Community Integration Measure Research Articles

Translation, Validity, and Reliability of the Persian Version of “Keele Assessment of Participation” (P-KAP) Questionnaire among Community-Dwelling Older Adults

Introduction The Keele Assessment of Participation (KAP) is a clear, short, valid, and reliable questionnaire developed specifically to evaluate participation restrictions. KAP has been translated into various languages. This study aimed to translate and determine the psychometric properties of the “Keele Assessment of Participation” in healthy community-dwelling elderly people. Methods A forward/backward translation procedure was used for translating the KAP questionnaire into Persian. Older adults (N = 165) aged 60 and over participated. Content and face validity were evaluated. Convergent validity was assessed by evaluating the correlation between KAP and the short-form 36 (SF-36), and community integration measure (CIM). Internal consistency and test-retest reliability (N = 110) were determined by assessing the Kappa and Cronbach’s alpha. Results The content and face validity of the Persian version of KAP (P-KAP) were appropriately reported as good. The P-KAP demonstrated acceptable internal consistency (α = 0.77) and test-retest reliability (Kappa = 0.82). The correlation between the P-KAP, the CIM, and the SF-36 total score was moderate and respectively −0.416 and −0.468 (p < 0.0001). Discussion The results of the current study found P-KAP to be an acceptable, reliable, and valid instrument.

Fatigue predicts level of community integration in people with stroke

ABSTRACT Background The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke. Objectives To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke. Methods This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score. Results After controlling for age, the CIM score significantly correlated with the scores for FAS (r=-0.48, p < 0.001), 6MWT distance (r = 0.24, p = 0.039), and SAFE (r=-0.39, p = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, p < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores. Conclusions This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling.

Neurogenic Bowel Management in Traumatic Spinal Cord Injury – A Narrative Review

Abstract Neurogenic bowel management in persons with spinal cord injury (SCI) is an important issue due to the associated morbidities causing a significant impact on the persons’ quality of life (QOL) and burden the caregiver and healthcare services. Complications such as constipation, diarrhoea, incontinence, social embarrassment and autonomic dysreflexia can be managed effectively and resourcefully to counter the ill effects. In India, the incidence of SCI is 15,000, with a prevalence of 0.15 million; most are educationally and economically underprivileged with substandard living conditions. Complications associated with neurogenic bowel tend to impede the implementation of vocational rehabilitation and community integration measures. The goals of management are to prevent complications and improve the QOL of persons with SCI. With the revolutionary progress in medical science, many pharmacological, non-pharmacological and surgical options have been formulated to satisfactorily and effectively manage the neurogenic bowel. In this narrative review, we have tried to compile some of the most popular and time-tested options for managing neurogenic bowel in persons with SCI.

Association of resilience with successful ageing and the mediating role of community participation

AbstractBackgroundHigher level of resilience plays a positive role in successful ageing. Participation was reported as a factor related to resilience and successful ageing. As resilience is developed based on interaction between personal characteristics and environment over time, enhancing resilience level of individuals in later life span is difficult. Finding out modifiable factors which mediate the relationship between resilience and successful ageing can be alternative way to promote successful ageing. The aim of this study was to examine the mediating role of community participation.MethodConvenience sampling was applied to recruit community‐dwelling older adults aged 60 or older who could self‐rate the questionnaire independently. Online and on‐site surveys were conducted using the same questionnaire. Total scores of Korean version of the Connor‐Davidson Resilience Scale (CD‐RISC) and Community Integration Measure (CIM) were used respectively to measure resilience and community participation. Sum score of the satisfaction across four areas‐ subjective health; subjective memory; social relationships; socioeconomic status was used to measure successful ageing. Mediation analysis using SAS 9.4 was conducted to examine the mediating role of community participation in relationship between resilience and successful ageing.ResultData from 284 individuals was analyzed (Mean age: 67.99 ± 7.28; Female: 50.70%). Mean scores of CD‐RISC, CIM, and successful ageing were 60.70, 36.65, 13.05 respectively. A total effect of resilience on successful ageing was statistically significant (β = 0.038, 95% CI = 0.027 to 0.049) after controlling for gender, age, education, living status, employment status, disabilities, depression and chronic disease. Community participation mediated the relationship between resilience and successful ageing (β = 0.006, 95% CI = 0.002 to 0.010). Mediating role of community participation explained 16.44% of total effect of resilience on successful ageing.ConclusionAssisting older adults to increase community participation can be considered as a community‐based health care service to promote successful ageing. Further studies to examine causality among resilience, community participation, and successful ageing is necessary to strengthen the evidence of effect of active community participation on successful ageing.

