Measures Of Activity Limitations Research Articles

Psychometric Properties of the Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) in Patients With Musculoskeletal Disorders: A Replication Study With Additional Findings

The Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) is a recently developed self-report outcome instrument designed to measure the extent of activity limitation as defined by the World Health Organization. The purposes of the study were to replicate some aspects of the original study of the OPTIMAL Difficulty and Confidence scales and to conduct additional psychometric tests. A cross-sectional design was used in the study. Of a total of 1,150 patients who received treatment at 4 outpatient centers over the study period, 1,030 patients were recruited for this study and completed the OPTIMAL instrument and previously validated region-specific functional status measures. A variety of analytic methods were used to examine the extent of redundancy between the OPTIMAL Difficulty and Confidence scales, as well as the internal consistency reliability, standard error of measurement, known-groups validity, and convergent validity of OPTIMAL Difficulty Scale scores. The OPTIMAL Difficulty and Confidence scale scores were found in a factor analysis to be load-based on anatomical region rather than on difficulty and confidence concepts. Internal consistency reliability for the subscales of the Confidence Scale varied and was .80 or higher for the lower-extremity subscale but .50 or less for the trunk and upper-extremity subscales. Only cross-sectional relationships were examined, and another pure measure of activity limitation was not used for comparison. The findings generally did not support the psychometric properties of the OPTIMAL instrument. Although not conclusive, the data suggested that the OPTIMAL Difficulty and Confidence scales demonstrate substantial overlap. Reliability was generally low, with the exception of the lower-extremity subscale. Scores for the subscales of the Difficulty Scale differentiated among patients with lower-extremity versus trunk or upper-extremity diagnoses, but associations with previously validated region-specific measures were generally weak or absent. Clinicians treating outpatients with musculoskeletal disorders should consider alternative measures when attempting to quantify the extent of activity limitations.

Developing and testing a new outcome measure

Health outcome measures are used to assess treatment effectiveness. Historically, survival was the most important health outcome. Treatments were assessed based on whether the patient lived or died. Now in the 21st century, treatments for many injuries and illnesses are so effective that many, if not most, patients survive. If patients survive, the quality of their survival becomes an important health outcome. The severity of impairments in body structure (limb loss) and function (weakness) are one way to assess the quality of survival. However, from the perspective of the patient, discomfort and disability are probably more important health outcomes. Limitation in mobility activities is an important component of disability, particularly for individuals with lower-limb loss (LLL). The treatment effectiveness of the rehabilitative care provided to servicemembers with LLL should be assessed by examining its effect on mobility limitations. Unfortunately, it is much more difficult to accurately measure mobility limitations than it is to measure survival. Measurement requires developing a set of rules to assign numbers to represent a concept or health outcome. When outcome measures contain multiple items, rules must also be developed to combine item scores to generate total and subscale scores. Determining the set of rules that will best represent a particular health outcome is affected by both the reason for measuring the outcome and the types of individuals being measured. Outcome measures can be used to examine small changes resulting from a treatment or to place individuals into broad categories. The purpose for using the outcome measure will dictate the types of items selected and the measurement dimension attached to these items. Measures of mobility activity limitations can be either performance-based or self-report. The types of individuals being measured will often determine which approach is best. A performance-based outcome measure requires both a set of rules for performing the test and a set of rules for scoring the test. It is not enough to simply create an outcome measure. It is essential to determine whether the rules used to create the outcome measure work to consistently and accurately represent the concept being measured. RELIABILITY For an outcome measure to be useful, it must be reliable in that it produces consistent findings if no real change has occurred. Performance-based outcome measures use raters. Raters must be trained to follow a standard set of rules to administer and score the measure. If raters do not adhere to rules, measurement errors may occur that adversely affect the reliability of the measure. Two types of rater reliability can be examined. Intrarater reliability indicates how consistently a rater administers and scores an outcome measure. Interrater reliability indicates how well two raters agree in the way they administer and score an outcome measure. To evaluate a measure's ability to detect real change, we must also examine score consistency over short periods in which no real change should occur. This is called test-retest reliability. An outcome measure used to evaluate progress over time must also be responsive in its ability to detect real change. Test-retest reliability is a critical factor in determining how well an outcome measure will detect real change. Reliability can be examined experimentally by testing how well scores agree between raters and time periods. Agreement is expressed mathematically by calculating a reliability coefficient representing the ratio of true score variance divided by true score variance plus error variance. A reliability coefficient of 1.0 represents perfect reliability, indicating that all of the differences between scores represent real differences between individuals. A reliability coefficient of 0.43 indicates that 43 percent of the variance is due to true score and 57 percent of the variance is due to measurement error. …

Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis

DesignCross-sectional clinical measurements. IntroductionActivity limitation is often persistent after surgically treated carpometacarpal (CMC) joint osteoarthritis (OA). PurposeTo describe content and concurrent validity, test–retest reliability and internal consistency of the Swedish version of the Patient Specific Functional Scale (PSFS) in patients with surgically treated CMC joint OA. MethodsFifty-eight patients were assessed ten weeks after surgical treatment of CMC joint OA. PSFS, the shorter version of Disabilities of the Arm, Shoulder and Hand (Quick DASH), EuroQol-5Dimensions (EQ-5D), pain intensity, joint movement of CMC joint, grip and pinch strength were assessed. Classification of activities was done according to the International Classification of Functioning, Disability and Health (ICF). Spearman correlation, intra-class correlation coefficient (ICC) and Kappa were calculated to assess validity, test–retest reliability and internal consistency. The PSFS was administered twice, 2–3 days apart. ResultsAll of the activity limitations stated in the PSFS could be classified according to the activity component in the ICF. Significant correlations for the PSFS were obtained with pain at rest (rs = −0.36) and the Quick DASH (rs = −0.28). Test–retest reliability was good, ICC (0.79) and the three items of the PSFS correlated 0.69–0.83 with the total score of PSFS. ConclusionContent validity was excellent, concurrent validity was low-moderate, as in earlier studies. The PSFS could be a valuable supplement to existing measures in measuring activity limitations in individuals with surgically treated CMC joint OA. Level of evidenceNot applicable.

Assessing function in patients undergoing joint replacement: a study protocol for a cohort study

BackgroundJoint replacement is an effective intervention for people with advanced arthritis, although there is an important minority of patients who do not improve post-operatively. There is a need for robust evidence on outcomes after surgery, but there are a number of measures that assess function after joint replacement, many of which lack any clear theoretical basis. The World Health Organisation has introduced the International Classification of Functioning, Disability and Health (ICF), which divides function into three separate domains: Impairment, activity limitations and participation restrictions. The aim of this study is to compare the properties and responsiveness of a selection of commonly used outcome tools that assess function, examine how well they relate to the ICF concepts, and to explore the changes in the measures over time.Methods/designTwo hundred and sixty three patients listed for lower limb joint replacement at an elective orthopaedic centre have been recruited into this study. Participants attend the hospital for a research appointment prior to surgery and then at 3-months and 1-year after surgery. At each assessment time, function is assessed using a range of measures. Self-report function is assessed using the WOMAC, Aberdeen Impairment, Activity Limitation and Participation Restriction Measure, SF-12 and Measure Yourself Medical Outcome Profile 2. Clinician-administered measures of function include the American Knee Society Score for knee patients and the Harris Hip Score for hip patients. Performance tests include the timed 20-metre walk, timed get up and go, sit-to-stand-to-sit, step tests and single stance balance test. During the performance tests, participants wear an inertial sensor and data from motion analysis are collected. Statistical analysis will include exploring the relationship between measures describing the same ICF concepts, assessing responsiveness, and studying changes in measures over time.DiscussionThere are a range of tools that can be used to assess function before and after joint replacement, with little information about how these various measures compare in their properties and responsiveness. This study aims to provide this data on a selection of commonly used assessments of function, and explore how they relate to the ICF domains.

Evaluation of an activities of daily living scale for adolescents and adults with developmental disabilities

BackgroundActivity limitations are an important and useful dimension of disability, but there are few validated measures of activity limitations for adolescents and adults with developmental disabilities. Objective/hypothesisTo describe the development of the Waisman Activities of Daily Living (W-ADL) Scale for adolescents and adults with developmental disabilities, and systematically evaluate its measurement properties according to an established set of criteria. MethodsThe W-ADL was administered among four longitudinally studied groups of adolescents and adults with developmental disabilities: 406 with autism; 147 with fragile-X syndrome; 169 with Down syndrome; and 292 with intellectual disability of other or unknown origin. The W-ADL contains 17 activities and each is rated on a 3-point scale (0 = “does not do at all”, 1 = “does with help”, 2 = “independent”), and a standard set of criteria were used to evaluate its measurement properties. ResultsAcross the disability groups, Cronbach's alphas ranged from 0.88 to 0.94, and a single-factor structure was most parsimonious. The W-ADL was reliable over time, with weighted kappas between 0.92 and 0.93. Criterion and construct validity were supported through substantial associations with the Vineland Screener, need for respite services, caregiving burden, and competitive employment. No floor or ceiling effects were present. There were significant group differences in W-ADL scores by maternally reported level of intellectual disability (mild, moderate, severe, profound). ConclusionsThe W-ADL exceeded the recommended threshold for each quality criterion the authors evaluated. This freely available tool is an efficient measure of activities of daily living for surveys and epidemiological research concerning adolescents and adults with developmental disabilities.

