Towards the Development of Clinical Measures for Spinal Cord Injury Based on the International Classification of Functioning,Disability and Health With Rasch Analyses

Objectives

To determine whether the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) can be integrated in clinical measures and to obtain insights to guide their future operationalization. Specific aims are to find out whether the ICF categories relevant to SCI fit a Rasch model taking into consideration the dimensionality found in previous investigations, local item dependencies, or differential item functioning.

Design

All second-level ICF categories collected in the Development of ICF Core Sets for SCI project in specialized centers within 15 countries from 2006 through 2008.

Setting

Secondary data analysis.

Participants

Adults (N=1048) with SCI from the early postacute and long-term living context.

Interventions

Not applicable.

Main Outcome Measures

Two unidimensional Rasch analyses: one for the ICF categories from body functions and body structures components and another for the ICF categories from the activities and participation component.

Results

Results support good reliability and targeting of the ICF categories in both dimensions. In each dimension, few ICF categories were subject to misfit. Local item dependency was observed between ICF categories of the same chapters. Group effects for age and sex were observed only to a small extent.

Conclusions

The validity of ICF categories to develop measures of functioning in SCI for clinical practice and research is to some extent supported. Model adjustments were suggested to further improve their operationalization and psychometrics.     

Determining the Most Robust Dimensional Structure of Categories from the International Classification of Functioning,Disability and Health Across Subgroups of Persons With Spinal Cord Injury to Build the Basis for Future Clinical Measures

Objective

To determine the most robust dimensional structure of the International Classification of Functioning, Disability and Health (ICF) categories relevant to spinal cord injury (SCI) across subgroups of lesion level, health care context, sex, age, and resources of the country.

Design

A multidimensional between-item response Rasch model was used. The choice of the dimensions was conceptually driven using the ICF components from the functioning chapters and splits of the activity and participation component described in the ICF.

Setting

Secondary analysis of data from an international, cross-sectional, multicentric study for the Development of ICF Core Sets for Spinal Cord Injury.

Participants

Persons with SCI (N=1048) from the early postacute and long-term living context from 14 middle/low- and high-resource countries.

Interventions

Not applicable.

Main Outcome Measure

Ratings of categories of the ICF relevant for SCI were analyzed.

Results

Five models were tested on the complete sample and 5 subgroups. The overall reliability of all models and reliability within dimensions of the unidimensional and 2-dimensional models were good to excellent. The ICF categories spread well along the disability scale. The model fit improvement from the unidimensional to the 2-dimensional and from the 2-dimensional to the 3-dimensional model was significant in all groups (P<.0001). The improvement, however, from a unidimensional to a 2-dimensional structure was markedly better than from a 2-dimensional to a 3-dimensional one.

Conclusions

We propose that a 2-dimensional structure separating body functions and body structures from the activity and participation categories should serve as a basis for developing clinical measures in SCI in the future.     

Effect of Body Mass Index on Stroke Rehabilitation

Objective

To investigate the association between body mass index (BMI) and the functional progress of patients with stroke, admitted to a rehabilitation hospital.

Design

A retrospective cohort study.

Setting

A freestanding university rehabilitation hospital stroke unit.

Participants

All patients (N=819) admitted to the stroke unit of a rehabilitation hospital during the study.

Interventions

Not applicable.

Main Outcome Measures

The primary study outcome measure was the FIM efficiency of patients by BMI category.

Results

For the 819 patients admitted during the observation period, BMI was compared with FIM score changes per day (FIM efficiency). After adjusting for age and sex, the FIM efficiency differed by BMI. The underweight group had the lowest FIM efficiency, followed by the obese and normal-weight subgroups. The overweight group had the highest FIM efficiency (P=.05) when compared with the obese subgroup.

Conclusions

Among patients admitted to an acute rehabilitation hospital for stroke rehabilitation, overweight patients had better functional progress than did patients in the other weight categories.     

What is the nursing team involvement in maintaining and promoting the mobility of older adults in hospital? A grounded theory study

Aims of the paper

To present a grounded theory of the nursing team involvement in the process of maintaining and promoting the mobility of hospitalised older adults.

Background

Being able to mobilise is an important determinant of quality of life in late adulthood. However, advancing age is often accompanied by worsening mobility, which may deteriorate further as a result of illness and particularly hospitalisation. Targeted in-patient rehabilitation interventions may have the capacity to maintain and promote older adults’ mobility. Some authors suggest that the nursing team may have a central role in such activities.