Reliability and validity of the supine-to-stand test in people with stroke.

To investigate the psychometric properties of the supine-to-stand test in people with stroke. Cross-sectional design. Fifty-two people with stroke (mean (standard deviation) age 63.13 (6.09) years; time post-stroke 93.13 (61.36) months) and 49 healthy older adults (61.90 (7.29) months). Subjects with stroke were recruited from the community dwelling in Hong Kong and assessed with the supineto- stand test, Fugl-Meyer Motor Assessment, ankle muscle strength test, Berg Balance Scale, limit of stability test, Timed Up-and-Go Test, Six-Minute Walk Test, Chinese version of Activities-specific Balance Confidence scale, Community Integration Measure (CIM-C), and 12-item Short-Form Health Survey (SF-12) in a university-based rehabilitation laboratory. The supine-to-stand test completion time demonstrated excellent intra-rater, inter-rater and test-retest reliability (intraclass correlation coefficient 0.946-1.000) for the people with stroke. The completion time was significantly negatively correlated with Berg Balance Scale, Six-Minute Walk Test, limit of stability - maximal excursion, and limit of stability - endpoint excursion results (r = -0.391 to -0.507), whereas it was positively correlated with the Timed Up-and-Go test results (r = 0.461). The optimal cut-off supine-to-stand test completion time of 5.25 s is feasible for a clinical measure to distinguish the performance of people with stroke from healthy older adults (area under the curve = 0.852, sensitivity = 81.1%, specificity = 84.0%). The supine-to-stand test is a reliable, sensitive, specific and easy-to-administer clinical test for assessing the supine-to-stand ability of people with stroke.

The validity and reliability of the Turkish version of the Community Integration Measure in patients with chronic stroke

Objective To translate and cross-culturally adapt The Community Integration Measure into Turkish (CIM-T) and to assess its reliability and validity in patients with chronic stroke. Patients and Methods Fifty participants completed the CIM-T, Community Integration Questionnaire (CIQ) and the London Handicap Scale (LHS). All participants completed the CIM-T questionnaire twice in 7 days. The internal consistency of the CIM-T was assessed using Cronbach’s alpha, while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of CIM-T was determined with CIQ and LHS by using Pearson’s and Spearman’s correlation coefficient analysis. Results The CIM-T demonstrated high internal consistency (Cronbach’s α = 0.955) and test-retest reliability (ICC= 0.992). The CIM-T showed a good correlation with CIQ (R = 0.727, p < 0.001) and LHS (R = 0.694, p < 0.001). Conclusion The Turkish version of CIM is a valid and reliable instrument for assessing chronic stroke patients. It is a preferable scale for the clinical evaluation of Turkish-speaking patients with chronic stroke.

Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge

Purpose This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. Methods 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. Results Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. Conclusion Experience of stigma in the first few months post-discharge may negatively impact individuals’ community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.

Investigating the Impact of Perceived Discrimination on the Integration and Life Satisfaction of New Wave Turkish Immigrants Living in Germany

IntroductionApproximately 21.2 million people with im- migrant backgrounds live in Germany, which constituted 26% of its total population in 2020. Approximately 67% of immigrants are from European countries, including Turkey. Turks account for 13.2% of immigrants and constitute one of the largest immigrant groups (Statistisches Bundesamt, 2020). The integration processes and life satisfaction of new wave Turkish immigrants are differ from the first and second generation Turkish immigrants.ObjectivesThe aim of this study was to investigate the impact of perceived discrimination on their integration process and life satisfaction of new wave Turkish immigrants living in Germany.MethodsThe Community Integration Measure (CIM), Satisfaction with Life Scale (SWLS), The Perceived Discrimination Scale (PDS) were used. Pearson correlation and Regression tests were used in our analyses to observe the differences in scale scores according to the variables. The relationship between the scale scores was analysed with the Pearson correlation test. The effect between the scale scores was analysed with the regression test.ResultsThe findings demonstrated that there was a significant negative relationship between perceived discrimination and social integration (p=0,05) as well as life satisfaction (p=0,05). In addition, there was a significant and positive relationship between social integration and life satisfaction of new wave Turkish immigrant participants.Conclusions The integration process and life satisfaction of new wave Turkish immigrants decreased when they perceive discrimination in their daily lives. However, the level of life satisfaction increased when they integrate into German society without any perceived discrimination.Disclosure of InterestNone Declared

Factors associated with long-term functional and psychosocial outcomes in patients with non-Hodgkin lymphoma.

