Reproducibility of the ABILOCO Questionnaire and Comparison Between Self-Reported and Observed Locomotion Ability in Adult Patients With Stroke

Caty GD, Theunissen E, Lejeune TM. Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

Objectives

To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist.

Design

Prospective study.

Setting

University hospital.

Participants

Adult stroke patients (N=28; 59±13y). The time since stroke ranged from 3 to 253 weeks.

Interventions

Not applicable.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively).

Conclusions

The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.     

Assessing Locomotion Ability in West African Stroke Patients: Validation of ABILOCO-Benin Scale

Objective

To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.

Design

Prospective study and questionnaire development.

Setting

Rehabilitation centers.

Participants

Stroke patients (N=230; mean age ± SD, 51.1±11.6y; 64.3% men).

Intervention

Not applicable.

Main Outcome Measures

Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as “impossible,” “difficult,” or “easy.” The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.

Results

Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).

Conclusions

ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients.     

Rasch analysis of the barthel index in the assessment of hospitalized older patients after admission for an acute medical condition

de Morton NA, Keating JL, Davidson M. Rasch analysis of the Barthel Index in the assessment of hospitalized older patients after admission for an acute medical condition.

Objective

To investigate the validity of item score summation for the original and modified versions of the Barthel Index.

Design

Rasch analysis of Barthel Index data.

Setting

General medical wards at 2 acute care hospitals in Australia.

Participants

Consecutive older medical patients (N=396).

Interventions

Not applicable.

Main Outcome Measures

Activity limitation was assessed by using the Barthel Index at hospital admission and discharge. At 1 hospital site, the original Barthel Index was used, and at the other hospital site the Modified Barthel Index (MBI) was used.

Results

More than half of the items showed misfit to the Rasch model for both versions of the Barthel Index. The continence items appear to measure a different construct to the other items. After the removal of the continence items, data for the remaining items still did not fit the Rasch model. Neither the original nor the MBI are unidimensional scales. An exception to this occurred when the original Barthel Index was rescored and only then for discharge and not for admission Barthel Index data.

Conclusions

Because clinicians do not typically rescore outcomes obtained by using the Barthel Index, these findings, combined with unacceptable ceiling effects, render the Barthel Index an assessment tool with limited validity for measuring and monitoring the health of older medical patients.     

A Measure of Physical Functioning to Define Stroke Recovery at 3 Months: Preliminary Results

Finch LE, Higgins J, Wood-Dauphinee SL, Mayo NE. A measure of physical functioning to define stroke recovery at 3 months: preliminary results.

Objective

To develop a physical functioning measure through Rasch analysis conceptualized using the International Classification of Functioning, Disability and Health (ICF).

Design

Observational cohort study.

Setting

Acute-hospital and community-based study.

Participants

Subjects (N=235) hospitalized with postacute stroke and reassessed in the community at 3-months (mean age, 71.6±12.9y).

Interventions

None.

Main Outcome Measures

Functional assessments 3 months poststroke included self-report and observational indices and tests commonly used to evaluate stroke survivors. Sociodemographic information was also collected. Rasch analysis assisted in combining the items across ICF components to develop the measure. Items were retained based on fit to the model and relationship to the construct; reliability and validity were assessed.

Results

The best 44 items formed the Physical Functioning Measure at 3 months (F3m) measure of functioning evaluating limb movement, balance, activities of daily living, and participation. All Rasch model assumptions were met. Both item and person reliably (.96) indicated a stable hierarchy, while precision varied from .51 to 1.2 logits. Early evidence for construct validity is adequate.

Conclusions

The F3m combines patient reported and observed ratings of performance items into a single measure quantifying functioning with good preliminary psychometric properties that with further testing can assist in directing and evaluating interventions and recovery.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

Rasch Analysis of the Executive Interview (The EXIT-25) and Introduction of an Abridged Version (The Quick EXIT)

Larson EB, Heinemann AW. Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick Exit).

Objectives

To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties.

Design

Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25.

Setting

A large, urban, academic free-standing rehabilitation facility.

Participants

The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27).

Interventions

Not applicable.

Main Outcome Measures

The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B.

Results

Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity.

Conclusions

The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.     

Rating scale analysis of the Berg Balance Scale

Kornetti DL, Fritz SL, Chiu Y-P, Light KE, Velozo CA. Rating scale analysis of the Berg Balance Scale. Arch Phys Med Rehabil 2004;85:1128-35.

