Resilience in patients with amputation because of Complex Regional Pain Syndrome type I

Abstract

Purpose: Although controversial, an amputation for longstanding and therapy-resistant Complex Regional Pain Syndrome Type I (CRPS-I) may improve quality of life and pain intensity. Resilience, the way people deal with adversity in a positive way may be related to these positive outcomes. This study focused on the relationship between resilience and post-amputation outcomes, i.e. quality of life, pain and recurrence of CRPS-I and psychological distress. Method: Twenty-six patients with an amputation related to CRPS-I filled in the Connor-Davidson Resilience Scale (CD-RISC), World Health Organisation -- Quality of life Assessment (WHOQOL-Bref) and the Symptom Checklist-90 Revised (SCL-90-R). An interview was conducted and a physical examination performed. Results were compared with reference groups from literature and a control group from the outpatient rehabilitation clinic at our medical center. Results: Resilience correlated significantly with all domains of the WHOQOL-Bref (ρ ranged from 0.41 to 0.72) and negatively with all domains of the SCL-90-R (ρ ranged from ?0.39 to ?0.68). Patients with an amputation because of CRPS-I have higher scores on resilience and quality of life than the control group. Resilience was lower in patients who reported CRPS-I symptoms compared to those who did not. Conclusions: The results confirmed our hypothesis that patients with an amputation because of CRPS-I who have a higher resilience also have a higher quality of life and experience lower psychological distress. The prognostic value of resilience in this patient group requires further research.

• Implications for Rehabilitation

• Until characteristics of patients with positive quality of life outcome have been further unraveled, amputation for CRPS-I should only be performed in expertise centers.

• Resilience, the process of adapting well in the face of adversity, should be further explored in Rehabilitation Medicine research in general.

• Measurement of resilience should be a standard procedure when patients with CRPS-I request an amputation.

• Improving resilience of patients in in- and outpatient rehabilitation clinics might be an additional treatment in rehabilitation care.

     

The relation of social support and depression in patients with chronic low back pain

Purpose: Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes. Social support is a modifiable factor that may influence depressive symptoms in people with LBP and, if so, could be a consideration in LBP management when depression is an issue. The aim of this study was to examine social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP.

Method: Patients with LBP (n?=?483), recruited from four imaging centers in Canada, completed an initial survey following imaging and a follow-up survey one year later, including the Medical Outcomes Study (MOS) Social Support Survey and the Center for Epidemiologic Studies Depression Scale. Multivariable regression analyses were used to examine the relationship between social support and depression.

Results: More social support (overall functional social support) at baseline was associated with recovery from depression (OR?=?0.24; 95% CI 0.10, 0.55) and less depressive symptoms (β?=?1.68; 95% CI?=?0.36, 3.00) at one-year follow-up. In addition, associations were found between specific aspects (subscales) of social support and the two depression outcomes.

Conclusions: Functional social support as a prognostic factor for depression and possible target of LBP management warrants further investigation.

• Implications for Rehabilitation

• Depression is a common condition in adults with low back pain (LBP), and is associated with poorer patient outcomes.

• This study provides evidence for social support as a prognostic factor for depressive symptoms and recovery from depression in patients with LBP problems.

• Management of pain conditions may be enhanced by a better understanding of modifiable risk factors for depression, such as social support.

     

Impact of depression following a stroke on the participation component of the International Classification of Functioning,Disability and Health

Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).

Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann–Whitney test was used to compare the participation scores between the two groups. Spearman’s correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.

Results: The group with depression had low participation scores (p?=?0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r?= ?0.6; p ?=?0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r²?=?0.51; p?=?0.001).

Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke.

• Implications for Rehabilitation

• Individuals with post-stroke depression experience a lower degree of social participation.

• Depression explains 51% of the decline in participation following a stroke.

• The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

     

Examining the relationship between post-traumatic stress disorder and social participation among Veterans with spinal cord injuries and disorders

Abstract

Purpose: The objectives of this study were to examine differences in social participation among Veterans with spinal cord injuries/disorders with and without post-traumatic stress disorder, and determine if lower social participation was independently associated with having post-traumatic stress disorder.

Methods: A cross-sectional mailed national survey was sent to a national sample of Veterans with spinal cord injuries/disorders who received prior-year Veterans Affairs healthcare. Surveys provided data on: demographics, health conditions, injury characteristics, and social participation. Analyses included bivariate comparisons, and multivariate logistic regression to determine if lower social participation was independently associated with post-traumatic stress disorder.