To assess the long-term functional, psychosocial and participation outcomes in an Australian cohort of non-Hodgkin lymphoma (NHL) survivors. A cross-sectional sample of adult NHL survivors at the Peter MacCallum Cancer Centre (between 2015 and 2020), participated by completing validated questionnaires. A series of analyses described their current level of function, psychosocial well-being, and participation. Of 129 participants (mean (M) ± standard deviation (SD) age: 62.5 ± 8.8 years), the majority (58%) had aggressive NHL and grade III-IV (72%), with time since diagnosis of 4.6 ± 1.2 years. Participants reported ongoing issues after completion of treatment: fatigue (63%), bladder dysfunction (61%), cognitive impairment (53%), and NHL-related pain (46%). Most made good functional recovery (M ± SD) (Functional Independent Measure-Motor: 79.5 ± 8.2), reported minimal change in their negative emotional states, and NHL-specific quality of life (QoL) (Functional Assessment of Cancer Therapy-Lymphoma: 133.5 ± 22.1). Participants were "well" adjusted to community living (Community Integration Measure: 42.2 ± 7.4) and satisfied with their current life (Satisfaction with Life Scale: 26.3 ± 6.0). Factors significantly associated with the poorer current level of function were: age at diagnosis < 60 years, time since NHL diagnosis > 4.5 years, and aggressive NHL type. Despite good functional recovery and adjustment in the community, NHL survivors report the presence of ongoing residual impairments and cognitive issues, which requires long-term rehabilitation-inclusive management.

Psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index in people with chronic stroke.

To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of the Upper Extremity Functional Index (C-UEFI) in people with chronic stroke. Cross-sectional study. University-affiliated neurorehabilitation research laboratory. The participants (N = 151) were people with chronic stroke (N = 101) and healthy controls (n = 50). We assessed the C-UEFI, Fugl-Meyer Assessment for Upper Extremity (FMA-UE), Wolf Motor Function Test (WMFT), Six-Minute Walk Test (6MWT), Motor Activity Log (MAL), Activity-Specific Balance Confidence (ABC) scale, Lawton Instrumental Activities of Daily Living (IADL) scale, Survey of Activities and Fear of Falling in the Elderly (SAFFE), Stroke Impact Scale (SIS) and Community Integration Measure (CIM) as outcome measures. The C-UEFI items demonstrated good test-retest reliability (intraclass correlation coefficient [ICC]3, 1 = 0.872) and excellent internal consistency (Cronbach's α = 0.922). People with chronic stroke had poorer C-UEFI scores than the healthy controls. The overall C-UEFI mean score of 101 people with stroke was significantly correlated with the mean scores of the FMA-UE, WMFT, MAL, ABC scale, IADL scale, SAFFE, SIS and CIM and the distance covered in the 6MWT. The C-UEFI cut-off score to distinguish between people with chronic stroke and healthy older adults according to upper extremity function was 57.5 out of 59 (sensitivity: 88.1%; specificity: 84%). The C-UEFI had good content validity, with an acceptable fit to the two-factor structure model. The C-UEFI is reliable and valid for assessing functional recovery of upper extremity activity in Chinese people with chronic stroke.

Loaded and unloaded timed stair tests as tools for assessing advanced functional mobility in people with stroke.

