ACTIVLIM-Stroke: A Crosscultural Rasch-Built Scale of Activity Limitations in Patients With Stroke

Test-retest reliability and responsiveness of an adapted version of the ABILHAND questionnaire to assess performance in bimanual daily life activities in stroke patients in sub-Saharan Africa

The ABILHAND is a widely used questionnaire assessing bimanual daily life activities in adults with stroke. A recently modified version tailored for the sub-Saharan African population (ABILHAND-Stroke Benin) has been created. This study aimed to investigate its test-retest reliability and responsiveness. The study included 132 adults with stroke with a mean (SD) age = 54.6 (11.2) years and 40% women. The mean (SD) time since stroke was 15.2 (12) months for the subsample ( n  = 51) included in the reliability analysis and 1 (0.6) month for the subsample ( n  = 81) of the responsiveness analysis. Participants were assessed within a week interval with the ABILHAND-Stroke Benin questionnaire for the reliability analysis. As for the responsiveness analysis, they were additionally assessed with the ACTIVLIM-Stroke questionnaire, the Box and Block Test (BBT), and the Stroke Impairment Assessment Set, at baseline (T1), 2-month later (T2), and on average of 1.5 (0.5) years after stroke (T3). The ABILHAND-Stroke Benin questionnaire showed an excellent test-retest reliability (intraclass correlation coefficient = 0.98, P  < 0.001, minimal detectable change = 10.3%). Regarding the responsiveness analysis, participants showed a larger improvement during the acute phase (T1-T2) compared with the chronic phase (T2-T3). Changes with the ABILHAND-Stroke Benin questionnaire were significantly correlated with changes with the other outcome measures (correlations ranged from 0.36 to 0.70, P  < 0.05) except with the BBT less affected hand. The ABILHAND-Stroke Benin questionnaire demonstrates an excellent test-retest reliability and was responsive to changes in adults with stroke.

Monitoring changes in locomotion-related daily life activities in post-stroke patients: the responsiveness of ABILOCO-Benin questionnaire

PURPOSE

To investigate the responsiveness of ABILOCO-Benin questionnaire, a West-African adapted questionnaire of performance in locomotion-related daily-life activities in adults with stroke.

MATERIALS AND METHODS

We conducted a longitudinal study involving 81 stroke patients (mean (SD) age: 54.6 (10.8) years; 58% male, mean (SD) time after stroke onset: 4.3 (2.5) weeks). Participants were assessed at baseline (T1), two-month later (T2), and on average of 1.5 (0.5) years after stroke (T3), with the ABILOCO-Benin questionnaire, functional ambulation classification (FAC), six-minute walking test, ACTIVLIM-Stroke questionnaire, modified Rankin Scale, and Stroke Impairment Assessment Scale. Global-, sub-group- (stable and improved based on FAC scores), and individual-based analysis of changes were performed.

RESULTS

Participants showed significantly larger improvement for all outcomes during the acute phase (T1-T2). Changes in the ABILOCO-Benin measures were significantly correlated with changes in other outcome measures. ABILOCO-Benin questionnaire detected a significant improvement in both the stable and improved groups at both T2 and T3 in the sub-group approach. Individual-based analysis with ABILOCO-Benin measures showed a significantly higher proportion of stable patients (n = 55) and lower proportion of improved ones (n = 23) between T2 and T3 (LR(df) = 15.52(4), p = 0.004).

CONCLUSIONS

ABILOCO-Benin is responsive to changes in adult stroke patients within both acute and chronic phases.

Are Optometrists Prepared to Be Involved in Post-Stroke Rehabilitation?

BACKGROUND/OBJECTIVES

Stroke survivors often experience various visual consequences that impact their daily life and may benefit from visual interventions. However, some of these usually go unaddressed as optometrists are rarely included in the post-stroke care pathway. Yet, optometrists are interested in contributing to the care of these patients. This survey evaluated the readiness of optometrists in diagnosing and managing visual disorders specific to stroke survivors.

METHODS

A questionnaire was developed by the researchers, pilot tested by 5 research optometrists and 15 community optometrists, and modified based on the feedback. Practicing optometrists were invited to complete the anonymous online survey through optometric organizations in Canada, the US, Hong Kong, India, and the UK.

RESULTS

Most respondents displayed strong knowledge, but 61.6% indicated that enhancing their knowledge would be helpful. The majority (87%) agreed that stroke is related to an increased incidence of falls. Participants' knowledge regarding the natural history of post-stroke visual disorders was poorer. There were also inconsistencies regarding what optometrists considered ideal interventions and what they undertook in practice. More than 50% of respondents reported that the quality of published evidence on post-stroke visual consequences was low or nonexistent.

CONCLUSIONS

Overall, survey respondents displayed sufficient knowledge. However, there are areas of uncertainty in their knowledge, which in many cases correspond to real gaps in the available evidence. There is a need to identify and remediate these gaps to enable optometrists to deliver quality optometric care as collaborative members of the post-stroke professional team, which would eventually improve the rehabilitation of stroke survivors.

Feasibility of a 10-week community-based mobile health rehabilitation program using the WalkWithMe application in late sub-acute and chronic stroke survivors in a low resource setting: A pilot study

 Physical functioning can be increased in people with stroke by using a mobile health application. This study aimed to investigate the feasibility of a 10-week community-based program using the WalkWithMe (WWM) application in people with late sub-acute and chronic stroke in Benin. An interventional pilot study with mixed methods research design was used examining the application of an unsupervised individualized mobile Health (mHealth) instructed training program. Main outcome included the application usage, safety, adherence, perceived enjoyment, mHealth quality, patient experiences and pre-post efficacy measures. Nine adults, five males, median age of 60 years and time since stroke of 12 months participated in this study. For most participants adherence with the application was over 70%. However, some usability problems were observed due to incorrect understanding and use by participants and technical problems. The application was very fun, stimulating and enjoyable. Significant improvements were found with median (pre/post measures) of locomotors skill (1.4/3.4); impairments (38/40), Barthel Index (85/95), activity limitation (2.1/3.1), and quality of life (194/218). A trend towards significant improvement was found with 6 minutes walking test (181/220, p = 0.06). The WWM application is perceived as a potential approach to increase physical activity and functioning among people with stroke in Benin.

Cross-cultural adaptation and validation of a French version of the Measure of Stroke Environment (MOSE) in stroke survivors in Sub-Saharan Africa

PURPOSE

To investigate the psychometric properties of the MOSE-Benin, a French-language version of the Measure of Stroke Environment (MOSE) for Sub-Saharan Africa.

