Construct validity and test-retest reliability of the questionnaire rising and sitting down in lower-limb amputees

de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down in lower-limb amputees.

Objective

To investigate the construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down (QR&S), a patient-reported measure of activity limitations in rising and sitting down, in lower-limb amputees.

Design

Cross-sectional study.

Setting

Outpatient department of a rehabilitation center.

Participants

Lower-limb amputees (N=171; mean age ± SD, 65±12y; 71% men; 83% vascular cause) participated in the study, 33 of whom also participated in the reliability study.

Interventions

Not applicable.

Main Outcome Measures

Construct validity was investigated by testing 8 hypotheses: limitations in rising and sitting down according to the QR&S would be: (1) greater in lower-limb amputees who are older, (2) independent of level of amputation, (3) greater in lower-limb amputees with a bilateral amputation, and (4) greater in lower-limb amputees who had rehabilitation treatment in a nursing home. Furthermore, limitations in rising and sitting down will be positively related to activity limitations according to (5) the Locomotor Capabilities Index (LCI), (6) the questions about rising and sitting down in the LCI, (7) the Climbing Stairs Questionnaire, and (8) the Walking Questionnaire. Construct validity was quantified with an independent t test and Pearson correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified with the intraclass correlation coefficient (ICC), standard error of measurement, and smallest detectable difference (SDD).

Results

Construct validity (7 of 8 null hypotheses not rejected) and test-retest reliability were good (ICC=.84; 95% confidence interval, .65–.93; standard error of the measurement=6.7%; SDD=18.6%).

Conclusions

The QR&S has good construct validity and good test-retest reliability in lower-limb amputees.     

Climbing Stairs After Outpatient Rehabilitation for a Lower-Limb Amputation

Objective

To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables.

Design

Cross-sectional study.

Setting

Outpatient department of a rehabilitation center.

Participants

Persons with an LLA (N=155; mean age ± SD, 64.1±11.2y; 73% men).

Interventions

Not applicable.

Main Outcome Measures

The necessity to climb stairs was assessed with the Prosthetic Profile of the Amputee. Several indicators of the ability to climb stairs were assessed including: (1) independence in climbing stairs with a handrail and (2) without a handrail, according to the Locomotor Capabilities Index; (3) numbers of floors actually climbed, according to a rating scale; and (4) limitations in climbing stairs, according to the Climbing Stairs Questionnaire (range, 0–100, with higher scores indicating less limitations). Multivariate logistic regression analysis was used to investigate the associations between the ability to climb stairs and personal and clinical variables.

Results

Of the participants, 47% had to climb stairs. The ability to climb stairs was: (1) 62% independently climbed stairs with a handrail and (2) 21% without a handrail; (3) 32% didn't climb any stairs, 34% climbed half a floor or 1 floor, and 34% climbed ≥2 floors; (4) the median sum score (interquartile range) of the Climbing Stairs Questionnaire was 38 (19–63), indicating marked limitations. Older participants and women were less able to climb stairs with and without a handrail.

Conclusions

A considerable number of persons with an LLA have to climb stairs in their home environment. Many of them, especially older participants and women, are particularly hampered in their ability to climb stairs.     

Reliability and validity of the dynamic gait index in persons with chronic stroke

Jonsdottir J, Cattaneo D. Reliability and validity of the Dynamic Gait Index in persons with chronic stroke.

Objective

To establish the test-retest and interrater reliability as well as the concurrent construct validity of the Dynamic Gait Index (DGI) as a measure for dynamic balance in people with chronic stroke.

Design

Cohort study.

Setting

Day hospital and ambulatory care at a rehabilitation center.

Participants

A consecutive sample of 25 participants, at least 3 months poststroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI.

Interventions

Not applicable.

Main Outcome Measures

The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, and the Bland and Altman method were used to analyze total scores and item scores. Concurrent construct validity was tested by correlating results to the Berg Balance Scale, the timed walking test, the Timed Up & Go test, and the Activities-specific Balance Confidence Scale.

