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.

     

Translation,cross-cultural adaptation and validity of the Brazilian version of the Foot and Ankle Ability Measure questionnaire

Purpose: To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument.

Methods: Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC_2,1) and Cronbach’s alpha tests, respectively.

Results: Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC_2,1 was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p?95: 0.62–0.87) and 0.65 (p?95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model.

Conclusions: There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.

• Implications for Rehabilitation

• Self-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.

• The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.

• Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders.

     

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.

     

Translation of the Leicester Cough Questionnaire into Swedish,and validity and reliability in chronic obstructive pulmonary disease

Abstract

Purpose: The purpose of this study was to translate and culturally adapt the Leicester Cough Questionnaire into Swedish and to test the validity and reliability of the Swedish version, in patients with chronic obstructive pulmonary disease.

Methods: The original Leicester Cough Questionnaire was translated into Swedish by a method, which followed an established forward-backward procedure, including cross-cultural adaptation and pretest. To test the validity of the final version of Leicester Cough Questionnaire in Swedish, the St George’s Respiratory Questionnaire and the COPD Assessment Test were used (n?=112) and to test reliability, the questionnaire was repeated (n?=?86).

Results: The Leicester Cough Questionnaire in Swedish showed proof of construct validity and proof of internal consistency (Cronbach’s alpha coefficient 0.97). All domains and total scores had good-excellent test-retest reliability (intra-class correlation coefficient 2,1?>?0.94). The standard error of measurement, (standard error of measurement percent), for the Leicester Cough Questionnaire in Swedish was 0.84 (5.15%). The smallest real difference, (smallest real difference percent), derived from cross sectional standard error of measurement was 2.33 (14.25%). The Bland–Altman plot indicated no systemic change in the mean.

Conclusion: The Leicester Cough Questionnaire in Swedish is a valid and reliable instrument to measure health-related quality of life in patients with chronic obstructive pulmonary disease and can be used in clinical settings.

• Implications for Rehabilitation

• The Leicester Cough Questionnaire, has been translated into Swedish, following an established forward-backward procedure, including cross-cultural adaptation

• The Swedish version of the Leicester Cough Questionnaire, is a valid, reliable instrument for measuring health-related quality of life regarding cough in patients with chronic obstructive pulmonary disease

• The Swedish version of the Leicester Cough Questionnaire is easy to administer and can be used in clinical and rehabilitation settings and for research purposes

• The absolute reliability presented at group and individual levels to indicate a real improvement is an advantage to assist when interpreting a clinically relevant difference

     

Reliability and responsiveness of measures of pain in people with osteoarthritis of the knee: a psychometric evaluation

Purpose: To examine the fit between data from the Short Form McGill Pain Questionnaire (SF-MPQ-2) and the Rasch model, and to explore the reliability and internal responsiveness of measures of pain in people with knee osteoarthritis. Methods: Participants with knee osteoarthritis completed the SF-MPQ-2, Intermittent and Constant Osteoarthritis Pain questionnaire (ICOAP) and painDETECT. Participants were sent the same questionnaires 3 and 6 months later. Results: Fit to the Rasch model was not achieved for the SF-MPQ-2 Total scale. The Continuous subscale yielded adequate fit statistics after splitting item 10 on uniform DIF for gender, and removing item 9. The Intermittent subscale fit the Rasch model after rescoring items. The Neuropathic subscale had relatively good fit to the model. Test–retest reliability was satisfactory for most scales using both original and Rasch scoring ranging from fair to substantial. Effect sizes ranged from 0.13 to 1.79 indicating good internal responsiveness for most scales. Conclusions: These findings support the use of ICOAP subscales as reliable and responsive measure of pain in people with knee osteoarthritis. The MPQ-SF-2 subscales found to be acceptable alternatives.

• Implications for Rehabilitation

• The McGill Pain Questionnaire short version 2 is not a unidimensional scale in people with knee osteoarthritis, whereas three of the subscales are unidimensional.

• The McGill Pain Questionnaire short version 2 Affective subscale does not have good measurement properties for people with knee osteoarthritis.