MATERIALS AND METHODS

The original English version of the MOSE has been translated into French following the guidelines for cross-cultural adaptation. The resulting questionnaire (MOSE-Benin) was administered to a convenience sample of participants recruited in Benin, a French-speaking country.

RESULTS

Eighty-two stroke survivors (41 females; mean ± SD: 54.94 ± 11.6 years old) participated in the study. Internal consistency of each domain of the MOSE-Benin and the overall questionnaire was high (Cronbach's α: 0.78 to 0.92). Test-retest reliability was excellent (n = 31; ICC: 0.977 to 0.998). Overall, the standard error of measurement (SEM) and the minimum detectable change (MDC) showed very low values (SEM = 0.85; MDC = 2.35). Convergent validity demonstrated moderate correlations for the three domains in separate comparison respectively with the ACTIVLIM-Stroke questionnaire, the Participation Measurement Scale, and the communication domain of the Stroke Impact Scale (r or ρ: 0.42 to 0.54; p < 0.0001).

CONCLUSION

MOSE-Benin has good evidence regarding psychometric properties (i.e., content validity, convergent validity, internal consistency, and test-retest reliability) that can support its use for the assessment of perceived environmental barriers after stroke in a French-speaking Sub-Saharan African country, such as Benin.

Translation, reliability, and validity of the Norwegian version of the ABILHAND-NMD and the ACTIVLIM for Myotonic Dystrophy type 1

PURPOSE

To translate ABILHAND-NMD and ACTIVLIM into Norwegian and assess their psychometric properties in adults with Myotonic Dystrophy type 1(DM1).

METHODS

ABILHAND-NMD and ACTIVLIM were translated into Norwegian through a standardized translation process. Psychometric properties of the translated questionnaires were tested. Intraclass correlation coefficient (ICC3.1) was used to assess test-retest reliability and Cronbach's α for internal consistency. The validity of the questionnaires was also assessed.

RESULTS

A total of 39 adults with DM1 were included. We found excellent test-retest reliability on ABILHAND-NMD (ICC 0.91) and ACTIVLIM (ICC 0.93). We found a good internal consistency of ABILHAND-NMD with Cronbach's α (95%CI) of 0.80 (0.69-0.88) and ACTIVLIM with Cronbach's α (95%CI) of 0.88 (0.82-0.93) An expert group of healthcare professionals and a pilot group reported good face and content validity. We found a high correlation between ABILHAND-NMD and ACTIVLIM (r = 0.75), p < 0.001 implying good convergent validity. ABILHAND-NMD and ACTIVLIM showed no floor effect, but a potential for ceiling effect.

CONCLUSION

The Norwegian versions of ABILHAND-NMD and ACTIVLIM are reliable and valid patient reported outcome measures for Myotonic Dystrophy type 1. The questionnaires are easy to administer as they take a short time to answer, and the participants reported no problems understanding the questions.

Measuring global activity performance in children with cerebral palsy in West Africa: validation of an adapted version of the ACTIVLIM-CP questionnaire

PURPOSE

To calibrate a West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) for children with cerebral palsy (CP).

MATERIALS AND METHODS

We recruited 287 children with CP of various age range: 2-6 years (n = 117, preschoolers), 6-12 years (n = 96, children) and 12-19 years (n = 74, adolescents). Caregivers of children of each age range completed the experimental version of the ACTIVLIM-CP-WA including 76 (preschoolers), 78 (children) and 76 (adolescents) global daily life activities. Responses were analyzed using the Rasch RUMM2030 software.

RESULTS

The final West-African version of ACTIVLIM-CP including 31 items (both common and age-specific items) defined a unidimensional, linear scale with well-discriminated response categories. It presented a high internal consistency (R = 0.94). Moreover, all items were locally independent and the item difficulty hierarchy was invariant regarding caregivers' education, children's age and gender, MACS and GMFCS levels. The ACTIVLIM-CP-WA measures were significantly correlated (p < 0.05) with Gross Motor Function Classification System (ρ = -0.77), Manual Ability Classification System (ρ = -0.75), Box and Block test (dominant hand r = 0.51; non-dominant hand r = 0.49), One-minute walking test (r = 0.28), and Timed up and Go test (r = -0.40).

CONCLUSIONS

The ACTIVLIM-CP-WA questionnaire provides a valid and reliable tool that has the potential to follow children's evolution and quantify changes consecutive to neurorehabilitation in Sub-Saharan Africa.IMPLICATIONS FOR REHABILITATIONThe West-African version of the ACTIVLIM-CP questionnaire (ACTIVLIM-CP-WA) measures global activities requiring a combination of lower and upper extremities in children with cerebral palsy.As a Rasch-built scale, measures are unidimensional and linear to document changes in children with cerebral palsy from 2 to 19 years in Sub-Saharan Africa.Rehabilitation professionals are encouraged to use the ACTIVLIM-CP-WA questionnaire as a psychometrically robust assessment tool measuring the global performance in daily life activities in children with cerebral palsy in Sub-Saharan Africa.

Relationships between cardiorespiratory fitness, physical activity practices, and functional outcomes one-year post-stroke in northern Benin: A case-control study

BACKGROUND

Currently, little is known on the relationships between cardiorespiratory fitness (CF), physical activity (PA), and functional outcomes after stroke, especially in low- and middle-income countries.

OBJECTIVES

We examine the relationships between CF, PA, and functional outcomes in one-year poststroke in Benin, a lower middle-income country.

METHODS

A case-control study was carried out in northern Benin. Twenty-one participants with chronic strokes were matched to 42 controls according to sex and age. PA patterns and associated energy expenditure (EE) were assessed with a BodyMedia's senseWear armband. CF was evaluated with the Physical Working Capacity at 75% of the predicted maximal heart rate index. The functional outcomes were evaluated using the modified Rankin scale (mRS) and the ACTIVLIM-Stroke scale.

RESULTS

Both people with stroke and the healthy pairs spent much time in sedentary behavior (median [P25; P75]: 672 [460; 793] min vs 515 [287; 666] min, p = 0.006). Although people with chronic stroke performed fewer steps compared to healthy controls (median: 2767 vs 5524, p = 0.005), results showed that total EE was not statistically significant in either group (median: 7166 Kcal vs 8245 Kcal, p = 0.07). In addition, the mRS score (r = 0.47, p = 0.033) and the ACTIVLIM-Stroke measure (r = 0.52, p = 0.016) were moderately associated with the CF index of people with chronic stroke.

CONCLUSION

The study showed clear trends for lower levels of PA in both people with chronic stroke and health controls. A correlation exists between CF, disability, and functional outcomes among stroke patients.