Pre-treatment compensation use is a stronger correlate of measures of activity limitations than cognitive impairment

Objectives: This study examined the relationship between baseline compensation use, activity limitations and cognitive impairment in persons who sustained moderate-to-severe acquired brain injury.Design: Randomized controlled clinical trial.Methods: A total of 22 individuals with medically documented brain injury and their family members completed a baseline assessment including measures of cognitive functioning (Repeatable Battery of Neuropsychological Assessment; RBANS), activity limitations (Neurobehavioural Functioning Inventory; NFI) and compensatory strategies use (Compensation Techniques Questionnaire; CTQ). There were no gender differences on measures of cognitive impairment, activity limitations or compensation use.Results: As predicted, cognitive impairment was not significantly associated with frequency of baseline compensation strategy use. Weaker word-list learning on RBANS was associated with greater family-reported memory problems on the NFI. Lower frequency of compensatory strategy use was correlated with greater patient-reported activity limitations on NFI, while it was not related to family ratings of activity limitations. After adjusting for history of depression and anxiety, baseline compensation use uniquely accounted for 16% of variance in predicting greater patient ratings of mood difficulties.Conclusions: Results indicate that, after acquired brain injury, baseline compensation use is more strongly associated with measures of activity limitations than is cognitive impairment.

Validity of the de Morton Mobility Index (DEMMI) for measuring the mobility of patients with hip fracture during rehabilitation

Purpose: Many patients suffer long term loss of mobility after hip fracture but there is no gold standard method for measuring mobility in this group. We aimed to validate a new mobility outcome measure, the de Morton Mobility Index (DEMMI) in a hip fracture population during inpatient rehabilitation. Method: The DEMMI was compared with the existing measures of activity limitation: 6 minute walk test, 6 metre walk test and Barthel Index on 109 consecutive patients admitted to rehabilitation after surgery for hip fracture. Patients were assessed by a physiotherapist at admission and discharge. Scale width, validity, minimal clinically important difference (MCID), responsiveness, and unidimensionality were investigated. Results: Evidence of convergent, discriminant and known groups validity were obtained for the DEMMI. Responsiveness was similar across instruments and the MCIDs were consistent with previous reports. A floor effect was identified for the 6 metre walk test and 6 minute walk test at hospital admission. Rasch analysis identified that the DEMMI maintains its unidimensional properties in this population. Conclusions: The DEMMI has a broader scale width than existing measures of activity limitation and provides a unidimensional measure of mobility for hip fracture patients during inpatient rehabilitation.Implications for RehabilitationLoss of mobility is a common and significant problem following hip fracture.The de Morton Mobilitiy Index (DEMMI) is an effective instrument for measuring mobility in patients with hip fracture during rehabilitationThe DEMMI is unidimensional, has a broader scale width than existing measures and offers an interval scale for measurement of mobility in hip fracture during rehabilitation

Anxiety symptoms and disorder predict activity limitations in the elderly

In the elderly, little attention has been paid to anxiety both on a symptom dimension and as a disorder, as an independent risk factor for the incidence of activity limitations. In a community-dwelling cohort of 1581 persons aged 65+, the association between trait anxiety symptoms (Spielberger Trait, third highest tertile) and baseline DSM-IV anxiety disorder, and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included, by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL). Of the sample, 14.2% had an anxiety disorder at baseline. Adjusting for baseline socio-demographic and health variables, depression (past and current), antidepressant and anxiolytic drugs, baseline anxiety disorder was associated with an increased risk of incident IADL limitation (OR (95% CI): 1.84 (1.01-3.39), p=0.048) and trait anxiety with increased incidence of social restriction (OR (95% CI): 2.41 (1.42-4.09), p=0.001). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41-6.05), p=0.004; OR (95% CI): 3.21 (1.31-7.89), p=0.011, respectively). Activity limitations were self-reported and may have been over-reported in participants with anxiety. Both trait anxiety symptomatology and anxiety disorder were independently associated with increased incidence of activity limitations with a gradient of severity: trait anxiety associated with incident social restriction and anxiety disorder with more severe IADL limitations, suggesting that anxiety is a predictor of activity limitations in the elderly independently of depression comorbidity.

