Cross-cultural adaptation to Brazilian Portuguese of the Activity Measure for Post-Acute Care (AM-PAC) short forms for outpatients in rehabilitation

Background

The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions.

Medical rehabilitation in the Netherlands (author's transl)

The present state-of-the-art in "Revalidation" in the Netherlands is described, where the term is used to denote medical rehabilitation including prevocational assessment of physically disabled persons. Sample surveys in 1971/72 revealed insufficient awareness and under-use of existing rehabilitation services. Since then, special emphasis has been placed on out-patient rehabilitation (clinics), with facilities and services being organised so as to serve a region of appr. 300,000 persons each, or an area within a radius of 30 kms from the facility. Organisation and staff schedules of rehabilitation facilities are discussed. Recently, marked preference of the "active" therapists can be noted. As in other countries, further development of the Anglo-Saxon team concept has, in the Netherlands too, given rise to a number of problems which are discussed more fully.     

A family-specific use of the Measure of Processes of Care for Service Providers (MPOC-SP)

OBJECTIVE: To examine the validity and utility of the Dutch Measure of Processes of Care for Service Providers (MPOC-SP) as a family-specific measure. DESIGN: A validation study. SETTING: Five paediatric rehabilitation settings in the Netherlands. MAIN MEASURES: The MPOC-SP was utilized in a general (reflecting on services provided for all clients and clients' families) and family-specific way (filled out in reference to a particular child and his or her family). SUBJECTS: Professionals providing rehabilitation and educational services to children with cerebral palsy. METHODS: For construct validity, Pearson's product-moment correlation coefficients (r ) between the scales were calculated. The ability of service providers to discriminate between general and family-specific ratings was examined by exploration of absolute difference scores. RESULTS: One hundred and sixteen service professionals filled out 240 family-specific MPOC-SPs. In addition, a subgroup of 81 professionals filled out a general MPOC-SP. For each professional, family-specific and general scores were paired, resulting in 151 general-family-specific MPOC-SP pairs. The construct validity analyses confirmed the scale structure: 21 items (77.8%) loaded highest in the original MPOC-SP factors, and all items correlated best and significantly with their own scale score (r 0.565 to 0.897; P<0.001). Intercorrelations between the scales ranged from r = 0.159 to r = 0.522. In total, 94.4% of the mean absolute difference scores between general and family-specific scale scores were larger than the expected difference. CONCLUSION: Service providers were able to discriminate between general and family-specific MPOC-SP item ratings. The family-specific MPOC-SP is a valid measure that can be used for individual evaluation of family-centred services and can be the impetus for family-related quality improvement.     

Parallel short forms for the assessment of activities of daily living in cardiovascular rehabilitation patients (PADL-cardio): development and validation

Purpose: To develop and validate parallel short forms for the assessment of activities of daily living in cardiac rehabilitation patients (PADL-cardio I & II).

Method: PADL-cardio I & II were developed based on a sample of 106 patients [mean age = 57.6; standard deviation (SD)?=?11.1; 72.6% males] using Rasch analysis and validated with a sample of 81 patients (mean age = 59.1; SD = 11.1; 88.9% males). All patients answered PADL-cardio and the Short Form 12 Health Survey.

Results: Both versions of PADL-cardio are composed of 10 items. The fit to the Rasch model was given documented by a non-significant Item-trait interaction score (PADL-cardio I: χ²?=?31.08, df =??30, p = 0.41; PADL-cardio II: χ²?=?45.6, df??=??40, p??=??0.25). The two versions were free of differential item functioning. Person-separation reliability was 0.72/0.78 and unidimensionality was given. The two versions correlated with r?=?0.98 and the correlation between PADL-cardio and the underlying item bank was 0.99 for both versions. Concurrent validity is indicated through correlations with the Short Form 12 Health Survey (r =??0.37 to ?0.40).

Conclusion: PADL-cardio provides a short and psychometrically sound option for the assessment of activities of daily living in cardiovascular rehabilitation patients. The two versions of PADL-cardio are equivalent. Hence, they can be used to reduce practice and retest effects in repeated measurement, facilitating the longitudinal assessment of activities of daily living.

• Implications for Rehabilitation

• New parallel test forms for the assessment of activities of daily living in cardiac rehabilitation (PADL-cardio I & PADL-cardio II) are available.

• PADL-cardio I & II consist of 10 items and are therefore especially timesaving. Concurrent validity is given through correlations with the Short Form Health Survey 12.

• Therapeutic success could be determined more precisely by the parallel forms reducing practice and retest effects.

