Functional Disability Scale Research Articles

A novel Gly137Asp MPZ mutation in a Charcot-Marie-Tooth disease type 1B family

Charcot-Marie-Tooth disease (CMT) is a clinically and genetically heterogeneous peripheral neuropathy. Myelin protein zero (MPZ) is a major myelin protein of the peripheral nerve and mutations in its gene cause a wide phenotypic spectrum including CMT1B, CMT2I, CMT2J and Dejerine-Sottas syndrome. The objective of this study was to find the causative mutation in a Korean large autosomal dominant demyelinating CMT family (FC240). Clinical disabilities were measured by a functional disability scale (FDS), a CMT neuropathy score (CMTNS), and a 9-hole peg test (9-HPT). Mutational analysis of the FC240 family revealed a novel c.410G>A (Gly137Asp) mutation in the MPZ gene. The mutation was completely co-segregated with affected members in the family, and was not found in controls. The clinical features and electrophysiological findings were compatible with CMT1B. Clinical symptoms revealed phenotypic diversities among family members and generations within the same family. In addition, the present patients with Gly137Asp mutation showed earlier age at onset and slow progression than the reported patient with Gly137Ser. Therefore, it seems that there were wide phenotypic variations within the same family harboring Gly137Asp mutation, and between Gly137Asp and Gly137Ser mutations.

Cross-cultural adaptation of the Neck Disability Index and Copenhagen Neck Functional Disability Scale for patients with neck pain due to degenerative and discopathic disorders. Psychometric properties of the Polish versions.

BackgroundEven though there are several region-specific functional outcome questionnaires measuring neck disorders that have been developed in English-speaking countries, no Polish version has ever been validated. The purpose of our study was to translate, culturally adapt and validate the Neck Disability Index (NDI) and Copenhagen Neck Functional Disability Scale (CDS) for Polish-speaking patients with neck pain.MethodsThe translation was carried out according to the International Quality of Life Association (IQOLA) Project. Sixty patients were treated due to degenerative and discopathic disorders in the cervical spine filled out the NDI-PL and the CDS-PL. The pain level was evaluated using the Visual Analog Scale. The mean age of the assessed group was 47.1 years (SD 8.9). We used Cronbach's alpha to assess internal consistency. We assessed the test-retest reliability using the Intraclass Correlation Coefficients (ICCs). The Spearman's rank correlation coefficient (rS) was used to determine dependency between quantitative characteristics. The Mann-Whitney test was applied to determine dependency between quantitative and qualitative characteristics.ResultsThe Cronbach's alpha values were excellent for the NDI-PL in the test and in the retest (0.84, 0.85, respectively), and for the CDS-PL (0.90 in the test and in the retest). Intraclass Correlation Coefficients were excellent for the CDS-PL and NDI-PL and equalled 0.93 (95% CI from 0.89 to 0.95) and 0.87 (95% CI from 0.80 to 0.92), respectively The concurrent validity was good in the test and in the retest (rs = 0.42 p < 0.001; rs = 0.40 p = 0.002, respectively) for NDI-PL and for CDS-PL (rs = 0.42 p < 0.001; rs = 0.40 p = 0.001, respectively). The adapted questionnaires showed a strong inter-correlation both in the test (0.87 p < 0.001) and in the retest (0.79 p < 0.001).ConclusionsThe present versions of the NDI-PL and CDS-PL, the first to be published in Polish, have proven to be reliable and valid for patients with degenerative changes in the cervical spine. The NDI-PL and CDS-PL have excellent internal consistency and test-retest reliability, and good concurrent validity. The adapted questionnaires showed a strong inter-correlation both in the test and in the retest. No ceiling or floor effects were detected in the NDI-PL and CDS-PL. The NDI-PL and CDS-PL are comparable with other versions and can be recommended and used in international comparative studies.