Objectives

To examine, using Rasch analysis, the rating scale performance of the Berg Balance Scale (BBS) and to describe the 45/56 cutoff score in functional terms.

Design

Retrospective chart review of BBS scores. Rasch rating scale analysis was performed on these data.

Setting

Outpatient Veterans Affairs medical center.

Participants

One hundred (99 men, 1 woman) community-dwelling veterans referred for balance deficits (age range, 64-88y).

Interventions

Not applicable.

Main outcome measure

The BBS.

Results

Condensing item-rating categories allowed the elimination of underutilized categories and constructed categories that better separated people of differing abilities. Rating pivot points were developed for each item to represent a transition between passing and failing. Following pivot-point development and rating scale rescoring, person and item measures became more evenly distributed across the BBS and resulted in changes in item difficulty order. In our sample, functional indicators of a score of at least 45/56 were a rating of passing the item “tandem stance,” as well as passing 2 of the following 3 items: “alternating foot,” “standing on one leg,” and “look behind.”

Conclusions

Our findings provide direction for improving the rating scale structure for each of the items and establish a connection between the BBS cutoff score of 45/56 and functional ability.     

Differential Performance of SF-36 Items in Healthy Adults With and Without Functional Limitations

Horner-Johnson W, Krahn GL, Suzuki R, Peterson JJ, Roid G, Hall T, the RRTC Expert Panel on Health Measurement. Differential performance of SF-36 items in healthy adults with and without functional limitations.

Objective

To determine whether Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) items show differential item functioning among healthy adults with various types of functional limitations as compared with a healthy sample with no identified limitations.

Design

Survey responses were analyzed by using partial correlations.

Setting

General community.

Participants

Participants (N=206) included (1) adults with spinal cord injury (SCI), (2) adults who were deaf or hard of hearing, (3) adults who were legally blind, (4) adults with psychiatric or emotional conditions, and (5) adults with no reported functional limitations. Participants were screened to ensure the absence of substantial health problems.

Interventions

Not applicable.

Main Outcome Measure

SF-36.

Results

Partial correlations showed a significant negative correlation, indicating differential item functioning (ie, apparent bias) for people with SCI on all 10 SF-36 Physical Functioning items. For people who were blind, 5 items showed a significant negative correlation. Two items had significant negative correlations for the deaf/hard-of-hearing group. One item showed significant negative performance for people with mental health conditions.

Conclusions

Our data indicated a possibility for measurement bias caused by the blending of health and function concepts in the SF-36.     

Patient-Reported Cognitive and Communicative Functioning: 1 Construct or 2?

Hula WD, Doyle PJ, Austermann Hula SN. Patient-reported cognitive and communicative functioning: 1 construct or 2?

Objectives

To examine the dimensionality of scales for measuring patient-reported cognitive and communicative functioning in a sample of stroke survivors and to evaluate the consequences for measurement of treating them as a single, undifferentiated construct.

Design

Secondary analysis of existing cross-sectional data.

Setting

Data were collected in outpatient rehabilitation clinics and in the community.

Participants

Unilateral stroke survivors (N=316) 3 months or more postonset referred for participation in research.

Interventions

Not applicable.

Main Outcome Measures

The Burden of Stroke Scale cognition and communication domain scales were evaluated by using confirmatory factor analysis, Rasch analysis, and tests of differential item functioning (DIF). To evaluate the impact of multidimensionality on the measurement of individual patients, separately estimated cognition and communication scores were compared. Combined and separately estimated scores were also examined for responsiveness to group differences in the presence of cognitive and communicative impairment.

Results

Factor analysis and Rasch model fit analyses equivocally supported the unidimensionality of the item pool. DIF analyses between participants with right versus left hemisphere stroke suggested multidimensionality. Scaling cognition and communication items separately resulted in different person scores for a significant number of patients and greater responsiveness to group differences.

Conclusions

Patient-reported scales assessing communication along with more general cognitive activities may possess an internal structure that is inconsistent with a unidimensional measurement model with potential negative consequences for measurement.     

Using the Rasch model in nursing research: An introduction and illustrative example

Objective

The purpose was to introduce the Rasch model by showing an application in nursing research.

Methods

The Rasch model was used to examine the psychometric properties of the nursing self-efficacy (NSE) scale. Data were collected among nursing students in Sweden. Two sets of items were analysed more thoroughly: an original set of nine items with eleven response categories and a revised set of seven items with seven response categories. Invariance of the item functioning and the categorisation of the items were analysed. Targeting was examined by comparisons of the items and persons locations. Differential Item Functioning across sample groups such as gender was examined using analysis of variance. The final set of seven items was also analysed more closely with respect to possible multidimensionality and response dependence.