Results

ICCs for test-retest and interrater reliability of total scores were good (.96, .96, respectively) whereas reliability for single item scores was moderate to good (range, .55−.93). The hypotheses for concurrent construct validity were confirmed with all measures (range, .68−.83).

Conclusions

The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with chronic stroke.     

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

Mong Y, Teo TW, Ng SS. 5-repetition sit-to-stand test in subjects with chronic stroke: reliability and validity.

Objectives

To examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.

Design

Cross-sectional study.

Setting

University-based rehabilitation center.

Participants

A convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.

Interventions

Not applicable.

Main Outcome Measures

5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.

Results

Excellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (ρ=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.

Conclusions

The 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.     

Translation, transcultural adaptation, reliability and validity of the Patient Satisfaction Questionnaire in German

Objectives

To translate the Patient Satisfaction Questionnaire (PSQ) from French to German, to undertake transcultural adaptation, and to test reliability and validity.

Design

German translation according to sequential forward and backward translation approach, and transcultural adaptation by a consensus process. Validity testing was assessed in a cross-sectional study.

Setting

Outpatient physiotherapy department of a multidisciplinary clinic.

Participants

One hundred and twenty-three outpatients with musculoskeletal health disorders after completion of outpatient physiotherapy.

Main outcome measures

Test-retest reliability was quantified using the intraclass correlation coefficient (ICC 2,1), and Chronbach's alpha was calculated to assess internal consistency of the questionnaire. A factor analysis was performed to investigate the factor structure of the questionnaire. No comparable gold-standard measurement of patient satisfaction was retrieved. The construct validity was assessed using Spearman's rank correlation coefficients between the most indicative item and the global scale excluding this item.

Results

Translation and transcultural adaptation according to international guidelines did not produce any content or language problems. For 23 test-retest questionnaires, the ICC ranged from 0.74 (Item 10) to 0.92 (Item 11), corresponding to a Chronbach's alpha ranging from 0.85 to 0.96. On Item 12, correlations of 0.53-0.83 were obtained for the subscores and 0.79 for the total score. High values were obtained for content validity and face validity.

Conclusions

The PSQ in German proved to be good in terms of practical application, comprehensibility, internal consistency, reliability and validity. It is suitable for use to record patient satisfaction after outpatient physiotherapy in German-speaking areas.     

A psychometric evaluation of measures of spirituality validated in culturally diverse palliative care populations

Context

Despite the need to accurately measure spiritual outcomes in diverse palliative care populations, little attention has been paid to the properties of the tools currently in use.

Objectives

This systematic review aimed to appraise the psychometric properties, multifaith appropriateness, and completion time of spiritual outcome measures validated in multicultural advanced cancer, HIV, or palliative care populations.

Methods

Eight databases were searched to identify relevant validation and research studies. A comprehensive search strategy included search terms in three categories: palliative care, spirituality, and outcome measurement. Inclusion criteria were: validated in advanced cancer, HIV, or palliative care populations and in an ethnically diverse context. Included tools were evaluated with respect to psychometric properties (validity, reproducibility, responsiveness, and interpretability), multifaith appropriateness, and time to complete.

Results

A total of 191 articles were identified, yielding 85 tools. Twenty-six tools (representing four families of measures and five individual tools) met the inclusion criteria. Twenty-four tools demonstrated good content validity and 12 demonstrated adequate internal consistency. Only eight tools demonstrated adequate construct validity, usually because specific hypotheses were not stated and tested. Seven tools demonstrated adequate test-retest reliability; two tools showed adequate responsiveness, and two met the interpretability criterion. Data on the religious faith of the population of validation were available for 11 tools; of these, eight were tested in multifaith populations.

Conclusion

Results suggest that, at present, the McGill Quality of Life Questionnaire, the Measuring the Quality of Life of Seriously Ill Patients Questionnaire, and the Palliative Outcome Scale are the most appropriate multidimensional measures containing spiritual items for use in multicultural palliative care populations. However, none of these measures score perfectly on all psychometric criteria, and their multifaith appropriateness requires further testing.     