Objectives

The study set out to describe the involvement of the nursing team in the process of maintaining and promoting the mobility of hospitalised older adults. It also sought to understand how members of the nursing team viewed their work in relation to physiotherapists and in relation to hospital policy on patient handling.

Design

Grounded theory provided the philosophical and structural underpinning to the study.

Settings

Data collection centred on three clinical settings which included a general rehabilitation ward, a regional spinal injuries unit and stroke rehabilitation ward.

Participants

Semi-structured interviews with 39 rehabilitation staff and 61 h of non-participant observation comprised the data set.

Findings

The nursing team involvement in patients’ mobility maintenance and rehabilitation was explained by the core category ‘care to keep safe.’ This category identified how the nursing team focused primarily on preventing patient problems rather than focusing on rehabilitation goals. A number of contextual factors in the workplace meant that the nursing team found it difficult to engage in activities to support mobility maintenance and rehabilitation.

Conclusions

Significant changes in the micro and macro context for rehabilitation practice are needed to enable the nursing team to engage more fully in the processes of mobility rehabilitation. Nurse-led initiatives which allow the nursing team to take an active role in implementing intentional strategies to maintain and promote mobility should be implemented and trialled for effectiveness.     

Trajectories in the Course of Body Mass Index After Spinal Cord Injury

Objective

To identify different trajectories of the course of body mass index (BMI) after spinal cord injury (SCI) and to study whether other cardiovascular risk factors (blood pressure, lipid profile) follow the same trajectories.

Design

Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1 and 5 years after discharge.

Setting

Rehabilitation centers.

Participants

Persons with a recent SCI (N=204).

Interventions

Not applicable.

Main Outcome Measure

BMI trajectories.

Results

Three BMI trajectories were identified: (1) a favorable stable BMI during and after rehabilitation (±22–23kg/m²) (54%); (2) a higher but stable BMI during inpatient rehabilitation (±24kg/m²) and an increase after discharge (up to 29kg/m²) (38%); and (3) an increase in BMI during inpatient rehabilitation (from ±23 up to 28kg/m²) and leveling off after discharge (8%). Profile analyses showed that an unfavorable change in BMI was not accompanied by clear unfavorable changes in blood pressure or lipid levels.

Conclusions

BMI in people with SCI follows distinct trajectories. Monitoring body mass, food intake, and daily physical activity during and especially after inpatient SCI rehabilitation is important to prevent obesity and related cardiovascular risk factors.     

Emotional Vitality: Concept of Importance for Rehabilitation

Objectives

To (1) provide a framework for the conceptualization of emotional vitality as an important construct for rehabilitation professionals; (2) outline the existing scope and breadth of knowledge currently available regarding the definition and measurement of emotional vitality in persons with chronic health conditions; and (3) identify the extent to which the components can be mapped to the International Classification of Functioning, Disability and Health (ICF).

Design

Activities included a scoping review of the literature, and a Delphi mapping exercise using the ICF.

Setting

Not applicable.

Participants

Not applicable.

Intervention

Not applicable.

Main Outcome Measure

Not applicable.

Results

The results of this study suggest that emotional vitality is a complex latent construct that includes (1) physical energy and well-being, (2) regulation of mood, (3) mastery, and (4) engagement and interest in life. Existing literature supported the presence of all 4 components of the construct. The mapping exercise showed that 3 of these components could be readily mapped to the Body Function chapter of the ICF (energy, mood, mastery).

Conclusions

Emotional vitality may influence both the physical and emotional adaptation to living with a chronic illness or disability and should be included in both assessment and treatment planning to optimize rehabilitation outcomes. Future research is needed to refine the definition and identify optimal methods of measuring this construct.     

Association Between the Volume of Inpatient Rehabilitation Therapy and the Risk of All-Cause and Cardiovascular Mortality in Patients With Ischemic Stroke

Objective

To investigate the relationship between the volume of inpatient rehabilitation therapy and mortality among patients with acute ischemic stroke, as well as to assess whether the association varies with respect to stroke severity.

Design

A retrospective study with a cohort of consecutive patients who had acute ischemic stroke between January 1, 2008, and June 30, 2009.

Setting

Referral medical center.