An Examination of Outcome Measures for Pain and Dysfunction in the Cervical Spine

Cross-sectional design. To examine and compare the factorial structure of 4 validated neck pain and dysfunction scales. Neck pain and dysfunction is commonly measured using 1 of 4 validated self-reporting questionnaires: the Neck Disability Index (NDI), the Northwick Park Neck Pain Questionnaire (NPQ), the Copenhagen Neck Functional Disability Scale (CNFDS), and the Neck Pain and Disability Scale (NPDS). Although used interchangeably in the literature, recent studies suggest that the 4 scales differ in the number and type of factors that they examine and the weighting of these factors. To date, there have been no direct comparisons made of these scales when applied simultaneously to the same patient population. Data were collected from 88 patients with mechanical neck pain who completed all 4 questionnaires. Exploratory principal components factor analyses were conducted to expose the underlying factors within each of the scales. Identified factors were examined, characterized, and compared. Factor analysis revealed a single factor for the NDI, 2 factors for the NPQ, and 3 factors for both the CNFDS and NPDS. Factors identified include neck pain, dysfunction related to general activities, neck-specific function, cognition, emotion, and the influence of participation restriction on psychosocial functioning. The 3 NPDS factors appear to assess the multidimensional nature of neck pain and dysfunction most comprehensively. When selecting and interpreting a neck pain and dysfunction scale, clinicians and researchers are encouraged to take into account the factors measured by the NDI, NPQ, CNFDS, and NPDS and their applicability to the specific neck patient population under examination. The decision of which factors are of greatest interest will influence the selection of an appropriate outcome instrument.

CT volume/density ratio as the marker of ischaemic brain injury

We believe that the CT volume/density ratio (VDR) of infarcted area reflects the degree of brain tissue damage during ischaemic stroke (IS). Forty six patients with IS were prospectively enrolled into the study. CT scan was performed on days 1 and 10 of hospitalization. S100BB serum level, gelatinase activities (MMP-2 and MMP-9) and neurological examination (NIHSS) were performed on days 1, 5 and 10 of IS. After 3 months, 42 patients were examined by functional disability scales: Barthel index (BI) and modified Rankin scale (mRS). The VDR of ischaemic focus correlated well with the average S100BB serum level, MMP-9 serum activity and NIHSS score. The weak but statistically significant relationships were noticed between the VDR vs BI and mRS estimated 3 months after stroke. VDR reflects well the damage ratio of brain tissue during IS. In addition, the study underlines the relationship between VDR vs patients' neurological status and disability after IS.

Characteristics of Chronic Pain and Its Impact on Quality of Life of Patients With HTLV-1-associated Myelopathy/Tropical Spastic Paraparesis (HAM/TSP)

we describe the prevalence of chronic pain and their characteristics in 43 consecutive patients presenting with human T-lymphotropic virus Type I (HTLV-1) associated myelopathy (HAM) /tropical spastic paraparesis in Salvador, Brazil. in this cross-sectional study, we included 43 consecutive patients with HAM/TSP from Sarah Salvador Unit of the Rehabilitation, in Bahia, Brazil. They were evaluated from September 2007 to July 2008. We used the following scales: Functional disability scales (EDSS, OSAME e HOFFER); visual analogue scale; Hospital Anxiety and Depression Scale; McGill Pain Questionnaire; DN4 Questionnaire and SF-36 Quality-of-Life Questionnaire. chronic pain was highly prevalent (38 patients---88.4%) in this population. We detected an inverse correlation between duration of the disease and the likelihood of patients to present with chronic pain (P<0.05). Individuals with greater neurologic deficits had much more neuropathic, whereas those with lower motor deficit had mainly the characteristics of nociceptive pain (P<0.05). A positive correlation was observed between the score of the dominant pain or the additional pain, and the number of pain descriptors (P<0.05 for both evaluations). The patients with chronic pain had worst Quality-of-Life scores (P<0.05). chronic pain was significantly associated with a higher likelihood of signs/symptoms of anxiety and depression, reflecting a negative impact of pain on patients´ quality of life.