The Timed Stair Test (TST) was originally designed to measure advanced functional mobility in patients who have undergone a total hip replacement. Its psychometric properties have not been examined systematically in people with stroke. The aims of this study were to: 1) determine the intra-rater reliability of TST under loaded and unloaded condition; 2) identify the minimal detectable changes (MDCs) in TST completion times; 3) investigate the concurrent validity between TST completion times and stroke-specific outcome measures; and 4) determine the cut-off TST completion time to differentiate the performance between people with stroke and healthy older adults. Cross-sectional study. A university-based rehabilitation center. Ninety-four people with stroke and 34 healthy older adults. TSTs were conducted under loaded and unloaded conditions. Two trials of the TST for each of the two conditions were performed on the same day. The Fugl-Meyer Assessment of Lower Extremity (FMA-LE), lower-limb muscle strength test assessed by a hand held dynamometer, Berg Balance Scale (BBS), Limit of Stability (LOS) Test, Timed Up and Go (TUG) Test, and the Cantonese version of the Community Integration Measure (CIM) were also used to assess the subjects. Excellent intra-rater reliability was demonstrated for TST completion times under loaded (intraclass correlation coefficient [ICC<inf>2,1</inf>]=0.991) and unloaded (ICC<inf>2,1</inf>=0.985) conditions. The MDCs in TST completion times were 6.55 seconds and 7.25 seconds under loaded and unloaded conditions, respectively. FMA-LE scores, mean strength of the affected-side dorsiflexors and plantar flexors, BBS scores, and LOS movement velocity and maximum excursion scores demonstrated fair to excellent negative correlations with TST completion times under both loaded (r=-0.314 to -0.786) and unloaded (r=-0.296 to -0.794) conditions. TUG results demonstrated good to excellent positive correlations with TST completion times under both loaded (r=0.875, P<0.001) and unloaded (r=0.872, P<0.001) conditions. The TST completion times of 26.3 seconds and 23.4 seconds under loaded and unloaded conditions, respectively, differentiated between people with stroke and healthy older adults. The TST is a reliable clinical tool for evaluating advanced functional mobility in people with stroke. TST is a fast and simple test that does not require sophisticated equipment, making it suitable for busy hospital and rehabilitation settings.

Testing the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke in people with chronic stroke

Purpose To culturally adapt and examine the psychometric properties of the Chinese (Cantonese) version of SATIS-Stroke (C-SATIS-Stroke) in people with chronic stroke. Materials and methods Forward and backward translations were performed in accordance with available guidelines. We administered the C-SATIS-Stroke to 101 people with stroke and 50 healthy older adults. We assessed the test–retest and internal reliability, measurement error, known-group validity, correlations with other outcome measures, optimal cut-off score and ceiling and floor effects. Results C-SATIS-Stroke demonstrated excellent internal consistency (Cronbach’s α = 0.959) and good test–retest reliability (intraclass correlation coefficient3,1 = 0.913). Compared with healthy controls, people with chronic stroke had lower C-SATIS-Stroke scores. The mean C-SATIS-Stroke score was significantly correlated with the mean scores of the Activities-specific Balance Confidence Scale, Stroke Impact Scale, Community Integration Measure and Survey of Activities and Fear of Falling in the Elderly. The cut-off score to distinguish the levels of satisfaction with activity and participation between people with chronic stroke and healthy older adults was 80 out of 108 (sensitivity: 77%; specificity: 72%). C-SATIS-Stroke exhibited ceiling effects but not floor effects. Conclusions C-SATIS-Stroke is a reliable and valid measure for assessing satisfaction with social participation among Chinese people with chronic stroke. IMPLICATIONS FOR REHABILITATION Satisfactory semantic, idiomatic, cultural, and conceptual equivalence of the C-SATIS-Stroke are in line with those of the original English version of the SATIS-Stroke Excellent reliability and validity of the C-SATIS-Stroke are also in line with those of the original English version of the SATIS-Stroke The C-SATIS-Stroke can be used to assess the subjective satisfaction feeling in terms of social participation among Chinese people with chronic stroke

Psychometric Evaluation of the Narrow Corridor Walk Test (NCWT) on Advanced Walking Balance in People with Stroke.

