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.

     

Psychometric properties of the Swedish version of the Falls Efficacy Scale-International for older adults with osteoporosis,self-reported balance deficits and fear of falling

Abstract

Purpose: Investigate the psychometric properties of the Swedish version of the Falls Efficacy Scale-International (FES-I).

Method: Cross-sectional study. Community-dwelling older adults with self-reported balance deficits and fear of falling were recruited from an ongoing randomised controlled study to evaluate the psychometric properties of the FES-I using Rasch model analysis.

Results: The Rasch model analysis revealed good category function, the questionnaire measured one dimension with an explained variance of 68.6% and item goodness-of-fit with mean square values (MnSq) 0.7–1.44. The item map showed that all items are spread over the scale, which indicates different difficulties in the items. Non-satisfactory person goodness-of-fit was shown with seven persons and showed person misfit according to both the MnSq-value and the z-value, 38 persons (40%) showed a person misfit when only following the threshold for MnSq.

Conclusions: The Swedish version of FES-I shows good psychometric properties with unidimensionality and item goodness-of-fit. Lower person goodness-of-fit was shown probably because of confounding factors that may influence the answers. The transformed values of the FES-I make it possible to use parametric statistics preferable for this population in future research.

• Implications for rehabilitation

• The Falls Efficacy Scale-International (FES-I) shows good psychometric properties with unidimensionality, item goodness-of-fit and good item reliability, which means that FES-I is a valuable tool when measuring concerns about falling in an older population with osteoporosis and could be useful in clinical settings.

• Confounding factors such as pain, high number of falls, low fall self-efficacy, experience of previous falls, and vertigo may influence the answers and result in low person goodness-of-fit.

     

WOMAC-pf as a measure of physical function in patients with Parkinson’s disease and late-onset sequels of poliomyelitis: unidimensionality and item behaviour

Purpose: To assess psychometric properties of the Western Ontario and MacMasters Universities Osteoarthritis Index (WOMAC)-pf, an osteoarthritis (OA)-specific questionnaire used to establish the level of physical functioning in patients with late-onset sequels of poliomyelitis (LOSP) and Parkinson’s disease (PD). Study design and setting: Unidimensionality (using principal component analyses [PCA] and Rasch analyses) was separately established for three diagnostic groups: OA (n = 288), LOSP (n = 168) and PD (n = 200). Additionally, differential item functioning (DIF) among the three diagnostic groups was assessed using ordinal regression (Polytomous Universal Model) analyses. Baseline data were used from an ongoing cohort study of these three patient populations. Results: Unidimensionality was adequate, with all items loading on the first principal component. The Rasch analyses revealed that item fit was generally good. Uniform and non-uniform DIF were found to be present among the three diagnostic groups in three and one of the 17 physical functioning subscale (WOMAC-pf) items, respectively. Conclusion: The WOMAC-pf is a unidimensional measure of physical functioning in patients with LOSP and PD, in addition to its established use in OA.

Implications for Rehabilitation

• Disability in physical functioning related to mobility (walking, stair climbing, etc.) is a common feature of many chronic diseases, including osteoarthritis, late-onset sequels of poliomyelitis and Parkinson’s disease.

• In this study, the Western Ontario and MacMasters Universities Osteoarthritis Index-pf was shown to be a useful and adequate tool to assess physical functioning in these patient groups.

• The study highlighted that, despite differences in diagnosis, history and course of the disease, patients with different conditions experience similar disabilities in their physical functioning.

     

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.

