The 2-minute walk test as a measure of functional improvement in persons with lower limb amputation

OBJECTIVE: To determine the construct validity and responsiveness of the 2-minute walk test as a measure of function in individuals with lower extremity amputation. DESIGN: The distances walked in 2 minutes were compared with the results on the physical functioning subscale of the Medical Outcomes Study Short-Form 36-Item Health Survey (SF-36) and the Houghton Scale. SETTING: Regional amputee rehabilitation program. PATIENTS: Retrospective data from 290 patients (mean age, 66yr) with unilateral transtibial, unilateral transfemoral, or bilateral amputations. INTERVENTION: Repeated testing. MAIN OUTCOME MEASURES: Distance walked in 2 minutes, SF-36 (aggregated into physical and mental composite scores), and the Houghton score. We also examined the change in the distance before and after a rehabilitation program. RESULTS: The distance walked in 2 minutes showed a weak correlation with the physical functioning subscale of the SF-36 (r = .22, p = .008) and a moderate correlation with the total Houghton score at discharge from rehabilitation (r = .493, p 相似文献   

Lower extremity prosthetic mobility: a comparison of 3 self-report scales

OBJECTIVE: To assess and compare the reliability and validity of the Houghton Scale, the Prosthetic Profile of the Amputee Locomotor Capabilities Index (PPA-LCI), and the Prosthetic Evaluation Questionnaire (PEQ) mobility subscale, 3 disease-specific self-report measures of functional mobility for lower extremity prosthetic mobility. DESIGN: Four-week test-retest: 1 sample for reliability analyses, 1 sample for validity analyses. SETTING: University-affiliated outpatient amputee clinic, in Ontario, Canada. PARTICIPANTS: Two outpatient amputee samples (sample 1 [n = 55], for reliability analysis; sample 2 [n = 329], for validity analysis). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Test-retest of reliability and convergent validity of the 3 scales. Convergent validity and discriminative ability were also assessed after setting a priori hypotheses for 2 scales of walking performance, balance confidence, and other indicators of ambulatory ability. RESULTS: The reliability of the PPA-LCI (intraclass correlation coefficient [ICC] = .88) was slightly higher than the Houghton Scale (ICC = .85) and the PEQ mobility subscale (ICC = .77). The PPA-LCI was prone to high ceiling effects (40%) that would limit its ability to detect improvement. Evidence for convergent validity, when compared with the 2-Minute Walk Test, Timed Up and Go, and the Activity-Specific Balance Confidence Scale, was supported as hypothesized in all the scales. Each of the scales was able to discriminate between different groups for amputation cause, walking distance, mobility device use, and automatism, with each having varying strength related to relative precision. The Houghton Scale was the only scale able to distinguish between amputation levels. CONCLUSIONS: Reliability and validity of all the scales are acceptable for group level comparison. None of the scales had clearly superior psychometric properties compared with the others. Further research is required to assess responsiveness.     

The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties

OBJECTIVE: To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. DESIGN: We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure's internal consistency, interrater reliability, construct validity, and criterion validity. SETTING: Acute inpatient rehabilitation in 3 metropolitan hospitals. PARTICIPANTS: A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine's Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. RESULTS: The HRERS has good internal consistency (alpha=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=-.24, P<.01), higher ratings of denial of illness (r=-.30, P<.001), and self-rated negative affect (r=-.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01). CONCLUSIONS: The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.     

Reliability, validity, and responsiveness of the locomotor capabilities index in adults with lower-limb amputation undergoing prosthetic training