• The McGill Pain Questionnaire short version 2 and the Intermittent and Constant Osteoarthritis Pain scales can be used to assess change over time.

• The painDETECT performs better as a screening measure than as an outcome measure.

     

Rasch validation of the Arabic version of the lower extremity functional scale

Purpose: The purpose of this study was to examine the internal construct validity of the Arabic version of the Lower Extremity Functional Scale (20-item Arabic LEFS) using Rasch analysis.

Methods: Patients (n?=?170) with lower extremity musculoskeletal dysfunction were recruited. Rasch analysis of 20-item Arabic LEFS was performed. Once the initial Rasch analysis indicated that the 20-item Arabic LEFS did not fit the Rasch model, follow-up analyses were conducted to improve the fit of the scale to the Rasch measurement model. These modifications included removing misfitting individuals, changing item scoring structure, removing misfitting items, addressing bias caused by response dependency between items and differential item functioning (DIF).

Results: Initial analysis indicated deviation of the 20-item Arabic LEFS from the Rasch model. Disordered thresholds in eight items and response dependency between six items were detected with the scale as a whole did not meet the requirement of unidimensionality. Refinements led to a 15-item Arabic LEFS that demonstrated excellent internal consistency (person separation index [PSI]?=?0.92) and satisfied all the requirement of the Rasch model.

Conclusion: Rasch analysis did not support the 20-item Arabic LEFS as a unidimensional measure of lower extremity function. The refined 15-item Arabic LEFS met all the requirement of the Rasch model and hence is a valid objective measure of lower extremity function. The Rasch-validated 15-item Arabic LEFS needs to be further tested in an independent sample to confirm its fit to the Rasch measurement model.

• Implications for Rehabilitation

• The validity of the 20-item Arabic Lower Extremity Functional Scale to measure lower extremity function is not supported.

• The 15-item Arabic version of the LEFS is a valid measure of lower extremity function and can be used to quantify lower extremity function in patients with lower extremity musculoskeletal disorders.

     

Cross-cultural adaptation and validation of the Arabic version of the knee outcome survey-activities for daily living scale

Purpose: The purpose of this study is to cross-culturally adapt the Knee Outcome Survey-Activities of Daily Living Scale into Arabic and to assess its psychometric properties (internal consistency, reliability, validity, and responsiveness) in patients with knee disorders.

Methods: The cross-cultural adaptation process for the Knee Outcome Survey-Activities of Daily Living Scale into Arabic was performed consistent with the published guidelines. The psychometric properties of this Arabic version were then evaluated. Participants completed this version three times: at baseline, 2–4 days later, and 4?weeks later. Correlations between the Arabic version of Knee Outcome Survey-Activities of Daily Living Scale and the Arabic version of the Short Form-36 Health Survey, Get Up and Go, and Ascending/Descending stairs tests were evaluated.

Results: Linguistic and cultural issues were addressed. The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale demonstrated excellent internal consistency (Cronbach’s alpha?=?0.97) and excellent test–retest reliability (intraclass correlation coefficient?=?0.97). Construct validity of the Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale with the Arabic version of Short Form-36 Health Survey subscales ranged from r?=?0.28 to 0.53, p?r?=??0.47 to ?0.60, p?Conclusions: The Arabic version of the Knee Outcome Survey-Activities of Daily Living Scale is a reliable, valid and responsive measure for assessing knee-related symptoms and functional limitations

• Implications for rehabilitation

• The Knee Outcome Survey-Activities of Daily Living Scale-Arabic is a reliable, valid and responsive measure for assessing knee-related functional limitations.

• This Arabic version can be used in clinical practice and for research purposes to assess symptoms and functional limitations in Arabic-speaking patients with knee disorders.

• This scale is responsive to track therapeutic outcome of Arabic-speaking patients with knee disorders.

     

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke

Purpose: Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis. Methods: A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM^?). Results: Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed “activities” and “participation” components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach’s α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM^?. Conclusions: WHODAS-II provides a reliable and valid instrument for measuring disability and components of “activities” and “participation” in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.

