Psychometric Validation of the Manual Ability Measure-36 (MAM-36) in Patients With Neurologic and Musculoskeletal Disorders

Chen CC, Bode RK. Psychometric validation of the Manual Ability Measure-36 (MAM-36) in patients with neurologic and musculoskeletal disorders.

Objectives

To evaluate the psychometric properties of the Manual Ability Measure-36 (MAM-36), a new hand function outcome measure, and to examine differences in manual abilities and item parameters in patients with neurologic and musculoskeletal conditions.

Design

Convenience sample from 2 time periods, cross-sectional.

Setting

Outpatient rehabilitation units and private hand clinics.

Participants

Patients (N=337; mean age, 50.3±14.9y) with a variety of neurologic and musculoskeletal (orthopedic) diagnoses. Most of these individuals were community dwelling, and all had residual functional limitations in the hand(s).

Interventions

Not applicable.

Main Outcome Measures

Rasch analysis was performed on MAM-36 data to evaluate both scale structure and psychometric properties, which include rating distribution, step measures, item fit, separation, and dimensionality. A t test was performed to examine the differences in manual abilities in patients with the 2 conditions. Uniform differential item functioning (DIF) between neurologic and musculoskeletal groups was examined. (DIF occurs when subgroup members within the sample with the same level of the underlying trait being measured respond differently to an individual item.) Manual ability estimates were recalibrated with step and common item anchoring; they were compared with those derived from the original analysis.

Results

The 36 items measured a single construct with no misfitting items. The scale was used as intended. The items can reliably separate the participants into 5 ability strata. Neurologic patients had a significantly lower mean manual ability than musculoskeletal patients. Fourteen items exhibited DIF. However, DIF had no effect on either scale quality or calibration of manual ability. We decided that a single rating scale is appropriate for both groups.

Conclusions

This study showed that the MAM-36 has more than adequate psychometric properties and can be used as a generic outcome measure for patients with a wide variety of clinical diagnoses.     

Health of community-dwelling adults with mobility limitations in the United States: prevalent health conditions. Part I

Rasch EK, Hochberg MC, Magder L, Magaziner J, Altman BM. Health of community-dwelling adults with mobility limitations in the United States: prevalent health conditions. Part I.

Objective

To characterize the extent and types of prevalent health conditions among nationally representative groups of adults with mobility, nonmobility, and no limitations.

Design

Data were collected during 5 rounds of household interviews from a probability subsample of households that represent the civilian, noninstitutionalized U.S. population. With some exceptions, round 1 variables were used for this analysis.

Setting

Community.

Participants

Data were analyzed on the same respondents from the 1996 to 1997 Medical Expenditure Panel Survey (MEPS) and the 1995 National Health Interview Survey Disability Supplement. Respondents were categorized into 3 groups for analysis: those with mobility limitations, nonmobility limitations; and no limitations. The analytic sample included 13,897 MEPS adults (≥18y).

Interventions

Not applicable.

Main Outcome Measures

Number, types, and prevalence of self-reported health conditions compared across groups.

Results

On average, adults with mobility limitations had significantly more prevalent conditions (3.6) than those with nonmobility limitations (2.4), or no limitations (1.3). Greater comorbidity existed in the context of fewer personal resources and more than half of adults with mobility limitations were working age.

Conclusions

Determining factors that influence the health of adults with mobility limitations is a critical public health issue.     

ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients

Caty GD, Arnould C, Stoquart GG, Thonnard J-L, Lejeune TM. ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients.

Objective

To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain).

Design

Prospective study and questionnaire development.

Setting

A faculty hospital.

Participants

Adult stroke patients (N=100) (age, 64±15y). The time since stroke ranged from 1 to 260 weeks.

Intervention

A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model.

Main Outcome Measure

The ABILOCO questionnaire.

Results

The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test.

Conclusions

The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.     

An exploratory analysis of functional staging using an item response theory approach

Tao W, Haley SM, Coster WJ, Ni P, Jette AM. An exploratory analysis of functional staging using an item response theory approach.

Objectives

To develop and explore the feasibility of a functional staging system (defined as the process of assigning subjects, according to predetermined standards, into a set of hierarchic levels with regard to their functioning performance in mobility, daily activities, and cognitive skills) based on item response theory (IRT) methods using short forms of the Activity Measure for Post-Acute Care (AM-PAC) and to compare the criterion validity and sensitivity of the IRT-based staging system to a non-IRT-based staging system developed for the FIM instrument.