Shared Decision-Making to Improve Health-Related Outcomes for Adults with Stroke Disease

Stroke is one of the leading causes of disability and death worldwide, a severe medical condition for which new solutions for prevention, monitoring, and adequate treatment are needed. This paper proposes a SDM framework for the development of innovative and effective solutions based on artificial intelligence in the rehabilitation of stroke patients by empowering patients to make decisions about the use of devices and applications developed in the European project ALAMEDA. To develop a predictive tool for improving disability in stroke patients, key aspects of stroke patient data collection journeys, monitored health parameters, and specific variables covering motor, physical, emotional, cognitive, and sleep status are presented. The proposed SDM model involved the training and consultation of patients, medical staff, carers, and representatives under the name of the Local Community Group. Consultation with LCG members, consists of 11 representative people, physicians, nurses, patients and caregivers, which led to the definition of a methodological framework to investigate the key aspects of monitoring the patient data collection journey for the stroke pilot, and a specific questionnaire to collect stroke patient requirements and preferences. A set of general and specific guidelines specifying the principles by which patients decide to use wearable sensing devices and specific applications resulted from the analysis of the data collected using the questionnaire. The preferences and recommendations collected from LCG members have already been implemented in this stage of ALAMEDA system design and development.

Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) in adults with chronic stroke: protocol of a randomised controlled trial

INTRODUCTION

Stroke causes multiple deficits including motor, sensitive and cognitive impairments, affecting also individual's social participation and independence in activities of daily living (ADL) impacting their quality of life. It has been widely recommended to use goal-oriented interventions with a high amount of task-specific repetitions. These interventions are generally focused only on the upper or lower extremities separately, despite the impairments are observed at the whole-body level and ADL are both frequently bimanual and may require moving around. This highlights the need for interventions targeting both upper and lower extremities. This protocol presents the first adaptation of Hand-Arm Bimanual Intensive Therapy Including Lower Extremities (HABIT-ILE) for adults with acquired hemiparesis.

METHODS AND ANALYSIS

This randomised controlled trial will include 48 adults with chronic stroke, aged ≥40 years. This study will compare the effect of 50 hours of HABIT-ILE against usual motor activity and regular rehabilitation. HABIT-ILE will be provided in a 2-week, adult's day-camp setting, promoting functional tasks and structured activities. These tasks will continuously progress by increasing their difficulty. Assessed at baseline, 3 weeks after and at 3 months, the primary outcome will be the adults-assisting-hand-assessment stroke; secondary outcomes include behavioural assessments for hand strength and dexterity, a motor learning robotic medical device for quality of bimanual motor control, walking endurance, questionnaires of ADL, stroke impact on participation and self-determined patient-relevant goals, besides neuroimaging measures.

ETHICS AND DISSEMINATION

This study has full ethical approval from the Comité d'éthique Hospitalo-Facultaire/Université catholique de Louvain, Brussels (reference number: 2013/01MAR/069) and the local medical Ethical Committee of the CHU UCL Namur-site Godinne. Recommendations of the ethical board and the Belgian law of 7 May 2004, concerning human experiments will be followed. Participants will sign a written informed consent ahead of participation. Findings will be published in peer-reviewed journals and conference presentations.

TRIAL REGISTRATION NUMBER

NCT04664673.

Relationships between overall physical activity and step counts in able-bodied adults and stroke survivors in developing countries: a cross-sectional study

PURPOSE

To investigate how step counts relate to overall physical activity (PA) in able-bodied adults and stroke survivors in developing countries.

MATERIALS AND METHODS

Sixty able-bodied adults (mean age: 48.8 ± 11.7 years old) and 60 stroke survivors (mean age: 56.7 ± 10.4 years old) were recruited in Benin (West-Africa). Step counts were collected for 7 consecutive days using the Garmin Forerunner 15 activity tracker. Then, participants completed the adapted French version of the International Physical Activity Questionnaire (IPAQ-AF) to report their PA over the same period. Spearman's rank correlation coefficients (ρ) were calculated between IPAQ-AF scores and the mean steps per day.

RESULTS

Very high correlations were observed between IPAQ-AF total scores and step counts, in able-bodied adults (ρ = 0.94; p < 0.001), and in stroke survivors (ρ = 0.91; p < 0.001). IPAQ-AF leisure-time presented negligible correlation with step counts in able-bodied adults. No activity was reported in occupation and intense domains in stroke survivors.

CONCLUSION

There is a strong relationship between overall PA and step counts in able-bodied adults and stroke survivors in Benin. Step counts appear to be an indicator of PA levels in developing countries, suggesting walking as a potential exercise to improve PA levels in stroke survivors.Implications for RehabilitationStep counts could serve as an indicator of physical activity levels in stroke survivors in developing countries.Walking may be suggested as exercise to improve physical activity levels in stroke survivors in developing countries.In Africa French speaking countries, the IPAQ-AF could be used to assess physical activity in stroke survivors and findings might guide programs to promote an active lifestyle as needed.

Relationships between Self-Efficacy and Post-Stroke Activity Limitations, Locomotor Ability, Physical Activity, and Community Reintegration in Sub-Saharan Africa: A Cross-Sectional Study

Stroke self-efficacy is under-investigated in sub-Saharan Africa. In particular, studies focusing on the relationship between self-efficacy and post-stroke functional outcomes are scarce. This cross-sectional study aimed to explore the association between self-efficacy and post-stroke activity limitations, locomotor ability, physical activity, and community reintegration in Benin, a sub-Saharan African country. To achieve this purpose, a selection of stroke patients was made from the admission registers of the physiotherapy clinics (rehabilitation units) of three reference hospitals in Benin from January to April 2018. Stroke patients who were still continuing their rehabilitation sessions were informed by direct contact. Those who had already finished their sessions were informed by telephone. Sixty stroke patients of those contacted gave their consent and were recruited for this study. The sample consisted of 44 men and 16 women with a mean age of 56.7 ± 10.4 years. Activity limitations, locomotor ability, physical activity, community reintegration, and self-efficacy were self-reported using ACTIVLIM-Stroke, Abiloco-Benin, the Africa francophone version of the International Physical Activity Questionnaire (IPAQ-AF), the Reintegration to Normal Living Index (RNLI), and a French version of the Stroke Self-efficacy Questionnaire (SSEQ-F), respectively. Spearman's rank correlation coefficients (ρ) were calculated to characterize the relationship between self-efficacy and activity limitations, locomotor ability, physical activity, and community reintegration. According to the results, self-efficacy showed a moderate correlation with physical activity (ρ = 0.65; p < 0.001) and high correlations with activity limitations (ρ = 0.81; p < 0.001), locomotor ability (ρ = 0.72; p < 0.001), and community reintegration (ρ = -0.84; p < 0.001). Thus, self-efficacy emerges as an important factor associated with the functional recovery of stroke patients in sub-Saharan Africa.

