Psychometric evidence of self-reported questionnaires for patellofemoral pain syndrome: a systematic review

Abstract

Purpose: To conduct a systematic review of psychometric properties of self-reported questionnaires used to assess the level of symptoms and disability in individuals with patellofemoral pain syndrome (PFPS). Methods: A structured search was conducted in four databases (Medline, Embase, CINAHL, SportDiscus). A total of 24 studies about five different self-reported questionnaires were analyzed. A pair of independent raters extracted data on validity, reliability and responsiveness to change, and performed critical appraisal (0–100%). Results: Activities of Daily Living Scale (ADLS), Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) and Lysholm Scale (LS) present excellent test–retest reliability (weighted average intraclass correlation coefficients [ICC]?>?0.80), whereas Functional Index Questionnaire (FIQ) is moderately reliable (ICC?=?0.61). Minimal detectable change is 8.3% for ADLS, 9.0% for AKPS, 19% for FIQ, 8.5% for IKDC and 30% for LS. ADLS, AKPS, IKDC and LS are highly responsive (effect size/standardized response mean >0.95) in individuals with PFPS, while FIQ is lowly responsive (effect size?=?0.49). Conclusion: Based on available evidence, ADLS presents the best psychometric properties and should be preferred when evaluating patients with PFPS. AKPS and IKDC are also adequate, while FIQ and LS are not recommended for individuals with PFPS.

• Implications for Rehabilitation

• While several questionnaires have been developed to assess symptoms and functional limitations caused by knee pain, their psychometric properties can vary depending on the condition presented by the patient.

• The Activities of Daily Living Scale of the Knee Outcome Survey should be preferred by clinicians when evaluating a patient with PFPS.

• The Anterior Knee Pain Scale and International Knee Documentation Committee Subjective knee evaluation are also adequate for use with this population.

• The Functional Index Questionnaire and Lysholm Scale are not recommended for PFPS.

     

Content and psychometric evaluations of questionnaires for assessing physical function in people with neck disorders: a systematic review of the literature

Purpose: The purpose was to investigate how physical function is assessed in people with musculoskeletal disorders (MSD) in the neck. Specifically, we aimed to determine: (1) Which questionnaires are used to assess physical function in people with MSD in the neck? (2) What do those questionnaires measure? (3) What are the measurement properties of the questionnaires?

Materials and methods: A systematic review was performed to identify questionnaires and psychometric evaluations. The content of the questionnaires was categorized according to the International Classification of Function, Disability and Health, and the psychometric properties were quality-rated using the COnsensus-based Standards for the selection of health Measurement INstruments checklist.

Results: Ten questionnaires and 32 articles evaluating measurement properties were analyzed. Most questionnaires covered only the components body functions and activity and participation, more often activity participation than body function. Internal consistency was adequate in most questionnaires, whereas responsiveness was generally low. Neck Disability Index was most evaluated, but the evaluations of all questionnaires tended to cover most properties in the checklist.

Conclusions: The questionnaires differed substantially in items and extent to which their psychometric properties had been evaluated. Focus of measurement was on activities in daily life rather than physical function as such.

• Implications for Rehabilitation

• To provide early diagnostics and effective treatment for patients with neck disorders, valid and reliable instruments that measure relevant aspects of the disorders are needed.

• This paper presents an overview of content and quality of questionnaires used to assess physical function in neck disorders, which may facilitate informed decisions about which measurement instruments to use when evaluating the course of neck disorders.

• Most of the questionnaires need more testing to judge the quality, however the NDI was the most frequently tested questionnaire.

• The COnsensus-based Standards for the selection of health Measurement INstruments checklist is a useful tool in relation to psychometric testing of questionnaires, but clear definitions of interpretation of the quality criteria in each study would enhance comparability of results.