Psychometric evaluation of the Mainland Chinese version of the Edinburgh Postnatal Depression Scale

Background

The Edinburgh Postnatal Depression Scale (EPDS) has been validated in many countries, but not in Mainland China.

Objectives

This study investigated the reliability and validity of the Mainland Chinese version of the EPDS.

Design

A three-stage design was used for this study. Stage I consisted of a multi-stepped process of forward and backward translation, using a panel of six experts to test content validity. Stage II established the psychometric properties of the EPDS by examining the convergent, discriminant and construct validity, internal consistency and stability of the scale. Stage III established its sensitivity, specificity and the optimal cutoff score of the EPDS according the DSM-IV-TR criteria using the Structured Clinical Interview.

Setting

Three regional public hospitals in Chengdu.

Participants

A convenience sample was composed of 312 and 451 pregnant women at 28-36 weeks’ gestation.

Method

Translation and back-translation of the original English instrument and content validation by an expert panel. Receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. The Beck Depression Inventory (BDI), Dyadic Adjustment Scale (DAS) and standard SF-12 Health Survey (SF-12) were used to investigate the convergent, discriminant and construct validity. The Cronbach's alpha reliability coefficient, split-half reliability and test-retest reliability were used to examine the internal consistency and stability of the scale.

Results

The translation process was rigorously conducted to ensure that equivalence was established. Content validity was confirmed by a satisfactory level of agreement with a content validity index (CVI) of 0.93. The area under curve (AUC) was 85.6% and the logistic estimate for the threshold score was 9.5 (sensitivity, 80.0%; specificity, 83.03%) for clinical depression. Convergent and construct validity was supported and discriminant validity suggested that the EPDS successfully discriminated among the non-depressed, mildly and clinically depressed groups. The split-half reliability of the EPDS was 0.76, Cronbach's alpha was 0.79 and test-retest reliability was 0.85.

Conclusions

Based on the results of this psychometric testing, the Mainland Chinese version of the EPDS is considered ready for use in the routine screening of pregnant women. It is hoped that with this type of cross-cultural information, the universality of the constructs of the instrument can be reliably demonstrated.     

Long-term reliability of the incremental shuttle walking test in clinically stable cardiovascular disease patients

Objective

The incremental shuttle walking test (ISWT) is a valuable tool for assessing changes in patients’ functional capacity during cardiac rehabilitation. However, studies have only assessed its test-retest reliability in the short term. The purpose of this study was to examine long-term test-retest reliability of the ISWT in clinically stable cardiac patients.

Design

Test-retest reliability assessment.

Setting

Continuous, community-based phase IV cardiac rehabilitation centre.

Participants

Thirty patients with cardiovascular disease (15 males, 15 females; age 55 to 80 years) volunteered to participate in the study.

Interventions

Participants undertook two ISWTs, a minimum of 8 weeks apart.

Main outcome measures

ISWT performance in metres.

Results

Overall, the mean distance walked in the pre-test was 502 ± 161 m and this did not differ from test to retest. The intraclass correlation coefficient was 0.80, indicating good test-retest reliability. Using the Bland and Altman method, there was a small mean test-retest difference (−7 m). The 95% limits of agreement were large, ranging from −203 m to 189 m.

Conclusions

Over long test-retest durations, there appears to be no learning effect in the ISWT, negating the need for a practice walk. The long-term random variation in the ISWT test is larger than in previous studies, probably due to greater physiological and psychological variation in the participants over 8 weeks compared with that seen in day-to-day testing. Factors influencing long-term test-retest reliability of the ISWT require further elucidation.     

Psychometric Properties of the Community Integration Questionnaire Adjusted for People With Aphasia

Dalemans RJ, de Witte LP, Beurskens AJ, van den Heuvel WJ, Wade DT. Psychometric properties of the community integration questionnaire adjusted for people with aphasia.