ACTIVLIM-Hemo: A new self-reported, unidimensional and linear measure of activity limitations in persons with haemophilia

INTRODUCTION

To assess activity limitations in people with haemophilia (PwH), the self-reported Haemophilia Activity List (HAL) is widely employed, despite several methodological limitations impacting the interpretation of categorical scores. Modern psychometric approaches avoid these limitations by using a probabilistic model, such as the Rasch model. The ACTIVLIM is a Rasch-built measurement of activity limitations previously validated in several clinical conditions like neuromuscular disorders.

AIMS

This study sought to develop the ACTIVLIM-Hemo, meaning an ACTIVLIM scale version specifically adapted to assess daily activity limitations in adult PwH.

METHODS

Daily activities were assessed as "impossible," "difficult" or "easy" by 114 PwH (median age of 44 years) with 63 of them reassessed after 12 days. The Rasch Rating Scale model was used to identify activities delineating a unidimensional and linear scale unbiased by demographic and clinical status. Concurrent validity was determined through correlation with the HAL sub-scores and sum score.

RESULTS

The ACTIVLIM-Hemo included 22 pertinent activities, with difficulties independent of demographic and clinical conditions, allowing a reliable measure of activity limitations (PSI = .92) expressed on a linear and unidimensional scale in PwH (7%-100 % range, ceiling effect of 1/114) with excellent test-retest reliability (ICC = .978). Spearman rank correlations between ACTIVLIM-Hemo and HAL sub-scores ranged between .623 and .869.

CONCLUSIONS

The ACTIVLIM-Hemo is an easy-to-administer, valid and reliable alternative to HAL in assessing activity limitations in PwH. Its invariant scale can be used across conditions and time to compare the functional status of PwH over a wide measurement range.

Effect of mixed and collective physical activity in chronic stroke rehabilitation: A randomized cross-over trial in low-income settings

BACKGROUND

The prevalence of physical inactivity after stroke is high and exercise training improves many outcomes. However, access to community training protocols is limited, especially in low-income settings.

OBJECTIVE

To investigate the feasibility and efficacy of a new intervention: Circuit walking, balance, cycling and strength training (CBCS) on activity of daily living (ADL) limitations, motor performance, and social participation restrictions in people after stroke.

METHODS

Forty-six community-dwelling individuals with chronic stroke who were no longer in conventional rehabilitation were randomized into an immediate CBCS group (IG; initially received CBCS training for 12 weeks in phase 1), and a delayed CBCS group (DG) that first participated in sociocultural activities for 12 weeks. In phase 2, participants crossed over so that the DG underwent CBCS and the IG performed sociocultural activities. The primary outcome was ADL limitations measured with the ACTIVLIM-Stroke scale. Secondary outcomes included motor performance (balance: Berg Balance Scale [BBS], global impairment: Stroke Impairment Assessment Set [SIAS] and mobility: 6-minute and 10-metre walk tests [6MWT and 10mWT] and psychosocial health [depression and participation]). Additional outcomes included feasibility (retention, adherence) and safety.

RESULTS

ADL capacity significantly improved pre to post CBCS training (ACTIVLIM-stroke, +3,4 logits, p < 0.001; effect size [ES] 0.87), balance (BBS, +21 points, p < 0.001; ES 0.9), impairments (SIAS, +11 points, p < 0.001; ES 0.9), and mobility (+145 m for 6MWT and +0.37 m/s for 10mWT; p < 0.001; ES 0.7 and 0.5 respectively). Similar improvements in psychosocial health occurred in both groups. Adherence and retention rates were 95% and 100%, respectively.

CONCLUSION

CBCS was feasible, safe and improved functional independence and motor abilities in individuals in the chronic stage of stroke. Participation in CBCS improved depression and social participation similarly to participation in sociocultural activities. The benefits persisted for at least 3 months after intervention completion.

PROTOCOL REGISTRATION NUMBER

PACTR202001714888482.

Psychometric testing of the Icelandic Occupational Self-Assessment (OSA-IS)

BACKGROUND

The Occupational Self-Assessment (OSA) is a self-report measure of occupational competence and values used to identify goals and assess outcomes. The Icelandic version of the OSA (OSA-IS) has been through several developmental stages to evaluate its psychometric properties. Through each stage, revisions have been made.

AIM

To investigate the psychometric properties of the fourth revised version of OSA-IS.

MATERIALS AND METHODS

Retrospective data from 291 rehabilitation clients with a range of conditions were analysed using Rasch analysis of unidimensionality and descriptive statistics. All statistics were compared to established criteria.

RESULTS

Analyses suggest the OSA-IS items define unidimensional constructs of occupational competence and values. Most (89%) participants completed the assessment in a reliable manner and no association was observed between demographic variables and fit status. Differences in the item hierarchies were observed between the original OSA and the OSA-IS, suggesting that Icelandic clients responded differently due to cultural, linguistic and/or sample differences.

CONCLUSION AND SIGNIFICANCE

OSA-IS is a psychometrically sound instrument that may be used to support identification of client-centred goals and for intervention development. Clinicians should use score tables specifically developed for the OSA-IS to measure outcomes.

Assessing patterns and stability of ADL hierarchical scales for functional disability assessment

BACKGROUND AND OBJECTIVES

This study examined the stability over time of activities of daily living (ADL) items in three comparable longitudinal datasets and evaluated ADL loss sequences for older adults in the U.S., South Korea, and Japan.

RESEARCH DESIGN AND METHODS

Data from the U.S. Health and Retirement Study, and its two international sister surveys, were analyzed. Subjects were community-dwelling adults aged 60 and above. For each dataset, Rasch analysis was implemented to determine if the ordering of items remained stable across multiple waves (2006-2014), such that a single ADL hierarchy may be derived from multi-wave data.

RESULTS

Data fitted the Rasch model well. Item calibrations were sufficiently stable across measurement periods in each dataset, reflecting a stable frame of reference. Results were also robust to sample variations. The derived ADL hierarchies based on scaled logit scores revealed that "dressing" and "bathing" were relatively more difficult items for older adults in all study populations.

DISCUSSION AND IMPLICATIONS

Scale stability is essential when exploiting longitudinal data to analyze patterns in ADL disabilities. The consistency in ADL scales across measurement periods supports their use as screening tools and identifying those at risk for transitions in care. Interventions to reduce dependency in bathing and dressing can help improve independent functioning for community-dwelling elderly.