     

Brazilian versions of the Measure of Processes of Care-20 and Measure of Processes of Care-Service Providers: translation,cross-cultural adaptation and reliability

BackgroundThe Measure of Processes of Care (MPOC) questionnaires evaluate Family-Centered Practice (FCP) in services for children with developmental disorders. The MPOC-20 and MPOC-SP are completed by parents and by rehabilitation professionals, respectively, and are widely used in several countries.ObjectivesTo translate and cross-culturally adapt the MPOC-20 and MPOC-SP to Brazilian Portuguese and evaluate their reliability and internal consistency.Methodsthis study included translation, back-translation, cognitive interviews, testing of the pre-final versions, analysis of reliability and of internal consistency of the final versions. Respondents included parents and rehabilitation professionals from rehabilitation centers in four capital cities in Brazil.ResultsTranslation and cultural-adaptation procedures ensured the Brazilian versions were understandable and semantically equivalent to the original MPOC-20 and MPOC-SP. Pre-final and final versions were analyzed and vetted by the original authors. The MPOC-20 internal consistency Cronbach's alpha varied between 0.61 and 0.91 (n = 107), the test-retest reliability ICC varied between 0.44 and 0.83 and the standard error of measurement varied between 0.66 and 0.85 (n = 50). The MPOC-SP internal consistency Cronbach's alpha varied between 0.52 and 0.83 (n = 92), the test-retest reliability ICC between 0.83 and 0.90, and the standard error of measure between 0.34 and 0.46 (n = 62).ConclusionThe Brazilian versions of the MPOC-20 and the MPOC-SP are in general stable and sufficiently reliable. They are relevant to the evaluation of FCP and provide information that can improve health services and ensure better care.     

Spinal cord injury (SCI) rehabilitation: systematic analysis of communication from the biopsychosocial perspective

Abstract

Purpose: Communication is powerful predictor of health-related quality of life and overall well-being, yet its role in promoting rehabilitation outcomes in spinal cord injury (SCI) is rarely mentioned. This article systematically analyzes and synthesizes literature from multiple disciplines according to a biopsychosocial perspective, providing an evidence base for clinical practice and clear direction for future research. Method: Systematic literature review and analysis, incorporating mapping to International Classification of Functioning, Disability and Health (ICF) codes. Results: In total 4338 entries were retrieved from CINAHL, PsychInfo, Medline, PubMed and SpeechBite databases for the period 1990–2014. A total of 115 treatment and observational studies (quantitative and qualitative) detailed aspects of communication according to structure, function, activity, participation and environmental factors; evident of the complex interactions between communicative function with daily living after SCI. Conclusions: Communication is a relative strength in SCI, key to empowerment, independence, social interaction, and well-being, yet its potential to enhance SCI rehabilitation outcomes remains largely underexplored and untapped. Through elucidating interactions between communication and functioning, the adapted ICF framework affords clinicians and researchers insight into areas of intervention most likely to result in widespread gains. Conscious consideration should be given to the role of communication, within an integrative, strengths-based, multidisciplinary approach to clinical practice and future research.

• Implications for Rehabilitation

• Communication fosters empowerment, independence and greater participation in life roles; recognized as a powerful predictor of health-related quality of life and overall well-being.

• The ICF framework elucidates influences to communicative function, and components which are influenced by communication, providing valuable insight for clinicians and researchers.

• Therapeutic and research endeavors guided by existing ICF core sets are at risk of failing to consider communication, thereby limiting rehabilitation outcomes.

• Tapping the potential of communication as a relative strength within SCI rehabilitation holds considerable promise, within integrative, strengths-based, multidisciplinary approaches to clinical practice and future research.

     

Validation of the Dutch Giving Youth a Voice Questionnaire (GYV-20): a measure of the client-centredness of rehabilitation services from an adolescent perspective

PURPOSE. The objective was to validate the Dutch translation of the Canadian Giving Youth a Voice Questionnaire (GYV-20) for use in paediatric rehabilitation settings in The Netherlands. The GYV-20 consists of 20 items (assessing four domains) and was designed to evaluate the client-centredness of rehabilitation services from an adolescent perspective. METHOD. The construct validity, concurrent validity, and reliability of the Dutch GYV-20 were determined. Participants were 116 youngsters aged 11 - 21 years (Mean = 15.9; SD = 2.1) recruited through six paediatric rehabilitation settings in The Netherlands. RESULTS. Correlations between the GYV-20 scale scores were positive (r = 0.69 - 0.78). The GYV-20 showed adequate internal consistency, with Cronbach's alpha ranging from 0.76 - 0.81. The ICCs of test-retest reliability ranged from 0.82 - 0.92, which demonstrated good stability of the GYV-20. Dutch adolescents judged the GYV-20 as a valuable and useful tool to evaluate rehabilitation services in The Netherlands. CONCLUSIONS. The Dutch GYV-20 showed sufficient evidence of construct validity and good reliabilities. The Dutch GYV-20 offers users a useful measurement option for various research and clinical purposes.     