Participants

Adults with acute ischemic stroke (N=1277) who were admitted to a tertiary hospital.

Interventions

Not applicable.

Main Outcome Measure

Stroke-related mortality.

Results

During the median follow-up period of 12.3 months (ranging from January 1, 2008, to December 31, 2009), 163 deaths occurred. Greater volume of rehabilitation therapy was associated with a reduced risk of all-cause and cardiovascular mortality (P for trend <.001 for both). Compared with the first tertile, the third tertile of rehabilitation volume was associated with a 55% lower risk of all-cause mortality (hazard ratio [HR]=.45; 95% confidence interval [CI], .30–.65) and a 50% lower risk of cardiovascular mortality (HR=.50; 95% CI, .31–.82). The association did not vary with respect to stroke severity (P for interaction = .45 and .73 for all-cause and cardiovascular mortality, respectively).

Conclusions

The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke. Thus, further programs aimed at promoting greater use of rehabilitation services are warranted.     

Interdisciplinary Cardiovascular and Neurologic Outpatient Rehabilitation in Patients Surviving Transient Ischemic Attack or Stroke With Minor or No Residual Deficits

Objective

To evaluate the feasibility and effectiveness of a comprehensive outpatient rehabilitation program combining secondary prevention and neurorehabilitation to improve vascular risk factors, neurologic functions, and health-related quality of life (HRQOL) in patients surviving a transient ischemic attack (TIA) or stroke with minor or no residual deficits.

Design

Prospective interventional single-center cohort study.

Setting

University hospital.

Participants

Consecutive consenting patients having sustained a TIA or stroke with 1 or more vascular risk factors (N=105) were included.

Interventions

Three-month hospital-based secondary prevention and neurorehabilitation outpatient program with therapeutic and educational sessions twice a week. Patients were evaluated at entry and program end.

Main Outcome Measures

Impact on vascular risk factors, neurological outcome, and HRQOL.

Results

A total of 105 patients entered the program and 95 patients completed it. Exercise capacity (P<.000), smoking status (P=.001), systolic (P=.001) and diastolic (P=.008) blood pressure, body mass index (P=.005), low-density lipoprotein cholesterol (P=.03), and triglycerides (P=.001) improved significantly. Furthermore, the 9-Hole-Peg-Test (P<.000), Six-minute Walking Test (P<.000), and One Leg Stand Test (P<.011) values as well as HRQOL improved significantly. The program could be easily integrated into an existing cardiovascular prevention and rehabilitation center and was feasible and highly accepted by patients.

Conclusions

Comprehensive combined cardiovascular and neurologic outpatient rehabilitation is feasible and effective to improve vascular risk factors, neurologic functions, and HRQOL in patients surviving TIA or stroke with minor or no residual deficits.     

Functional Recovery After Severe Traumatic Brain Injury: An Individual Growth Curve Approach

Objective

To examine person, injury, and treatment characteristics associated with recovery trajectories of people with severe traumatic brain injury (TBI) during inpatient rehabilitation.

Design

Observational prospective longitudinal study.

Setting

TBI rehabilitation units.

Participants

Adults (N=206) with severe nonpenetrating TBI admitted directly to inpatient rehabilitation from acute care. Participants were excluded for prior disability and intentional etiology of injury.

Interventions

Naturally occurring treatments delivered within comprehensive multidisciplinary teams were recorded daily in 15-minute units provided to patients and family members, separately.

Main Outcome Measures

Motor and cognitive FIM were measured on admission, discharge, and every 2 weeks in between and were analyzed with individual growth curve methodology.

Results

Inpatient recovery was best modeled with linear, cubic, and quadratic components: relatively steep recovery was followed by deceleration of improvement, which attenuated prior to discharge. Slower recovery was associated with older age, longer coma, and interruptions to rehabilitation. Patients admitted at lower functional levels received more treatment, and more treatment was associated with slower recovery, presumably because treatment was allocated according to need. Therefore, effects of treatment on outcome could not be disentangled from effects of case mix factors.

Conclusions

FIM gain during inpatient recovery from severe TBI is not a linear process. In observational studies, the specific effects of treatment on rehabilitation outcomes are difficult to separate from case mix factors that are associated with both outcome and allocation of treatment.     

Mobility activities measurement for outpatient rehabilitation settings

Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Mobility activities measurement for outpatient rehabilitation settings.