     

Test–retest reliability and responsiveness of a French Canadian Upper Limb Functional Index (ULFI-FC)

Abstract

Purpose: The Upper Limb Functional Index (ULFI) is a self-report questionnaire assessing activity limitations and participation restrictions resulting from an upper limb musculoskeletal disorder (MSD). A French Canadian version of the ULFI (ULFI-FC) has recently demonstrated good internal consistency, and convergent validity, as well as clinical applicability in a rehabilitation context where clinicians have important time constraints. This study aimed to examine the test–retest reliability and responsiveness of the ULFI-FC. Methods: In order to study the ULFI-FC’s responsiveness, 60 participants completed the ULFI-FC and a French Canadian version of the DASH (DASH-FC) twice at an interval of two to six weeks, based on the evolution of their upper limb MSD. Half of the sample also completed the ULFI-FC three days after the second assessment for the test–retest reliability analysis. Results: The ULFI-FC demonstrated high test–retest reliability (ICC?=?0.92–0.97) and good internal responsiveness (Cohen’s d?=?0.49–0.62; standardized responsive means?=?0.60–0.88). External responsiveness was further supported by moderate correlations of change scores with the DASH-FC (r?=?0.42–0.64). Conclusions: Study findings support the use of the ULFI-FC in rehabilitation as an outcome measure to monitor activity limitations and participation restrictions among French-speaking patients presenting with upper limb MSD.

• Implications for Rehabilitation

• The ULFI-FC is a reliable and valid tool with good responsiveness to change for assessing activity limitations and participation restrictions in adults presenting with upper limb musculoskeletal disorders.

• This tool can thus be useful in clinical and research settings.

• By exploring meaningful activities that are affected by patients' upper limb musculoskeletal disorders, the tool's Patient Specific Index is particularly relevant for clinicians adhering to a patient-centered approach.

     

Assessment of spasticity after stroke using clinical measures: a systematic review

Abstract

Purpose: To identify and appraise the literature on clinical measures of spasticity that has been investigated in people after stroke. Methods: The literature search involved four databases (PubMed, CINAHL, Embase and The Cochrane Library) up to February 2014. The selected studies included those that aimed to measure spasticity using a clinical assessment tool among adult patients post-stroke. Two independent raters reviewed the included articles using a critical appraisal scale and a structured data extraction form. Results: A total of 40 studies examining 15 spasticity assessment tools in patients post-stroke were reviewed. None of the reviewed measurement tools demonstrated satisfactory results for all psychometric properties evaluated, and the majority lacked evidence concerning validity and absolute reliability. Conclusion: This systematic review found limited evidence to support the use of most of clinical measures of spasticity for people post-stroke. Future research examining the application and psychometric properties of these measures is warranted.

• Implications for Rehabilitation

• There is a need for objective clinical tools for measuring spasticity that are clinically feasible and easily interpreted by clinicians.

• This review identified various clinical measures of spasticity that have been investigated in people after stroke.

• Insufficient evidence of psychometric properties precludes recommending one tool over the others.

• Future research should focus on investigating the psychometric properties of clinical measures of spasticity.

     

Assessment of activity limitations and participation restrictions with persons with chronic fatigue syndrome: a systematic review

Abstract

Purpose: To summarize measurement instruments used to evaluate activity limitations and participation restrictions in patients with chronic fatigue syndrome (CFS) and review the psychometric properties of these instruments. Method: General information of all included measurement instruments was extracted. The methodological quality was evaluated using the COSMIN checklist. Results of the measurement properties were rated based on the quality criteria of Terwee et?al. Finally, overall quality was defined per psychometric property and measurement instrument by use of the quality criteria by Schellingerhout et?al. Results: A total of 68 articles were identified of which eight evaluated the psychometric properties of a measurement instrument assessing activity limitations and participation restrictions. One disease-specific and 37 generic measurement instruments were found. Limited evidence was found for the psychometric properties and clinical usability of these instruments. However, the CFS-activities and participation questionnaire (APQ) is a disease-specific instrument with moderate content and construct validity. Conclusion: The psychometric properties of the reviewed measurement instruments to evaluate activity limitations and participation restrictions are not sufficiently evaluated. Future research is needed to evaluate the psychometric properties of the measurement instruments, including the other properties of the CFS-APQ. If it is necessary to use a measurement instrument, the CFS-APQ is recommended.

• Implications for Rehabilitation

• Chronic fatigue syndrome (CFS).

• Chronic fatigue syndrome causes activity limitations and participation restrictions in one or more areas of life.

• Standardized, reliable and valid measurement instruments are necessary to identify these limitations and restrictions.

• Currently, no measurement instrument is sufficiently evaluated with persons with CFS.

• If a measurement instrument is needed to identify activity limitations and participation restrictions with persons with CFS, it is recommended to use the CFS-APQ in clinical practice and scientific research.