OBJECTIVE: To assess the reliability, validity, and responsiveness of both the standard and revised Locomotor Capabilities Index (LCI) in people with lower-limb amputation who undergo prosthetic training. DESIGN: Reliability and validity study. SETTING: Two freestanding rehabilitation centers. PARTICIPANTS: Fifty inpatients with a recent unilateral lower-limb amputation. INTERVENTIONS: Not applicable.Main outcome measures The standard LCI and a new version with a 5-level ordinal scale (LCI-5) were tested for internal consistency, test-retest reliability, ceiling effect, and effect size. The construct validity of both versions was analyzed by correlation with the Rivermead Mobility Index, a timed walking test, and the FIM instrument. RESULTS: The Cronbach alpha of both LCI versions was.95. The item-to-total correlations (Spearman rho) ranged from.50 to.87 (P<.0001 for all). The percent agreement and kappa values for the item scores ranged, respectively, from 78.4% to 100% and.58 to 1.00 in the LCI, and from 75.7% to 97.3% and.54 to.96 in the LCI-5. The intraclass correlation coefficient (model 2,1) for the total scores was.98 for both versions; the Bland-Altman plot revealed no systematic trend for either version. Both the LCI and LCI-5 correlated with all criterion measures (rho range,.61-.76), with the LCI-5 showing a larger effect size during the rehabilitation period and a lower ceiling effect. Patients with transtibial amputation were more independent in performing activities than were those with transfemoral amputation; their locomotor capability negatively correlated with age. CONCLUSIONS: Both the LCI and LCI-5 captured the global locomotor ability of people with lower-limb amputation during prosthetic training. The new LCI-5 presents similar and sometimes better psychometric properties than the standard LCI.     

The Cumberland ankle instability tool: a report of validity and reliability testing

OBJECTIVE: To test the Cumberland Ankle Instability Tool (CAIT), a 9-item 30-point scale, for measuring severity of functional ankle instability. DESIGN: Cross-sectional study. SETTING: General community. PARTICIPANTS: Volunteer sample of 236 subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Concurrent validity by comparison with the Lower Extremity Functional Scale (LEFS) and a visual analog scale (VAS) of global perception of ankle instability by using the Spearman rho. Construct validity and internal reliability with Rasch analysis using goodness-of-fit statistics for items and subjects, separation of subjects, correlation of items to the total scale, and a Cronbach alpha equivalent. Discrimination score for functional ankle instability by maximizing the Youden index and tested for sensitivity and specificity. Test-retest reliability by intraclass correlation coefficient, model 2,1 (ICC(2,1)). RESULTS: There were significant correlations between the CAIT and LEFS (rho=.50, P<.01) and VAS (rho=.76, P<.01). Construct validity and internal reliability were acceptable (alpha=.83; point measure correlation for all items, >0.5; item reliability index, .99). The threshold CAIT score was 27.5 (Youden index, 68.1); sensitivity was 82.9% and specificity was 74.7%. Test-retest reliability was excellent (ICC(2,1)=.96). CONCLUSIONS: CAIT is a simple, valid, and reliable tool to measure severity of functional ankle instability.     

The amputee mobility predictor: an instrument to assess determinants of the lower-limb amputee's ability to ambulate

OBJECTIVES: To describe the development of the Amputee Mobility Predictor (AMP) instrument designed to measure ambulatory potential of lower-limb amputees with (AMPPRO) and without (AMPnoPRO) the use of a prosthesis, and to test its reliability and validity. DESIGN: Measurement study using known groups method and concurrence with existing measures. SETTING: Academic medical center. PARTICIPANTS: A convenience sample of 191 lower-limb amputee subjects who had completed prosthetic training, 24 in the reliability study (mean age +/- standard deviation, 68.3+/-17.9y, range, 28-99y) and 167 in the validity study (mean age, 54.8+/-18.6y; range, 18-100y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Intra- and interrater reliability; construct validity by known groups method; concurrent validity by comparisons with 6-minute walk test, Comorbidity Index, age, and time since amputation; predictive validity by comparison with 6-minute walk test after controlling for other factors. RESULTS: Interrater reliability was.99 for subjects tested with and without their prosthesis; intrarater reliability was.96 and.97. Both the AMPnoPRO (P<.0001) and the AMPPRO scores (P<.0001) distinguished among the 4 Medicare functional classification levels. The AMP correlated strongly with 6-minute walk scores (AMPnoPRO r=.69, P<.0001; AMPPRO r=.82, P<.0001) and the amputee activity survey (AMPnoPRO r=.67, P<.0001; AMPPRO r=.77, P<.0001), and negatively correlated with age (AMPnoPRO r=-.69, P<.0001; AMPPRO r=.56, P<.0001) and comorbidity (AMPnoPRO r=-.43, P<.0001; AMPPRO r=.38, P<.0001). CONCLUSION: The AMP with and without a prosthesis are reliable and valid measures for the assessment of functional ambulation in lower-limb amputee subjects.     