Objectives

To describe the feasibility of the Community Integration Questionnaire (CIQ) adjusted for use in people with aphasia and to report its psychometric properties in people with aphasia (internal consistency, factor analysis, test-retest reliability, convergent validity).

Design

A cross-sectional, interview-based psychometric study. Test-retest reliability was evaluated in 20 people (minimal to severe aphasia) by 2 different interviewers within a 2-week period.

Setting

Community.

Participants

In total 490 stroke survivors with (minimal to severe) aphasia were approached, of which 165 (34%) participants returned the answering letter. Participants (N=150) agreed to take part and were interviewed using a structured interview format.

Interventions

Not applicable.

Main Outcome Measures

Community Integration Questionnaire (CIQ), Frenchay Aphasia Screening Test, Barthel Index, Dartmouth Coop Functional Health Assessment Charts (COOP)-World Organisation of Family Doctors (WONCA) Charts, Life Satisfaction Questionnaire.

Results

A total of 150 stroke survivors with aphasia completed the CIQ adjusted for people with aphasia. The CIQ adjusted for people with aphasia was a feasible instrument. Results showed good internal consistency for the CIQ total (standardized Cronbach α=.75), excellent test-retest reliability (intraclass correlation coefficient=.96), moderate correlations with the Barthel Index, the COOP-WONCA, and the Life Satisfaction Questionnaire with regard to construct validity. Significant relations were found with regard to age and aphasia severity.

Conclusions

The CIQ adjusted for people with aphasia seems to be an adequate instrument to assess participation in people with aphasia.     

Validity and Reliability of Assessment Tools for Measuring Unsupported Sitting in People With a Spinal Cord Injury

Boswell-Ruys CL, Sturnieks DL, Harvey LA, Sherrington C, Middleton JW, Lord SR. Validity and reliability of assessment tools for measuring unsupported sitting in people with a spinal cord injury.

Objectives

To develop simple tests to assess the abilities of people with spinal cord injury (SCI) to sit unsupported and to assess the construct validity and test-retest reliability of these tests.

Design

Cross-sectional comparisons, convenience sample.

Setting

Biomechanical laboratory.

Participants

People (N=30) with SCI between the C6 and the L2 level of 2 months to 37 years duration before assessment. The sample was stratified by impairment level (at T8) and time since injury (1y postinjury).

Interventions

Not applicable.

Main Outcome Measures

On 2 separate occasions, participants performed tests that measured the distance of upper-body sway and maximal torso leaning, errors made during a coordinated stability task, timed dressing/undressing of the upper body and alternating arm reaching, and percentage change in seated upper body/arm reaching.

Results

All tests showed good construct validity in that they distinguished between participants with higher (C6-T7) and lower (T8-L2) level impairments (P<.05) and between participants with acute (≤1y) and chronic (>1y) lesions (P<.05). The tests also showed good to excellent test-retest reliability (intraclass correlation coeffiecient_3,1 range, .51-.91).

Conclusions

These simple and quick-to-administer tests have both construct validity and test-retest reliability. They would be appropriate for research and clinical purposes to quantify the abilities of people with SCI to sit unsupported.     

Rehabilitation setting and associated mortality and medical stability among persons with amputations

Dillingham TR, Pezzin LE. Rehabilitation setting and associated mortality and medical stability among persons with amputations.

Objective

To estimate the differences in outcomes across postacute care settings—inpatient rehabilitation, skilled nursing facility (SNF), or home—for dysvascular lower-limb amputees.

Design

Medicare claims data for 1996 were used to identify a cohort of elderly persons with major lower-limb dysvascular amputations. One-year outcomes were derived by analyzing claims for this cohort in 1996 and 1997.

Setting

Postacute care after amputation.

Participants

Dysvascular lower-limb elderly amputees (N=2468).

Interventions

Not applicable.

Main Outcome Measures

Mortality, medical stability, reamputations, and prosthetic device acquisition.