Results: Veterans with (vs. without) post-traumatic stress disorder (n?=?896) reported lower social participation (40.2 vs. 43.9, p?<?0.0001). Multivariate analyses showed that longer duration of injury (OR?=?0.98, 95% CI: 0.97–1.00, p?=?0.04) and white race (OR?=?0.62, 95% CI: 0.38–1.01, p?=?0.05) were associated with lower odds of post-traumatic stress disorder, while a greater number of health conditions (OR?=?1.43, 95% CI: 1.25–1.64, p?<?0.0001) was associated with greater odds. When controlling for covariates, lower social participation was independently associated with post-traumatic stress disorder (OR?=?0.94, 95% CI: 0.90–0.98, p?=?0.003).

Conclusions: Results indicate post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation. Efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation.

• Implications for Rehabilitation

• Individuals with spinal cord injuries/disorders often have post-traumatic stress disorder; in Veterans with spinal cord injuries/disorders this may be compounded by trauma incurred through military experiences.

• Social participation, an important aspect of rehabilitation and community integration following spinal cord injury or disorder, may be hindered by symptoms of post-traumatic stress disorder.

• Our data show that post-traumatic stress disorder is associated with lower social participation in Veterans with spinal cord injuries/disorders, independent of other factors that may impact participation.

• These results indicate that efforts to screen for and treat post-traumatic stress disorder among persons with spinal cord injuries/disorders, regardless of injury-specific factors, are needed to improve participation in this patient population.

     

Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP)

Abstract

Purpose: This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. Methods: Patients with chronic pain conditions (n?=?845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction. Results: The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health. Conclusions: The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety.

• Implications for Rehabilitation

• The prevalence of insomnia is high in patients with complex chronic pain conditions.

• Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects.

• Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia.

• One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.

     

No association between level of vitamin D and chronic low back pain in Swedish primary care: a cross-sectional case-control study

Objective: Assessment of vitamin D levels and deficiency status in individuals with chronic low back pain (CLBP) in a Swedish general population, compared with controls matched for sex and age.

Design: Cross-sectional case-control study.

Setting: Primary care, southern Sweden.

Subjects: Participants (n?=?44) with self-reported low back pain for at least 3 months and individually sex- and age-matched controls without a chronic pain condition (n?=?44), recruited from the general population by random letter of invitation.

Main outcome measure: Association between vitamin D level and CLBP when adjusting for possible confounders in a multivariate forward conditional logistic regression model.

Results: Mean S-25-hydroxyvitamin D levels were 81 and 80?nmol/L in the CLBP and control group, respectively. The prevalence of vitamin D deficiency was low and similar in the CLBP group and the control group. Vitamin D level was not associated with CLBP when potential confounders were taken into account.

Conclusions: No difference in vitamin D levels between participants with CLBP and matched controls could be demonstrated in the present sample. Assessment of vitamin D level and deficiency status may be of questionable value in the management of CLBP in primary care settings at similar latitudes, unless there are additional risk factors for deficiency or specific indicators of osteomalacia.

• Key Points

• Vitamin D deficiency is common and reported in many chronic pain conditions, including chronic low back pain (CLBP), but evidence for an association and causality is insufficient.

• The present study found no association between vitamin D levels and CLBP in a case-control sample of 44?+?44 individuals from the Swedish general population.

• Prevalence of vitamin D deficiency was low and comparable in individuals with CLBP and controls without chronic pain, matched for sex and age.

• Assessment of vitamin D status, for the purpose of finding and treating an underlying cause of pain, may be of limited value in the management of CLBP in primary care settings at similar latitudes.

     

The therapeutic role of motor imagery on the functional rehabilitation of a stage II shoulder impingement syndrome

Abstract

Purpose: Motor imagery (MI) has been used as a complementary therapeutic tool for motor recovery after central nervous system disease and peripheral injuries. However, it has never been used as a preventive tool. We investigated the use of MI in the rehabilitation of stage II shoulder impingement syndrome. For the first time, MI is used before surgery. Method: Sixteen participants were randomly assigned to either a MI or control group. Shoulder functional assessment (Constant score), range of motion and pain were measured before and after intervention. Results: Higher Constant score was observed in the MI than in the control group (p?=?0.04). Participants in the MI group further displayed greater movement amplitude (extension (p?<?0.001); flexion (p?=?0.025); lateral rotation (p?<?0.001). Finally, the MI group showed greater pain decrease (p?=?0.01). Conclusion: MI intervention seems to alleviate pain and enhance mobility, this is probably due to changes in muscle control and consequently in joint amplitude. MI might contribute to postpone or even protect from passing to stage III that may require surgery.