Psychometric properties of the Activities-specific Balance Confidence Scale among individuals with a lower-limb amputation

OBJECTIVE: To evaluate the internal consistency, test-retest reliability, and construct validity of the Activities-specific Balance Confidence (ABC) Scale among people who have a lower-limb amputation. DESIGN: Retest design. SETTING: A university-affiliated outpatient amputee clinic in Ontario. PARTICIPANTS: Two samples of individuals who have unilateral transtibial and transfemoral amputation. Sample 1 (n=54) was a consecutive and sample 2 (n=329) a convenience sample of all members of the clinic population. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Repeated application of the ABC Scale, a 16-item questionnaire that assesses confidence in performing various mobility-related tasks. Correlation to test hypothesized relationships between the ABC Scale and the 2-minute walk (2MWT) and the timed up-and-go (TUG) tests; and assessment of the ability of the ABC Scale to discriminate among groups based on amputation cause, amputation level, mobility device use, automatic stepping ability, wearing time, stair climbing ability, and walking distance. RESULTS: Test-retest reliability (intraclass correlation coefficient) of the ABC Scale was .91 (95% confidence interval [CI], .84-.95) with individual item test-retest coefficients ranging from .53 to .87. Internal consistency, measured by Cronbach alpha, was .95. Hypothesized associations with the 2MWT and TUG test were observed with correlations of .72 (95% CI, .56-.84) and -.70 (95% CI, -.82 to -.53), respectively. The ABC Scale discriminated between all groups except those based on amputation level. CONCLUSIONS: Balance confidence, as measured by the ABC Scale, is a construct that provides unique information potentially useful to clinicians who provide amputee rehabilitation. The ABC Scale is reliable, with strong support for validity. Study of the scale's responsiveness is recommended.     

Development and validation of the Headache Needs Assessment (HANA) survey

OBJECTIVE: To develop and validate a brief survey of migraine-related quality-of-life issues. The Headache Needs Assessment (HANA) questionnaire was designed to assess two dimensions of the chronic impact of migraine (frequency and bothersomeness). METHODS: Seven issues related to living with migraine were posed as ratings of frequency and bothersomeness. Validation studies were performed in a Web-based survey, a clinical trial responsiveness population, and a retest reliability population. Headache characteristics (eg, frequency, severity, and treatment), demographic information, and the Headache Disability Inventory were used for external validation. RESULTS: The HANA was completed in full by 994 adults in the Web survey, with a mean total score of 77.98 +/- 40.49 (range, 7 to 175). There were no floor or ceiling effects. The HANA met the standards for validity with internal consistency reliability (Cronbach alpha =.92, eigenvalue for the single factor = 4.8, and test-retest reliability = 0.77). External validity showed a high correlation between HANA and Headache Disability Inventory total scores (0.73, P<.0001), and high correlations with disease and treatment characteristics. CONCLUSIONS: These data demonstrate the psychometric properties of the HANA. The brief questionnaire may be a useful screening tool to evaluate the impact of migraine on individuals. The two-dimensional approach to patient-reported quality of life allows individuals to weight the impact of both frequency and bothersomeness of chronic migraines on multiple aspects of daily life.     

The concurrent validity and responsiveness of the high-level mobility assessment tool for measuring the mobility limitations of people with traumatic brain injury

OBJECTIVE: To investigate the concurrent validity and responsiveness of the High-Level Mobility Assessment Tool (HiMAT) in people after traumatic brain injury (TBI). DESIGN: This study compared the concurrent validity and responsiveness of the motor subsection of the FIM instrument and the gross function component of the Rivermead Motor Assessment (RMA) with the HiMAT, a new measure of high-level mobility developed for use in TBI. SETTING: A major rehabilitation hospital. PARTICIPANTS: A convenience sample of 103 participants with TBI were recruited from a major rehabilitation hospital. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: HiMAT, motor FIM, and the gross function RMA. RESULTS: The correlation between the HiMAT and motor FIM was moderate (r=.53, P<.001), largely because of a ceiling effect in the motor FIM. The correlation between the HiMAT and gross function RMA was strong (r=.87, P<.001), yet the gross function RMA was also susceptible to a ceiling effect, with 51.5% of subjects achieving the maximum score. The HiMAT was more responsive than the motor FIM and the gross function RMA on all indices. CONCLUSIONS: The HiMAT is a new unidimensional scale with moderate concurrent validity for measuring high-level mobility. The HiMAT is more responsive and has less of a ceiling effect than either the motor FIM or the gross function RMA.     