Implications for Rehabilitation

• The impact of stroke on patients’ functioning in terms of activities and participation is important in the postacute and long-term rehabilitation phase.

• The World Health Organization Disability Assessment Schedule (WHODAS-II) was developed specifically to measure activities and participation.

• Psychometric properties of the WHODAS-II in stroke have received some attention recently, mostly using classical approaches.

• This study has tested the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis and it has been found that WHODAS-II provides a reliable and valid instrument for measuring functioning and components of “activities” and “participation” in stroke survivors.

     

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.

     

Brazilian Portuguese version of the Revised Fibromyalgia Impact Questionnaire (FIQR-Br): cross-cultural validation,reliability, and construct and structural validation

Purpose: This study aimed to culturally adapt and validate the Revised Fibromyalgia Impact Questionnaire (FIQR) to Brazilian Portuguese, by the use of analysis of internal consistency, reliability, and construct and structural validity.

Method: A total of 100 female patients with fibromyalgia participated in the validation process of the Brazilian Portuguese version of the FIQR (FIQR-Br).The intraclass correlation coefficient (ICC) was used for statistical analysis of reliability (test–retest), Cronbach’s alpha for internal consistency, Pearson’s rank correlation for construct validity, and confirmatory factor analysis (CFA) for structural validity.

Results: It was verified excellent levels of reliability, with ICC greater than 0.75 for all questions and domains of the FIQR-Br. For internal consistency, alpha values greater than 0.70 for the items and domains of the questionnaire were observed. Moderate (0.40?r?r?>?0.70) correlations were observed for the scores of domains and total score between the FIQR-Br and FIQ-Br. The structure of the three domains of the FIQR-Br was confirmed by CFA.

Conclusions: The results of this study suggest that that the FIQR-Br is a reliable and valid instrument for assessing fibromyalgia-related impact, and supports its use in clinical settings and research. The structure of the three domains of the FIQR-Br was also confirmed.

• Implications for Rehabilitation

• Fibromyalgia is a chronic musculoskeletal disorder characterized by widespread and diffuse pain, fatigue, sleep disturbances, and depression. The disease significantly impairs patients’ quality of life and can be highly disabling.

• To be used in multicenter research efforts, the Revised Fibromyalgia Impact Questionnaire (FIQR) must be cross-culturally validated and psychometrically tested. This paper will make available a new version of the FIQR-Br since another version already exists, but there are concerns about its measurement properties.

• The availability of an instrument adapted to and validated for Brazilian Portuguese may make it possible to reliably verify the effects of rehabilitation programs on disability from fibromyalgia.

• The FIQR-Br showed results comparable with other versions of the FIQR in other languages, thereby enabling comparison of effects of rehabilitation interventions on disability from fibromyalgia conducted in Brazil with results of studies carried out in other parts of the world.

     

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.

     

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.

     

Measurement properties of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ): a study based on Classical Test Theory

Purpose: The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated.

Method: 112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs).

Results: For construct validity (N?=?105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2).

Conclusion: The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.

• Implications for Rehabilitation

• The Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).

• Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.

• The equivalence of scores from online, paper or interview administration is supported.

• A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient.

     

Quality of life for post-polio syndrome: a patient derived,Rasch standard scale

Objective: To design a disease-specific quality of life (QoL) questionnaire for people with post-polio syndrome (PPS).

Methods: Qualitative interviews were conducted with 45 people with PPS to identify themes and derive potential items reflecting impact upon QoL. After cognitive debriefing, these were made into a questionnaire pack along with comparative questionnaires and posted to 319 patients. The 271 (85%) returned questionnaires were subjected to exploratory factor analysis (EFA) and Rasch analysis.

Results: A 25 item scale, the post-polio quality of life scale (PP-QoL), showed good fit to the Rasch model (conditional chi-square p?=?0.156), unidimensionality (% t-tests 2.0: CI 0.7–3.8), and Cronbach’s alpha of 0.87. With the latent estimate transformed to a 0–100 scale, the mean score was 56.9 (SD 18.5) with only 3.3% of respondents at the floor or ceiling of the scale. Test–retest reliability showed an intraclass correlation coefficient (ICC) (2.1) of 0.916, and correlation of 0.85.