Design

Prospective, longitudinal cohort study of patients interviewed at hospital discharge and 1, 6, and 12 months after inpatient rehabilitation.

Setting

Follow-up interviews conducted in patients' homes.

Participants

Convenience sample of 516 patients (47% men; sample mean age, 68.3y) at baseline (retention at the final follow-up, 65%) with neurologic, lower-extremity orthopedic, or complex medical conditions.

Interventions

Not applicable.

Main Outcome Measures

AM-PAC basic mobility, daily activity, and applied cognitive activity stages; FIM executive control, mobility, activities of daily living, and sphincter stages. Stages refer to the hierarchic levels assigned to patients' functioning performances.

Results

We were able to define IRT-based staging definitions and create meaningful cut scores based on the 3 AM-PAC short forms. The IRT stages correlated as well or better to the criterion items than the FIM stages. Both the IRT-based stages and the FIM stages were sensitive to changes throughout the 6-month follow-up period. The FIM stages were more sensitive in detecting changes between baseline and 1-month follow-up visits. The AM-PAC stages were more discriminant in the follow-up visits.

Conclusions

An IRT-based staging approach appeared feasible and effective in classifying patients throughout long-term follow-up. Although these stages were developed from short forms, this staging methodology could also be applied to improve the meaning of scores generated from IRT-based computerized adaptive testing in future work.     

Factor structure and concurrent/convergent validity of the modified somatic perception questionnaire and pain beliefs instrument

Objective

Our goal was to create a parsimonious combination of the Modified Somatic Perception Questionnaire (MSPQ) and the Pain Beliefs Screening Instrument (PBSI) through factorial structural analysis and to investigate the associations of the new scale (if unique) to disability, health condition, and quality of life report in patients with neck and low back pain scheduled for spine fusion surgery.

Methods

Factor analysis was used to refine all items within the 2 scales to 4 distinct factors: (1) somatic complaints of the head/neck, (2) somatic complaints of the gastrointestinal symptom, (3) pain beliefs and fear, and (4) self perception of serious problems. Each factor was assessed for concurrent validity with other well-established tools including the Deyo comorbidity index, the Short Form (SF)-36 mental and physical component subscales, and the Oswestry and Neck Disability Indices (ODI/NDI).

Results

The PBSI was fairly to moderately correlated with assessment tools of quality of life (SF-36) and disability assessment (ODI/NDI). Some of the items in the factor 1 from the MSPQ were slightly associated with the Deyo comorbidity index but not with the ODI/NDI.

Conclusions

The items from the MSPQ failed to associate with measures of quality of life and disability and thus may provide only marginal value when assessing the multidimensional aspects associated with neck and low back pain. The PBSI has moderate correlation with disability assessments. Neither tool was found to strongly correlate with disability measures or with SF-36 scales (mental and physical component subscales). Additional tools may be needed to further identify the dimensions associated with chronic pain patients.     

Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II

Rasch EK, Magder L, Hochberg MC, Magaziner J, Altman BM. Health of community-dwelling adults with mobility limitations in the United States: incidence of secondary health conditions. Part II.

Objective

To compare incident health conditions that occurred over a 2-year period in nationally representative groups of adults with mobility, nonmobility, and no limitations.

Design

Data were collected prospectively from a probability subsample of households that represent the civilian, noninstitutionalized U.S. population.

Setting

Five rounds of household interviews were conducted over 2 years.

Participants

Data were analyzed on the same respondents from the 1996−1997 Medical Expenditure Panel Survey (MEPS) and the 1995 National Health Interview Survey Disability Supplement. Respondents were categorized into 3 groups for analysis; those with mobility limitations, nonmobility limitations, and no limitations. The analytic sample included 12,302 MEPS adults (≥18y).

Interventions

Not applicable.

Main Outcome Measures

Number, types, and 2-year incidence of self-reported health conditions compared across groups.

Results

The mean number of incident conditions (95% confidence intervals [CIs]) over the 2-year period was greatest in adults with mobility limitations (mean, 4.7; 95% CI, 4.4−4.9) compared with those with nonmobility limitations (mean, 3.9; 95% CI, 3.7−4.2) or no limitations (mean, 2.6; 95% CI, 2.5−2.7). Incident conditions affected most major body systems.