Development and validation of the Chinese version of the Diabetes Management Self-efficacy Scale

OBJECTIVE: The purpose of this study was to translate the Diabetes Management Self-Efficacy Scale (DMSES) into Chinese and test the validity and reliability of the instrument within a Taiwanese population. RESEARCH DESIGN AND METHODS: A two-stage design was used for this study. Stage I consisted of a multi-stepped process of forward and backward translation, using focus groups and consensus meetings to translate the 20-item Australia/English version DMSES to Chinese and test content validity. Stage II established the psychometric properties of the Chinese version DMSES (C-DMSES) by examining the criterion, convergent and construct validity, internal consistency and stability testing. The sample for Stage II comprised 230 patients with type 2 diabetes aged 30 years or more from a diabetes outpatient clinic in Taiwan. RESULTS: Three items were modified to better reflect Chinese practice. The C-DMSES obtained a total average CVI score of .86.The convergent validity of the C-DMSES correlated well with the validated measure of the General Self-Efficacy Scale in measuring self-efficacy (r=.55; p<.01). Criterion-related validity showed that the C-DMSES was a significant predictor of the Summary of Diabetes Self-Care Activities scores (Beta=.58; t=10.75, p<.01). Factor analysis supported the C-DMSES being composed of four subscales. Good internal consistency (Cronbach's alpha=.77 to .93) and test-retest reliability (Pearson correlation coefficient r=.86, p<.01) were found. CONCLUSIONS: The C-DMSES is a brief and psychometrically sound measure for evaluation of self-efficacy towards management of diabetes by persons with type 2 diabetes in Chinese populations.     

Alberta infant motor scale: reliability and validity when used on preterm infants in Taiwan

BACKGROUND AND PURPOSE: The goal of this study was to examine the reliability and validity of measurements obtained with the Alberta Infant Motor Scale (AIMS) for evaluation of preterm infants in Taiwan. SUBJECTS: Two independent groups of preterm infants were used to investigate the reliability (n=45) and validity (n=41) for the AIMS. METHODS: In the reliability study, the AIMS was administered to the infants by a physical therapist, and infant performance was videotaped. The performance was then rescored by the same therapist and by 2 other therapists to examine the intrarater and interrater reliability. In the validity study, the AIMS and the Bayley Motor Scale were administered to the infants at 6 and 12 months of age to examine criterion-related validity. RESULTS: Intraclass correlation coefficients (ICCs) for intrarater and interrater reliability of measurements obtained with the AIMS were high (ICC=.97-.99). The AIMS scores correlated with the Bayley Motor Scale scores at 6 and 12 months (r=.78 and.90), although the AIMS scores at 6 months were only moderately predictive of the motor function at 12 months (r=.56). CONCLUSION AND DISCUSSION: The results suggest that measurements obtained with the AIMS have acceptable reliability and concurrent validity but limited predictive value for evaluating preterm Taiwanese infants.     

Monitoring rate of recovery to predict outcome in minimally responsive patients

Existing methods of assessing neurobehavioral responsiveness in severely brain-injured patients are limited by their inability to recognize subtle clinical changes over time. This study evaluates the Coma Recovery Scale (CRS), developed for use during acute rehabilitation. The CRS was designed to detect subtle changes in neurobehavioral status and to predict outcome in patients with sever alterations of consciousness. Acceptable levels of concurrent validity were established with the Disability Rating Scale ([DRS], r = -.93) and the Glasgow Coma Scale ([GCS], r = .90). The CRS was also found to have adequate interrater reliability (kappa = .83). Twenty-eight minimally responsive patients, unable to communicate or follow commands reliably, were evaluated on the CRS, the DRS, and the GCS. Although initial scores on all three scales were significantly correlated with outcome at discharge, change scores were more predictive of outcome. In addition, CRS change scores correlated higher with outcome (r = -.78, p less than .01) than DRS and GCS change scores. These findings indicate that the CRS is a sensitive measure of neurobehavioral responsiveness and suggest that rate of change during acute rehabilitation may be an important outcome predictor.     