Results

The 1-year mortality for the elderly amputees was 41%. Multivariate probit models controlling for patient characteristics indicated that patients discharged to inpatient rehabilitation were significantly (P<.001) more likely to have survived 12 months postamputation (75%) than those discharged to an SNF (63%) or those sent home (51%). Acquisition of a prosthesis was significantly (P<.001) more frequent for persons going to inpatient rehabilitation (73%) compared with SNF (58%) and home (49%) dispositions. The number of nonamputee-related hospital admissions was significantly less for persons sent to a rehabilitation service than for those sent home or to an SNF. Subsequent amputations were significantly (P<.025) less likely for amputees receiving inpatient rehabilitation (18%) than for those sent home (25%).

Conclusions

Receiving inpatient rehabilitation care immediately after acute care was associated with reduced mortality, fewer subsequent amputations, greater acquisition of prosthetic devices, and greater medical stability than for patients who were sent home or to an SNF. Such information is vital for health policy makers, physicians, and insurers.     

Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series

Charrow A, DiFazio M, Foster L, Pasquina PF, Tsao JW. Intradermal botulinum toxin type A injection effectively reduces residual limb hyperhidrosis in amputees: a case series.

Objective

To study the effectiveness of botulinum toxin type A (BTX-A) therapy for residual limb hyperhidrosis, prosthesis fit and function, and residual and phantom limb pain in patients with limb amputation.

Design

Consecutive case series.

Setting

Outpatient physical medicine and rehabilitation clinic.

Participants

Walter Reed Army Medical Center patients (N=8) with unilateral traumatic upper- or lower-limb amputation.

Intervention

BTX-A was injected transdermally in a circumferential pattern around the residual limb by using a 1-cm matrix grid.

Main Outcome Measure

A 10-cm continuous Likert visual analog scale was used to assess residual limb sweating and pain and prosthesis fit and function before and 3 weeks after BTX-A injections.

Results

Patients reported a significant reduction in sweating and improvement in prosthesis fit and function after treatment. However, residual limb and phantom pain were unaffected by treatment.

Conclusions

BTX-A may be an effective treatment for residual limb hyperhidrosis, resulting in subjective improvement in prosthesis fit and functioning. BTX-A should be considered as a method to manage excessive sweating in the residual limb of traumatic amputees.     

Determinants of Skin Problems of the Stump in Lower-Limb Amputees

Meulenbelt HE, Geertzen JH, Jonkman MF, Dijkstra PU. Determinants of skin problems of the stump in lower-limb amputees.

Objective

To identify determinants of skin problems in lower-limb amputees.

Design

Survey, using a questionnaire.

Setting

Not applicable.

Participants

Lower-limb amputees (N=2039) who either obtained their prosthesis through the Orthopedische Instrument Makerij (a group of orthopedic workshops in the Netherlands) or were a member of the (Dutch) National Society of Amputees (Landelijke Vereniging van Geamputeerden) were invited to participate. In total, 872 lower-limb amputees agreed to participate.

Intervention

Amputees filled in the questionnaire to assess characteristics of the amputation and prosthesis, level of activity, stump and prosthesis hygiene, and skin problems. Stepwise backward logistic regression was performed to analyze determinants of skin problems.

Main Outcome Measure

Skin problems in the month prior to completing the questionnaire.

Results

A total of 816 questionnaires were received. Eventually 805 questionnaires were suitable for statistical analysis. Protective determinants were (in order of magnitude of association) older age, male sex, and amputation because of peripheral arterial disease and/or diabetes. Provocative determinants were (in order of magnitude of association) use of antibacterial soap, smoking, and washing the stump 4 times a week or more often. In total, 63% of the participants (95% confidence interval, 60%-67%) reported 1 or more skin problems.

Conclusions

The provocative determinants identified in this study—use of antibacterial soap, smoking, and stump washing frequency—have to be studied for their clinical relevance.     

The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility

Giacino JT, Kalmar K, Whyte J. The JFK Coma Recovery Scale-Revised: measurement characteristics and diagnostic utility.

Objective

To determine the measurement properties and diagnostic utility of the JFK Coma Recovery Scale-Revised (CRS-R).