Post-stroke fatigue: how it relates to motor fatigability and other modifiable factors in people with chronic stroke

Post-stroke fatigue (PSF) is a common symptom associated with disability and decreased quality of life. Distinction can be made between perceived fatigue and fatigability. The first aim of this study was to evaluate the prevalence of perceived fatigue and fatigability amongst patients with chronic stroke and to explore how these two parameters relate. The second aim was to study the relationship between modifiable factors (sleep disorders, anxiety, depression and activities of daily living) and fatigue in this population. Sixty-two patients with chronic stroke (> 6 months) were included. Perceived fatigue was evaluated using the Fatigue Severity Scale (FSS). Motor fatigability was assessed with the percent change in meters walked from first to last minute of the 6-min Walk Test and an isometric muscular fatigability test. Subjects also completed self-report questionnaires assessing anxiety and depression (Hospital Anxiety and Depression Scale-HADS), sleep quality (Pittsburgh Sleep Quality Index-PSQI) and activity limitations (ACTIVLIM-stroke). Seventy-one percent of participants presented PSF. There was no correlation between the FSS and motor fatigability. FSS significantly correlated with HADS-Anxiety (ρ = 0.53, P < 0.001), HADS-depression (ρ = 0.63, P < 0.001), PSQI (ρ = 0.51, P < 0.001) and ACTIVLIM (ρ = - 0.30, P < 0.05). A linear regression model showed that the HADS-Depression, the PSQI and the ACTIVLIM explained 46% of the variance of the FSS. A high proportion of chronic stroke patients presents PSF, with no relation between their fatigue and fatigability. Perceived fatigue is associated with potentially modifiable factors: anxious and depressive symptoms, poor sleep quality and activity limitations. Registered at ClinicalTrials.gov (NCT04277234) (21/02/2019).

A Novel Multiple-Cue Observational Clinical Scale for Functional Evaluation of Gait After Stroke - The Stroke Mobility Score (SMS)

Background

For future development of machine learning tools for gait impairment assessment after stroke, simple observational whole-body clinical scales are required. Current observational scales regard either only leg movement or discrete overall parameters, neglecting dysfunctions in the trunk and arms. The purpose of this study was to introduce a new multiple-cue observational scale, called the stroke mobility score (SMS).

Material/Methods

In a group of 131 patients, we developed a 1-page manual involving 6 subscores by Delphi method using the video-based SMS: trunk posture, leg movement of the most affected side, arm movement of the most affected side, walking speed, gait fluency and stability/risk of falling. Six medical raters then validated the SMS on a sample of 60 additional stroke patients. Conventional scales (NIHSS, Timed-Up-And-Go-Test, 10-Meter-Walk-Test, Berg Balance Scale, FIM-Item L, Barthel Index) were also applied.

Results

(1) High consistency and excellent inter-rater reliability of the SMS were verified (Cronbach’s alpha >0.9). (2) The SMS subscores are non-redundant and reveal much more nuanced whole-body dysfunction details than conventional scores, although evident correlations as e.g. between 10-Meter-Walk-Test and subscore “gait speed” are verified. (3) The analysis of cross-correlations between SMS subscores unveils new functional interrelationships for stroke profiling.

Conclusions

The SMS proves to be an easy-to-use, tele-applicable, robust, consistent, reliable, and nuanced functional scale of gait impairments after stroke. Due to its sensitivity to whole-body motion criteria, it is ideally suited for machine learning algorithms and for development of new therapy strategies based on instrumented gait analysis.

Effects of the model of human occupation-based home modifications on the time use, occupational participation and activity limitation in people with disabilities: a pilot randomized controlled trial

Purpose: To compare the effect of intervention providing home modifications and assistive devices based on MOHO theory with home exercise on people with disability in time use, competence and values of occupational performance and activity limitations.Methods: Participants were 20 people with disabilities due to deficits in central nervous system. Eleven people in the experimental group partook in environmental modifications and assistive device intervention and nine people in the control partook in home exercise programmes. A total of eight sessions were progressed, one pre-test, six sessions of interventions and one post-test. Occupational Questionnaire (OQ) was used to evaluate one's time use. Occupational Self Assessment (OSA) was used to test the competence and values of one's everyday occupational performance. Activity Limitations Measure (ACTIVLIM) was used to assess the activity limitation of one's functional ability. Wilcoxon signed rank test was used to analyse the comparison of the pre-post of time use, competence and values of occupational performance, and activity limitations. Mann-Whitney U was used to compare between both groups.Results: Among the four occupational areas of OQ, the participation time in ADL significantly increased and rest significantly decreased in the experimental group (p<.05). The competence of occupational performance also increased in the experimental group whereas the values of occupational performance increased in the control group (p<.05). The activity limitation significantly decreased in control group (p<.05) but not in the experimental group.Conclusions: Using the interaction between human and environment for environmental modification increased the time use in occupational participation and competence to perform occupation in people with disability. By applying MOHO theory to evaluate and modify one's home environment and activity performance, we could comprehend the life style of clients and suggest opportunities to actively participate in ADLs.Implications for rehabilitationUsing the interaction between human and environment for environmental modification increased the time use in occupational participation and competence to perform occupation in people with disability.By applying MOHO theory to evaluate and modify one's home environment, we could comprehend the life style of clients and suggest opportunities to actively participate in ADLs.Adapting MOHO theory to enhance activity participation will contribute to enhance the quality of occupational therapy services in community settings.

Activity and participation in stroke survivors in a low-income setting: A cross-sectional study

OBJECTIVES

To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS).

METHODS

In this cross-sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM-Stroke, 10-m walk test (10MWT), 6-min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub-groups (<0.4 m/s, 0.4-0.8 m/s and >0.8 m/s) based on 10MWT scores.

RESULTS

ACTIVLIM-Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0-20). Sub-group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p < .001) were found between WS sub-groups for both activity and participation.

CONCLUSION

Stroke survivors in Kinshasa presented a good performance for basic-activities of daily life (basic-ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic-ADLs, walking distance and participation, and inversely.

The quantification of task-difficulty of upper limb motor function skill based on Rasch analysis

Background: The degree of difficulty of skills of paretic upper limbs in daily life has not been investigated.Objective: To determine the internal validity and level of difficulty of items of the Functional Skills Measure After Paralysis (FSMAP), which can be used to evaluate the functional skills of daily living for stroke patients.Method: A total of 105 first-stroke patients were assessed using the FSMAP. The evaluation system consists of 65 items in 15 categories. We examined the internal validity and level of difficulty of these items using Rasch analysis. In this study, an item with either infit or outfit of ≥1.5 was defined as underfit.Results: Rasch analysis showed that 8 items were underfit. The highest infit and outfit logits were 2.47 for "Trouser donning/doffing" and 8.44 for "Paper manipulation". "Shirt donning/doffing" was the easiest item and "Coin manipulation" was the most difficult, with difficulty logits of -35.8 and 41.5, respectively.Conclusion: The therapist can confirm items that the patient can or cannot perform. By understanding the level of difficulty of each item, the most appropriate functional skill to focus on acquiring next can be identified.