Results

The Rasch analysis of the original set of nine items showed high reliability measured by a person separation index, but it also indicated severe problems with the targeting, the categorisation of the items as well as lack of invariance. Although the revised set comprising seven items with seven categories performed better than the original item set some items showed misfit according to formal test statistics. Graphical examination showed, however, that the items operated in the right direction. The formal test of local independence of the items indicated minor signs of multidimensionality, alternatively response dependence.

Conclusions

The Rasch model is useful for rigorous examination and development of measurement instruments in nursing research. The Rasch model facilitates disclosure of lack of invariance and other measurement problems that may not be easily detected by traditional analyses. Hence, the NSE-scale would probably have performed much better if the developmental work had been guided by Rasch analyses. In future work on the scale, priority should be given to improving the targeting and the categorisation of the items.     

Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease

Jeger RV, Rickenbacher P, Pfisterer ME, Hoffmann A. Outpatient rehabilitation in patients with coronary artery and peripheral arterial occlusive disease.

Objective

To assess participation rates and outcome in outpatient cardiac rehabilitation (OCR) of patients with peripheral arterial occlusive disease (PAOD).

Design

Prospective cohort study.

Setting

Referral center, ambulatory care.

Participants

All patients undergoing OCR at 2 university hospitals in Switzerland from March 1999 to August 2005.

Intervention

OCR during 3 months.

Main Outcome Measures

Primary endpoints were workload during bicycle stress test and quality of life (QOL), both at the end of OCR. Secondary endpoints were complications during OCR and termination of OCR.

Results

Of 1508 patients, 99 (7%) had PAOD (27 with Fontaine stage I, 69 with stage II, 3 with stage III). Patients with PAOD were older, had more cardiovascular risk factors, and were more likely to have undergone cardiac bypass grafting than those without PAOD. PAOD patients at OCR entry achieved a lower exercise workload than non-PAOD patients (PAOD patients, 105±31W and 69%±17% of target vs non-PAOD patients, 125±38W and 79%±19%; P<.001) but both groups achieved similar gains in exercise capacity at the end of OCR (PAOD patients, 126±44W and 82%±25% vs non-PAOD patients, 153±48W and 98%±24%; P<.001). For both groups, QOL was similar at baseline and follow-up, and improved equally in most dimensions. OCR was discontinued more often in patients with PAOD than in those without (18% vs 10%, P=.018). Cardiac and noncardiac complication rates were similar.

Conclusions

Patients with PAOD undergoing OCR have a similar benefit but higher dropout rates than other patients. Thus, PAOD patients should be encouraged to participate in OCR, possibly by creating specifically tailored concepts.     

Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.

Objective

To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.

Design

Intervention study with crossover design.

Setting

University research center.

Participants

Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.

Intervention

Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).

Main Outcome Measures

Physical function, gait, dynamic balance.

Results

The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.

Conclusions

Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.     

Application of Rasch Analysis to Examine Psychometric Aspects of the Activities-Specific Balance Confidence Scale When Used in a New Cultural Context

Arnadottir SA, Lundin-Olsson L, Gunnarsdottir ED, Fisher AG. Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context.

Objective

To investigate by using Rasch analysis the psychometric properties of the Activities-Specific Balance Confidence (ABC) Scale when applied in a new Icelandic context.

Design

Cross-sectional, population-based, random selection from the Icelandic National Registry.

Setting

Community-based.

Participants

Icelanders (N=183), 65 to 88 years old, and 48% women.

Interventions

Not applicable.

Main Outcome Measure

ABC, an instrument used to evaluate how confident older people are in maintaining balance and remaining steady when moving through the environment. An Icelandic translation of the ABC (ABC-ICE) scale was evaluated by implementing Rasch rating scale analysis to transform ordinal ABC-ICE scores into interval measures and evaluating aspects of validity and reliability of the scale.

Results

Participants were not able to differentiate reliably between the 11 rating scale categories of the ABC-ICE. Additionally, 3 items failed to show acceptable goodness of fit to the ABC-ICE rating scale model. By collapsing categories and creating a new 5-category scale, only 1 item misfit. Removing that item resulted in a modified version of ABC-ICE with 5 categories and 15 items. Both item goodness-of-fit statistics and principal components analysis supported unidimensionality of the modified ABC-ICE. The ABC-ICE measures reliably separated the sample into at least 4 statistically distinct strata of balance confidence. Finally, the hierarchical order of item difficulties was consistent with theoretic expectations, and the items were reasonably well targeted to the balance confidence of the persons tested.