To investigate (i) the interrater and test-retest reliabilities of completion time and number of steps in the Narrow Corridor Walking Test (NCWT); (ii) the minimal detectable changes (MDCs) in NCWT results; (iii) the correlations between NCWT results and stroke-specific outcome measures; and (iv) the optimal cut-off values of NCWT results for discriminating the difference in advanced balance ability between people with stroke and healthy older adults. Cross-sectional. Thirty people with stroke and 30 healthy older adults. People with stroke completed the NCWT on two separate days with a 7- to 10-day interval. The Fugl-Meyer Assessment (FMA), ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and the Chinese version of the Community Integration Measure (CIM) were used to assess. The healthy older adults completed the NCWT once. The NCWT completion time and NCWT steps showed excellent interrater reliability and test-retest reliability and significant correlations with FMA, affected ankle dorsiflexor muscle strength, BBS score, and TUG completion time. A cut-off value of 7.40 s for NCWT completion time and 13.33 for the NCWT steps distinguished people with stroke from healthy older adults. The MDCs of the NCWT completion time and NCWT steps were 6.87 s and 5.50, respectively. The NCWT is a reliable clinical measurement tool for the assessment of advanced balance ability in people with stroke.

Effect of Portable Rent Subsidies and Mentorship on Socioeconomic Inclusion for Young People Exiting Homelessness

There have been no published randomized clinical trials with a primary outcome of socioeconomic inclusion for young people who have experienced homelessness. To explore whether young people exiting homelessness who received rent subsidies and adult mentorship experienced more socioeconomic inclusion relative to young people who received only rent subsidies. This was a convergent mixed-methods, unblinded, 2-group, parallel randomized clinical trial with 1:1 allocation embedded within a community-based framework in 3 cities in Ontario, Canada. Participants were enrolled between March 1 and September 30, 2019, and were followed up through March 31, 2022. Participants (n = 24) were randomly assigned adult mentors (n = 13) who had been recruited and screened by community partner agencies. All participants received portable rent subsidies (subsidy not tied to a specific location) for 2 years. Primary quantitative outcomes were self-reported measures of community integration (psychological and physical) and self-esteem-proxy indicators of socioeconomic inclusion. Community integration was measured with the Community Integration Scale, with a score range of 1 to 7 for the physical component and 4 to 20 for the psychological component; higher scores indicate higher integration. Self-esteem was measured with the Rosenberg Self-Esteem Scale, with a score range of 0 to 30; higher scores indicate greater self-esteem. Secondary quantitative outcomes included social connectedness, hopelessness, and academic and vocational participation. All analyses followed the intention-to-treat principle. A total of 24 youths (12 women [50.0%]; mean [SD] age, 21.8 [2.2] years [range, 18-26 years]; race and ethnicity: 10 White [41.7%], 8 Black [33.3%], 2 Asian [8.3%], 2 Indigenous [8.3%], and 2 different choice [8.3%]) transitioned out of homelessness and into market-rent housing. All youths in the group that received mentorship and in the group that did not receive mentorship had stable or nonsignificant improvements in all study outcomes at the primary end point of 18 months compared with baseline (mean [SD] Community Integration Scale psychological score: mentorship group, 11.3 [2.6] at baseline and 11.2 [3.9] at 18 months; no-mentorship group, 10.8 [4.1] at baseline and 13.2 [2.9] at 18 months; mean [SD] Rosenberg Self-Esteem Scale score: mentorship group, 16.0 [4.6] at baseline and 18.1 [5.2] at 18 months; no-mentorship group, 16.3 [6.1] at baseline and 19.6 [5.7] at 18 months). However, there were no significant differences between the 2 groups in the Community Integration Scale psychological score (adjusted mean difference, -2.0; 95% CI, -5.0 to 1.0; P = .18) and Rosenberg Self-Esteem Scale score (adjusted mean difference, -1.4; 95% CI, -5.0 to 2.3; P = .44) 18 months after randomization. Ancillary analysis suggested that youths with informal mentors (mentors outside the study) at baseline felt more psychologically integrated at 18 months relative to those with no informal mentors at baseline (adjusted mean difference, 3.6; 95% CI, 0.4-6.8; P = .03). In this randomized clinical trial, COVID-19 pandemic-related restrictions made it challenging for mentors and mentees to connect, which may have affected the findings. Steady socioeconomic outcomes-potentially attributable to portable rent subsidies-are noteworthy, given the socioeconomic inequities this population has faced during the COVID-19 pandemic. The possible benefit of informal mentorship warrants further investigation. This small pilot study was designed with the intention of generating data and hypotheses for a full-scale study; findings should be interpreted with caution. ClinicalTrials.gov Identifier: NCT03779204.