Insomnia in youth with chronic pain: a longitudinal study

Adolescents with chronic pain frequently report difficulties falling and staying asleep. It is unknown whether these difficulties are transient or whether they persist over time. This study aimed to 1) examine trajectories of insomnia symptoms over one year in adolescents with chronic pain compared to their healthy peers; 2) evaluate depression, sleep hygiene, pre-sleep arousal (worries and somatic sensations at bedtime), and pain intensity as risk factors for chronic insomnia; and 3) evaluate chronic insomnia as a predictor of longitudinal quality of life and activity limitations outcomes. Sixty-one adolescents from a pain clinic were compared to 60 youth from the community (mean age = 15.07; 73% female). Participants completed measures of depressive symptoms, sleep hygiene, sleep quality, pain intensity, activity limitations, and quality of life at enrollment, and 6-month and 12-month follow-ups. Longitudinal analyses indicated that youth with chronic pain were significantly more likely to report insomnia symptoms at each data wave compared to their healthy peers (p < 0.001). Insomnia symptoms were relatively stable for both groups with no significant changes across the 1-year period. Generalized estimating equation (GEE) modeling identified three risk factors for chronic insomnia: having chronic pain (β = 1.52, p <0.001), higher depressive symptoms (β = 0.05, p = 0.03), and poorer sleep hygiene (β = -0.98, p = 0.003). Longitudinal analyses controlling for group status (pain vs. healthy), pain intensity, and depressive symptoms demonstrated that chronic insomnia symptoms predicted lower quality of life (β = -0.81, p < 0.01) and greater activity limitations (β = 0.58, p < 0.05). These findings indicate that insomnia symptoms tend to persist over time, suggesting that youth with chronic pain may benefit from targeted sleep treatment. Research is needed to determine the optimal timing of pain and sleep interventions for youth with comorbid chronic pain and insomnia.

How well do observed functional limitations explain the variance in Roland Morris scores in patients with chronic non-specific low back pain undergoing physiotherapy?

Self-rated activity limitations in patients with non-specific chronic low back pain (cLBP) do not correlate well with performance in traditional tests of impairment (e.g. back strength, ROM, etc.). Tests using more "functional activities" have therefore been recommended as alternative "objective" outcome measures. We examined the relationship between a battery of such tests and self-reported activity limitations, before and in response to physiotherapy, and the influence of psychological factors on the relationship. 37 patients with cLBP took part (45 ± 12 years; 23 female, 14 male); 32 completed 9 weeks' physiotherapy. Before and after therapy, the patients completed the Roland Morris (RM) disability questionnaire and questionnaires to assess fear avoidance beliefs, catastrophising and psychological disturbance. They also performed eight simple functional tests (stair climb, prolonged flexion, stand to floor, lift test, sock test, roll-up test, pick-up test, fingertip-to-floor test). Baseline RM scores were significantly (p < 0.05) correlated with all but one of the functional test scores (ranging from r = -0.34 (half-flexion) to 0.56 (pick-up test), and with a functional test index score for all tests together (r = 0.60, p < 0.0001). The correlation between the change-scores (after treatment) for RM and for the functional test index was 0.55 (p = 0.001). Psychological factors explained 7-23 % variance in RM scores (baseline, post-therapy, and change scores), beyond that which was explained by the functional tests. Effect sizes for patients with a self-rated "good global outcome" were 1.23 for RM and 0.75 for the functional test index; for those with a "poor outcome", they were -0.08 and 0.23, respectively. Moderately high correlations (for both absolute and change scores) were observed between the subjective and observed measures of activity limitation. This indicates that to some extent they are assessing the same underlying construct, but it also suggests that each is delivering a certain amount of unique information. Psychological factors explained some of the discrepancy between the two types of measure. Both were responsive to therapy, and their change scores reflected well the patients' global outcome ratings. The two methods of assessing activity limitations should serve to complement one another in the assessment of treatment outcome.