Cross-cultural adaptation and validation of the Ukrainian version of the ABILHAND-Kids questionnaire

PURPOSE

To develop and cross-culturally validate the Ukrainian version of the ABILHAND-Kids questionnaire by testing its psychometric properties in a sample of Ukrainian children with cerebral palsy.

METHODS

The ABILHAND-Kids questionnaire was translated into Ukrainian, cross-culturally adapted, and administered to 113 parents of children with cerebral palsy. The psychometric properties of the Ukrainian version and its cross-cultural validation were investigated through the Rasch rating scale model.

RESULTS

One major misfit has been found for the item "Rolling up a sleeve of a sweater" that further was removed. The item "Putting on a backpack/schoolbag" was split into gender-specific items, separately for girls and for boys, as it was systematically easier for Ukrainian girls. All remaining items contributed to the definition of a unidimensional measure of manual ability. The internal consistency reliability of the scale was high (R = 0.95). No significant floor (4%) and ceiling effects (5%) were observed. Three major differential item functioning items were found across Belgium and Ukraine, highlighting the need to use the Ukrainian calibration of ABILHAND-Kids in Ukraine.

CONCLUSION

The Ukrainian ABILHAND-Kids questionnaire has good psychometric properties for assessing manual ability in Ukrainian children with cerebral palsy, holding potential to be implemented in clinical practice nationwide.Implications for rehabilitationCerebral palsy impairs manual ability leading to decreased quality of life and participation.Professionals need valid and reliable tools to detect small changes of manual ability during rehabilitation.Metric properties and availability of the Ukrainian version of the ABILHAND-Kids questionnaire make it a useful tool in the assessment of children with cerebral palsy.

Effectiveness of upper-limb robotic-assisted therapy in the early rehabilitation phase after stroke: A single-blind, randomised, controlled trial

BACKGROUND

Upper-limb robotic-assisted therapy (RAT) is promising for stroke rehabilitation, particularly in the early phase. When RAT is provided as partial substitution of conventional therapy, it is expected to be at least as effective or might be more effective than conventional therapy. Assessments have usually been restricted to the first 2 domains of the International classification of functioning, disability and health (ICF).

OBJECTIVE

This was a pragmatic, multicentric, single-blind, randomized controlled trial to evaluate the effectiveness of upper-limb RAT used as partial substitution to conventional therapy in the early phase of stroke rehabilitation, following the 3 ICF domains.

METHODS

We randomized 45 patients with acute stroke into 2 groups (conventional therapy, n=22, and RAT, n=23). Both interventions were dose-matched regarding treatment duration and lasted 9 weeks. The conventional therapy group followed a standard rehabilitation. In the RAT group, 4 sessions of conventional therapy (25%) were substituted by RAT each week. RAT consisted of moving the paretic upper limb along a reference trajectory while the robot provided assistance as needed. A blinded assessor evaluated participants before, just after the intervention and 6 months post-stroke, according to the ICF domains UL motor impairments, activity limitations, and social participation restriction.

RESULTS

In total, 28 individuals were assessed after the intervention. The following were more improved in the RAT than conventional therapy group at 6 months post-stroke: gross manual dexterity (Box and Block test +7.7 blocks; P=0.02), upper-limb ability during functional tasks (Wolf Motor Function test +12%; P=0.02) and patient social participation (Stroke Impact Scale +18%; P=0.01). Participants' abilities to perform manual activities and activities of daily living improved similarly in both groups.

CONCLUSION

For the same duration of daily rehabilitation, RAT combined with conventional therapy during the early rehabilitation phase after stroke is more effective than conventional therapy alone to improve gross manual dexterity, upper-limb ability during functional tasks and patient social participation.

Comprehensive ADL Outcome Measurement after Stroke: Rasch Validation of the Lucerne ICF-Based Multidisciplinary Observation Scale (LIMOS)

OBJECTIVE

To establish Rasch validation of the Lucerne International Classification of Functioning, Disability and Health (ICF)-based Multidisciplinary Observation Scale (LIMOS) in stroke. LIMOS measures the level of assistance in daily life activities related to motor function, communication, cognition, and domestic life. Rasch Measurement Theory (RMT) transforms an ordinal scale into an interval scale and thus the Rasch-based LIMOS scale captures a more accurate improvement of functional outcomes via Rasch-transformed scores.

DESIGN

Cross-sectional study design.

SETTING

Neurorehabilitation center, Luzerne, Switzerland.

PARTICIPANTS

We recruited participants with stroke (N=407; age=63.2±16.0y; n=157 women) through consecutive sampling.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants were assessed with LIMOS at admission and discharge of rehabilitation. We used RMT to evaluate overall model fit, response dependency, floor and ceiling effect, reliability, and differential item functioning (DIF) for sex, age, type, and time of stroke on the 4 LIMOS subscales using the Rasch Unidimensional Measurement Model (RUMM) 2030 program.

RESULTS

The Rasch-based LIMOS subscales fit the Rasch model after reducing and rescoring items: motor (from 20 to 18 items), communication (5 items), cognition (from 15 to 13 items), and domestic life (5 items). There was no floor or ceiling effect. Some artificial DIF was identified. Scoring at discharge was dependent on the scoring responses at admission, which means that without applying a correction factor to the discharge scores, there was an underestimation of change in scores between admission and discharge, ranging from 0.24 to 0.97 logits (10.79%-49.24%) on the different subscales.

CONCLUSIONS

The Rasch-based LIMOS scale is recommended to measure functional outcome in people with acute or chronic stages of ischemic or hemorrhagic stroke.

Comparison between self-reported and observed locomotion ability scores in patients with stroke: a cross-sectional study

This study aimed to investigate (i) the validity of self-reported scores of locomotion ability in stroke survivors using the ABILOCO-Benin questionnaire, and (ii) the congruence between online Rasch analysis of the ABILOCO-Benin raw scores and a conversion table set along with the questionnaire development. Thirty-five adult poststroke patients [mean age: 52 (SD: 10) years, 60% men] recruited from the rehabilitation department of National University Hospital of Cotonou (Benin), self-reported their locomotion ability, filling out the ABILOCO-Benin questionnaire [self-reported scores (SRS)]. Afterwards, a physical therapist observed and rated the patients' locomotion ability, while they performed each of the 15 items of the questionnaire [performance-based scores (PBS)]. Both raw SRS and PBS were then converted to linear measures using (i) an online Rasch analysis method and (ii) an ordinal-to-interval transformation table. Analyses showed high correlation (intraclass correlation coefficient=0.74, P<0.001) and nonsignificant difference (P=0.778) between SRS and PBS. Linear measures from online Rasch and a conversion table also exhibited high correlation (intraclass correlation coefficient=0.92; P<0.001). However, the difference between online analysis and the conversion table was significant (P=0.022). In conclusion, self-report is a valid method to administer ABILOCO-Benin in stroke patients. The conversion table offers a valid opportunity for quick transfer of raw scores to linear measures. However, the accuracy of linear measures from the conversion table may be slightly affected by missing responses.