中文版Barthel指数的信度与效度研究

目的 研究脑卒中患者中文版Barthel指数(Barthel Index,BI)的信度和效度.方法 147例急性脑卒中患者分别由不同评定者对同一脑卒中患者于入院当天、入院第15天、发病后第90天进行BI的评定.用Kappa值表示重测信度与评定者间信度,用Cronbach α值表示分半信度、内部一致性信度.采用Spearman相关分析预测效度,采用因子分析方法评定结构效度.结果 所有重测信度、评定者间信度的Kappa值差异均有统计学意义(P＜0.01);分半信度:BI奇偶项两部分的Cronbach α值分别为0.837、0.824,两部分的rs为0.903;内部一致信度:Cronbach α值为0.916;效度研究中患者的KMO统计量为0.854,Bartlett球形检验拒绝相关阵是单位阵(P＜0.01);入院时、发病15天的BI评分结果与发病90天后BI呈正相关(rs=0.614,0.583,均P＜0.01);与斯堪的那维亚卒中量表(Scandinavian Stroke Scale,SSS)结果呈正相关(rs=0.619,0.704,0.882,均P＜0.01),与美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)呈负相关(rs=-0.587,-0.705,-0.790,均P＜0.01).结论 中文版的BI重测信度和评定者间信度佳,内部一致性好;具有结构效度、预测效度;使用方便,易于掌握,可广泛应用于脑卒中的评定中.     

The effects of dehydration on rehabilitation outcomes of elderly orthopedic patients

OBJECTIVE: To study the effects of dehydration, by using the indices of prerenal azotemia and orthostasis, on the rehabilitation outcomes of elderly orthopedic patients. DESIGN: Prospective, pilot study. SETTING: Regional inpatient rehabilitation center. PARTICIPANTS: A consecutive sample of 39 patients (29 women, 10 men), ranging in age from 58 to 94 years (mean, 78y), of whom 13 had total hip replacements, 12 had total knee replacements, and 14 had hip fractures. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS), change in the FIM trade mark instrument score, and discharge to home. RESULTS: The mean LOS was significantly longer in the group with prerenal azotemia (n=21, 12.9+/-3.0d, t=2.49, P<.01) than in the nonazotemic group (n=18, 9.4+/-4.6d). LOS was also significantly longer in the orthostatic group (n=18, 13.7+/-3.4d, t=2.94, P<.01) than in the nonorthostatic group (n=21, 9.8+/-3.9d). Two-way analysis of variance showed a statistically significant effect on LOS for both azotemia (F=8.4, P=.006) and orthostasis (F=10.5, P=.003). A statistical interaction existed (F=4.7, P=.038), but it was more pronounced in the absence of both conditions, as opposed to the presence of both. LOS for the group with both azotemia and orthostasis was 13.6+/-2.7 days (n=10, F=4.7, P=.038), in contrast to 7.2+/-2.8 days in the group without either condition (n=10). Of the patients who had neither azotemia nor orthostasis, 100% (n=10) went home; 80% (n=8) of patients who had both conditions went home. Logistic regression analysis, however, did not show a statistically significant correlation between discharge to home and the presence of azotemia, orthostasis, or both. CONCLUSION: Prerenal azotemia and orthostasis are present in a significant number of elderly orthopedic patients and have a major effect on rehabilitation outcomes.     