     

Explaining daily functioning in young adults with obstetric brachial plexus lesion

Abstract

Purpose: To study the influence of obstetric brachial plexus lesion (OBPL) on arm–hand function and daily functioning in adults, and to investigate the relationship of arm-hand function and pain to daily functioning. Method: Adults with unilateral OBPL who consulted the brachial plexus team at the VU University Medical Center in the past were invited to participate. Daily functioning was measured with the Disability of the Arm, Shoulder and Hand (DASH) questionnaire and the SF36, pain with VAS Pain Scales and arm-hand function with the Nine Hole Peg Test (9-HP-test) and the Action Research Arm Test (ARAT). Scores of the affected arm were compared to those of the non-affected arm or norm values for healthy controls. Results: Twenty-seven persons (mean age 22, SD 4.2 years), of whom 10 men, participated. The ARAT and 9-HP-test scores for the affected arm were significantly worse than those for the non-affected arm. Moderate to severe pain in the affected arm, the non-affected arm or the back was reported by 50% of the participants. The DASH general, sports/music and SF36 physical functioning scores were significantly worse than norm values. The ARAT/9-HP-test and daily functioning showed little association. Low to moderate associations were found between pain and daily functioning. Conclusions: Many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Implications for Rehabilitation

• Obstetric brachial plexus lesion (OBPL) is caused by traction to the brachial plexus during labour, resulting in denervation of the muscles of the arm and shoulder girdle.

• Adults with OBPL are hardly seen in rehabilitation medicine.

• This study shows that many young adults with OBPL experience limitations in daily functioning. Pain, rather than arm-hand function, seems to explain these limitations.

• Fifty percent of the participants complained about moderate or severe pain, which was located in the affected arm, the back and the non-affected arm. There seems an age-related increase in pain prevalence.

• Persons who had undergone plexus surgery had a significantly worse arm-hand function, but comparable scores on daily functioning scales compared to persons without plexus surgery.

• When limitations in daily functioning or pain occur, referral to a rehabilitation physician is indicated.

     

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

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

Implications for Rehabilitation

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

• Impairments of trunk control is a common problem in stroke

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

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

     

Rasch analysis of the Chedoke–McMaster Attitudes towards Children with Handicaps scale

Aim To assess whether the Chedoke–McMaster Attitudes towards Children with Handicaps (CATCH) 36-item total scale and subscales fit the unidimensional Rasch model. Method The CATCH was administered to 1881 children, aged 7–16 years in a cross-sectional survey. Data were used from a random sample of 416 for the initial Rasch analysis. The analysis was performed on the 36-item scale and then separately for each subscale. The analysis explored fit to the Rasch model in terms of overall scale fit, individual item fit, item response categories, and unidimensionality. Item bias for gender and school level was also assessed. Revised scales were then tested on an independent second random sample of 415 children. Results Analyses indicated that the 36-item overall scale was not unidimensional and did not fit the Rasch model. Two scales of affective attitudes and behavioural intention were retained after four items were removed from each due to misfit to the Rasch model. Additionally, the scaling was improved when the two most negative response categories were aggregated. There was no item bias by gender or school level on the revised scales. Items assessing cognitive attitudes did not fit the Rasch model and had low internal consistency as a scale. Conclusion Affective attitudes and behavioural intention CATCH sub-scales should be treated separately. Caution should be exercised when using the cognitive subscale.

• Implications for Rehabilitation

• The 36-item Chedoke–McMaster Attitudes towards Children with Handicaps (CATCH) scale as a whole did not fit the Rasch model; thus indicating a multi-dimensional scale.

• Researchers should use two revised eight-item subscales of affective attitudes and behavioural intentions when exploring interventions aiming to improve children’s attitudes towards disabled people or factors associated with those attitudes.

• Researchers should use the cognitive subscale with caution, as it did not create a unidimensional and internally consistent scale. Therefore, conclusions drawn from this scale may not accurately reflect children’s attitudes.