Methodological issues arising from a pilot RCT investigating the effectiveness of joint protection

Aims: This article describes the difficulties encountered when attempting to evaluate the addition of joint protection education to an exercise programme in the treatment of patients with osteoarthritis (OA) of the hand. This involved a pilot study for a randomized controlled trial, which was carried out in order to inform the design of future studies. Methods: Subjects were recruited from rheumatology and orthopaedic out-patient clinics in a district general hospital for a 6 month period in 2006. They were assessed at baseline and 12 weeks after intervention. There were 2 intervention groups: one receiving exercise therapy and formal joint protection education from an occupational therapist over 2 sessions, supplemented with a joint protection information booklet, and the control group which received exercise therapy and informal joint protection advice. The primary outcome measures were pain and hand function measured using the hand pain visual analogue scale and the Cochin Hand Functional Disability Scale. Six patients were recruited with OA of the hand (mean age 59.2 years and mean disease duration 8.9 years) with three randomized to the intervention group, and three to the control group. Findings: There were methodological issues arising from the study, including sample recruitment issues, time scale, limited participant numbers and ethical constraints. No statistically valid data was gained to ascertain whether exercise therapy was more effective when given in conjunction with joint protection advice than without. Conclusions: Although some results were achieved that suggested there were improvements in the measures of perceived hand pain, health status, grip strength and pinch grip, these were not statistically meaningful. The improvements were greater in the control group, which received exercise therapy without joint protection advice. Hand function was reduced in both intervention groups. The reasons for this could not be answered in this study. A larger study would need to be undertaken in order to gain statistically valid data to evaluate the effectiveness of joint protection advice for people with OA hand.

Can Methylphenidate Objectively Provide Relief in Patients With Uncontrolled Blepharospasm? A Pilot Study Using Surface Electromyography

To determine whether there is an objective benefit to prescribing Ritalin for patients with uncontrolled blepharospasm exists. Seven subjects with benign essential blepharospasm, who were being treated with botulinum toxin injections and Ritalin LA, were recruited for this pilot study. Patients were asked to participate during the period of time when symptoms were beginning to return. Subjects underwent video and surface electromyography (sEMG) monitoring before and 2 hours after the administration of Ritalin. Mean sEMG potential for each eye was compared before and after the administration of Ritalin. Subjects also rated their disability based on a previously developed and reproducible blepharospasm functional disability scale. Functional Disability Scores were compared, and post-Ritalin treatment benefit was determined. The mean voltage of the sEMG was lower in 13 of 14 eyes after the administration of Ritalin. For the right eye, the voltage decreased by 50% (106.4 ± 13.6 mV to 52.7 ± 7.1 mV, p = 0.015), and for the left eye, by 31% (81.9 ± 9.7 mV to 56.6 ± 6.1 mV, p = 0.031). The Functional Disability Scores were also lower after the administration of Ritalin than before (p = 0.016). A significant decrease in mean voltage after the administration of Ritalin was found in this preselected group of patients. Subjective improvement with decreased disability and increased functional benefit was also found in all subjects. Based on the results of this study, a randomized, controlled study comparing Ritalin versus placebo is needed to determine whether Ritalin should be routinely prescribed for benign essential blepharospasm during the symptomatic window period.

Self-Reports and Performance-Based Tests of Hand Function in Persons with Osteoarthritis

ABSTRACTObjective: The purpose of this study was to examine the reliability and validity of three self-reports of hand function in persons with osteoarthritis. Method: Forty people with osteoarthritis completed self-report questionnaires of hand function at two points at a 1-week interval to assess test–retest reliability. To determine concurrent validity, participants were also administered performance-based tests of hand strength, dexterity, and joint motion. Results: Intraclass correlation coefficients for test–retest reliability ranged from .84 to .95 for the Hand Function Disability Scale, .51 to .93 for the Michigan Hand Outcomes Questionnaire, and .74 for the Dreiser's Functional Index. Spearman rho correlations showed good to moderate correlations between the self-reports and performance measures of hand strength and joint motion. Conclusion: Overall, self-reports appear to be reliable and valid measures of hand function and may help therapists determine the level of difficulty with daily tasks and monitor outcomes of therapy in persons with osteoarthritis.