     

Development and validation of the Diabetes Knowledge Assessment Test for use in medical rehabilitation

Abstract

Purpose: To develop and validate the Diabetes Knowledge Assessment Test (DKAT), an assessment designed to measure diabetes knowledge of medical rehabilitation patients with or without diabetes. Methods: Content validity methods were used to develop the DKAT, which was administered to rehabilitation patients to examine psychometric properties. Results: Subjects were 75 inpatients (56% with diabetes; 45% male), and 75 outpatients (49% with diabetes; 69% male). The initial DKAT consisted of 49 items, which was reduced to 32 items based on psychometric criteria. Point-biserial item discrimination indices ranged from 0.26 to 0.61. Item difficulty indices ranged from 27 to 96%. Cronbach’s alpha was 0.82. Known groups construct validity comparisons revealed that patients with diabetes obtained significantly higher DKAT scores than patients without diabetes (p?=?0.01), supporting construct validity. Scores did not differ significantly by gender, educational attainment, age, or outpatient versus inpatient (all p?>?0.05), further supporting construct validity. Confirmatory factor analysis identified two factors: “Complications” and “Risks-Symptoms-Management”. Conclusions: Findings support claims that DKAT scores are valid and reliable for diabetes knowledge assessment across a range of rehabilitation conditions. It is appropriate for use with persons with or without diabetes engaging in rehabilitation services as an inpatient or outpatient.

• Implications for Rehabilitation

• Medical rehabilitation patients represent an important population in which to assess core diabetes knowledge due to the extremely high prevalence of diabetes.

• We were unable to identify instruments with validity evidence aimed at assessing diabetes knowledge in rehabilitation populations, therefore undertook development of the DKAT.

• The DKAT represents a psychometrically promising assessment that can inform individuals at risk with the signs and symptoms of diabetes, as well as behavioral actions to reduce risk.

• The DKAT can also be used to identify those with a diagnosis of diabetes in need of formal diabetes education.

     

Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training

Purpose: To investigate utility of the Community Integration Questionnaire (CIQ) in a mixed sample of adults with neurological and neuropsychiatric disorders. Method: Cross-sectional, interview-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?54), who participated in a pre-vocational readiness and social skills training program. Psychometric properties of the Community Integration Questionnaire (CIQ) were assessed and validated against Mayo-Portland Adaptability Inventory (MPAI) and The Problem Checklist from the New York University Head Injury Family Interview (PCL). Results: Based on the revised scoring procedures, psychometric properties of the CIQ Home Competency scale were excellent, followed by the Total score and Social Integration scale. Productive Activity scale had low content validity and a weak association with the total score. Convergent and discriminant validity of the CIQ were demonstrated by correlation patterns with MPAI scales in the expected direction. Significant relationship was found with PCL Physical/Dependency scale. Significant associations were found with sex, living status, and record of subsequent employment. Conclusions: The results provide support for the use of the CIQ as a measure of participation in individuals with neurological and neuropsychiatric diagnoses and resulting disabilities.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with dysfunction of the central nervous system is to promote their participation in social, vocational, and domestic activities.

• The Community Integration Questionnaire (CIQ) is a brief and efficient instrument for measuring these participation domains.

• This study demonstrated good psychometric properties and high utility of the CIQ in a sample of 54 individuals participating in a prevocational training program.

     

The relationship between functional disability and health-related quality of life in patients with a rotator cuff tear

Purpose:To determine the relationship between functional disability and health-related quality of life (HRQoL) in rotator cuff tear (RCT) patients. Method:In 67 RCT patients (mean age, 54 years; 57% males), functional disability was self-reported with the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), HRQoL with the Short-Form 36 Health Survey (SF-36), and pain by visual analogue scale. ASES results were divided into tertiles (12–38, 39–51, and 52–82). Results:Mean ASES score was 48 (range, 12–82). Patients with the highest functional disability and highest pain level had the lowest HRQoL. For the highest, middle, and lowest ASES categories, respectively, mean SF-36 Physical Component Summary (PCS) scores were 35 SD 5, 36 SD 8, and 41 SD 6 (p< 0.001) (r = 0.47 for ASES vs. PCS; p< 0.001), and Mental Component Summary (MCS) scores were 50 SD 13, 56 SD 10, and 58 SD 8 (p = 0.011) (r = 0.37 for ASES vs. MCS; p= 0.003). Conclusions: Patients with higher functional disability had lower HRQoL. RCT extensively affects patients’ lives; therefore, capturing both generic and shoulder-specific measures of RCT problems is recommended.