     

Community-based study of health-related quality of life in spinal cord injury,muscular dystrophy,multiple sclerosis,and cerebral palsy

Purpose: To assess health-related quality of life (HRQOL) in adults with spinal cord injury (SCI), muscular dystrophy (MD), multiple sclerosis (MS), and cerebral palsy (CP). Methods: This is a multicenter, community-based, cross-sectional study of adults diagnosed with CP (94), MD (99), MS (98), SCI (99), and healthy adults (105). The WHOQOL-BREF and WHOQOL-DIS questionnaire were used. Results: Significant differences in physical functioning between adults with CP and SCI and adults with MS (p?=?0.003 and p < 0.001, respectively), as well as between adults with SCI and MD (p?=?0.001) were found. Univariate tests revealed significant psychological functioning differences between adults with SCI and MD (p?=?0.02) and SCI and MS (p?=?0.001). There was a significant difference in physical functioning between controls and adults with SCI (p?=?0.049) and a significant difference in psychological functioning between controls and adults with MS (p?=?0.039). No statistically significant differences were found between the groups in social and environmental domains. Conclusions: Physical and physiological functioning were affected to various degrees in the studied neurodisabilities, while all groups reported similar levels of functioning and well-being in social and environmental domains.

Implications for Rehabilitation

• Health-related quality of life (HRQOL) in adults with neurodisabilities living in a community differs from HRQOL in these individuals sampled in clinical and/or rehabilitation settings.

• Psychosocial aspects of HRQOL relevant to physical disability were similarly affected across those groups.

• Physical and physiological domains in HRQOL were affected to various degrees among adults with neurodisabilities living in a community.

• Levels of functioning and well-being in social and environment domains of HRQOL are similar among adults with neurodisabilities living in a community.

• Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy.

     

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.

     

Further validation of the Multiple Sclerosis Self-Efficacy Scale

Abstract

Purpose: This study examined the factorial and construct validity of the Multiple Sclerosis Self-Efficacy (MSSE) Scale in two samples of people with multiple sclerosis (MS). Method: Two samples (n's?=?292, 275) of participants with MS were recruited from across the United States. Participants in both studies completed a questionnaire battery that included the MSSE and measures of symptoms, dysfunction, disability, psychosocial aspects, mental/emotional well-being, and quality of life. Factorial validity was tested using confirmatory factor analysis (CFA), whereas construct validity was examined based on bivariate correlations with scores from other measures. Results: The two-factor measurement model provided a poor fit for the 18 items on the MSSE in both the samples. This model provided a good fit for a modified, 10-item scale in both samples. The 10-item version of the MSSE was highly correlated with the original MSSE (r?=?0.97, p?<?0.001) and related constructs (e.g. disability, r?=?0.69, p?<?0.0001). The standardized Cronbach's αs of the two subscales (function and control) of the 10-item version ranged between 0.78 and 0.94 for both samples. Conclusions: Scores from the modified, 10-item version of the MSSE provide a valid and reliable measure of MS-specific self-efficacy among persons with MS.

• Implications for Rehabilitation

• The importance of self-efficacy in managing the consequences of multiple sclerosis (MS) has increased.

• The Multiple Sclerosis Self-Efficacy (MSSE) Scale was developed and validated for measuring self-efficacy in function maintenance and control over MS from patients' perspectives. In the past almost 20 years, this scale has not undergone additional validation of its factor structure and construct validity in large-scale samples of persons with MS.

• The original two-factor construct did not provide a good fit for the 18 items on the MSSE in two independent samples. We modified the MSSE and found the 10 items fitted by the two-factor construct well with one sample and demonstrated cross-validity of the 10 items in the second sample.

• The 10-item version of the MSSE has good reliability and construct validity in both independent samples. Researchers and clinicians should adopt these 10 items when examining MS self-efficacy of patients.

     

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.

     

Psychometric properties of the neck disability index amongst patients with chronic neck pain using item response theory

Objective: The Neck Disability Index (NDI) is commonly used for clinical and research assessment for chronic neck pain, yet the original version of this tool has not undergone significant validity testing, and in particular, there has been minimal assessment using Item Response Theory. The goal of the present study was to investigate the psychometric properties of the original version of the NDI in a large sample of individuals with chronic neck pain by defining its internal consistency, construct structure and validity, and its ability to discriminate between different degrees of functional limitation.