Self-Reports of Hand Function in Persons with Diabetes

ABSTRACTThe purpose of this study was to examine the reliability and validity of three self-reports of hand function for persons with diabetes. Thirty-six people with type II diabetes completed self-report questionnaires of hand function including the Hand Function Disability Scale (HFDS), Michigan Hand Outcomes Questionnaire (MHQ), and Dreiser's Functional Hand Index (DFI) at two points in time to assess test–retest reliability. To determine validity, participants were also administered performance-based tests of hand strength, dexterity, and joint motion using the Keital Function Test, and Hand Mobility in Scleroderma Test. Test–retest reliability intraclass correlation coefficients for test–retest reliability ranged from 0.89 to 0.96 for the HFDS; 0.58 to 0.94 for the MHQ; and 0.90 for the DFI. Spearman Rho correlations showed fair correlations between the HFDS and applied hand strength. Fair correlations were also found between the scores on the MHQ and hand strength and joint motion, while scores on the DFI did not correlate with hand strength, dexterity, or joint motion. Overall, the HFDS and the MHQ appear to be reliable and valid measures of hand function in persons with diabetes and may help occupational therapists determine the level of difficulty with daily tasks and monitor outcomes of therapy in persons with diabetes.

Measuring the rate of progression in Friedreich ataxia: Implications for clinical trial design

Friedreich ataxia is an autosomal recessive neurodegenerative disorder characterized by ataxia of all four limbs, dysarthria, and arreflexia. A variety of measures are currently used to quantify disease progression, including the Friedreich Ataxia Rating Scale, examiner-rated functional disability scales, self-reported activities of daily living and performance measures such as the timed 25-foot walk, 9-hole pegboard test, PATA speech test, and low-contrast letter acuity vision charts. This study examines the rate of disease progression over one and two years in a cohort of 236 Friedreich ataxia patients using these scales and performance measure composites. The Friedreich Ataxia Rating Scale and performance-measure composites captured disease progression, with a greater sensitivity to change over 2 years than over 1 year. The measures differed in their sensitivity to change and in possible bias. These results help to establish norms for progression in FRDA that can be useful in measuring the long-term success of therapeutic agents and defining sample-size calculations for double-blind clinical trials.

Attention Deficits and Response to Drug Therapy in Patients With Treatment-Resistant Schizophrenia: Results Through Confirmatory Factorial Analysis

IntroductionThere are no experimental data that demonstrate whether patients with neuroleptic-resistant schizophrenia differ or not in their pattern of neuropsychological functioning from patients with adequate drug response. MethodFifty-two patients with drug-resistant psychosis (DRS) and 42 patients with schizophrenia not resistant to treatment (NDRS) were recruited following the criteria of Kane et al (1988). A sample of 45 healthy controls matched by age, sex and educational level was also recruited. The clinical evaluations used were the Positive and Negative Symptom (PANSS), functional disability (WHO-DAS) and Clinical Global Impression (CGI) scales. ResultsThrough the use of confirmatory factorial analysis, we obtained a latent cognitive structure of six cognitive factors: attention, processing speed, verbal memory, working memory, verbal fluency and executive functions. As expected, the control group performed better than the two patient groups (both DRS and NDRS) in all neuropsychological domains. Additionally, the DRS group scored significantly worse in attention than the NDRS group even though no differences between these two groups were found in age of disease onset, number of hospitalisations or length of hospitalisation. From a clinical point of view, the DRS group showed greater severity of positive symptoms (P<0.01) and higher global deterioration (P<0.01), which did not translate into greater functional disability. ConclusionsThe results obtained do not allow us to conclude that there is a specific neuropsychological profile in neuroleptic-resistant patients. The only differential parameter was performance in the attention domain. Our findings better fit the hypothesis of a “clinical continuum” and differ from the categoric classification of this mental disorder.

Validation of Duruöz Hand Index for Diabetic Hand Dysfunction

ObjectivesDuruöz Hand Index (DHI) is a functional disability scale that can be used successfully to assess the functional disability with different hand arthropathies. The hands are frequently involved in diabetic...