Objective

To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF).

Design

A cross-sectional self-report–based psychometric study.

Setting

Outpatient rehabilitation settings (N=3) in 3 urban areas of Spain.

Participants

Convenience sample of 615 patients with musculoskeletal conditions (mean age, 38.1y) participating in an active physiotherapy program.

Interventions

Not applicable.

Main Outcomes Measures

A 22-item Mobility Activities Measure by using a self-report questionnaire that assessed whether patients had limitations on daily activities across major ICF categories of mobility subdomains. Factor analysis, tests of item scaling, internal consistency reliability analysis, Rasch item response theory modeling, and modified parallel analysis were used.

Results

Initial exploratory factor analysis results for each ICF subdomain produced a total of 5 distinct and interpretable factors or dimensions: changing and maintaining body position involving sitting and/or lying; changing and maintaining body position involving standing up; carrying, moving, and handling objects using the hand and shoulder; carrying, moving, and handling objects using the hand and/or forearm; and walking and moving. Dimensionality of these 5 factors was verified by using confirmatory factor analyses and scaling assumptions were met for each dimension. Rasch scaling and modified parallel analysis supported the unidimensionality.

Conclusions

The Mobility Activities Measure is a promising new self-report measure of mobility activities as defined by the ICF. Information about Mobility Activities Measure items and dimensions from this study will be useful in the future operationalization and implementation of ICF.     

The challenges of achieving person-centred care in acute hospitals: A qualitative study of people with dementia and their families

Background

Person-centred care has been identified as the ideal approach to caring for people with dementia. Developed in relation to long stay settings, there are challenges to its implementation in acute settings. However, international policy indicates that acute care for people with dementia should be informed by the principles of person-centred care and interventions should be designed to sustain their personhood.

Objectives

Using Kitwood's five dimensions of personhood as an a priori framework, the aim of this paper was to explore the way in which current approaches to care in acute settings had the potential to enhance personhood in older adults with dementia.

Design

Data collected to explore the current experiences of people with dementia, family carers and co-patients (patients sharing the ward with people with mental health problems) during hospitalisation for acute illness were analysed using a dementia framework that described core elements of person centred care for people with dementia.

Settings

Recruitment was from two major hospitals within the East Midlands region of the UK, focusing on patients who were admitted to general medical, health care for older people, and orthopaedic wards.

Participants

Participants were people aged over 70 on the identified acute wards, identified through a screeing process as having possible mental health problems. 34 patients and their relatives were recruited: this analysis focused on the 29 patients with cognitive impairment.

Method

The study involved 72 h of ward-based non-participant observations of care complemented by 30 formal interviews after discharge concerning the experiences of the 29 patients with cognitive impairment. Analysis used the five domains of Kitwood's model of personhood as an a priori framework: identity, inclusion, attachment, comfort and occupation.

Results

While there were examples of good practice, health care professionals in acute settings were not grasping all opportunities to sustain personhood for people with dementia.

Conclusions

There is a need for the concept of person-centred care to be valued at the level of both the individual and the organisation/team for people with dementia to have appropriate care in acute settings.     

Variation in Pediatric Traumatic Brain Injury Outcomes in the United States

Objective

To ascertain the degree of variation, by state of hospitalization, in outcomes associated with traumatic brain injury (TBI) in a pediatric population.

Design

A retrospective cohort study of pediatric patients admitted to a hospital with a TBI.

Setting

Hospitals from states in the United States that voluntarily participate in the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project.

Participants

Pediatric (age ≤19y) patients hospitalized for TBI (N=71,476) in the United States during 2001, 2004, 2007, and 2010.

Interventions

None.

Main Outcome Measures

Primary outcome was proportion of patients discharged to rehabilitation after an acute care hospitalization among alive discharges. The secondary outcome was inpatient mortality.

Results

The relative risk of discharge to inpatient rehabilitation varied by as much as 3-fold among the states, and the relative risk of inpatient mortality varied by as much as nearly 2-fold. In the United States, approximately 1981 patients could be discharged to inpatient rehabilitation care if the observed variation in outcomes was eliminated.

Conclusions

There was significant variation between states in both rehabilitation discharge and inpatient mortality after adjusting for variables known to affect each outcome. Future efforts should be focused on identifying the cause of this state-to-state variation, its relationship to patient outcome, and standardizing treatment across the United States.     