Conclusion: The disease-specific PP-QoL demonstrated excellent reliability, appropriate concurrent validity, and satisfied the standards of the Rasch model. It enables examination of the impact of health status upon perceived QoL, and the impact of rehabilitation interventions. The scale is freely available for academic or not-for-profit users to improve research in this neglected, disabling condition.

• Implications for Rehabilitation

• In post-polio syndrome (PPS), existing work examines aspects of health-related quality of life (HRQoL), such as activity limitations.

• A disease-specific QoL measure would enable researchers to model the impact of health status, such as fatigue or mobility restrictions, upon QoL in PPS.

• The post-polio quality of life scale (PP-QoL) is based on the patients’ lived experience, meets Rasch standards and is free for use for academic and not-for-profit researchers.

• The raw score is reliable for individual use in clinical settings, and interval scale transformation is available for parametric applications and the calculation of change scores.

     

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.

     

Child engagement in daily life: a measure of participation for young children with cerebral palsy

Abstract

Purpose: The objectives of this study were to determine the: (1) internal consistency and test–retest reliability of the Child Engagement in Daily Life measure; (2) construct validity of the measure (known groups methods), that is, the ability of the measure to discriminate participation in family and recreational activities and self-care among young children of varying age and motor ability and between children with and without cerebral palsy, and (3) stability and hierarchical ordering of the items for young children with CP to devise an interval-level scoring system. Methods: 429 children with CP and their parents and 110 parents of children without CP participated in this methodological study. Parents completed the Child Engagement in Daily Life measure and therapists assessed the children's gross motor function. Rasch analysis was used to create an interval-level measure. Results: Children's frequency in and enjoyment of participation in family and recreational activities and self-care varied by age and gross motor ability. Internal consistency of the domains of the measure was high, Cronbach alpha values ranging from 0.86 to 0.91; test–retest for participation in family and recreational activities was acceptable, ICC?=?0.70, and in self-care was high, ICC?=?0.96. The items in the measure had a good fit and a logical hierarchical ordering. Conclusion: Study results support the validity and reliability of the Child Engagement in Daily Life measure as an assessment of participation in family and recreational activities and self-care for young children with CP.

• Implications for Rehabilitation

• Participation in family and recreational activities and self-care for young children with cerebral palsy can be reliably and validly assessed using the Child Engagement in Daily Life measure.

• Service providers are encouraged to support young children's participation in family and recreational activities and self-care.

     

The Spanish lower extremity functional scale: A reliable,valid and responsive questionnaire to assess musculoskeletal disorders in the lower extremity

Abstract

Purpose: The Lower Extremity Functional Scale (LEFS) is a widely used questionnaire to evaluate the functional impairment of a patient with a disorder of one or both lower extremities. It also can be used to monitor the patient over time and to evaluate the effectiveness of an intervention. Nevertheless there is no Spanish version of the LEFS, so the aim of this study was the translation and cross-cultural adaption of the Spanish version of the LEFS and to evaluate its psychometrics properties. Methods: The questionnaire was cross cultural adapted into Spanish. The psychometric properties tested in the Spanish version of the LEFS were: internal consistency, test–retest reliability, constructs validity, discriminative validity, responsiveness, concurrent validity and floor and ceiling effects in 132 participants seeking for treatment due to lower extremity dysfunction. Results: The Spanish version of the LEFS had high internal consistency (Cronbach’s α?=?0.989), test–retest reliability (ICC?=?0.998, 95% CI: 0.996–0.999) and presented a high correlation with the SF-36 (36-Item Short-Form Health Survey) especially with the physical function and pain subscales. The construct validity showed a single factor that account for 84.95% of the variance. The standard error of measurement of the Spanish version of the LEFS was 0.88 scale points (95% CI) and the minimal detectable change was 2.18 scale points (95% CI). The sample, collected from five Spanish physical therapy centers, was divided in groups (acute, sub-acute and chronic subjects). Within group changes showed a significant improvement on the LEFS score (p?<?0.001) and effect sizes were large in all conditions. The LEFS allowed to distingue between acute and not acute conditions; for this criterion ROC curve was performed at baseline (area under the curve [AUC]?=?0.95). There was no floor or ceiling effects. Conclusions: The Spanish version of the LEFS has been shown to be a valid and reliable tool to assess musculoskeletal dysfunction in the lower extremity that could be used with Spanish speaker population.