Charcot–Marie–Tooth disease type 2J with MPZ Thr124Met mutation: clinico-electrophysiological and MRI study of a family

The purpose of the present study was to describe clinico-electrophysiological features and lower limb muscle MRI findings in a CMT2J pedigree due to MPZ Thr124Met mutation. We examined the proband, aged 56 years, and her affected daughter and son, aged 30 and 29 years. Disease severity in terms of ability to walk and run was established using a nine-point functional disability scale (FDS). We administered the CMT neuropathy score (CMTNS) based on patient's symptoms, neurologic examination and neurophysiologic testing. All three patients had non-symptomatic Adie's pupil. The proband and her son presented with late-onset lower limb sensorimotor neuropathy and pes cavus; the proband's daughter had no signs of polyneuropathy. FDS score was 4 in the proband, 2 in her son, and 0 (normal) in her daughter. In both symptomatic patients, electrophysiological study showed a pattern of length-dependent axonal neuropathy mainly involving lower limb nerves; this was normal in the other patient. CMTNS was 18 in the proband, 12 in her son, and 0 (normal) in her daughter. MRI of foot and leg musculature was normal in the proband's daughter, whereas the other two patients showed massive fatty atrophy of intrinsic foot musculature, extensive and diffuse fatty atrophy of leg muscles in the proband, and mild distally accentuated fatty infiltration of calf muscles in her son. Muscle edema, detected only in the proband's son, was present in 7 out of 22 (33%) of visualized leg muscles, whereas contrast enhancement occurred in 6 of them. The reported mutation may manifest with either isolated Adie's pupil or pupil abnormalities with late-onset sensorimotor length-dependent axonal polyneuropathy, though the presence of pes cavus might indicate an earlier onset. MRI examination helps to delineate an accurate extent of muscle involvement in the disease.

Efficacy of connective tissue massage and Mc Mennell joint manipulation in the rehabilitative treatment of the hands in systemic sclerosis

Rehabilitation may contribute to the management of systemic sclerosis (SSc) dealing with disabilities due to hand involvement. The aim of this study is to evaluate the efficacy of a rehabilitation programme based on the combination of connective tissue massage and Mc Mennell joint manipulation specifically conceived for SSc patients' hands. Forty SSc patients were enrolled: 20 (interventional group) were treated for a 9-week period (twice a week, 1 h per session) with a combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme, and 20 (control group) were assigned only to home exercise programme. Patients of both groups were assessed at baseline (T0), after 9 week (T1) and at a 9 weeks follow-up (T2). They were evaluated for quality of life by SF-36 and Health Assessment Questionnaire (HAQ), hands involvement by Hand Mobility in Scleroderma (HAMIS) test, Cochin hand functional disability scale and the measurements of ROM. In the interventional group, fist closure, HAMIS test and Cochin hand functional disability scale improved at the end of the treatment (p < 0.0001) as well as HAQ, Physical Synthetic Index (PSI) and Mental Synthetic Index (MSI) of SF-36 scores (HAQ and PSI, p < 0.0001; MSI, p < 0.001). In the control group, the programme of home daily exercises improved only fist closure at the end of the treatment (p < 0.0001). The combination of connective tissue massage, Mc Mennell joint manipulation and home exercise programme is effective in the rehabilitative treatment of SSc hands. This combined treatment may lead to an improvement of hand function and quality of life.