• Implications for Rehabilitation

• Adding motor imagery training to classical physical therapy in a stage II impingement syndrome:

• Helps in alleviating pain

• Enhances shoulder mobility

• Motor imagery is a valuable technique that can be used as a preventive tool before the stage III of the impingement syndrome.

     

Assessing catastrophic thinking associated with debilitating mental health conditions

Purpose: The present study examined the psychometric properties of the Symptom Catastrophizing Scale (SCS). The SCS items were drawn from the Pain Catastrophizing Scale but were modified to make them better suited to the context of debilitating mental health conditions that are not necessarily associated with pain. The number of items was reduced from 13 to 7, and the response scale was simplified.

Methods: The SCS was administered to individuals diagnosed with Major Depressive Disorder (MDD) (N?=?79) or with a chronic musculoskeletal (MSK) condition (N?=?88).

Results: Exploratory factor analyzes revealed single factor solutions of the SCS for both the MSK and MDD samples. The internal consistency of the SCS was good. The SCS was significantly correlated with measures of pain severity, depressive symptom severity and disability in both samples. Individuals with MDD scored higher on the SCS than individuals with MSK. The SCS was shown to be sensitive to treatment-related reductions in catastrophic thinking.

Conclusions: Preliminary analyzes suggest that the SCS is a reliable and valid measure of symptom-related catastrophic thinking associated with debilitating mental health conditions.

• Implications for Rehabilitation

• Although catastrophic thinking has been identified as a risk factor for disability, current assessment tools are not well suited for individuals with debilitating mental health conditions.

• This paper describes a brief assessment instrument that can be used to assess catastrophic thinking in individuals with debilitating mental health conditions.

• The results of this study suggest that targeting catastrophic thinking might yield reductions in symptom severity and disability in work-disabled individuals with major depressive disorder.

     

Narrative environments and the capacity of disability narratives to motivate leisure-time physical activity among individuals with spinal cord injury

Abstract

Purpose: Few individuals with spinal cord injury (SCI) engage in the recommended amount of leisure time physical activity (LTPA). Yet little is known about how, and why, active individuals engage in specific types of LTPA. This study explored how a unique narrative environment and disability narratives motivated individuals with SCI to engage in LTPA. Method: Fourteen individuals with SCI from a physical activity program participated in approximately hour-long interviews. Interviews were then subjected to a narrative analysis. Results: Individuals who used a restitution narrative (n?=?6) were motivated to engage in functional LTPA because of the desire to maintain the body and restore the past self. The individual who used the chaos narrative (n?=?1) preferred solitary LTPA as exposure to others with SCI was a constant reminder of the lost, pre-injury self. Individuals who used a quest narrative (n?=?7) explored LTPA options that fit with their interests; these individuals were open to new types of LTPA, such as sport and outdoor recreation. Conclusion: The plot of three disability narratives can all motivate the pursuit of LTPA; however, not all types of LTPA are seen as equal. LTPA interventions can be enhanced through the lessons learned from this unique type of environment.

• Implications for Rehabilitation

• Despite individuals’ views about their disability, they can still be motivated to engage in routine LTPA.

• Different theoretical determinants, such as health or social benefits, hold different relevance for LTPA among individuals with differing disability narratives.

• The environment provided by practitioners can therefore elicit some stories of SCI while stifling others. Open narrative environment will attract individuals to listen and maintain involvement in LTPA.

     

Are the changes in observed functioning after multi-disciplinary rehabilitation of patients with fibromyalgia associated with changes in pain self-efficacy?

Objective: To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients.

Design: In-depth analyses of secondary outcomes of a randomized-controlled trial.

Subjects: Women (N?=?187) with fibromyalgia.

Methods: Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined.

Results: Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (r_s?=?0.08, p?=?0.27) and process (r_s?=?0.12, p?=?0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (r_s?=?0.31, p?r_s?=?0.41, p?r_s?=??0.31, p?p?=?0.24). However, a subgroup (34%) had a clinically relevant improvement in pain self-efficacy. This group was younger (mean age 41.4 vs. 45.8, p?=?0.01), more recently diagnosed (1.8 vs. 2.8 years, p?=?0.003), but had an unresolved welfare situation (59% vs. 40%, p?=?0.02).

Conclusion: The main hypothesis was falsified, as there was no association between pain self-efficacy and actual performance of activity. The relation to functioning may be limited to perceived, cognitive-emotional aspects, as indicated by the weak to moderate correlations to the self-reported measures.