Conclusions

Because secondary conditions are potentially preventable, determining factors that influence their occurrence is an important public health issue requiring specific action.     

Rasch analysis of the barthel index in the assessment of hospitalized older patients after admission for an acute medical condition

de Morton NA, Keating JL, Davidson M. Rasch analysis of the Barthel Index in the assessment of hospitalized older patients after admission for an acute medical condition.

Objective

To investigate the validity of item score summation for the original and modified versions of the Barthel Index.

Design

Rasch analysis of Barthel Index data.

Setting

General medical wards at 2 acute care hospitals in Australia.

Participants

Consecutive older medical patients (N=396).

Interventions

Not applicable.

Main Outcome Measures

Activity limitation was assessed by using the Barthel Index at hospital admission and discharge. At 1 hospital site, the original Barthel Index was used, and at the other hospital site the Modified Barthel Index (MBI) was used.

Results

More than half of the items showed misfit to the Rasch model for both versions of the Barthel Index. The continence items appear to measure a different construct to the other items. After the removal of the continence items, data for the remaining items still did not fit the Rasch model. Neither the original nor the MBI are unidimensional scales. An exception to this occurred when the original Barthel Index was rescored and only then for discharge and not for admission Barthel Index data.

Conclusions

Because clinicians do not typically rescore outcomes obtained by using the Barthel Index, these findings, combined with unacceptable ceiling effects, render the Barthel Index an assessment tool with limited validity for measuring and monitoring the health of older medical patients.     

Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer

Hale LA, Pal J, Becker I. Measuring free-living physical activity in adults with and without neurologic dysfunction with a triaxial accelerometer.

Objective

To investigate the reliability, validity, and utility of a triaxial accelerometer to measure physical activity in the free-living environment in adults with and without neurologic dysfunction.

Design

Repeated-measures design.

Setting

General community.

Participants

Volunteer sample of 17 men and 30 women (age range, 28−91y) living in the community with stroke of greater than 6 months in duration (n=20), Parkinson disease (n=7), or multiple sclerosis (n=11), and healthy but sedentary controls (n=9).

Interventions

Not applicable.

Main Outcome Measures

Physical activity measured with the TriTrac RT3 accelerometer, 7-day recall questionnaire, and activity diary.

Results

The accelerometer reliably measured free-living physical activity (intraclass correlation coefficient, .85; 95% confidence interval, .74−.91; P=.000). The standard error of measurement indicated that a second test would differ from a baseline test by ±23%. Mean daily RT3 data collected in the first 3 days differed significantly from that of the mean daily RT3 data collected over 7 days. The RT3 appeared to distinguish level of mobility better than the 7-day recall questionnaire, and participants found the RT3 to be a user-friendly and acceptable measure of physical activity.

Conclusions

The triaxial accelerometer provided a stable measure of free-living physical activity, was found to distinguish between people with varying levels of mobility, and was well tolerated by participants. The results indicate that collecting data for 3 days was not reflective of data collected over 7 days.     

Measures of Physical Ability Are Unrelated to Objectively Measured Physical Activity Behavior in Older Adults Residing in Continuing Care Retirement Communities

Zalewski KR, Smith JC, Malzahn J, VanHart M, O'Connell D. Measures of physical ability are unrelated to objectively measured physical activity behavior in older adults residing in continuing care retirement communities.

Objective

To explore the relationship between measures of physical performance, physical activity, and self-reported physical activity.

Design

Cross-sectional analysis.

Setting

Continuing care retirement communities (CCRCs) in the greater Milwaukee area.

Participants

Older adults from independent or assisted living apartments (N=59).

Interventions

Not applicable.

Main Outcome Measures

Physical performance was measured with comfortable and fast gait speeds and the six-minute walk test. Physical activity was measured by an ankle-mounted accelerometer to observe daily steps; stepping rate was averaged over a 7-day wear time. Self-reported physical activity was measured by the Physical Activity Scale for the Elderly (PASE).

Results

Participants reported walking more steps per day than older adults who are not living in CCRCs. There was no relationship between physical abilities and total steps walked (r=.087-.213, P>.05). No relationship was observed between measures of physical performance or total steps and PASE scores (r=−.034-.177, P = not significant). The relative contributions of physical activity categories to total PASE score were different than published reports for older adults not living in CCRCs.