Clinical Comparability of Dysport and Botox in Essential Blepharospasm

Purpose: To compare the clinical efficacy, duration of effect, and safety of Dysport and Botox for patients with essential blepharospasm using functional disability scale. Methods: Patients with a confirmed diagnosis of essential blepharospasm who had received Botox (Allergan, USA) from September 2006 to May 2007 were enrolled in this study. We switched from Botox to Dysport (Ipsen, UK) after the botulinum effect of previous injection had disappeared and compared the clinical efficacy of two drugs. We used a 2.5:1 Dysport:Botox conversion ratio. The clinical efficacy of the drugs treatment was evaluated using a functional disability scale. We compared the duration of the effect and the safety of the two drugs. Results: The study included 48 patients (43 women, 5 men). There was no significant difference in mean functional disability scores or in any item of the functional disability scale. There was no significant difference in duration of effect between Botox (100.237.34 days) and Dysport (99.139.7days). There was also no significant difference in frequency of adverse reaction between Botox (13%) and Dysport (10%). Conclusions: When a dose conversion of 2.5:1 Dysport:Botox was used for essential blepharospasm patients, the two drugs displayed almost identical clinical efficacy, duration of effect, and safety.

Terbutaline in myasthenia gravis: A pilot study

The objective of this study was to assess the short-term efficacy and safety of terbutaline, a β2-adrenergic agonist, in patients with myasthenia gravis (MG) in a randomized, double-blind, placebo-controlled, crossover study. The primary endpoint for efficacy was a reduction of at least 3 points in the quantitative MG score (QMGS). Secondary endpoints included changes in the functional disability scale (FDS), forced vital capacity (FVC), grip strength, anti-acetylcholine receptor (AChR) antibody levels and decremental response. During the terbutaline phase, five of eight (63%) patients had an improvement in the QMGS of 3.0 or greater, while 3/8 (38%) patients had improvement in the FDS of one grade. No improvement was seen during the placebo period. Statistical analysis using Wilcoxon signed-rank test confirmed that terbutaline treatment resulted in a significant improvement in QMGS. There was no change in FVC, grip strength or anti-AChR antibody levels, but there was an improvement in the decremental response during terbutaline phase. Terbutaline was well-tolerated in all study subjects. We conclude that terbutaline may be an effective adjunct therapy in a subset of patients with myasthenia, although confirmation with larger trials will be required.

Serum Calcium as Prognosticator in Ischemic Stroke

Calcium (Ca(2+)) plays a role in the cellular and molecular pathways of ischemic neuronal death. We evaluated the impact of both early and delayed Ca(2+) levels on clinical outcomes from acute ischemic stroke. The relations between blood calcium level obtained early (<4.5 hours), and delayed (72 to 96 hours) after ischemic stroke onset versus clinical outcomes were analyzed in 826 subjects enrolled in an international trial in the Virtual International Stroke Trials Archive. Subjects were categorized into Ca(2+) quartiles. Outcome measures analyzed included baseline and 72- to 96-hour stroke severity, as well as 3-month functional and global disability scales. The independent effect of calcium on outcome was evaluated by median and logistic regression analysis. Six hundred and fifty-nine (80%) of the trial subjects had complete baseline data including Ca(2+) levels. Bivariately, the highest delayed Ca(2+) quartile (versus lowest) was associated with lesser stroke severity and better 3-month functional and independence scale outcomes (all P<0.001), but no significant outcome differences were noted among early Ca(2+) levels. In multivariable analysis, delayed Ca(2+) in the highest quartile (versus lowest quartile) was associated with greater 3-month independence score on the Barthel Index scale (76.9 versus 55.4, P=0.006). No other significant outcome differences were noted between highest and lowest quartiles for both early and delayed Ca(2+) quartiles. Elevated 72- to 96-hour serum Ca(2+) levels independently predict greater independence 3 months after ischemic stroke, but very early serum Ca(2+) appear not to have any prognostic significance.

Randomized Trial of IV Dexamethasone for Acute Migraine in the Emergency Department: Friedman BW, Greenwald P, Bania TC, et al. Neurology 2007;69:2038–44