Measuring subjective aspects of participation in adults with disabilities: A systematic review of the coverage, content validity and internal structure of standardised instruments

Objective To systematically review evidence on the coverage, content validity and internal structure of self-report measures capturing subjective aspects of participation for adults with disabilities. Data sources EMBASE, MEDLINE and reference lists were searched until July 10th, 2022 for articles on measurement properties of instruments measuring participation as defined in the International Classification of Functioning, Disability and Health, from a subjective perspective. Method Each instrument was assessed for its coverage of subjective aspects of participation. The Consensus-based Standards for the Selection of Health Measurement Instruments were used to assess the quality of each study. Content validity and internal structure (structural validity, internal consistency and cross-cultural validity) were rated against published standards and qualified by the adapted Grading of Recommendations Assessment, Development and Evaluation. Results Thirty-eight studies regarding 10 instruments were analysed. Most instruments mix activity and participation items. Only the Measure of Experiential Aspects of Participation (with high-quality evidence of sufficient structural validity and generally sufficient internal consistency), the Participation Enfranchisement and the Community Integration Measure showed adequate coverage. For all instruments, evidence of content validity is of low- to very low quality. There is high-quality evidence that the Participation Scale is not unidimensional. Conclusion In general, the coverage and the evidence for content validity and internal structure of measures capturing experiential aspects of participation are limited. The Measure of Experiential Aspects of Participation has the best level of evidence in support of its use. The score of the Participation Scale cannot be considered an adequate reflection of participation.

Translation and initial validation of Chinese (Cantonese) version of Modified Fatigue Impact Scale (MFIS-C) in people with stroke

PurposeTo translate and culturally adapt the Modified Fatigue Impact Scale (MFIS) to Chinese version, and to psychometrically test it in stroke population.MethodsThis study consisted of 2 phases. In phase one, we translated and culturally adopted the original English version of MFIS into Chinese (Cantonese) (MFIS-C). In phase two, the MFIS was psychometrically tested using a cohort of community-dwelling people with stroke (n = 101) and healthy control (n = 50). Among the stroke participants, 52 of them were reassessed after a 1-week interval.ResultsThe MFIS-C demonstrated satisfactory content validity and good to excellent internal consistency. The overall MFIS-C and its subscales have good test-retest reliability. The MDC95 were 14.86, 7.49, and 9.70 for the overall MFIS-C physical, cognitive and psychosocial subscales, respectively. The overall MFIS-C and its 2 subscales have significant weak to moderate negative correlations with the Community Integration Measure and the 12-item Short Form Health Survey Version 2. Our findings revealed that the people with chronic stroke living in Hong Kong were reported to have high level of fatigue.ConclusionThe MFIS-C is a reliable and valid measure for assessing the level of fatigue in people with stroke.

Longitudinal effects of time since injury and age at injury on outcomes of people with spinal cord injury in Queensland, Australia

Study designLongitudinal cohort study.ObjectivesTo investigate the longitudinal effects of time since injury and age at injury on outcomes of quality of life, physical function, secondary conditions and participation, in people with traumatic spinal cord injury (SCI).SettingCommunity resident people with spinal cord injury in Queensland, Australia.MethodsA baseline sample of 270 people with SCI was recruited. Telephone surveys on measures of quality of life (WHOQOL-Bref), secondary conditions (Secondary Conditions Surveillance Instrument, subset), physical functioning (Functional Independence Measure motor subscale) and participation (Community Integration Measure) were conducted each year between 2004 and 2008, and again in 2018. Random-effect within-between models were used to determine the effect of time since injury and age at injury on each outcome variable. Inverse probability-of-censoring weights were used to correct for selection bias.ResultsThere was an effect of time since injury on secondary conditions, with a one-year change associated with 9% higher odds of having worse Secondary Conditions Surveillance Instrument scores (odds ratio = 1.09, 95% confidence interval = 1.02, 1.17; p = 0.006). We did not find any evidence of a time since injury effect on quality of life, physical function, or participation. Similarly, we did not find any evidence of an age at injury effect on any outcome variable.ConclusionsSecondary conditions may increase with longer time since injury among people with SCI, suggesting appropriate formal and informal supports are required to minimise the impact of these emerging health problems as individuals age.