Validation of the Dutch Giving Youth a Voice Questionnaire (GYV-20): A measure of the client-centredness of rehabilitation services from an adolescent perspective

Purpose. The objective was to validate the Dutch translation of the Canadian Giving Youth a Voice Questionnaire (GYV-20) for use in paediatric rehabilitation settings in The Netherlands. The GYV-20 consists of 20 items (assessing four domains) and was designed to evaluate the client-centredness of rehabilitation services from an adolescent perspective.

Method. The construct validity, concurrent validity, and reliability of the Dutch GYV-20 were determined. Participants were 116 youngsters aged 11 – 21 years (Mean = 15.9; SD = 2.1) recruited through six paediatric rehabilitation settings in The Netherlands.

Results. Correlations between the GYV-20 scale scores were positive (r = 0.69 – 0.78). The GYV-20 showed adequate internal consistency, with Cronbach's α ranging from 0.76 – 0.81. The ICCs of test-retest reliability ranged from 0.82 – 0.92, which demonstrated good stability of the GYV-20. Dutch adolescents judged the GYV-20 as a valuable and useful tool to evaluate rehabilitation services in The Netherlands.

Conclusions. The Dutch GYV-20 showed sufficient evidence of construct validity and good reliabilities. The Dutch GYV-20 offers users a useful measurement option for various research and clinical purposes.     

Measuring the quality of children's postoperative pain management: initial validation of the child/parent Total Quality Pain Management (TQPM) instruments

Quality improvement measurement instruments for pediatric postoperative pain management are virtually nonexistent. Without standardized instruments to measure pediatric pain management outcomes, practitioners are hampered in their efforts to improve the quality of pain management for children. In this study, instruments for children (8--12 years) and parents were developed and tested to measure the quality of children's postoperative pain management. The child (Child TQPM) and parent (Parent TQPM) Total Quality Pain Management instruments were tested with 50 parent/child dyads across two large treatment centers. The pain rating scale modified for these instruments demonstrated good criterion validity with the well established Varni/Thompson Pediatric Pain Questionnaire Visual Analogue Scale. Parent--child agreement was described for responses across instruments. Construct validity was examined through selected inter-item relationships. Psychometric analyses support the initial measurement properties of the pediatric TQPM instruments.     

Development of a short form of the Quality from the Patient's Perspective (QPP) questionnaire

? Patients' views on the quality of care are important and it is desirable that these can be assessed using short, yet valid and reliable instruments. ? The aim of the work reported here was to develop and test a short version of an established questionnaire: Quality from the Patient's Perspective (QPP). ? Patients (n=162, 79% response rate) receiving care at medical and surgical departments in two Swedish hospitals responded to the original QPP as well as to a newly developed short version. An ethical research committee approved the study. ? Pearson correlations were computed between the long and short forms and differences between means were analysed with t‐tests. Reliability was estimated by computing Cronbach alpha coefficients. ? Correlations of acceptable size were found between the short form and the original QPP. The short form also had acceptable reliability coefficients. ? The strengths of the work are that the items in the short version are derived from a patient perspective and are formulated in words used by patients; the items still have a theoretical foundation, which makes the interpretation of results more meaningful; global formulations such as `What do you think about your care?' have been avoided; the short format should make the questionnaire more attractive for many patients to respond to. ? Limitations are that results indicate that the short form does not fully measure what the long form does. Therefore, when the short form is used in practice, a two‐step procedure is suggested, where a follow‐up is done with a selection of items from the original long form. This selection could be restricted to areas where problems may be suspected, based on the results from the short form.     