Development and evaluation of the children's experiences of dental anxiety measure

BACKGROUND

Existing measures of children's dental anxiety have not been developed with children or based on a theoretical framework of dental anxiety.

AIM

To develop the children's experiences of dental anxiety measure (CEDAM) and evaluate the measure's properties.

DESIGN

The measure was developed from interviews with dentally anxious children. Children recruited from a dental hospital and secondary school completed the CEDAM and Modified Child Dental Anxiety Scale (MCDAS). A subgroup of children completed the CEDAM before and after receiving an intervention to reduce dental anxiety to examine the measure's responsiveness. Rasch and Classical test analyses were undertaken.

RESULTS

Children were aged between 9 and 16 years (N = 88 recruited from a dental hospital and N = 159 recruited from a school). Rasch analysis confirmed the measure's unidimensionality. The CEDAM correlated well with the MCDAS (rho = 0.67, P < 0.01) and had excellent internal consistency (Cronbach's alpha = 0.88) and test-retest reliability (ICC = 0.98). The CEDAM was also able to detect changes in dental anxiety following the intervention (baseline mean = 22.36, SD = 2.57 and follow-up mean = 18.88, SD = 2.42, t(df = 37) = 9.54, P < 0.01, Cohen's d = 1.39).

CONCLUSIONS

The results support the reliability, validity and responsiveness of the CEDAM. Initial findings indicate it has potential for use in future intervention trials or in clinical practice to monitor children's dental anxiety.

Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale

OBJECTIVE

To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke.

DESIGN

Observational study and questionnaire development.

SETTING

Outpatient rehabilitation centers.

PARTICIPANTS

Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation.

RESULTS

After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation.

CONCLUSIONS

The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.

ACTIVLIM-CP a new Rasch-built measure of global activity performance for children with cerebral palsy

OBJECTIVE

Children with cerebral palsy (CP) often have upper extremity (UE) and lower extremity (LE) impairments. While tools measuring separately UE and LE abilities are currently used, activities in which UE and LE are used in combination - numerous in everyday life - cannot be assessed because no instrument allows capturing global activity performance in children with CP. This study aimed to develop a clinical tool for measuring their global activity performance using the Rasch model.

STUDY DESIGN

The caregivers of 226 children with CP (2-18 years old) answered a 154-item experimental questionnaire. Within 4-6 weeks, 129 of them filled in the questionnaire a second time. Responses were analyzed using the Rasch RUMM2020 software.

RESULTS

The final 43 item scale presented a high reliability (R=0.98) and reproducibility (R=0.97). The item difficulty hierarchy was consistent over time and did not vary according to age, gender, or clinical form, allowing the follow-up of children from 2 to 18 years old.

CONCLUSIONS

ACTIVLIM-CP is a unidimensional scale specifically developed to measure global activity performance in children with CP providing a reliable tool to follow children's evolution and document changes related to neurorehabilitation, especially where a combination of UE and LE is targeted. Its responsiveness is still to be tested.

Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: part 2 - cross-sectional validation

Objective: To test the items, identified through qualitative inquiry that might form the basis of a new Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life (OHQoL) of young people with malocclusion. Methods: Piloting with 13 young people reduced the number of items from 37 to 28. Cross-sectional testing involved a convenience sample aged 10–16 years, attending the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield. The fit and function of the initial MIQ questions were examined using item response theory. Results: 184 participants (113 females; 71 males) completed a questionnaire (response 85%), seven participants were excluded due to missing responses. The mean age of participants was 12·9 years (SD 1·4) and they had a wide range of malocclusions. The majority were White British (67·4%). Data from 47 participants were used to analyse test–retest reliability. Rasch analysis was undertaken, which further reduced the number of items in the questionnaire from 28 to 17. Unidimensionality of the scale was confirmed. The analysis also identified that the original 5-point response scale could be reduced to three points. The new measure demonstrated good criterion validity (r = 0·751; P < 0·001) and construct validity with the two global questions (‘Overall bother’ ρ = 0·733 and ‘Life overall’ ρ = 0·701). Internal consistency (Cronbach's alpha = 0·906) and test–retest reliability Intraclass correlation coefficient (ICC = 0·78; 95% CI 0·61–0·88) were also good. Conclusion: Cross-sectional testing has shown the new MIQ to be both valid and reliable. Further evaluation is required to confirm the generalisability as well as the ability of the new measure to detect change over time (responsiveness).

Measuring functional recovery in stroke patients: the responsiveness of ACTIVLIM-stroke

BACKGROUND AND PURPOSE

To determine the efficacy of the ACTIVLIM-Stroke questionnaire in detecting changes in functional status of stroke patients.

METHOD

Sixty-eight Benin and Belgian stroke patients participated in this 2-month longitudinal study, involving baseline and follow-up assessments. Outcome measures combined ACTIVLIM-Stroke questionnaire, Barthel Index (BI), 6-minute-walk test (6MWT) and modified Rankin scale (MRS). Responsiveness of ACTIVLIM-Stroke was investigated through different methodological approaches and compared with BI, 6MWT and MRS. Statistical analyses were performed using the paired t tests, effect size (ES) and correlation tests.

RESULTS

ACTIVLIM-Stroke detected changes in the whole sample (p<0.001, ES=0.78) and even in a subgroup of patients (p<0.001, ES=0.29) that were classified as stable according to the MRS. Moreover, ACTIVLIM-Stroke permitted the classification of patients into more discriminative groups, including those showing an important improvement (p<0.001, ES=1.87), a slight but non-clinically meaningful improvement (p<0.001, ES=0.38), and no improvement (p=0.1, ES=0.11), demonstrating its high sensitivity to change. Furthermore, there were concordant relationships between ACTIVLIM-Stroke change and any observed changes in BI, 6MWT and MRS scores (r≥0.50, p<0.001), confirming the external responsiveness of ACTVLIM-Stroke.