Implications for Rehabilitation

• Rotator cuff tears (RCTs) result from injury or degeneration, and tear prevalence increases with age.

• RCT causes disabling pain, decline in muscle strength and shoulder mobility.

• RCT patients with decreased functioning have impaired quality of life.

     

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

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

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

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

• Implications for rehabilitation

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

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

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

     

Psychometric properties of the HI-FI problem checklist in a sample of adults with neurological and neuropsychiatric disorders: factors contributing to life satisfaction after long-term disability

Purpose To assess psychometric properties of the problem checklist (PCL) in a sample of individuals with neurological and neuropsychiatric disorders many years after trauma; to identify factors that impact life satisfaction and promote functional competence after long-term disability. Method Cross-sectional, interview- and assessment-based study. Participants were community-dwelling adults with disabilities resulting from neurological and neuropsychiatric disorders (N?=?53), who participated in a pre-vocational readiness and social skills training program. The Problem Checklist from the New York University Head Injury Family Interview (PCL), a battery of self-rated and clinician-rated measures of social/emotional status, and neuropsychological tests were main outcome measures. Results PCL is a valid and reliable instrument with acceptable psychometric properties (reliability coefficients for two scales and the total score are above (0.795). Use of maladaptive coping strategies in our sample was reflected in inverse relationship between depression and denial of disability, and in the tendency to overrate self-reported symptoms by participants with acquired trauma. Considerably lower self-ratings of symptoms across all PCL scales were seen in those of our participants who live with parents. Conclusions The study offers initial support for the use of PCL as a measure of long-term functional outcome in individuals with neurological and neuropsychiatric diagnoses. The goal of rehabilitation in patients with long-term disabilities is increase in life satisfaction.

• Implications for Rehabilitation

• An important goal of rehabilitation and training programs for individuals with long-term disabilities due to dysfunction of the central nervous system is to improve their quality of life.

• The HI-FI Problem Checklist (PCL) is a brief and efficient instrument for assessing functional outcomes after long-term disability.

• This study demonstrated acceptable psychometric properties of the PCL in a sample of 53 individuals participating in a pre-vocational training program and provided initial support for its utility for patients with various diagnoses.

     

A collaborative approach to supporting communication in the assessment of decision-making capacity

Purpose: This paper explores the clinical implications of acquired communication disorders in decisional capacity. Discipline-specific contributions are discussed in a multidisciplinary context, with a specific focus on the role of speech and language pathologists (SLPs). Method: Key rehabilitation issues in determining decisional capacity are identified. The impact of communication impairment on capacity is discussed in light of the research literature relating to supportive communication and collaborative practice that respects human rights. Results: Guidelines are presented for professionals involved in the assessment of the decisional capacity of individuals with communication disorders of neurological origin. They guide an assessor through: assessing cognition, language and speech; determining preferred communication domains; and practical strategies and considerations for maximising communication. Conclusion: There is a dearth of guidelines available that deal with augmenting and supporting communication of individuals with acquired communication disorders of neurological origin when it comes to assessing legal decision-making capacity. Capacity assessment is a multidisciplinary realm, and the involvement of SLPs is key to maximising the decision-making capacity of these individuals.

• Implications for rehabilitation

• All clinicians have an obligation to maximise client autonomy and participation in decision-making.

• Assessments of capacity should involve a general cognitive ability assessment, followed by a decision-specific assessment tool or question set for the decision facing the patient.

• The involvement of speech and language pathologists (SLPs) is key to assess and facilitate capacity determinations in instances of cognitive-communication disorder.

• Impairments in different aspects of auditory comprehension require different accommodations.

     

The Pediatric Version of the Eating Assessment Tool: a caregiver administered dyphagia-specific outcome instrument for children

Purpose: To develop and evaluate the psychometric properties of the Pediatric version of the caregiver administered Eating Assessment Tool.

Methods: The study included developmental phase and reported content, criterion validity, internal consistency and test–retest reliability of the Pediatric Eating Assessment Tool. Literature review and the original Eating Assessment Tool were used for line-item generation. Expert consensus assessed the items for content validity over two Delphi rounds. Fifty-one healthy children to obtain normative data and 138 children with cerebral palsy to evaluate test–retest reliability, internal consistency, and criterion validity were included. The Penetration-Aspiration Scale was used to assess criterion validity.