• Implications for Rehabilitation

• Cross-cultural adaptation of a self-reported questionnaire to evaluate musculoskeletal lower extremity disorders in the Spanish population.

• To provide Spanish clinicians and physiotherapists a useful tool to assess the lower extremity function.

• To provide Spanish researchers a valid tool for research on lower extremity function: patient’s improvement due to treatment, compare results obtained between populations, treatment.

     

Mental health,health related quality of life and recurrent musculoskeletal pain in children with cerebral palsy 8–18 years old

Purpose: To extend knowledge on mental health with children’s self-report and explore mental health and health related quality of life (HRQL) in a context of recurrent musculoskeletal pain in cerebral palsy (CP). Method: Eighty-three participants, mean age 14.2?±?2.8 years, were assessed with clinical examination, interview and questionnaires. Gross motor function was GMFCS level I 42%, level II 42%, level III 12% and level IV–V 5%. Children self-reported mental health on SDQ (Strengths and Difficulty Questionnaire), HRQL on PedsQL (Pediatric Quality of Life), and pain on CHQ (Child Health Questionnaire). Mothers proxy-reported on the same questionnaires and reported own mental health on GHQ (General Health Questionnaire). Results: Both self-reported mental health and HRQL was better than proxy-reported. Recurrent musculoskeletal pain was associated with more mental health problems and reduced HRQL in self-reports, but not in proxy-reports. Conclusions: In CP, the importance of child-report on mental health and HRQL when possible, in addition to parent proxy-report, cannot be overstated. Close co-operation between (re)habilitation and child psychiatry is urgent. Further research on self-reported mental health and impact of mental health problems is warranted together with a focus on the impact of recurrent musculoskeletal pain on participation.

Implications for Rehabilitation

• Children with cerebral palsy experience musculoskeletal pain that is associated with more self-reported mental health problems and lower HRQL.

• Because mothers tend to not recognise these associations, self-report (when possible) is essential.

• A bio-psycho-social perspective in both individual and family approach is important because of the associations mentioned and because parents report that their children have a high prevalence of mental health problems.

• Assessment of HRQL has the potential to capture both pain and mental health problems, and should be an integrated part of the systematic clinical follow-up.

     

Validity and reliability of a novel measure of activity performance and participation

Purpose: To develop and evaluate an innovative clinician-rated measure, which produces global numerical ratings of activity performance and participation. Method: Repeated measures study with 48 community-dwelling participants investigating clinical sensibility, comprehensiveness, practicality, inter-rater reliability, responsiveness, sensitivity and concurrent validity with Barthel Index. Results: Important clinimetric characteristics including comprehensiveness and ease of use were rated >8/10 by clinicians. Inter-rater reliability was excellent on the summary scores (intraclass correlation of 0.95–0.98). There was good evidence that the new outcome measure distinguished between known high and low functional scoring groups, including both responsiveness to change and sensitivity at the same time point in numerous tests. Concurrent validity with the Barthel Index was fair to high (Spearman Rank Order Correlation 0.32–0.85, p?>?0.05). The new measure’s summary scores were nearly twice as responsive to change compared with the Barthel Index. Other more detailed data could also be generated by the new measure. Conclusions: The Activity Performance Measure is an innovative outcome instrument that showed good clinimetric qualities in this initial study. Some of the results were strong, given the sample size, and further trial and evaluation is appropriate.

• Implications for Rehabilitation

• The Activity Performance Measure is an innovative outcome measure covering activity performance and participation.

• In an initial evaluation, it showed good clinimetric qualities including responsiveness to change, sensitivity, practicality, clinical sensibility, item coverage, inter-rater reliability and concurrent validity with the Barthel Index.

• Further trial and evaluation is appropriate.