Methods: This is a cross-sectional cohort study of 585 consecutive patients with chronic neck pain seen in a university hospital rehabilitation clinic. Internal consistency was evaluated using Cronbach’s alpha, construct structure was evaluated by exploratory factor analysis, and discrimination ability was determined by Item Response Theory.

Results: The NDI demonstrated good internal consistency assessed by Cronbach’s alpha (0.87). The exploratory factor analysis identified only one factor with eigenvalue considered significant (cutoff 1.0). When analyzed by Item Response Theory, eight out of 10 items demonstrated almost ideal difficulty parameter estimates. In addition, eight out of 10 items showed high to perfect estimates of discrimination ability (overall range 0.8 to 2.9).

Conclusions: Amongst patients with chronic neck pain, the NDI was found to have good internal consistency, have unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability.

• Implications for Rehabilitation

• The Neck Disability Index has good internal consistency, unidimensional properties, and an excellent ability to distinguish patients with different levels of perceived disability.

• The Neck Disability Index is recommended for use when selecting patients for rehabilitation, setting rehabilitation goals, and measuring the outcome of intervention.

     

ICF-CY based assessment tool for children with autism

Purpose: The objectives of this study was to develop an International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY) based questionnaire for children with autism, investigate the inter-rater reliability of the questionnaire and assess functional performance in children with autism. Method: The ICF-CY based questionnaire for children with autism comprised 118 items was designed with reference the ICF-CY structure. The study protocol was divided into two parts. In the first part, the inter-rater reliability of the questionnaire was investigated using information from 26 children (aged 3–6 years) with autism and using the intra-class correlation coefficients to estimate reliability. The second part of the study aimed to assess functional performance of another independent sample (136 children, aged 3–6 years) utilizing the questionnaire. Mean scores were compared by nonparametric statistic. Results: The inter-rater reliability for each domains of the questionnaire was found to be moderate to high (intra-class correlation coefficients ranged from 0.72 to 0.97). Children with autism had major problems in voice and speech functions. They had high dependency when executing individual activities of learning and applied knowledge. They also required maximal assistance while engaging in social activities related to conversation and major life categories. Conclusions: This preliminary study shows that ICF-CY based questionnaire has good reliability and can reflect the functional profile of preschool children with autism. However, further study is needed to confirm other psychometric characteristics.

Implications for Rehabilitation

• The ICF-CY provides a comprehensive overview of functioning and constitutes a universal language for interdisciplinary work with children.

• Children with autism had major problems in voice and speech functions.

• The questionnaire is suitable for use in evaluating a heterogeneous group of children with autism.

     

Gender and diagnostic impact on everyday technology use: a differential item functioning (DIF) analysis of the Everyday Technology Use Questionnaire (ETUQ)

Abstract

Background: As the use of everyday technology is increasingly important for participation in daily activities, more in-depth knowledge of everyday technology use in relation to diagnosis and gender is needed. The purpose of this study was to investigate the stability of the perceived challenge of a variety of everyday technologies across different samples of varying diagnoses including both males and females.

Methods: This cross-sectional study used 643 data records from clinical and research samples, including persons with dementia or related disorders, acquired brain injury, intellectual disability, various mental or medical disorders, and adults without known diagnoses. The Everyday Technology Use Questionnaire, comprising 93 everyday technology artifacts and services (items) measuring the level of everyday technology challenge and relevance of and perceived ability to use these was used for data gathering. A two-faceted Rasch model in combination with differential item functioning (DIF) analyses were used for comparing item hierarchies across samples.

Results: Only three items (3.2%) demonstrated a clinically relevant DIF by gender, and nine items (9.7%) by diagnosis.

Discussion: The findings support a stable hierarchy of everyday technology challenge in home and community that can facilitate planning of an accessible and inclusive society from a technological departure point.