Relevant patient perceptions and experiences for evaluating quality of interaction with physiotherapists during outpatient rehabilitation: a qualitative study

Objective

To identify elements of the physiotherapist–patient interaction considered by patients when they evaluate the quality of care in outpatient rehabilitation settings.

Design

A qualitative study with nine focus groups, Two researchers conducted the focus groups, and a topic guide with predetermined questions was used. Each group discussion was audiotaped,, transcribed verbatim and analyzed thematically according to a modified grounded theory approach.

Setting

Three postacute ambulatory centers in Barcelona, Madrid and Seville (Spain).

Participants

Fifty-seven adults undergoing outpatient rehabilitation for musculoskeletal conditions/injuries.

Results

Patients based their evaluations of quality of care on their assessment of physiotherapists’ willingness to provide information and education, technical expertise and interpersonal manners (eg. respect, emotional support and sensitivity changes in the patient's status). Both positive and negative aspects of the physiotherapist–patient interaction emerged under all these themes, except for friendly and respectful communication.

Conclusion

This study identified which elements of the physiotherapist–patient interaction are considered by patients when evaluating the quality of care in rehabilitation outpatient settings. Further research should work to develop self-report questionnaires about patients’ experiences of the physiotherapist–patient interaction in rehabilitation services to provide empirical and quantitative evidence.     

Does the Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer capture the problems in functioning treated by physiotherapists in women with breast cancer?

Objective

The Comprehensive International Classification of Functioning, Disability and Health (ICF) Core Set for Breast Cancer is an application of the ICF, and represents the typical spectrum of problems in functioning and contextual factors that may influence functioning of patients with breast cancer. The objective of this study was to examine the content validity of this ICF core set from the perspective of physiotherapists.

Design

Physiotherapists from around the world experienced in the treatment of patients with breast cancer were interviewed about patients’ problems, patients’ resources and environmental aspects that physiotherapists take care of in a three-round survey using the Delphi technique. The responses were linked to the ICF. The degree of agreement was calculated by means of the Kappa statistic.

Participants

Physiotherapists experienced in breast cancer treatment.

Results

Fifty-nine physiotherapists from 19 countries named 769 problems treated by physiotherapists in patients with breast cancer. One hundred and sixty-six ICF categories were linked to these answers. Nineteen ICF categories reached >75% agreement among the physiotherapists but are not represented in the Comprehensive ICF Core Set for Breast Cancer. Ten concepts were linked to the not-yet-classified personal factors component. Eleven concepts are not covered by the ICF. The Kappa coefficient for the agreement between the two persons who performed the linking was 0.66 (95% bootstrapped confidence interval 0.63 to 0.68).

Conclusions

The content validity of the Comprehensive ICF Core Set for Breast Cancer was largely supported by the physiotherapists. However, several issues were raised which were not covered and these need to be investigated further.     

Cognitive Processing Speed Is Related to Fall Frequency in Older Adults With Multiple Sclerosis

Objective

To examine mobility, balance, fall risk, and cognition in older adults with multiple sclerosis (MS) as a function of fall frequency.

Design

Retrospective, cross-sectional design.

Setting

University research laboratory.

Participants

Community-dwelling persons with MS (N=27) aged between 50 and 75 years were divided into 2 groups—single-time (n=11) and recurrent (n=16; >2 falls/12 mo) fallers—on the basis of fall history.

Intervention

Not applicable.

Main Outcome Measures

Mobility was assessed using a variety of measures including Multiple Sclerosis Walking Scale-12, walking speed (Timed 25-Foot Walk test), endurance (6-Minute Walk test), and functional mobility (Timed Up and Go test). Balance was assessed with the Berg Balance Scale, posturography, and self-reported balance confidence. Fall risk was assessed with the Physiological Profile Assessment. Cognitive processing speed was quantified with the Symbol Digit Modalities Test and the Paced Auditory Serial Addition Test.

Results

Recurrent fallers had slower cognitive processing speed than single-time fallers (P≤.01). There was no difference in mobility, balance, or fall risk between recurrent and single-time fallers (P>.05).

Conclusions

Results indicated that cognitive processing speed is associated with fall frequency and may have implications for fall prevention strategies targeting recurrent fallers with MS.     