Construct Validity and Test-Retest Reliability of the Walking Questionnaire in People With a Lower Limb Amputation

de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Walking Questionnaire in people with a lower limb amputation. ObjectiveTo investigate the construct validity and test-retest reliability of the Walking Questionnaire, a patient-reported measure of activity limitations in walking in people with a lower limb amputation. DesignCross-sectional study. SettingOutpatient department of a rehabilitation center. ParticipantsPeople with a lower limb amputation (N=172; mean age ± SD, 65±12y; 71% men; 82% vascular cause) participated in the study, 33 of whom also participated in the reliability study. InterventionsNot applicable. Main Outcome MeasuresConstruct validity was investigated by testing 11 hypotheses: limitations in walking according to the Walking Questionnaire will be greater in people with a lower limb amputation who (1) are older, (2) have a bilateral amputation, (3) have a higher level of amputation, (4) underwent their rehabilitation treatment in a nursing home, (5) walk less (in terms of time), and (6) walk shorter distances. Furthermore, limitations in walking will be positively related to activity limitations according to the (7) Locomotor Capabilities Index, (8) “distance walked” question on the Prosthetic Profile of the Amputee Questionnaire, (9) Questionnaire Rising and Sitting Down, (10) Climbing Stairs Questionnaire, and (11) Special Interest Group on Amputation Medicine/Dutch Working Group on Amputations and Prosthetics mobility scale. Construct validity was quantified by using the Mann-Whitney U test and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient. ResultsConstruct validity (10 of 11 hypotheses not rejected) and test-retest reliability were good (intraclass correlation coefficient =.73; 95% confidence interval, .43–.88). ConclusionsThe Walking Questionnaire has good construct validity and test-retest reliability in people with a lower limb amputation.

Summarizing activity limitations in children with chronic illnesses living in the community: a measurement study of scales using supplemented interRAI items

BackgroundTo test the validity and reliability of scales intended to measure activity limitations faced by children with chronic illnesses living in the community. The scales were based on information provided by caregivers to service program personnel almost exclusively trained as social workers. The items used to measure activity limitations were interRAI items supplemented so that they were more applicable to activity limitations in children with chronic illnesses. In addition, these analyses may shed light on the possibility of gathering functional information that can span the life course as well as spanning different care settings.MethodsAnalyses included testing the internal consistency, predictive, concurrent, discriminant and construct validity of two activity limitation scales. The scales were developed using assessment data gathered in the United States of America (USA) from over 2,700 assessments of children aged 4 to 20 receiving Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services, specifically Personal Care Services to assist children in overcoming activity limitations. The Medicaid program in the USA pays for health care services provided to children in low-income households. Data were collected in a single, large state in the southwestern USA in late 2008 and early 2009. A similar sample of children was assessed in 2010, and the analyses were replicated using this sample.ResultsThe two scales exhibited excellent internal consistency. Evidence on the concurrent, predictive, discriminant, and construct validity of the proposed scales was strong. Quite importantly, scale scores were not correlated with (confounded with) a child's developmental stage or age. The results for these scales and items were consistent across the two independent samples.ConclusionsUnpaid caregivers, usually parents, can provide assessors lacking either medical or nursing training with reliable and valid information on the activity limitations of children. One can summarize these data in scales that are both internally consistent and valid. Researchers and clinicians can use supplemented interRAI items to provide guidance for professionals and programs serving children, as well as older persons. This research emphasizes the importance of developing medical information systems that allow one to integrate information not only across care settings but also across an individual's life course.

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

This study describes the development of a Rasch-built scale measuring activity limitations in stroke patients, named ACTIVLIM-Stroke. This new Rasch-built measure was constructed based on stroke patients' perceptions of difficulty in performing daily activities. Patients were recruited from inpatient and outpatient rehabilitation departments in Belgium and Benin. A 73-item questionnaire was completed by 204 participants. A random subsample of 83 subjects was given the questionnaire a second time. Data were analyzed using RUMM2030 software. After successive Rasch analyses, the ACTIVLIM-Stroke questionnaire, a unidimensional and linear 20-item measure of activity limitations, was constructed. All 20 items fulfilled Rasch requirements (overall and individual item fit, category discrimination, invariance, local response independence, and nonredundancy in item difficulty). This simple patient-based scale encompasses a large range of activities related to self-care, transfer, mobility, manual ability, and balance. The ACTIVLIM-Stroke questionnaire exhibited high internal validity, excellent internal consistency, and good crosscultural validity. The test-retest reliability of item difficulty hierarchy (intraclass correlation coefficient=0.99) and patient location (intraclass correlation coefficient=0.92) were both excellent. Furthermore, it showed good external construct validity using correlations with the Functional Independence Measure motor and the Barthel Index and a higher discriminating capacity than either of these widely used indices. The ACTIVLIM-Stroke questionnaire has good psychometric qualities and provides accurate measures of activity limitations in patients with stroke. It is recommended for evaluating clinical and research interventions in patients with stroke, because it provides a higher discrimination and might be more sensitive to change.