• Implications for Rehabilitation

• The ability to manage everyday technology is increasingly important for participation in everyday activities at home and in the community for people with and without disabilities.

• This study demonstrates that differences in perceived challenges in using various everyday technologies across gender and diagnosis are minimal.

• The findings provide evidence of no or minor systematic bias in testing when using the Everyday Technology Use Questionnaire in clinical practice and research.

• Empirical knowledge about the perceived challenge of specific everyday technologies of people with variations in gender or diagnosis is still sparse, hence this study can inspire practice and future research.

     

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.

     

Physical functioning of low back pain patients: perceived physical functioning and functional capacity,but not physical activity is affected

Abstract

Purpose: Physical functioning is a multidimensional construct covering perceived functioning, functional capacity and actual physical activity. Currently, the assessment of physical functioning in low back pain (LBP) patients has been limited to only one or two of these aspects. This study evaluates physical functioning of LBP patients by assessing the three individual aspects using questionnaires and ambulant sensor-based measurements. Methods: Actual physical activity, functional capacity and perceived functioning were measured in 26 patients undergoing patient specific treatment before, direct and 3–4 weeks after the first treatment using, respectively, sensor-based activity monitoring, sensor-based motion analysis test and the Oswestry questionnaire. Patients were compared to a healthy control group. Results: Perceived functioning and functional capacity, but not actual physical activity is impaired in pre-treatment LBP patients. After treatment, patients improved in perceived physical functioning and functional capacity approaching healthy levels, however only slight (p?>?0.05) improvements in actual physical activity were found. Moreover, only few and weak correlations were found between the different aspects of physical functioning. Conclusion: Perceived functioning, actual physical activity and functional capacity are three independent outcome dimensions, being complementary but not redundant. Especially, perceived functioning and physical capacity need attention when evaluating LBP patients during rehabilitation.

• Implications for Rehabilitation

• Perceived physical functioning and physical capacity are negatively affected by low back pain and improve after treatment.

• Low back pain patients perform their daily activity independent of pain and complaints.

• Inertia sensor-based motion analysis can objectify treatment effects showing low back pain patients their progress in rehabilitation.

• New interventions can be justified with inertia sensor technology in low back pain patients.

     

Improving the utility of the fine motor skills subscale of the comprehensive developmental inventory for infants and toddlers: a computerized adaptive test

Abstract

Aim: This study aimed at improving the utility of the fine motor subscale of the comprehensive developmental inventory for infants and toddlers (CDIIT) by developing a computerized adaptive test of fine motor skills.

Methods: We built an item bank for the computerized adaptive test of fine motor skills using the fine motor subscale of the CDIIT items fitting the Rasch model. We also examined the psychometric properties and efficiency of the computerized adaptive test of fine motor skills with simulated computerized adaptive tests.

Results and conclusions: Data from 1742 children with suspected developmental delays were retrieved. The mean scores of the fine motor subscale of the CDIIT increased along with age groups (mean scores?=?1.36–36.97). The computerized adaptive test of fine motor skills contains 31 items meeting the Rasch model’s assumptions (infit mean square?=?0.57–1.21, outfit mean square?=?0.11–1.17). For children of 6–71 months, the computerized adaptive test of fine motor skills had high Rasch person reliability (average reliability >0.90), high concurrent validity (rs?=?0.67–0.99), adequate to excellent diagnostic accuracy (area under receiver operating characteristic?=?0.71–1.00), and large responsiveness (effect size?=?1.05–3.93). The computerized adaptive test of fine motor skills used 48–84% fewer items than the fine motor subscale of the CDIIT. The computerized adaptive test of fine motor skills used fewer items for assessment but was as reliable and valid as the fine motor subscale of the CDIIT.

• Implications for Rehabilitation

• We developed a computerized adaptive test based on the comprehensive developmental inventory for infants and toddlers (CDIIT) for assessing fine motor skills.

