clear outcome expectations and valid and reliable measurement.

• This review demonstrates a lack of outcome measures that specifically measure self-management of stroke. A minority of outcome measures that were used as proxy indicators for SM fulfill some of the criteria for quality outlined in the COSMIN checklist.

• Clinicians should select measures which appropriately reflect expected outcomes, giving due consideration to the theoretical underpinnings of the intervention. Further work is required to establish which measures currently in use, if any, accurately reflect stoke self-management.

• In the meantime, researchers should seek to develop psychometrically sound measures of stroke self-management to assist effective evaluation of such interventions in stroke.

     

Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.

• The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.

• This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

     

Sex-based differences in pain distribution in a cohort of patients with persistent post-traumatic neck pain

Objectives: To analyze a cohort of 745 consecutive patients referred to a regional specialist clinic for evaluation of post-traumatic neck pain during a five-year period.

Methods: A cross-sectional observational study of baseline assessments performed by multi-professional rehabilitation teams according to a standardized checklist.

Results: The cohort contained nearly twice as many females as males (64% versus 36%). The type of injury did not differ between sexes. Of the entire cohort, 38% were diagnosed with widespread pain, 50% with regional pain, and 12% with local pain. The pain distribution among the females was 43% widespread, 48% regional, and 9% local, and corresponding figures among males were 29%, 53%, and 18%. Longer time between trauma and assessment did not affect pain distribution among the men, but a tendency towards more widespread pain was observed among the women.

Discussion: The importance of "female sex" as risk factor for the development of persistent pain after neck trauma needs to be discussed further. The high frequency of regional and widespread pain among patients with persistent neck pain after trauma calls for both multidisciplinary assessments and treatment strategies. The relationships between different pain distribution patterns, disability, activity, and psychological factors need to be studied further.

• Implications for rehabilitation

• Patients suffering from pain and disability after neck trauma constitute a significant proportion of patients with persistent pain.

• The importance of the risk factor “female sex" should be further discussed in the development of persistent pain after neck trauma.

• The high frequency of regional and widespread pain among patients with persistent neck pain after trauma calls both for multidisciplinary assessments and treatment strategies.

• The relationships between different pain distribution patterns, disability, activity, and psychological factors need to be studied further.

     

A comparative review of measurement instruments to inform and evaluate effectiveness of disability inclusive development

Abstract

Purpose: A review of existing measurement instruments was conducted to examine their suitability to measure disability prevalence and assess quality of life, protection of disability rights and community participation by people with disabilities, specifically within the context of development programs in low and middle-income countries. Methods: From a search of PubMed and the grey literature, potentially relevant measurement instruments were identified and examined for their content and psychometric properties, where possible. Criteria for inclusion were: based on the WHO’s International Classification of Functioning Disability and Health (ICF), used quantitative methods, suitable for population-based studies of disability inclusive development in English and published after 1990. Characteristics of existing instruments were analysed according to components of the ICF and quality of life domains. Results: Ten instruments were identified and reviewed according to the criteria listed above. Each version of instruments was analysed separately. Only three instruments included a component on quality of life. Domains from the ICF that were addressed by some but not all instruments included the environment, technology and communication. Conclusion: The measurement instruments reviewed covered the range of elements required to measure disability-inclusion within development contexts. However no single measurement instrument has the capacity to measure both disability prevalence and changes in quality of life according to contemporary disability paradigms. The review of measurement instruments supports the need for developing an instrument specifically intended to measure disability inclusive practice within development programs.

• Implications for Rehabilitation

• Surveys and tools are needed to plan disability inclusive development.

• Existing measurement tools to determine prevalence of disability, wellbeing, rights and access to the community were reviewed.

• No single validated tool exists for population-based studies, uses quantitative methods and the components of the ICF to measure prevalence of disability, well-being of people with disability and their access to their communities.

• A measurement tool that reflects the UNCRPD and addresses all components of the ICF is needed to assist in disability inclusive development, especially in low and mid resource countries.