Development and validation of the Health Care Satisfaction Questionnaire (HCSQ) in elders

The Health Care Satisfaction Questionnaire (HCSQ) was designed for the evaluation of health care and services in a manner that controls acquiescence bias yet is characterized by a simple structure. The HCSQ was developed and validated within the context of the Program of Research to Integrate Services for the Maintenance of Autonomy (PRISMA) in the Sherbrooke and Quebec City areas of Quebec, Canada. Exploratory and confirmatory factor analyses were done with 873 subjects and confirmed the multidimensional nature of the concept of satisfaction. Three factors explained more than 52% of the total variance. The analysis of internal consistency produced Cronbach alpha coefficients of .93, .74, and .78 for Factors 1, 2, and 3, respectively. The alpha of the overall scale was .92. The intraclass correlation coefficient (test-retest) for the entire scale was .72 (95% CI: .52-.84). In light of these findings, the characteristics and multidimensional perspective of the HCSQ appear to be useful for measuring and advancing knowledge about health care and services satisfaction.     

Development and validation of a short version of the French Hand Function Sort questionnaire in vocational rehabilitation

BackgroundThe Hand Function Sort (HFS) is a pictorial self-administered questionnaire with 62 items. It is a valid and reliable scale focused on the physical function of the upper limbs. It is used to predict the return to work.ObjectivesWe aimed to develop and validate a short version of the French version of the HFS (HFS-F) to simplify its use in clinical practice.MethodsWe included patients with upper-limb chronic pain hospitalised for vocational rehabilitation from 2012 to 2019. Vocational rehabilitation aims to improve the autonomy of patients to regain their previous working capacity. The 62 items of the HFS-F were analysed in terms of patient and expert assessments, floor/ceiling effect, item-to-total correlation, principal component analysis, and Rasch analysis. A short HFS-F was developed. Thereafter, we assessed its internal consistency, test–retest reliability, criterion validity with the full-length HFS-F, construct validity with different scales (Disabilities of the Arm, Shoulder, and Hand [DASH]; Brief Pain Inventory [BPI]; Hospital Anxiety and Depression [HAD]), standard error of measurement (SEM), and minimal detectable change (MDC).ResultsSix experts were consulted, 34 patients were interviewed, and 629 questionnaires were analysed. Among the items, 25 were selected after the final round with the six experts. The internal consistency and test–retest reliability were excellent (Cronbach α = 0.95, intraclass correlation coefficient = 0.92, 95% confidence interval [95% CI] 0.87 to 0.95). The correlation coefficient between scores of the short and full-length HFS-F was 0.841 (95% CI: 0.752 to 0.897, P < 10–4), and those between the short HFS-F score and the DASH, BPI, HAD-Anxiety, and HAD-Depression scores were ?0.816 (95% CI: ?0.714 to ?0.881, P < 10–4), ?0.529 (95% CI: ?0.338 to ?0.674, P < 10–4), ?0.451 (95% CI: ?0.244 to 0.614, P = 0.0001), and ?0.360 (95% CI: ?0.140 to ?0.542, P = 0.0018), respectively. The SEM and MDC values were estimated at 6/100 and 17/100, respectively.ConclusionsA short version of the HFS-F was developed and validated. We named this questionnaire the 25 HFS-F.     

Education in pulmonary rehabilitation: the patient's perspective

Wilson JS, O’Neill B, Reilly J, MacMahon J, Bradley JM. Education in pulmonary rehabilitation: the patient’s perspective.

Objectives

To ascertain from patients’ perspectives what should be included in the educational component of pulmonary rehabilitation and how it should be delivered, and to compare those perspectives with the views of health professionals.

Design

Qualitative research method using focus groups of patients and health professionals.

Setting

A regional respiratory center and outpatient clinic.

Participants

Purposive samples of 32 patients with chronic obstructive pulmonary disease (COPD) (forced expiratory volume in 1 second, 18%–67% predicted) divided into 6 focus groups; 8 health professionals knowledgeable about COPD and pulmonary rehabilitation who attended a multidisciplinary focus group meeting.

Interventions

Participants attended focus group meetings (2–3h) guided by a series of questions and topics; results were posted to the participants for their verification.

Main Outcome Measure

The educational content of a pulmonary rehabilitation program.

Results

Deficits in patients’ knowledge, understanding, and management of their disease were identified. Six key educational topics resulted: disease education, management of breathlessness, management of an exacerbation, medication, psychosocial support, and welfare and benefits systems. Patients and health professionals preferred group information sessions provided by knowledgeable people speaking layman’s language, with oral presentations being supplemented by written information.

Conclusions

Gaining a greater understanding of patients’ educational needs permits health professionals who design pulmonary rehabilitation programs to include these requirements in a format that is acceptable to patients. The key topics, content, and format for delivery of the educational component for pulmonary rehabilitation were identified. Future research should focus on the development of an educational package and assessment of its efficacy, which would facilitate equitable patient access to education in pulmonary rehabilitation.