• Implications for Rehabilitation

• Improvement in observed activity post multi-disciplinary rehabilitation was not associated with change in pain self-efficacy.

• Patients performed better after rehabilitation, but did not perceive to have improved their capacity.

• The relationship between pain self-efficacy and functioning may be limited to cognitive-emotional aspects rather than actual activity.

• Both observational and self-reported measures should be included in evaluating outcomes of rehabilitation for patients with fibromyalgia.

     

Adapted Tango improves aspects of participation in older adults versus individuals with Parkinson’s disease

Purpose: Our aims were to determine (1) the impact of aging versus combined aging and disease on participation and (2) participation before and after a 12-week, Adapted Tango dance intervention (AT) in older adults with and without Parkinson’s disease (PD).

Methods: Participant responses to open and closed-ended questions on the Impact on Participation and Autonomy questionnaire (IPA) were recorded before, one-week-after, and three-months after 20 lessons of AT. Twenty-five older individuals with PD and 63 older adults without PD were initially enrolled and assessed, and 44 older adults and 22 individuals with PD finished the program with post-testing.

Results: Thematic analysis revealed major themes of difficulty with mobility, transportation and financial management, feelings of being forced to limit activities, and interest in work or volunteering for both groups at baseline and post-test. At post-test, additional emphasis on resilience in the face of challenges was noted. No differences were noted between groups on the IPA subscales at baseline. Quantitative analysis with a 2 (group)?×?3 (time) MANOVA revealed a main effect of time (p?p?p?=?0.073), and Family Role (p?=?0.057).

Conclusions: Adapted Tango improved aspects of participation for these cohorts of older adults with and without PD.

• Implications for Rehabilitation

• Both Parkinson’s disease and neurotypical aging can negatively impact participation in life’s activities in older adults.

• Adapted Tango is an alternative therapy that has improved quality of life and mobility in people with PD and older adults.

• Quantitative data show that Adapted Tango may improve some aspects of participation for older adults with and without PD.

• Open-ended responses reveal aging and combined aging and disease-related issues have a lasting impact upon participation.

     

A pilot study – the potential value of an activity-based feedback system for treatment of individuals with chronic lower back pain

Abstract

Purpose: The aim of this pilot study was to evaluate the potential value of a new personalized activity-based feedback treatment. Method: A prognostic cohort study was carried out in the daily environment of the patients. Seventeen individuals with chronic lower back pain (CLBP) symptoms for >3 months were included. Patients were from the Netherlands, aged 18–65 years. Patients wore an accelerometer and a Personal Digital Assistant (PDA) for 15?d. Patients received continuous and time-related personalized feedback and were instructed to follow the activity pattern as displayed on the PDA. Technical performance and compliance with the system were rated. Objective and subjective activity scores were compared for exploring awareness. The absolute difference between the activity pattern of the patient and the norm value used was calculated and expressed as mean difference. Pain intensity was measured using the VAS. Results: The technical performance and compliance with the system were rated moderate. More than half of the patients were aware of their activity level during the feedback days (67%). A positive effect of the feedback was seen in a trend which showed a decrease in the absolute difference between the activity pattern of the patient and the norm value (p?=?0.149) and a significant decrease in pain intensity levels (p?=?0.005). Conclusions: This pilot study suggested that an individual-tailored feedback system that focuses on the activity behavior of the patient has potential as the treatment of individuals with CLBP.

• Implications for Rehabilitation

• Activity-based feedback for individuals with chronic low back pain:

• Many patients are not aware of their activity patterns.

• The activity patterns of patients differ from those of healthy controls.

• It is important to make patients aware of their activity patterns in order to change activity behavior.

• An individual-tailored feedback system seems promising in decreasing pain intensity levels for a subgroup of patients.

     

Predictors of post-traumatic growth in stroke survivors

Abstract

Purpose: The development of post-traumatic growth was studied longitudinally within 14?months poststroke. The predictions of two models of post-traumatic growth were examined.

Method: Forty-three stroke survivors were investigated at two time points (i.e., time 1 and time 2), six months apart. Each completed the Post-traumatic Growth Inventory, Rumination Scale, Impact of Events Scale, Multidimensional Scale of Social Support, the Barthel Index and the COPE scale.