This randomized, double-blind, placebo-controlled multicenter trial conducted in four New York hospital emergency departments (EDs) examined the efficacy of i.v. dexamethasone as adjuvant therapy for patients presenting with acute migraine. Migraine headache was defined by the International Headache Society's International Classification of Headache Disorders, with patients requiring lumbar puncture, those with persistent focal neurologic deficits, fever, pregnancy, lactation, allergy or intolerance to study medications excluded. There were 205 patients randomized to receive either 10 mg i.v. dexamethasone or placebo, with all patients receiving 20 mg i.v. metoclopramide as primary treatment of their migraine, and 25 mg of diphenhydramine to prevent akathisia. The primary outcome was the percentage of subjects who achieved and maintained a persistent pain-free state. The secondary outcome was the percentage of subjects who reported normal performance of their usual activities for the post-ED period, as measured by the functional disability scale. These outcomes were analyzed by chi-squared tests performed using SPSS v.11.0.1 (SPSS Inc., Chicago, IL), with a number needed to treat ≤ 5 pre-defined to indicate clinical usefulness of therapy, and p < 0.04 considered significant. The persistent pain-free outcome was achieved in 25% of those randomized to dexamethasone and 19% of placebo (p = 0.34). No functional impairment after ED discharge occurred in 67% of those randomized to dexamethasone and 59% of placebo (p = 0.20). In the subgroup of subjects with migraine lasting longer than 72 h, 38% of those randomized to dexamethasone were persistently pain free vs. 13% of placebo (p = 0.06). Acute medication reactions occurred more commonly in the dexamethasone group (39 vs. 26%, respectively, p = 0.08). The authors conclude that routine administration of i.v. dexamethasone for the treatment of acute migraine in the ED cannot be recommended, although it might be useful for patients with migraine lasting longer than 72 h.

Reliability and validity of the Italian version of the hand functional disability scale in patients with systemic sclerosis

The English version of hand functional disability scale is a validated instrument for measuring hand involvement in patients with systemic sclerosis (SSc). Because validation of multiple-language versions of existing validated questionnaires plays a key role in standardizing the outcome measurement and increasing the statistical power of clinical studies, this study aims to validate a translated Italian version of hand functional disability scale which is not available at the moment. The Italian version of hand functional disability scale was tested on 50 patients with SSc. To determine test-retest reliability, 40 SSc patients were asked to complete the questionnaire a second time within 2 weeks of the initial testing session. The test-retest reliability and internal consistency were determined by intra-class correlation coefficient (ICC) and Cronbach's alpha. External consistency was measured by comparing with an already validated test, the Health Assessment Questionnaire (HAQ), and clinical measurements. To explore the relationships among these variables, multiple correspondence analysis (MCA) was adopted. The statistical analysis of each domain and the total score revealed a good test-retest reliability (ICCs > 0.75) and internal consistency (Cronbach's alpha > 0.7). Furthermore, a good external consistency was confirmed by evaluating the differences between the distributions of hand functional disability scale score for SSc patients with or without hand involvement (arthralgias, arthritis, flexion contractures, and digital ulcers) and comparing results with those obtained for HAQ. Finally, MCA demonstrates a strong correlation among functional disability scale areas and HAQ scores. The hand functional disability scale is a self-administered questionnaire and it has been specially developed to measure hand impairment in patients with hand disorders. Our data support its validity and reliability in Italian SSc patients.

Neck pain and disability due to neck pain: what is the relation?

Pain and disability are interrelated, but the relationship between pain and disability is not straightforward. The objective of this study was to investigate the relationship between neck pain (NP) intensity, NP duration, and disability based on the population-based 'Funen Neck and Chest Pain' study. Pain intensity was measured using 11-box numerical rating scales, pain duration was measured using the Standardized Nordic Questionnaire, and disability was measured by the Copenhagen Neck Functional Disability Scale. Spearman rank correlation coefficients and logistic regression analyses were used to measure correlations and strength of associations between pain intensity, pain duration, and disability given domain specific characteristics (socioeconomic, health and physical, comorbidity, and variables related to consequences of NP). Neck pain was very common, but mainly mild and did not result in major disability. The correlations between NP intensity and disability were moderate but strongly associated, whereas weaker correlations and almost no associations were found between NP duration and disability. Pain duration is a poor indicator of disability. Given these variations, pain intensity and disability should be considered as two distinct dimensions and measured separately. These results have implications for future clinical and epidemiological studies.