Design

Analysis of interrater and test-retest reliability, internal consistency, concurrent validity, and diagnostic accuracy.

Setting

Acute inpatient brain injury rehabilitation hospital.

Participants

Convenience sample of 80 patients with severe acquired brain injury admitted to an inpatient Coma Intervention Program with a diagnosis of either vegetative state (VS) or minimally conscious state (MCS).

Interventions

Not applicable.

Main outcome measures

The CRS-R, the JFK Coma Recovery Scale (CRS), and the Disability Rating Scale (DRS).

Results

Interrater and test-retest reliability were high for CRS-R total scores. Subscale analysis showed moderate to high interrater and test-retest agreement although systematic differences in scoring were noted on the visual and oromotor/verbal subscales. CRS-R total scores correlated significantly with total scores on the CRS and DRS indicating acceptable concurrent validity. The CRS-R was able to distinguish 10 patients in an MCS who were otherwise misclassified as in a VS by the DRS.

Conclusions

The CRS-R can be administered reliably by trained examiners and repeated measurements yield stable estimates of patient status. CRS-R subscale scores demonstrated good agreement across raters and ratings but should be used cautiously because some scores were underrepresented in the current study. The CRS-R appears capable of differentiating patients in an MCS from those in a VS.     

Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain

Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and numeric pain rating scale in patients with mechanical neck pain.

Objective

To examine the psychometric properties including test-retest reliability, construct validity, and minimum levels of detectable and clinically important change for the Neck Disability Index (NDI) and the numeric rating scale (NRS) for pain in a cohort of patients with neck pain.

Design

Single-group repeated-measures design.

Setting

Outpatient physical therapy (PT) clinics.

Participants

Patients (N=137) presenting to PT with a primary report of neck pain.

Interventions

Not applicable.

Main Outcome Measures

All patients completed the NDI and the NRS at the baseline examination and at a follow-up. At the time of the follow-up, all patients also completed the global rating of change, which was used to dichotomize patients as improved or stable. Baseline and follow-up scores were used to determine the test-retest reliability, construct validity, and minimal levels of detectable and clinically important change for both the NDI and NRS.

Results

Test-retest reliability was calculated using an intraclass correlation coefficient (ICC) (NDI ICC=.50; 95% confidence interval [CI], .25-.67; NRS ICC=.76; 95% CI, .51-.87). The area under the curve was .83 (95% CI, .75-.90) for the NDI score and .85 (95% CI, .78-.93) for the NRS score for determining between stable and improved patients. Thresholds for the minimum clinically important difference (MCID) for the NDI were 19-percentage points and 1.3 for the NRS.

Conclusions

Both the NDI and NRS exhibit fair to moderate test-retest reliability in patients with mechanical neck pain. Both instruments also showed adequate responsiveness in this patient population. However, the MCID required to be certain that the change in scores has surpassed a level that could be contributed to measurement error for the NDI was twice that which has previously been reported. Therefore the ongoing analyses of the properties of the NDI in a patient population with neck pain are warranted.     

Association of activity limitations and lower-limb explosive extensor power in ambulatory people with stroke

Saunders DH, Greig CA, Young A, Mead GE. Association of activity limitations and lower-limb explosive extensor power in ambulatory people with stroke.

Objective

To determine whether the explosive lower-limb extensor power of the affected and unaffected sides, and any asymmetry, are associated with activity limitations after stroke.

Design

Cross-sectional observational study of baseline data from a randomized controlled trial.

Setting

Measurements made in a hospital clinical research facility.

Participants

Community-dwelling (N=66) subjects with stroke who were independently ambulatory. Subjects’ mean age was 72±10 years.

Interventions

Not applicable.

Main Outcome Measures

The lower-limb extensor power of each lower limb (in W/kg), performance of specific functional activities (comfortable walking velocity, Functional Reach Test, chair-rise time, Timed Up & Go test), and global indices of activity limitation (FIM instrument, Rivermead Mobility Index, Nottingham Extended Activities of Daily Living).