Spontaneous Coronary Artery Dissection in a 27-Year-Old Woman

Background

Spontaneous coronary artery dissection (SCAD) causes acute coronary syndromes or sudden death in young patients who are often lacking classic coronary disease risk factors. Systemic inflammatory and connective tissue diseases have been suggested as risk factors for SCAD.

Objective

To review the risk factors, diagnosis, and management of this uncommon but life-threatening disease.

Case Report

We report a case of a 27-year-old woman with a history of an ill-defined inflammatory arthropathy who presented with an acute ST-elevation myocardial infarction. SCAD was diagnosed by coronary angiography. Percutaneous coronary intervention was attempted but was unsuccessful. The patient recovered uneventfully with medical management and was ultimately diagnosed with systemic lupus erythematosus.

Conclusions

SCAD is a rare but important cause of acute coronary syndromes and sudden death. It commonly occurs in young women. Although pregnancy is the most well-established risk factor, systemic inflammatory and connective tissue diseases have also been suggested as risk factors.     

Prevalence of low bone mineral density in inpatients with traumatic brain injury receiving neurobehavioural rehabilitation: a postoperative,observational study

Background

Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors.

Objectives

To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice.

Design

Prospective, observational.

Setting

Specialist, residential unit providing care for individuals with brain injury, many with a history of severe challenging behaviour.

Participants

Current inpatients (n = 51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years).

Methods

Participants’ BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected.

Results

Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia.

Conclusions

Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.     

Comparative Evaluation of Core Muscle Recruitment Pattern in Response to Sudden External Perturbations in Patients With Patellofemoral Pain Syndrome and Healthy Subjects

Objective

To evaluate the core muscles' electromyographic activity in response to unexpected perturbations to the pelvis in patients with patellofemoral pain syndrome (PFPS) and healthy subjects.

Design

Case-control study.

Setting

Center for human motion science research.

Participants

Women (N=54) aged 18 to 40 years, including 27 subjects with diagnosed PFPS and 27 healthy controls.

Intervention

An unexpected perturbation was applied to the lateral side of the pelvis by pulling a 1kg medicine ball back to an angle in which releasing the pendulum applied the energy of 20% of the subject's body mass index. This intervention was repeated 3 times with a minimum of 30 seconds of rest between the trials.

Main Outcome Measures

Electromyographic onsets and durations of the transversus abdominis/internal oblique, erector spinae (ES), and gluteus medius (GM) muscles were recorded in response to the unexpected lateral perturbation to the pelvis.

Results

The recruitment pattern of the core muscles was different between the 2 groups. In the subjects with PFPS, the abdominal muscles and the ES activated significantly earlier and longer, whereas the GM responded significantly later than in the controls. The duration of GM activity was not significantly different between the groups.

Conclusions

The results of this investigation suggest that the core muscles are recruited differently in subjects with PFPS to provide core stability. It appears that core neuromuscular improvement could be an effective strategy in rehabilitation of patients with PFPS.     

Psychometric properties of scale constructed from the International Classification of Functioning,Disability and Health (ICF) core set for breast cancer based on Rasch analysis

Objectives

The purpose of this study was to construct a clinical instrument to measure functioning in breast cancer survivors using the International Classification of Functioning, Disability and Health (ICF) categories for body functions, activity and participation, and environmental factors, based on a Rasch analysis.

Methods

Items were generated from the brief ICF core set for breast cancer and in-depth interviews from eight oncologists. Psychometric properties were evaluated in 158 female Korean patients with breast cancer using Rasch analysis, such as fit of the ICF categories, targeting between the ICF categories and a person’s abilities, unidimensionality, and reliability.

Results

The Rasch refinement led to a change from the original 43-item, 5-level scale to a 30-item, 3- or 4-level scale. Rasch reliabilities were 0.89 (body function scale), 0.96 (activity and participation scale), and 0.93 (environmental scale). The item-difficulty hierarchy was stable across age (<50 or ≥50 years) and had no non-fitting items or gaps (all information weighted fit (infit)/outlier sensitive fit (outfit) mean square error of 0.7–1.3, n?=?140).

Conclusion

The Brief Core Set Breast Cancer Questionnaire for Screening is a reliable and valid 30-item questionnaire based on the brief ICF core set. It allows measurement of functioning as a unidimensional construct in patients with breast cancer.