The Lower Extremity Functional Scale (LEFS): scale development, measurement properties, and clinical application. North American Orthopaedic Rehabilitation Research Network

BACKGROUND AND PURPOSE: The purpose of this study was to assess the reliability, construct validity, and sensitivity to change of the Lower Extremity Functional Scale (LEFS). SUBJECTS AND METHODS: The LEFS was administered to 107 patients with lower-extremity musculoskeletal dysfunction referred to 12 outpatient physical therapy clinics. METHODS: The LEFS was administered during the initial assessment, 24 to 48 hours following the initial assessment, and then at weekly intervals for 4 weeks. The SF-36 (acute version) was administered during the initial assessment and at weekly intervals. A type 2,1 intraclass correlation coefficient was used to estimate test-retest reliability. Pearson correlations and one-way analyses of variance were used to examine construct validity. Spearman rank-order correlation coefficients were used to examine the relationship between an independent prognostic rating of change for each patient and change in the LEFS and SF-36 scores. RESULTS: Test-retest reliability of the LEFS scores was excellent (R = .94 [95% lower limit confidence interval (CI) = .89]). Correlations between the LEFS and the SF-36 physical function subscale and physical component score were r=.80 (95% lower limit CI = .73) and r = .64 (95% lower limit CI = .54), respectively. There was a higher correlation between the prognostic rating of change and the LEFS than between the prognostic rating of change and the SF-36 physical function score. The potential error associated with a score on the LEFS at a given point in time is +/-5.3 scale points (90% CI), the minimal detectable change is 9 scale points (90% CI), and the minimal clinically important difference is 9 scale points (90% CI). CONCLUSION AND DISCUSSION: The LEFS is reliable, and construct validity was supported by comparison with the SF-36. The sensitivity to change of the LEFS was superior to that of the SF-36 in this population. The LEFS is efficient to administer and score and is applicable for research purposes and clinical decision making for individual patients.     

A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke

OBJECTIVE: To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. DESIGN: One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients' comprehensive activities of daily living (ADL) function. SETTING: Three rehabilitation units in Taiwan. PARTICIPANTS: Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. RESULTS: For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78-.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [d], .63) and small (d range, .27-.33), respectively, whereas the responsiveness of the weight-shifting tests was limited (d range, .04-.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function (r2 range, .15-.17). The PASS showed high reliability (ICC=.84) and small responsiveness (d=.41), and the PASS in the second evaluation had acceptable predictive validity (r2=.24). CONCLUSIONS: The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.     

The reliability and validity of pain interference measures in persons with cerebral palsy

OBJECTIVE: To evaluate the reliability and validity of 2 measures of pain interference in persons with cerebral palsy (CP). DESIGN: Standardized interviews to assess pain and impact of pain on activities. SETTING: University medical center. PARTICIPANTS: Fifty adults with CP. INTERVENTIONS: Patients asked to rate pain's intensity, interference with general activities, and depression levels. MAIN OUTCOME MEASURES: Pain interference scales: Chronic Pain Grade (CPG) and Brief Pain Inventory (BPI); rating of disability: Craig Handicap Assessment and Reporting Technique (CHART); rating of depression: Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS: Mean interference of pain on 3 CPG items (pain interference with daily activities, social activities, work) were 1.74 +/- 2.45, 1.06 +/- 2.05, and.89 +/- 1.84 (out of 10), respectively. Mean interference on 10 modified BPI interference items ranged from 2.28 +/- 3.01 to 3.67 +/- 3.15 (out of 10). The composite CPG interference score did not correlate significantly with pain intensity. However, the composite BPI interference score did correlate significantly with pain intensity (r = .66, P < .01). There was no significant association shown between average pain and the CHART score (r = -.21, NS). Pain showed a significant association with CES-D score (r = .45, P < .05). Internal consistency of the 3 CPG items was inadequately low (Cronbach alpha = .59), whereas that of the 10 BPI items was excellent (.89). CONCLUSIONS: The pain interference items of the BPI serve as a reliable and valid measure of pain's impact on persons with CP-related pain.     