Conclusions

Common measures of physical performance often used by clinicians in making decisions on rehabilitation outcomes do not appear to be related to the actual functioning of older adults residing in senior communities. The nature of the environment customized to the needs of the older adult may facilitate increased physical activity participation independent of physical abilities.     

Rasch Analysis of the Executive Interview (The EXIT-25) and Introduction of an Abridged Version (The Quick EXIT)

Larson EB, Heinemann AW. Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick Exit).

Objectives

To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties.

Design

Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25.

Setting

A large, urban, academic free-standing rehabilitation facility.

Participants

The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27).

Interventions

Not applicable.

Main Outcome Measures

The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B.

Results

Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity.

Conclusions

The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.     

Improvement of Gaze Control After Balance and Eye Movement Training in Patients With Progressive Supranuclear Palsy: A Quasi-Randomized Controlled Trial

Zampieri C, Di Fabio RP. Improvement of gaze control after balance and eye movement training in patients with progressive supranuclear palsy: a quasi-randomized controlled trial.

Objective

One of the main oculomotor findings in progressive supranuclear palsy (PSP) is the inability to saccade downward. In addition, people with PSP have difficulty suppressing fixation, which may contribute to vertical gaze palsy. The objective was to investigate the effectiveness of a rehabilitation intervention tailored to enhance suppression of fixation and gaze shift in participants with PSP.

Design

Controlled trial with a quasi-randomized design. Measures occurred at week 1 and 5. Researchers assessing participants were blind to the group assignments.

Setting

Movement disorders assessment laboratory.

Participants

Nineteen adults with possible or probable PSP who were ambulatory for short distances and had far visual acuity of 20/80 and a Folstein Mini-Mental State score of more than 23.

Interventions

Balance training complemented with eye movement and visual awareness exercises was compared with balance training alone.

Main Outcome Measures

Gaze control was assessed using a vertical Gaze Fixation Score and a Gaze Error Index.

Results

Gaze control after the balance plus eye exercise significantly improved, whereas no significant improvement was observed for the group that received balance training alone.

Conclusions

These preliminary findings support the use of balance and eye movement exercises to improve gaze control in PSP.     

Functional limitations and depression after traumatic brain injury: examination of the temporal relationship

Pagulayan KF, Hoffman JM, Temkin NR, Machamer JE, Dikmen SS. Functional limitations and depression after traumatic brain injury: examination of the temporal relationship.

Objective

To examine the temporal relationship between self-reported injury-related functional limitations and depressive symptomatology after traumatic brain injury (TBI).

Design

A longitudinal cohort study with 3 evaluation points.

Setting

A level I trauma center.

Participants

Adolescents and adults (N=135) with complicated mild to severe TBI (72% had complicated mild injuries) who were recruited within 24 hours of injury and then completed the measure at all 3 time points.

Interventions

Not applicable.

Main Outcome Measures

Sickness Impact Profile and Center for Epidemiological Studies−Depression Scale.

Results

Individuals who reported more depressive symptomatology consistently endorsed more injury-related difficulties, showing the strong relationship between depression and perceived psychosocial functioning. Examination of these relationships over time revealed that increased depressive symptomatology follows higher levels of perceived injury-related changes but that reports of injury-related changes are not associated with earlier depression. These findings suggest a unidirectional temporal relationship between these variables.

Conclusions

Perceived changes in daily functioning appear to influence emotional well-being over time after TBI. However, depressive symptoms do not appear to negatively impact individuals' perception of later functioning. These results further our understanding of the complicated relationship between these variables and may have important implications for treatment of depression after TBI.     

Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients?

Latham NK, Mehta V, Nguyen AM, Jette AM, Olarsch S, Papanicolaou D, Chandler J. Performance-based or self-report measures of physical function: which should be used in clinical trials of hip fracture patients?

Objectives

To assess the validity, sensitivity to change, and responsiveness of 3 self-report and 4 performance-based measures of physical function: activity measure for postacute care (AM-PAC) Physical Mobility and Personal Care scales, the Medical Outcomes Study 36-Item Short Form Health Survey Physical Function scale (SF-36 PF), the Physical Functional Performance test (PFP-10), the Short Physical Performance Battery (SPPB), a 4-meter gait speed, and the six-minute walk test (6MWT).

Design

A prospective observational study of patients after a hip fracture. Assessments were performed at baseline and 12 weeks postenrollment.