Results: All items were found to be necessary. Content validity index was 0.91. The mean score of Pediatric Eating Assessment Tool for healthy children and children with cerebral palsy was 0.26?±?1.83 and 19.5?±?11, respectively. The internal consistency was high with Cronbach’s alpha =0.87 for test and retest. An excellent correlation between the Pediatric Eating Assessment Tool and Penetration-Aspiration score for liquid and pudding swallowing was found (p?r?=?0.77; p?r?=?0.83, respectively). A score >4 demonstrated a sensitivity of 91.3% and specificity of 98.8% to predict penetration/aspiration.

Conclusions: The Pediatric Eating Assessment Tool was shown to be a valid and reliable tool to determine penetration/aspiration risk in children.

• Implications for rehabilitation

• The pediatric eating assessment tool: a new dyphagia-specific outcome survey for children.

• The Pediatric Version of the Eating Assessment Tool is a dysphagia specific, parent report outcome instrument to determine penetration/aspiration risk in children.

• The Pediatric Version of the Eating Assessment Tool has good internal consistency, test–retest reliability and criterion-based validity.

• The Pediatric Version of the Eating Assessment Tool may be utilized as a clinical instrument to assess the need for further instrumental evaluation of swallowing function in children.

     

Cross-cultural adaptation,reliability and validity of the Turkish version of the Lower Limb Functional Index

Abstract

Purpose: This study aims to adapt culturally a Turkish version of the Lower Limb Functional Index (LLFI) and to determine its validity, reliability, internal consistency, measurement sensitivity and factor structure in lower limb problems. Method: The LLFI was translated into Turkish and cross-culturally adapted with a double forward–backward protocol that determined face and content validity. Individuals (n?=?120) with lower limb musculoskeletal disorders completed the LLFI and Short Form-36 questionnaires and the Timed Up and Go physical test. The psychometric properties were evaluated for the all participants from patient-reported outcome measures made at baseline and repeated at day 3 to determine criterion between scores (Pearson’s r), internal consistency (Cronbachs α) and test–retest reliability (intraclass correlation coefficient – ICC_2.1). Error was determined using standard error of the measurement (SEM) and minimal detectable change at the 90% level (MDC₉₀), while factor structure was determined using exploratory factor analysis with maximum likelihood extraction and Varimax rotation. Results: The psychometric characteristics showed strong criterion validity (r?=?0.74–0.76), high internal consistency (α?=?0.82) and high test–retest reability (ICC_2.1?=?0.97). The SEM of 3.2% gave an MDC₉₀?=?5.8%. The factor structure was uni-dimensional. Conclusions: Turkish version of LLFI was found to be valid and reliable for the measurement of lower limb function in a Turkish population.

• Implications for Rehabilitation

• Lower extremity musculoskeletal disorders are common and greatly impact activities among the affected individuals pertaining to daily living, work, leisure and quality of life.

• Patient-reported outcome (PRO) measures have advantages as they are practical, cost-effective and clinically convenient for use in patient-centered care.

• The Lower Limb Functional Index is a recently validated PRO measure shown to have strong clinimetric properties.

     

Coding of meaningful concepts in lymphedema-specific questionnaires with the ICF

Abstract

Purpose: To identify and quantify the meaningful concepts within questionnaires focusing on lymphedema using the International Classification of Functioning, Disability and Health (ICF). Methods: Electronic searches of Medline, EMBASE, CINAHL, CENtral and Pedro (2005–2010) were conducted. The concepts in the questionnaires were retrieved from the included studies and linked to the ICF. Results: Of the 2381 abstracts retrieved, 136 studies were included. The study population suffered from lymphedema in the upper limb (65%), in the lower limb (25%), in the midline (3%) and in combinations of these areas (7%). In total, 12 lymphedema-specific questionnaires were found (nine for the upper limb, two for the lower limb and one for lymphedema in general). A total of 301 concepts were extracted from the questionnaires, of which 271 (90%) could be linked to the ICF. There were 45 two-level ICF categories linked to concepts in ≥2 questionnaires; 13 in Body Functions, 6 in Body Structures, 16 in Activities and Participation and 10 in Environmental Factors. The most frequently measured categories were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”. Conclusion: The ICF provides a valuable reference to identify concepts in questionnaires focusing on individuals with lymphedema.

• Implications for Rehabilitation

• Lymphedema is a chronic condition and the problems in physical functioning related to lymphedema can result in distress and loss of quality of life.

• ICF Core Sets for lymphedema consist of a lymphedema-specific selection of ICF categories, which makes it easier to implement the use of the ICF in medical and allied health care.