CONCLUSIONS

ACTIVLIM-Stroke showed good responsiveness and can detect accurately clinical changes in the functional status of stroke patients. The BI and the 6MWT were also responsive and may provide complementary information while investigating change in functional status. However, in addition to being highly sensitive to change, ACTIVLIM-Stroke presents significant methodological advantages for quantifying functional changes in stroke patients.

Rasch analysis of the Edmonton Symptom Assessment System and research implications

BACKGROUND

Reliable and valid assessment of the disease burden across all forms of cancer is critical to the evaluation of treatment effectiveness and patient progress. The Edmonton Symptom Assessment System (esas) is used for routine evaluation of people attending for cancer care. In the present study, we used Rasch analysis to explore the measurement properties of the esas and to determine the effect of using Rasch-proposed interval-level esas scoring compared with traditional scoring when evaluating the effects of an exercise program for cancer survivors.

METHODS

Polytomous Rasch analysis (Andrich's rating-scale model) was applied to data from 26,645 esas questionnaires completed at the Juravinski Cancer Centre. The fit of the esas to the polytomous Rasch model was investigated, including evaluations of differential item functioning for sex, age, and disease group. The research implication was investigated by comparing the results of an observational research study previously analysed using a traditional approach with the results obtained by Rasch-proposed interval-level esas scoring.

RESULTS

The Rasch reliability index was 0.73, falling short of the desired 0.80-0.90 level. However, the esas was found to fit the Rasch model, including the criteria for uni-dimensional data. The analysis suggests that the current esas scoring system of 0-10 could be collapsed to a 6-point scale. Use of the Rasch-proposed interval-level scoring yielded results that were different from those calculated using summarized ordinal-level esas scores. Differential item functioning was not found for sex, age, or diagnosis groups.

CONCLUSIONS

The esas is a moderately reliable uni-dimensional measure of cancer disease burden and can provide interval-level scaling with Rasch-based scoring. Further, our study indicates that, compared with the traditional scoring metric, Rasch-based scoring could result in substantive changes to conclusions.

Improving the measurement of health-related quality of life in adolescent with idiopathic scoliosis: the SRS-7, a Rasch-developed short form of the SRS-22 questionnaire

Scoliosis Research Society-22 (SRS-22) questionnaire was developed to evaluate health-related quality of life (HRQL) in adolescent idiopathic scoliosis (AIS) patients. Rasch analysis (RA) is a statistical procedure which turns questionnaire ordinal scores into interval measures. Measures from Rasch-compatible questionnaires can be used, similar to body temperature or blood pressure, to quantify disease severity progression and treatment efficacy. Purpose of the current work is to present Rasch analysis (RA) of the SRS-22 questionnaire and to develop an SRS-22 Rasch-approved short form. 300 SRS-22 were randomly collected from 2447 consecutive IS adolescents at their first evaluation (229 females; 13.9 ± 1.9 years; 26.9 ± 14.7 Cobb°) in a scoliosis outpatient clinic. RA showed both disordered thresholds and overall misfit of the SRS-22. Sixteen items were re-scored and two misfitting items (6 and 14) removed to obtain a Rasch-compatible questionnaire. Participants HRQL measured too high with the rearranged questionnaire, indicating a severe SRS-22 ceiling effect. RA also highlighted SRS-22 multidimensionality, with pain/function not merging with self-image/mental health items. Item 3 showed differential item functioning (DIF) for both curve and hump amplitude. A 7-item questionnaire (SRS-7) was prepared by selecting single items from the original SRS-22. SRS-7 showed fit to the model, unidimensionality and no DIF. Compared with the SRS-22, the short form scale shows better targeting of the participants' population. RA shows that SRS-22 has poor clinimetric properties; moreover, when used with AIS at first evaluation, SRS-22 is affected by a severe ceiling effect. SRS-7, an SRS-22 7-item short form questionnaire, provides an HRQL interval measure better tailored to these participants.

Assessing locomotion ability in West African stroke patients: validation of ABILOCO-Benin scale

OBJECTIVE

To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.

DESIGN

Prospective study and questionnaire development.

SETTING

Rehabilitation centers.

PARTICIPANTS

Stroke patients (N=230; mean age ± SD, 51.1±11.6 y; 64.3% men).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as "impossible," "difficult," or "easy." The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.

RESULTS

Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).

CONCLUSIONS

ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients.

Enhancing patient-provider communication for long-term post-stroke spasticity management

Stroke is a major public health concern, with estimated 16 million people worldwide experiencing first-time strokes each year, a number that is expected to rise. Two-thirds of those experiencing a stroke are younger than 70 years of age. Stroke is a leading cause of disability in adults as a result of major sequelae that include spasticity, cognitive impairment, paresis, and depression. Disabling spasticity, defined as spasticity severe enough to require intervention, occurs in 4% of stroke survivors within 1 year of first-time stroke. The aim of this report is to focus instead on a discussion of patient-provider communication, and its role in post-stroke spasticity (PSS) rehabilitation within the context of patient-centered health care. A discussion based on a review of the literature, mainly since 2000. Problems within communication are identified and suggestion to enhance communication are proposed thus improving patient-centered goal setting/goal achievement for the effective management of spasticity rehabilitation. These are as follows: (i) involving family members, (ii) educating patients and family members on stroke and rehabilitation, and (iii) establishing a common definition for long-term goals. Increased communication among physicians, patients, and payers may bridge some of the gaps and increase the effectiveness of PSS rehabilitation and management.

The reliability and validity of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke

PURPOSE

Psychometric properties of the World Health Organization Disability Assessment Schedule (WHODAS-II) in stroke have received some attention recently, mostly using classical approaches, but there is still an absence of investigation from a modern psychometric perspective. This study aimed to test the reliability and validity of the WHODAS-II in stroke, using modern psychometric analysis.

METHODS

A total of 188 community-dwelling poststroke patients were recruited. Internal construct validity was assessed by Rasch analysis, reliability by internal consistency and person separation index (PSI), and external construct validity by associations with Functional Independence Measure (FIM(™)).

RESULTS

Rasch analysis indicated that total score (based upon 32 items, omitting the work-related items) was satisfactory, after adjustment for local dependency. The proposed "activities" and "participation" components also satisfied Rasch model expectations. An existing short form was problematic due to inclusion of a work-related item, but an alternative 10-item version was acceptable. Cronbach's α for the WHODAS-II, its domains and components varied between 0.83 and 0.99 and PSI between 0.70 and 0.95. External construct validity was confirmed by expected correlations with FIM(™).

CONCLUSIONS

WHODAS-II provides a reliable and valid instrument for measuring disability and components of "activities" and "participation" in stroke survivors. Various combinations of the item set may provide a range of scales to suit most research needs.