Setting

Inpatient and outpatient rehabilitation facilities in Norway, the United Kingdom, Sweden, Israel, Germany, the United States, Denmark, and Spain.

Participants

A sample of study participants (N=108) who had a hip fracture.

Interventions

Not applicable.

Main Outcome Measures

Assessments of validity (known-groups, concurrent, construct, and predictive), sensitivity to change (effect size, standardized response mean [SRM], SE of measure, minimal detectable change (MDC), and responsiveness (optimal operating cut-points and area under the curve) between baseline and 12-week follow-up.

Results

All physical function measures achieved comparably acceptable levels of validity. Odds ratios in predicting patient Global Assessment of Improvement at 12 weeks were as follows: AM-PAC Physical Mobility scale, 5.3; AM-PAC Personal Care scale, 3.6; SF-36 PF, 4.3; SPPB, 2.0; PFP-10, 2.5; gait speed, 1.9; and 6MWT, 2.4. Effect sizes and SRM exceeded 1 SD for all 7 measures. Percent of patients who exceeded the MDC₉₀ at week 12 were as follows: AM-PAC Physical Mobility scale, 90%; AM-PAC Personal Care scale, 74%; SF-36 PF, 66%; SPPB, 36%; PFP-10, 75%; gait speed, 69%; and 6MWT, 75%. When evaluating responsiveness using the area under receiver operating curves for each measure, all measures had acceptable responsiveness, and no pattern emerged of superior responsiveness depending on the type of measure used.

Conclusions

Findings reveal that the validity, sensitivity, and responsiveness of self-report measures of physical function are comparable to performance-based measures in a sample of patients followed after fracturing a hip. From a psychometric perspective, either type of functional measure would be suitable for use in clinical trials where improvement in function is an endpoint of interest. The selection of the most appropriate type of functional measure as the primary endpoint for a clinical trial will depend on other factors, such as the measure's feasibility or the strength of the association between the hypothesized mechanism of action of the study intervention and a functional outcome measure.     

Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study

Lew HL, Lee EH, Castaneda A, Klima R, Date E. Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study.

Objective

To determine the efficacy of botulinum toxin type A (BTX-A) in treating neck and upper-back pain of myofascial origin.

Design

A randomized, double-blind, placebo-controlled pilot study.

Setting

Outpatient physical medicine and rehabilitation clinic of a university-affiliated tertiary hospital.

Participants

A total of 29 subjects enrolled from among 45 screened patients. No subject withdrawal due to serious adverse events occurred.

Intervention

Subjects were evaluated at baseline, received a 1-time injection of either BTX-A (treatment group) or saline (control group), and were followed up at 2 weeks and at months 1, 2, 3, 4, and 6.

Main Outcome Measures

Visual analog scale (VAS) for pain, the Neck Disability Index (NDI), and the Medical Outcome Study 36-Item Short-Form Health Survey (SF-36).

Results

Improvements in the VAS and NDI scores were seen in the treatment group but were not significant when compared with the controls. Statistically significant improvements for the treatment group were seen in the SF-36 bodily pain (at months 2 and 4) and mental health (at month 1) scales but not in the other scales, nor in the summary measures. No serious adverse events were reported.

Conclusions

Trends toward improvements in VAS and NDI scores of the BTX-A group are encouraging, but they were possibly due to a placebo effect and were not statistically significant. The BTX-A subjects, at certain time points, showed statistically significant improvements in the bodily pain and mental health scales of the SF-36 compared with controls. Our study had limited power and population base, but the results could be used to properly power follow-up studies to further investigate this topic.     

Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome

Noonan VK, Kopec JA, Zhang H, Dvorak MF. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome.

Objective

To determine the effect of associated spinal cord injury (SCI) conditions on the health status and quality of life (QOL) in people with traumatic central cord syndrome.

Design

Cross-sectional design.

Setting

Community-based.

Participants

Subjects (N=70) with traumatic central cord syndrome who were a minimum of 2 years postinjury.

Interventions

Not applicable.

Main Outcome Measures

Presence of associated SCI conditions (neuropathic pain, spasticity, bowel, bladder, and/or sexual dysfunction, decreased motor function); health status (36-Item Short-Form Health Survey [SF-36], symptom satisfaction); and QOL.