• ICF Core Sets for lymphedema can act as a framework for more unity in questionnaires concerning consequences of lymphedema.

• Part of the development process of ICF Core Sets for lymphedema is the linking of items from lymphedema-specific clinical questionnaires to ICF codes. The ICF codes most frequently used to link the items in the reviewed questionnaires were “Structure of upper extremity”, “Immunological system functions”, “Looking after one’s health”, “Sensation of pain”, “Touch functions”, “Dressing” and “Health services, systems and policies”.

     

An initial factor analysis of prominent aspects of health experiences for women with neck-shoulder pain

Purpose: The prospect of adequate comparisons is essential to decide on the effectiveness of different treatments. As there is a lack of unity in choice of questionnaires and included measures concerning musculoskeletal disorders, further investigations based on international recommendations are of interest. The intention of present study was to initiate the development of a clinically useful short-form questionnaire. The aim was to select items that capture prominent health aspects for women with neck-shoulder pain and thereby reduce the number of items to a clinically more convenient amount, and to determine the underlying structure of included items. Method: Data were collected in a randomised controlled trial including women with non-specific neck-shoulder pain >3 months (n?=?117). Data collection included three core domains: pain intensity, physical and emotional functioning, and analysis was performed using Principal component analysis, and Varimax rotation. Results: The resulting 9-factor solution included interference, solicitous/distracting responses, mood and feelings about self and relations, pain intensity, punishing responses, personal growth, life control, sleep, and appetite (29 items). Conclusions: The results will contribute to the development of a reduced battery of questions representing core dimensions. Such questionnaire would lighten the assessment load in the clinic as well as in research.

Implications for Rehabilitation

• Despite the call for multidimensional evaluation of MSDs, measurement is often reduced to pain and disability.

• A lack of unity in choice of outcome measures limits the possibilities for comparisons and hinders the development of effective treatment methods.

• International recommendations regarding outcome measures can serve to unify evaluation.

• This study presents the first step in the development of a short-form questionnaire for evaluation of neck-shoulder pain, based on international recommendations for clinical evaluation of pain conditions

     

The extremity function index (EFI), a disability severity measure for neuromuscular diseases: psychometric evaluation

Objective: To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease severity in neuromuscular diseases.

Design: A cross-sectional postal survey study was performed among patients diagnosed with a neuromuscular disease.

Methods: Patients completed both adapted extremity function scales, questionnaires for psychometric evaluation, and disease-specific questions. Confirmatory factor analysis was performed, and reliability and validity were examined.

Results: Response rate was 70% (n?=?702). The Extremity Function Index model with a two-factor structure – for upper and lower extremities – showed an acceptable fit. The Extremity Function Index scales showed good internal consistency (alphas: 0.97–0.98). The known-groups validity test confirmed that Extremity Function Index scales discriminate between categories of “Extent of limitations” and “Quality of Life.” Convergent and divergent validity tests confirmed that Extremity Function Index scales measure the physical impact of neuromuscular diseases. Relative validity tests showed that the Extremity Function Index scales performed well in discriminating between subgroups of patients with increasing “Extent of limitations” compared to concurrent measurement instruments.

Conclusion: The Extremity Function Index proved to be a sound and easy to apply self-report disability severity measurement instrument in neuromuscular diseases.

• Implications for rehabilitation

• The Extremity Function Index reflects the functioning of all muscles in the upper and lower extremities involved in activities of daily living.

• The Extremity Function Index is an easy to administer and patient-friendly disability severity measurement instrument that has the ability to evaluate differences in disability severity between relevant neuromuscular disease subgroups.

• The Extremity Function Index is a valid and reliable disability severity measurement instrument for neuromuscular diseases.

     

Development of the Spanish version of the Spinal Cord Independence Measure version III: cross-cultural adaptation and reliability and validity study

Abstract

Purpose: To provide a translation and cross-cultural adaptation of the Spinal Cord Independence Measure (SCIM) version III for Spain and to validate the Spanish version of the SCIM III (eSCIM III). Patients and methods: Development of eSCIM III has involved translation, back-translation and assessment of cultural equivalence procedures. eSCIM version III, was administered to 64 patients with spinal cord injury, admitted to our hospital. Investigation of the psychometric characteristics included: (1) study of the inter-rater reliability, (2) internal consistency (Cronbach’s α), (3) validation and confirmation of the correlation between eSCIM III and Functional Independence Measure (FIM), and (4) sensitivity to change. Results: The reliability of eSCIM III showed an intra-class coefficient value >0.97 in the different subscales assessed. Internal consistency of eSCIM III was shown by a Cronbach’s α value of 0.93. The validity of eSCIM III was confirmed by the close correlation with FIM (r?=?0.94, p?<?0.0001). The sensitivity to change of eSCIM III was also confirmed. Conclusions: eSCIM III was found to be culturally equivalent to the original version, as reliability and validity of this tool were demonstrated. It can be used in Spain for functional assessment of patients with spinal cord injury.