Results: Post-traumatic growth was evident four to five months after stroke, increasing significantly over the next six months at which point levels resembled those reported in cross-sectional stroke studies. Active and denial coping and rumination at time 1 were positively associated, and age was negatively associated, with post-traumatic growth at time 2, but acceptance coping was not associated. Neither active coping nor rumination mediated the effect of social support on post-traumatic growth as predicted. As predicted, rumination mediated the relationship between post-traumatic stress and post-traumatic growth. Exploratory stepwise regression demonstrated rumination and active coping at time 1 accounted for 45% of variance in post-traumatic growth at time 2.

Conclusions: Post-traumatic growth can develop soon after stroke. Deliberate rumination is a key factor in post-traumatic growth. Both active coping and denial coping were associated with post-traumatic growth demonstrating the psychological complexity of poststroke adjustment.

• Implications for rehabilitation

• Therapists can expect stroke survivors to show post-traumatic growth in the first months after stroke.

• Therapists should look to promote post-traumatic growth and positive adjustment through working with survivors to increase active coping (attempts to deal effectively with the impact of stroke) and rumination (cognitive processing of the impact of the stroke).

• Since denial coping was also associated with posttraumatic growth, stroke survivors who maintain overly optimistic views about the severity and impact of their stroke are likely to benefit from therapists continually facilitating capacity for growth and well-being.

     

A life-course perspective on stigma-handling: resilience in persons of restricted growth narrated in life histories

Abstract

Purpose: The aim of the study is to explore how personal and contextual experiences throughout the life course are recollected as having influenced the development of stigma-handling strategies among people associated with disability and stigma. The article describes the development of stigma handling among ageing persons of restricted growth in order to avert negative effects, develop resilience, strengthen the self and support a positive identity. Method: Qualitative retrospective interviews were conducted with ten persons – seven women and three men aged between 45 and 65 years – of short stature. Their narratives are analysed from a life-course perspective and the results presented under two main themes: the development of strategies during different stages of life, and the use of general non-stage-bound strategies. Results: The study shows how stigma-handling has evolved from childhood to become, by adult years, refined, contextualised strategies demonstrating human resilience. The analysis documents the impact of human agency on personal lives and the subjects’ efforts and strengths in handling adversity. Conclusion: The results demonstrate how the “insider perspective” reveals the individual’s resources, resilience and strategies and provides an important perspective for the rehabilitation setting.

• Implications for Rehabilitation

• The study document human agency, resilience and strength in a life course perspective among people of restricted growth faced with stigmatization.

• The efforts and stigma handling strategies developed during the life course, such as withdrawal, humour, ignoring and positive thinking, are important tools to be recognized with relevance for other patient groups.

• The “insider perspective” revealing the potentialities and strength of human agency and resilience, should be further explored within the field of rehabilitation.

     

Psychometric properties of the International Classification of Functioning,Disability and Health set for spinal cord injury nursing based on Rasch analysis

Objective: To examine the psychometric properties of the International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing (ICF-SCIN) using Rasch analysis.

Methods: A total of 140 spinal cord injury patients were recruited between December 2013 and March 2014 through convenience sampling. Nurses used the components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF-SCIN to rate the patients’ functioning. Rasch analysis was performed using RUMM 2030 software.

Results: In each component, categories were rescored from 01234 to 01112 because of reversed thresholds. Nine testlets were created to overcome local dependency. Four categories which fit to the Rasch model poorly were deleted. After modification, the components BF, BS, and AP showed good fit to the Rasch model with a Bonferroni-adjusted significant level (χ^2?=^?86.29, p?=?0.006; χ^2?=^?22.44, p?=?0.130; χ^2?=^?39.92, p?= 0.159). The person separation indices (PSIs) for the three components were 0.80, 0.54, and 0.97, respectively. No differential item functioning (DIF) was detected across age, gender, or educational level.

Conclusions: The fit properties of the ICF set were satisfactory after modifications. The ICF-SCIN has the potential as a nursing assessment instrument for measuring the functioning of patients with spinal cord injury.

• Implications for rehabilitation

• The International Classification of Functioning, Disability and Health (ICF) set for spinal cord injury nursing contains a group of categories which can reflect the functioning of spinal cord injury patients from the perspective of nurses.

• The components body functions (BF), body structures (BS), and activities and participation (AP) of the ICF set for spinal cord injury achieved the fit to the Rasch model through rescoring, generating testlets, and deleting categories with poor fit.

• The ICF set for spinal cord injury nursing (ICF-SCIN) has the potential to be used as a clinical nursing assessment tool in measuring the functioning of patients with spinal cord injury.