Conclusions

Rasch analysis indicated a need to modify the ABC-ICE to improve its psychometric properties. Further studies are needed to determine if similar analyses of other versions of the ABC, including the original one, will yield similar results.     

Community Reintegration in Rehabilitated South Indian Persons With Spinal Cord Injury

Samuelkamaleshkumar S, Radhika S, Cherian B, Elango A, Winrose W, Suhany BT, Prakash MH. Community reintegration in rehabilitated South Indian persons with spinal cord injury.

Objectives

To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables.

Design

Survey.

Setting

Rehabilitation center of a tertiary care university teaching hospital.

Participants

Community-dwelling persons with SCI (N=104).

Interventions

Not applicable.

Main Outcome Measures

Craig Handicap Assessment and Reporting Technique (CHART).

Results

The mean scores for each CHART domain were physical independence 98±5, social Integration 96±11, cognitive independence 92±17, occupation 70±34, mobility 65±18, and economic self sufficiency 53±40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration.

Conclusions

Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Prevalence of Malingering in Patients With Chronic Pain Referred for Psychologic Evaluation in a Medico-Legal Context

Greve KW, Ord JS, Bianchini KJ, Curtis KL. Prevalence of malingering in patients with chronic pain referred for psychologic evaluation in a medico-legal context.

Objective

To provide an empirical estimate of the prevalence of malingered disability in patients with chronic pain who have financial incentive to appear disabled.

Design

Retrospective review of cases.

Setting

A private neuropsychologic clinic in a southeastern metropolitan area.

Participants

Consecutive patients (N=508) referred for psychologic evaluation related to chronic pain over a 10-year period (1995-2005).

Interventions

Not applicable.

Main Outcome Measures

Prevalence of malingering was examined using 2 published clinical diagnostic systems (Malingered Pain-Related Disability and Malingered Neurocognitive Dysfunction) as well as statistical estimates based on well validated indicators of malingering.

Results

The prevalence of malingering in patients with chronic pain with financial incentive is between 20% and 50% depending on the diagnostic system used and the statistical model's underlying assumptions. Some factors associated with the medico-legal context such as the jurisdiction of a workers' compensation claim or attorney representation were associated with slightly higher malingering rates.

Conclusions

Malingering is present in a sizable minority of patients with pain seen for potentially compensable injuries. However, not all excess pain-related disability is a result of malingering. It is important not to diagnose malingering reflexively on the basis of limited or unreliable findings. A diagnosis of malingering should be explicitly based on a formal diagnostic system.     

Psychometric Validation of the Manual Ability Measure-36 (MAM-36) in Patients With Neurologic and Musculoskeletal Disorders

Chen CC, Bode RK. Psychometric validation of the Manual Ability Measure-36 (MAM-36) in patients with neurologic and musculoskeletal disorders.

Objectives

To evaluate the psychometric properties of the Manual Ability Measure-36 (MAM-36), a new hand function outcome measure, and to examine differences in manual abilities and item parameters in patients with neurologic and musculoskeletal conditions.

Design

Convenience sample from 2 time periods, cross-sectional.

Setting

Outpatient rehabilitation units and private hand clinics.

Participants

Patients (N=337; mean age, 50.3±14.9y) with a variety of neurologic and musculoskeletal (orthopedic) diagnoses. Most of these individuals were community dwelling, and all had residual functional limitations in the hand(s).

Interventions

Not applicable.

Main Outcome Measures

Rasch analysis was performed on MAM-36 data to evaluate both scale structure and psychometric properties, which include rating distribution, step measures, item fit, separation, and dimensionality. A t test was performed to examine the differences in manual abilities in patients with the 2 conditions. Uniform differential item functioning (DIF) between neurologic and musculoskeletal groups was examined. (DIF occurs when subgroup members within the sample with the same level of the underlying trait being measured respond differently to an individual item.) Manual ability estimates were recalibrated with step and common item anchoring; they were compared with those derived from the original analysis.

Results

The 36 items measured a single construct with no misfitting items. The scale was used as intended. The items can reliably separate the participants into 5 ability strata. Neurologic patients had a significantly lower mean manual ability than musculoskeletal patients. Fourteen items exhibited DIF. However, DIF had no effect on either scale quality or calibration of manual ability. We decided that a single rating scale is appropriate for both groups.