Results

The SF-36 physical component score (PCS) was lower in subjects who reported problems with bowel, bladder, and/or sexual function (−6.9; 95% confidence interval [CI], −11.6 to −2.2). The PCS was decreased in subjects with a lower motor score and this relationship was negatively affected by spasticity and being less educated. The SF-36 mental component score was negatively affected by neuropathic pain and a lower motor score. Neuropathic pain and a lower motor score were both associated with subjects being dissatisfied with their symptoms. Subjects who had a higher motor score were more likely to have a higher QOL (odds ratio, 1.7; 95% CI, 1.1 to 2.7).

Conclusions

The associated SCI conditions bowel, bladder, and/or sexual dysfunction, neuropathic pain, decreased motor function, and spasticity negatively affect the health status of persons with traumatic central cord syndrome. Diminished motor recovery was the only associated SCI condition to impact QOL. By developing a conceptual model and adjusting for confounders, an estimate for each associated SCI condition's effect on patient outcomes was obtained. Our results indicate the importance of treating or ameliorating associated SCI conditions in order to maximize physical and mental functioning.     

Calibration of an item pool for assessing the disability associated with foot pain: an application of item response theory to the Manchester Foot Pain and Disability Index

Objective

To analyze the relative validity of the 17-item Manchester Foot Pain and Disability Index (MFPDI) using graded response item response theory analysis (G-IRT).

Design

The design of the study involved a survey instrument validation.

Participants/Patients

A total of 682 respondents with a history of foot pain in the last month.

Methods

Factor analysis and G-IRT were used to analyze the dimensionality and relative validity of each scale item.

Results

Exploratory factor analysis yielded a two-factor solution. G-IRT resulted in the removal of one of the original 17 items from the MFPDI. Analyses revealed that six of the nine foot and ankle function items of the MFPDI demonstrated excellent discrimination. For the seven pain and appearance items, only one item demonstrated excellent discrimination, the remaining demonstrated moderate discrimination.

Conclusion

G-IRT was successful in outlining selected items representative of disability and pain and appearance. By reducing the MFPDI to 16 items, the Modified MFPDI is multidimensional and is associated with the underlying construct of activity related foot and ankle disability and pain and appearance. By reducing the MFPDI to 16 items, a clinician can be confident that the outcome instrument accurately represents the latent construct of disability and pain and appearance.     

The Impact of Age and Comorbidity on the Progression of Disability in Late-Onset Sequelae of Poliomyelitis

Stolwijk-Swüste JM, Tersteeg I, Beelen A, Lankhorst GJ, Nollet F, on behalf of the CARPA Study Group. The impact of age and comorbidity on the progression of disability in late-onset sequelae of poliomyelitis.

Objectives

To describe the functional course over 5 years in patients aged 45 to 85 years with late-onset sequelae of poliomyelitis (LOSP) and to explore the impact of age and comorbidity.

Design

Prospective cohort study with 5 measurements over 5 years.

Setting

University hospital.

Participants

Subjects with LOSP (N=168).

Interventions

Not applicable.

Main Outcome Measures

FIM, Medical Outcomes Study 36-Item Short Form health survey for physical functioning subscale (SF-36-PF), walking test, isokinetic quadriceps strength, and cumulative illness rating scale (CIRS) for comorbidity.

Results

The FIM score (mean baseline ± SD, 121±4) and SF-36-PF (mean baseline ± SD, 39.5±24) decreased 2.2 and 3.7 points, respectively, over 5 years independent of age. The distance walked in 2 minutes (mean baseline ± SD, 126.2±34m) decreased 4.5m, quadriceps strength (mean baseline ± SD, 88.0±42.2Nm) declined 7Nm (8%), and CIRS (median baseline=6; range, 0-21) increased 1.5 points. A higher CIRS score was correlated with a lower FIM score and faster decrease in the FIM. A longitudinal model of factors associated with the FIM included sex, age, leg strength sum-score, arm strength sum-score, and CIRS score. The interaction of CIRS and leg strength sum-score with follow-up time was significant. A model of factors associated with SF-36-PF included sex, age, leg strength sum-score, and CIRS score.

Conclusions

Despite a reduction in muscle strength, disability increased little in patients with LOSP. Increased age and comorbidity has a negative effect on disability. Comorbidity and the severity of leg paresis affected the course of functional independence but not the course of perceived physical functioning.     