Psychometric Properties of the Trail Walking Test for People With Stroke.

ObjectiveTo investigate (i) the inter-rater and test–retest reliability of the trail walking test (TWT) and the minimum detectable change in the TWT completion time; (ii) the correlations between the TWT completion time and stroke-specific impairments; and (iii) the cutoff TWT completion time to distinguish between people with stroke and healthy older adults according to dual-tasking ambulation ability.DesignCross-sectional study.SettingUniversity-based rehabilitation center.ParticipantsIn total, 104 people with stroke and 53 healthy older adults.Main Outcome MeasuresThe TWT, the Fugl–Meyer Assessment of Lower Extremity (FMA-LE), the ankle muscle strength test, the limit of stability (LOS) test, the Berg Balance Scale (BBS), the Timed Up and Go test (TUG), and the Community Integration Measure (CIM).ResultsThe mean TWT completion time in subjects with stroke was 124.906 s. The TWT demonstrated excellent inter-rater reliability [intraclass correlation (ICC) = 0.999] and good test–retest reliability (ICC = 0.876) in people with stroke. The TWT performance demonstrated significant negative correlations with the FMA-LE scores (r = −0.409), LOS movement velocity (affected and unaffected sides; r = −0.320 and −0.388, respectively), and LOS endpoint excursion (affected and unaffected sides; r = −0.357 and −0.394, respectively); a significant positive correlation with the LOS reaction time (affected side; r = 0.256); a moderate negative correlation with the BBS scores (r = −0.72); and an excellent positive correlation with the TUG completion time (r = 0.944). The receiver operating characteristic curve analysis revealed that an optimal cutoff of 69.61 s for the TWT completion time had an outstanding diagnostic power to distinguish between people with stroke and healthy older adults (area under the curve = 0.919) with high sensitivity (88.5%) and specificity (83.0%).ConclusionResults of our preliminary study demonstrated that the TWT is a reliable, valid, sensitive, and specific clinical test for evaluating dual-tasking ambulation ability in people with stroke aged 45 years or above and without cognitive impairments. It can differentiate the dual-tasking ambulation ability between people with stroke and healthy older adults.

Assessing the psychosocial dimensions of frailty among older adults in Singapore: a community-based cross-sectional study

ObjectiveTo examine how multiple dimensions of mental and social health, in addition to physical health, were associated with frailty among older adults.DesignA door-to-door sampling household community-based survey.SettingThirty-two public housing blocks...

Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors.

The Six-Spot Step Test (SSST) was originally developed to assess walking ability while challenging balance during walking in patients with multiple sclerosis. It provides more comprehensive information on ambulatory abilities than several existing measures such as the Timed Up and Go test (TUG test), the Functional Gait Assessment, and the Dynamic Gait Index. To assess the advanced balance control ability of stroke survivors, we modified the SSST to serve this purpose. The aim of this study was to expand the current understanding of the psychometric properties of the SSST using healthy older adults and stroke survivors. This study adopted an experimental design. University-affiliated neurorehabilitation laboratory. A total of 50 study participants, including 25 chronic stroke survivors and 25 healthy older adults, were recruited from the community. The SSST was administered to the stroke survivors twice (day 1 and 2) with a 1-week interval. The Fugl-Meyer assessment for the lower extremities (FMA-LE), the Berg Balance scale (BBS), the limit of stability (LOS) test, the Timed Up and Go test (TUG test), and the Chinese version of the Community Integration Measures (CIM-C) were assessed on day 1 by random order. The healthy control group was assessed with the Six-Spot Step Test only on day 1. The SSST showed excellent inter-rater, intra-rater, and test-retest reliability (intraclass correlation coefficient >0.95, P<0.001). Significant correlations were found between SSST performance and the FMA-LE results (r=0.517, P<0.05), BBS scores (r=-0.531, P<0.05), and TUG test scores (r=0.828, P<0.001). The MDC in the mean SSST time for the affected leg and the unaffected leg in stroke survivors was 6.05s. The cutoff time was 10.11s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the affected leg and 10.18s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the unaffected leg. The SSST was a reliable test and showed a significant correlation with FMA-LE scores, BBS scores, and TUG test times in stroke survivors. The SSST can be used to assess the advanced balance control of stroke survivors.