Patient preference and gait efficiency in a geriatric population with transfemoral amputation using a free-swinging versus a locked prosthetic knee joint

OBJECTIVE: To investigate patient preference, walking speed, and prosthetic use in a geriatric population with transfemoral amputation using a free-swinging prosthetic knee or a locked knee joint. DESIGN: Before-after trial. SETTING: Ambulatory patients at an amputee rehabilitation facility. PARTICIPANTS: A convenience sample of 14 geriatric individuals with a unilateral dysvascular transfemoral amputation (age range, 61-80y), who were using a prosthesis with a free-swinging knee in the community, 3 months after discharge from an amputee rehabilitation program. INTERVENTION: Change from a free-swinging knee to a locked knee. MAIN OUTCOME MEASURES: Patient preference, distance walked in 2 minutes, and prosthetic use as measured by the Houghton Scale. RESULTS: Eleven of 14 participants preferred the locked knee. Irrespective of preference, the mean 2-minute walk distance was 44.9 +/- 28.9m with the free-swinging knee and 54.4 +/- 35m with the locked knee (P = .001). Prosthetic use was greater with the locked knee (7.8 +/- 2.2) than with the free-swinging knee (6.6 +/- 2.5) (P = .01). CONCLUSIONS: Most geriatric participants with transfemoral amputation preferred locked knees and walked faster and used their prostheses more when using a locked knee prosthesis.     

Reproducibility,Construct Validity,and Responsiveness of the Tetraplegia Upper Limb Activities Questionnaire,TUAQ. Part 2

ObjectiveTo test reliability, construct validity and responsiveness of the Tetraplegia Upper Limb Activities Questionnaire (TUAQ), a patient-reported outcome measure that assesses perceived performance and satisfaction with 10 standardized activities.DesignOutcome measure psychometric evaluation.SettingSpinal cord injury units in 2 countries.ParticipantsReproducibility: 47 individuals with tetraplegia. Construct validity and responsiveness: 33 individuals with tetraplegia undergoing surgery to restore hand function (N=80).InterventionsReproducibility: The TUAQ was completed on 2 occasions, 2 weeks apart. Construct validity and responsiveness: Participants completed the TUAQ prior to surgery and 3-12 months after hand reconstruction surgery. Internal consistency was examined using Cronbach α. Two agreement parameters were examined: the SEM and minimal detectable change with 90% confidence interval (MDC₉₀). Construct validity was evaluated using Pearson product moment correlation against a priori hypotheses. Responsiveness was assessed using paired t tests and effect size.ResultsTest-retest reliability and internal consistency was high (intraclass correlation coefficient of 0.89 for performance scale and 0.88 for satisfaction, Cronbach α of 0.92 and 0.90, respectively). For agreement the SEM scores were 4.7 and 3.5, with MDC₉₀ of 10.9 and 8.2, respectively. Responsiveness and construct validity showed sound results with no ceiling or floor effects and with large effect size (>1.05).ConclusionsThe TUAQ demonstrates good psychometric properties for reliability and agreement for persons with tetraplegia and responsiveness and construct validity for surgical reconstruction of hand function for persons with tetraplegia. The TUAQ appears appropriate to be used as a patient-reported outcome measure for clinical and research purposes in this population.     

The Pittsburgh Rehabilitation Participation Scale: reliability and validity of a clinician-rated measure of participation in acute rehabilitation

OBJECTIVE: To demonstrate interrater reliability and predictive validity of the Pittsburgh Rehabilitation Participation Scale (PRPS), a clinician-rated 6-point Likert-type item measuring patient participation in inpatient rehabilitation sessions. DESIGN: Prospective measurement of patient participation in physical and occupational therapy sessions during inpatient rehabilitation. SETTING: University-based, freestanding acute rehabilitation hospital. PARTICIPANTS: Two hundred forty-two inpatients, primarily elderly, with a variety of impairment diagnoses (eg, stroke), who were admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Change in the 13 motor items from the FIM trade mark instrument, from admission to discharge. RESULTS: The PRPS had high interrater reliability (intraclass correlation coefficient [ICC]=.91 for occupational therapists; ICC=.96 for physical therapists). The subjects had mean PRPS scores +/- standard deviation of 4.73+/-0.76. Mean PRPS scores predicted rehabilitation outcome (N=242, r=.32, P<.0001), as measured by change in motor FIM. The strength of this association did not change in a multivariate model that controlled for age, gender, race, impairment group, medical comorbidity count, length of stay, and admission FIM. CONCLUSIONS: Patient participation during acute inpatient rehabilitation can be easily and reliably measured, and PRPS scores predict functional outcome. The PRPS may have applicability in clinical and research outcome measurement.