• Implications for Rehabilitation

• Development of the Spanish version of the Spinal Cord Independence Measure version III.

• The importance of the adaptation of Spinal Cord Independence Measure (SCIM) is that it guarantees the possibility of measuring the same concept in different cultures and countries.

• The eSCIM III is the first, specific assessment tool in patients with spinal cord injury adapted for its use in Spain.

• The eSCIM III is a tool conceptually equivalent to the original version. It has the reliability and validity of SCIM III in order to be used by clinicians.

     

Using a social robot to teach gestural recognition and production in children with autism spectrum disorders

While it has been argued that children with autism spectrum disorders are responsive to robot-like toys, very little research has examined the impact of robot-based intervention on gesture use. These children have delayed gestural development. We used a social robot in two phases to teach them to recognize and produce eight pantomime gestures that expressed feelings and needs. Compared to the children in the wait-list control group (N?=?6), those in the intervention group (N?=?7) were more likely to recognize gestures and to gesture accurately in trained and untrained scenarios. They also generalized the acquired recognition (but not production) skills to human-to-human interaction. The benefits and limitations of robot-based intervention for gestural learning were highlighted.

• Implications for Rehabilitation

• Compared to typically-developing children, children with autism spectrum disorders have delayed development of gesture comprehension and production.

• Robot-based intervention program was developed to teach children with autism spectrum disorders recognition (Phase I) and production (Phase II) of eight pantomime gestures that expressed feelings and needs.

• Children in the intervention group (but not in the wait-list control group) were able to recognize more gestures in both trained and untrained scenarios and generalize the acquired gestural recognition skills to human-to-human interaction.

• Similar findings were reported for gestural production except that there was no strong evidence showing children in the intervention group could produce gestures accurately in human-to-human interaction.

     

The Fugl–Meyer assessment of the upper extremity: reliability,responsiveness and validity of the Danish version

Objective: To translate the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE) into Danish and to establish the inter-tester reliability, responsiveness, Minimal Clinically Important Difference (MCID) and concurrent validity of the FMA-UE in a population of stroke patients. Method: The translation was conducted in accordance with the principles outlined by the ISPOR Task Force for Translation and Cultural Adaption. Inter-rater reliability was assessed at baseline. Each patient was tested by two examiners and inter class correlation (ICC) was calculated. Responsiveness was assessed using receiver operating characteristic (ROC) curve statistics. The FMA-UE change score was used to assess sensitivity and specificity and to correctly determine which patients had improved. The MCID and the area under the curve (AUC) were established using the ROC. The FMA-UE’s concurrent validity with the Motor Assessment Scale was determined using Spearman’s rank correlation. Setting: The study took place at Skive Neurorehabilition, Denmark from May 2014 to February 2015. Participants: Inpatients, who were in the acute to sub-acute stage of stroke and aged?>?18 years. Interventions: Not applicable. Main outcome measure: The FMA-UE. Results: In 50 inpatients the ICC was 0.95, AUC was 0.87, with a sensitivity of 77%, a specificity of 89% and an MCID?≥?4. Concurrent validity was high, with r?=?0.94–0.95. Conclusion: The FMA-UE was successfully translated into Danish. An MCID?≥?4 was found. This study provides evidence that the FMA-UE is a reliable, responsive and valid instrument for measuring upper limb impairment after stroke.

• Implications for rehabilitation

• One of the most widely recognized measures of upper extremity motor impairment post-stroke is the Fugl-Meyer Assessment of the Upper Extremity (FMA-UE).

• The psychometric properties of a measurement depends on the population and setting in which it is used.

• In this study, the FMA-UE is translated into Danish and the psychometric properties of FMA-UE is determined in a Danish population of patients with stroke.

• The FMA-UE is now available to use for clinicians in Denmark.