Effect of robot-mediated therapy on upper extremity dysfunction post-stroke—a single case study

Objectives

Studies of neuroplasticity suggest that repetitious movements optimise changes at brain level, and that this response is optimised if the task is challenging and engaging. The evidence to date on physiotherapy interventions suggests that an increased intensity of therapy provides better outcomes and that exercise-based interventions demonstrate positive treatment effects. Robot-mediated therapy (RMT) is an innovative way of providing these components. This study investigated the effect of RMT on upper extremity function post-stroke.

Design

Single case study using an ABC design.

Setting

Physiotherapy outpatient department.

Participant

A 79-year-old female, 22 months following right cerebrovascular accident.

Interventions

Phase A consisted of a series of nine baseline measurements, phase B consisted of nine 30-minute sessions of RMT, and phase C consisted of nine 30-minute sessions of sling suspension.

Main outcome measures

Fugl-Meyer Assessment, the Motor Assessment Scale and the Short-Form-36 (SF-36) questionnaire.

Results

The rate of recovery during the RMT phase B was greater than that with no treatment (A) and that with sling suspension (C) for the Fugl-Meyer Assessment and the Motor Assessment Scale. Improvement was seen only in those domains addressed by the RMT system. No change in quality of life as measured by the SF-36 was noted.

Conclusions

Treatment delivered by this RMT system had a positive effect on the rate of recovery at the level of impairment of body function and at the level of activities. The superiority of RMT over sling suspension is consistent with the theories of neuroplasticity which suggest that repetitious movements must be challenging and meaningful. While these initial results concur with those of previous studies of RMT, further evidence is required before this form of intervention should be incorporated routinely into clinical practice.     

Validating the six-minute walk test as a measure of recovery after elective colon resection surgery

Moriello C, Mayo NE, Feldman L, Carli F. Validating the six-minute walk test as a measure of recovery after elective colon resection surgery.

Objective

To provide evidence for construct and longitudinal validity of the six-minute walk test (6MWT) as a measure of postsurgical recovery.

Design

Data from a randomized clinical trial.

Setting

A major teaching hospital in a Canadian urban city.

Participants

Patients (N=63) undergoing elective colon resection.

Interventions

Not applicable.

Main Outcome Measures

Functional walking capacity was measured using the 6MWT at before surgery and at 3 and 6 weeks after surgery.

Results

At 3 weeks, 26 (41%) patients recovered to baseline or greater on the 6MWT distance, and 37 (59%) were at baseline or better by 6 weeks postdischarge. At all time points, the 6MWT distance correlated with age, the American Society of Anesthesiologists (ASA) score of surgical risk, albumin, the physical function subscale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the physical component summary score of the SF-36. Baseline 6MWT distance correlated with postoperative 6MWT recovery, and baseline SF-36 and ASA were associated with postoperative recovery. Patients with intraoperative complications had a clinically relevant lower 6MWT than those without complications at all time points.

Conclusions

This study provides evidence for construct validity and sensitivity to change for the 6MWT as a measure of surgical recovery.     

Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial

Kirby RL, Corkum CG, Smith C, Rushton P, MacLeod DA, Webber A. Comparing performance of manual wheelchair skills using new and conventional rear anti-tip devices: randomized controlled trial.

Objective

To test the hypotheses that, compared with participants using manual wheelchairs equipped with conventional rear anti-tip devices (C-RADs), those using a new RAD design that deploys through an arc (Arc-RAD) perform RAD-relevant wheelchair skills better and as safely.

Design

A randomized controlled study.

Setting

A rehabilitation center.

Participants

Participants (N=30) including 16 able-bodied and 14 wheelchair users.

Intervention

Participants were provided with wheelchair skills training (up to 2.4h).

Main Outcome Measures

Total percentage score on a set of 23 RAD-relevant skills of the Wheelchair Skills Test (WST, version 3.2) administered a minimum of 3 days after training.

Results

For the C-RAD and Arc-RAD groups, the mean ± standard deviation RAD-relevant WST scores were 32.3%±8.5% and 85.1%±18.9% (Kruskal-Wallis, P<.001). Of the 23 RAD-relevant individual skills, the success rates for the Arc-RAD group were at least 20% higher (the criterion we set for clinical significance) in 17 (74%). For the C-RAD group, the success rate was 0% for the 12 wheelie-dependent skills, the 13-cm-high obstacle, and the 15-cm level change ascent. There were no serious adverse effects in either group.

Conclusions

The new RAD design allows much better performance on relevant wheelchair skills than the conventional design without compromising safety.