Conclusions

This study showed that the MAM-36 has more than adequate psychometric properties and can be used as a generic outcome measure for patients with a wide variety of clinical diagnoses.     

The clinical learning environment and supervision instrument (CLES): validity and reliability of the Dutch version (CLES+NL)

Background

The clinical learning environment and supervision scale (CLES) is a valid and reliable tool that was developed to assess the quality of nursing students’ clinical placements.

Objectives

To obtain a reliable and valid Dutch version of the CLES that is in line with the Flemish culture and educational context.

Design

Scale validation study on data provided by a cross-sectional survey.

Settings

190 wards in 31 institutions for healthcare in Flanders, Belgium.

Participants

768 student nurses enrolled in the 3 year bachelor programme at University College Ghent, Faculty of Healthcare Vesalius.

Methods

Face and content validation was followed by data collection. Factor analysis was performed using varimax rotation. Subsequently, internal consistency reliability was tested on the total scale and its subdimensions using Cronbach's alpha.

Results

We gathered 768 questionnaires. Factor analysis revealed 5 subdimensions with an eigenvalue greater than 1, explaining 71.281% of the variance. The overall internal consistency and the consistency of the five subdimensions is high. Our data supports face, content and construct validity of the CLES + NL.

Conclusions

The CLES + NL is a valid and reliable instrument that can be used to evaluate the quality of nursing wards as learning environments in Flanders.     

A preliminary investigation of physiotherapy students’ attitudes towards issues of sexuality in clinical practice

Objectives

To investigate the attitudes of physiotherapy students to a variety of clinical interactions that have sexual connotations.

Design

A questionnaire was distributed that required students to indicate their anticipated level of comfort in a variety of situations. Third and fourth year students were also asked whether they perceived that their degree programme had dealt with each of these issues adequately.

Setting

One university in Australia.

Participants

Three hundred and thirty-three first, second, third and fourth year students enrolled in an undergraduate physiotherapy degree programme.

Main outcome measure

A modified version of Cohen's Comfort Scale Questionnaire.

Results

Over half of the students anticipated that they would not feel comfortable in dealing with the issues raised in nine of the 19 sexually themed items. The three items that students endorsed as the least comfortable were ‘walking in on a patient/client who is masturbating’ (95%), ‘dealing with a patient/client who makes an overt sexual remark’ (74%) and ‘dealing with a patient/client who makes a covert sexual remark’ (68%). Significant gender differences were identified for five of the items. Over 90% of third and fourth year students considered that their degree programme had not dealt with five of the items. Although approximately one-third of senior students thought that their degree programme had covered dealing with overt (33%) and covert (32%) sexual comments adequately, these items were still rated as eliciting a high level of discomfort.

Conclusions

Feelings of discomfort when interacting with clients can impact negatively on service provision and could be a major barrier to appropriate therapeutic intervention. Future research examining the nature and origin of discomfort in clinical settings and the role of undergraduate education in decreasing discomfort is warranted.     

Psychometric Evaluation of the Rasch-Based Depression Screening in Patients With Neurologic Disorders

Forkmann T, Norra C, Wirtz M, Gauggel S, Boecker M. Psychometric evaluation of the Rasch-based depression screening in patients with neurologic disorders.

Objectives

To provide a first evaluation of the Rasch-Based Depression Screening (DESC) in consecutive patients with neurologic disorders.

Design

Cross-sectional study.

Setting

Hospital specializing in neurologic disorders.

Participants

Eligible patients (N=323; mean age ± SD, 53.4±17.2y; 49.3% women) age 18 years and older.

Interventions

Not applicable.

Main outcome Measures

DESC with 2 parallel versions.

Results

Both versions of the DESC showed good item separation (DESC-I=4.96; DESC-II=4.94) and person separation (DESC-I=2.01; DESC-II=2.14) as well as item separation reliability (DESC-I=.96; DESC-II=.96) and person separation reliability (DESC-I=.80; DESC-II=.82). All items fit the Rasch model (infit and outfit mean squares ≤1.3). There were no signs of violation of unidimensionality. One item of DESC-I showed differential item functioning because of age and 1 item because of sex. Parallel test reliability of the 2 DESC forms was r equal to .92.

Conclusions

The DESC shows good psychometric characteristics that suggest high psychometric quality of the instrument in patients with neurologic disorders. Differential item functioning on single items needs further examination but should not substantially interfere with the valid interpretation of DESC sum scores.