     

Musculoskeletal complaints in individuals with finger or partial hand amputations in the Netherlands: a cross-sectional study

Purpose: To compare the prevalence of musculoskeletal complaints (MSCs) in individuals with finger or partial hand amputations (FPHAs) with a control group and to explore the effect and predictors of MSCs in individuals with FPHAs.

Method: A questionnaire-based cross-sectional study was conducted. The primary outcome measures were: prevalence of MSCs, health status, pain-related disability, physical work demands, work productivity, and hand function.

Results: The response rate was 61%. A comparable proportion of individuals with FPHAs (n?=?99) and controls (n?=?102) reported MSCs in the preceding 4 weeks (33% vs. 28%, respectively) or in the preceding year (37% vs. 33%, respectively). Individuals with FPHAs with MSCs experienced more pain than controls with MSCs. Regular occurrence of stump sensations and self-reported limited range of motion (ROM) of the wrist of the affected limb were predictors for MSCs in individuals with FPHAs.

Conclusions: The prevalence of MSCs was comparable in individuals with FPHAs and controls. However, clinicians should pay special attention to the risk of developing MSCs in patients with stump sensations and limited ROM of the wrist of the affected limb. Future research should focus on the role of wrist movements and compensatory movements in the development of MSCs in individuals with FPHAs.

• Implications for Rehabilitation

• The prevalence of musculoskeletal complaints (MSCs) in individuals with finger or partial hand amputations (FPHAs) and control subjects was similar.

• Regular occurrence of stump sensations and limited range of motion of the wrist of the affected limb were predictors of developing MSCs in individuals with FPHAs.

• Clinicians should pay special attention to individuals with FPHAs with the presence of these predictors of developing MSCs.

• For a better understanding of the development of and treatment options for MSCs, future research focusing on the role of wrist function in the development of MSCs in individuals with FPHAs is necessary.

     

Multiple stakeholder perceptions of assistive technology for individuals with cerebral palsy in New Zealand

Background: This study sought to gain an understanding of the experiences and perspectives of assistive technology from different stakeholders in technology adoption, in the New Zealand context.

Methods: A focus group was held with individuals with cerebral palsy (n?=?5), service providers (n?=?4), caregivers (n?=?3) and a biomechanical engineer. The data recordings from the focus group were transcribed and coded using thematic analysis.

Results: Themes emerged around barriers imposed by the assessment process and training in assistive technology procedures, the influence of family members, the environment that assistive technology is used in, and psychosocial aspects of being able to participate and integrate into society.

Conclusion: The results are similar to other literature, suggesting new innovations and changes are in dire need, to improve assistive technology experiences for all stakeholders.

• Implications for Research

• Service providers for assistive technology desire more effective training and support of existing and emerging technologies.

• Although the set procedure for acquiring assistive technology in New Zealand is comprehensive, incorporating multiple perspectives, it is difficult to follow through in practice. More innovative procedures are needed.

• The movement of Universal Design is significantly improving the perception of individuals with disabilities, and has enabled greater social inclusion. More assistive technology developers need to ensure that they incorporate these principles in their design process.

     

The construct validity of the Dutch version of the activity card sort

Purpose: Establishing construct validity of the ACS-NL in individuals with Parkinson’s disease (PD).

Method: Discriminative validity was established in 191 community-dwelling individuals with PD using an extreme groups design (Hoehn and Yahr stages 1 and 3). Convergent validity was determined by relating the performance scores of the ACS-NL to the scores of the Canadian Occupational Performance Measure (COPM) and the Parkinson’s Disease Questionnaire (PDQ-39) scores, and relating ACS-NL satisfaction scores to the COPM scores and to the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-P).

Results: The ACS-NL discriminated between individuals with PD with H&;Y stages 1 and 3 (U?=?524.5, Z?=??5.453). ACS-NL performance scores correlated weakly with COPM scores (r?=?(0).19) and moderately with PDQ-39 scores (r?=?0.44–0.55). The ACS-NL satisfaction scores correlated weakly with COPM scores (r?= 0.23), and moderately with USER-P scores (r?≥?0.40).

Conclusions: This study contributed to the validation of the ACS-NL. The assessment enhances the possibility of monitoring participation in activities in individuals with PD.

• Implications for Rehabilitation

• The ACS-NL appears to hold good potential for use in the assessment of participation in activities in individuals with PD.

• The ACS-NL has added value parallel to administration of other instruments measuring participation (COPM) and quality of life (PDQ-39).

• This study demonstrates the capacity of the ACS to measure a unique construct of participation and helps to improve the psychometric properties and administration of the ACS-NL in practice.