Results

Low lower-limb extensor power in either lower limb was the principal factor from among the confounders we recorded that significantly (R² range, .21-.46) predicted the limitation of specific functional activities, and low lower-limb extensor power in either lower limb was the principal predictive factor for global indices of activity limitation (R² range, .13-.38). The degree of asymmetry of lower-limb extensor power between legs was low and had little or no predictive value.

Conclusions

In ambulatory persons with stroke, activity limitations are associated with deficits in lower-limb extensor power of both lower limbs, and not the severity of any residual asymmetry. These findings suggest that interventions to increase lower-limb extensor power in both lower limbs might reduce activity limitations after stroke.     

Psychometric validation of the neuropathic pain symptom inventory for its use in Spanish

Context

Clinical instruments are required for the assessment of neuropathic pain (NP).

Objectives

The primary aim of this study was to perform a complete psychometric validation of the Neuropathic Pain Symptom Inventory (NPSI) in Spanish patients.

Methods

A linguistically validated version in Spanish of the NPSI and other clinical instruments for NP were administered on two occasions separated by at least one month to 548 patients suffering from chronic NP. The authors evaluated the responsiveness, the construct validity, and the internal structure of the NPSI by means of, respectively, receiver operating characteristic (ROC) curves analysis and calculation of reliable change indices, a multitrait-multimethod (MTMM) design, and primary component analysis. Internal consistency and test-retest reliability were evaluated, respectively, by calculating several Cronbach’s alpha coefficients and intraclass correlation coefficients of some scores selected appropriately.

Results

The areas under the ROC curves were greater than 0.85. The MTMM design found convergent-discriminant correlations correctly aligned for all NPSI subscores in the first assessment, and for all but paresthesia/dysesthesia subscores in the second assessment. The five components of the NPSI described by its authors were confirmed on one occasion, but the “electric shocks” and “stabbing” items did not associate consistently, as in the original version, the first time the NPSI was administered. All reliability coefficients were above 0.70.

Conclusion

The Spanish NPSI has good concurrent and construct validity and is reliable for a wide range of patients with NP. One exception to the original structure was found affecting one item, presumably relating to a cultural feature.     

Reliability of Center of Pressure Measures for Assessing the Development of Sitting Postural Control in Infants With or at Risk of Cerebral Palsy

Kyvelidou A, Harbourne RT, Shostrom VK, Stergiou N. Reliability of center of pressure measures for assessing the development of sitting postural control in infants with or at risk of cerebral palsy.

Objective

To establish the test-retest reliability of linear and nonlinear measures, including intra- and intersession reliability, when used to analyze the center of pressure (COP) time series during the development of infant sitting postural control in infants with or at risk for cerebral palsy (CP).

Design

Longitudinal study.

Setting

University hospital laboratory.

Participants

Infants with or at risk for CP (N=18; mean age ± SD at entry into the study, 13.7±3.6mo).

Interventions

Not applicable.

Main Outcome Measures

Infant sitting COP data were recorded for 3 trials at each session (2 sessions for each month within 1 week) for 4 consecutive months. The linear COP parameters of the root mean square, the range of sway for both the anterior-posterior and the medial-lateral directions, and the sway path were calculated. In addition, the nonlinear parameters of approximate entropy, Lyapunov exponent (LyE), and the correlation dimension for both directions were also calculated. Intra- and intersession reliability was computed by the intraclass correlation coefficient (ICC).

Results

Regarding nonlinear measures, LyE showed high intra- and intersession ICC values in comparison with all other parameters evaluated. Intrasession and intersession reliability increased overall in the last 2 months of data collection and as sitting posture improved.

Conclusions

Our results suggested that the methodology presented is a reliable way of examining the development of sitting postural control in infants with or at risk for CP, and the reliability results generally parallel values found in sitting postural behavior in typical infants. Therefore, this methodology may be helpful in examining efficacy of therapy protocols directed at advancing sitting postural control in infants with motor developmental delays.