• The computerized adaptive test has been shown to be efficient because it uses fewer items than the original measure and automatically presents the results right after the test is completed.

• The computerized adaptive test is as reliable and valid as the CDIIT.

     

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

Abstract

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

• Implications for Rehabilitation

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

• Balance exercises that include training of sensory strategies.

• Self-management and self-management support.

• Pharmacologic intervention, such as Dalfampradine.

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

     

Evaluation of cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning,Disability, and Health: a large-scale,multi-institutional observational study

Purpose: We comprehensively evaluated cognitive and social functioning in patients requiring long-term inpatient psychiatric care using the International Classification of Functioning, Disability, and Health.

Method: We surveyed 1967 patients receiving long-term inpatient psychiatric care. Patients were further categorized into an old long-stay group (n?=?892, >5 years in hospitals) and a new long-stay group (n?=?1075, 1–5 years in hospitals). We obtained responses for all the International Classification of Functioning, Disability, and Health items in domain b (Body Functions) and domain d (Activities and Participation). We estimated weighted means for each item using the propensity score to adjust for confounding factors.

Results: Responses were received from 307 hospitals (response rate of hospitals: 25.5%). Cognitive and social functioning in the old long-stay group was more severely impaired than in the new long-stay group. No statistically significant differences were observed regarding the International Classification of Functioning, Disability, and Health items associated with basic activities of daily living between the two groups.

Conclusion: Combined therapy consisting of cognitive remediation and rehabilitation on social functioning for this patient population should be started from the early stage of hospitalization. Non-restrictive, independent environments may also be optimal for this patient population.

• Implications for rehabilitation

• Rehabilitation of cognitive and social functioning for patients requiring long-term inpatient psychiatric care should be started in the early stages of hospitalization.

• In psychiatric fields, the International Classification of Functioning, Disability, and Health checklist could facilitate individualized rehabilitation planning by allowing healthcare professionals to visually assess the comprehensive functioning of each patient using graphics such as radar charts.

     

Rasch measurement: the Arm Activity measure (ArmA) passive function sub-scale

Purpose: To evaluate the conformity of the Arm Activity measure (ArmA) passive function sub-scale to the Rasch model. Methods: A consecutive cohort of patients (n?=?92) undergoing rehabilitation, including upper limb rehabilitation and spasticity management, at two specialist rehabilitation units were included. Rasch analysis was used to examine scaling and conformity to the model. Responses were analysed using Rasch unidimensional measurement models (RUMM 2030). The following aspects were considered: overall model and individual item fit statistics and fit residuals, internal reliability, item response threshold ordering, item bias, local dependency and unidimensionality. Results: ArmA contains both active and passive function sub-scales, but in this analysis only the passive function sub-scale was considered. Four of the seven items in the ArmA passive function sub-scale initially had disordered thresholds. These items were rescored to four response options, which resulted in ordered thresholds for all items. Once the items with disordered thresholds had been rescored, item bias was not identified for age, global disability level or diagnosis, but with a small difference in difficulty between males and females for one item of the scale. Local dependency was not observed and the unidimensionality of the sub-scale was supported and good fit to the Rasch model was identified. The person separation index (PSI) was 0.95 indicating that the scale is able to reliably differentiate at least two groups of patients. Conclusions: The ArmA passive function sub-scale was shown in this evaluation to conform to the Rasch model once disordered thresholds had been addressed. Using the logit scores produced by the Rasch model it was possible to convert this back to the original scale range.

• Implications for Rehabilitation

• The ArmA passive function sub-scale was shown, in this evaluation, to conform to the Rasch model once disordered thresholds had been addressed and therefore to be a clinically applicable and potentially useful hierarchical measure.

• Using Rasch logit scores it has be possible to convert back to the original ordinal scale range and provide an indication of real change to enable evaluation of clinical outcome of importance to patients and clinicians.