P-620 - Anxiety: a risk factor for the incidence of activity limitations in the elderly

Background Whereas depression as a risk factor for the incidence of activity limitations in the elderly has been confirmed, little attention has been paid to anxiety, despite its high prevalence, with or without comorbid depression. Method In a community-dwelling cohort of 1581 participants aged 65 years and over, the association between trait anxiety symptoms (Spielberger State-Trait Anxiety Inventory, third highest tercile) and current DSM-IV anxiety disorder (GAD, PTSD, OCD, panic disorder, agoraphobia or social phobia) at baseline and 7-year incident activity limitations was determined using mixed logistic regression models. Repeated measures of activity limitations included by increased severity level: social restriction (neighbourhood and house confined), mobility (Rosow and Breslau scale) and limitations in instrumental activities of daily living (IADL). Results Of the sample, 42% were male and 14.2% had an anxiety disorder at baseline. Adjusting for socio-demographic and health variables, past and present depression and anxiolytic drugs, trait anxiety symptomatology was associated with increased incidence of social restriction (OR (95% CI): 2.46 (1.45–4.16), p = 0.0008) and current anxiety disorder with an increased risk of incident IADL limitation (OR (95% CI): 1.86 (1.01–3.41), p = 0.046). Associations remained significant in participants free of depressive symptoms at baseline (OR (95% CI): 2.92 (1.41–6.05), p = 0.004; OR (95% CI): 3.21 (1.31–7.89), p = 0.011, respectively). Conclusion Despite high comorbidity between depressive and anxiety symptoms, both trait symptomatology and anxiety disorder are independently associated with increased incident dependency with a gradient of severity: trait anxiety symptoms associated with incident social restriction and anxiety disorder with incidence of IADL limitations.

Construct Validity and Test-Retest Reliability of the Questionnaire Rising and Sitting Down in Lower-Limb Amputees

de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down in lower-limb amputees. Objective To investigate the construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down (QR&S), a patient-reported measure of activity limitations in rising and sitting down, in lower-limb amputees. Design Cross-sectional study. Setting Outpatient department of a rehabilitation center. Participants Lower-limb amputees (N=171; mean age ± SD, 65±12y; 71% men; 83% vascular cause) participated in the study, 33 of whom also participated in the reliability study. Interventions Not applicable. Main Outcome Measures Construct validity was investigated by testing 8 hypotheses: limitations in rising and sitting down according to the QR&S would be: (1) greater in lower-limb amputees who are older, (2) independent of level of amputation, (3) greater in lower-limb amputees with a bilateral amputation, and (4) greater in lower-limb amputees who had rehabilitation treatment in a nursing home. Furthermore, limitations in rising and sitting down will be positively related to activity limitations according to (5) the Locomotor Capabilities Index (LCI), (6) the questions about rising and sitting down in the LCI, (7) the Climbing Stairs Questionnaire, and (8) the Walking Questionnaire. Construct validity was quantified with an independent t test and Pearson correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified with the intraclass correlation coefficient (ICC), standard error of measurement, and smallest detectable difference (SDD). Results Construct validity (7 of 8 null hypotheses not rejected) and test-retest reliability were good (ICC=.84; 95% confidence interval, .65–.93; standard error of the measurement=6.7%; SDD=18.6%). Conclusions The QR&S has good construct validity and good test-retest reliability in lower-limb amputees.

Reliability and Validity of the Valued Activity Inventory for Adults with Cancer

The authors assessed the psychometric properties of the Valued Activity Inventory for Adults With Cancer (VAI-AC), a self-report instrument that measures activity limitations. Participants included 50 older adults undergoing chemotherapy who completed the VAI-AC and measures of physical and mental function, symptom intensity, and mood 3 days before and the day of chemotherapy. Test-retest reliability was assessed by determining the average number of items for which the importance of an activity was rated consistently and by calculating the intraclass correlation coefficient (ICC) for the first and second VAI-AC scores. Convergent validity was assessed by correlating the VAI-AC scores with the other measures. Participants consistently rated the importance of 90% of the items. The 72-hour test-retest reliability ICC was 0.67. Participants with fewer activity limitations indicated better physical function (r = 0.58, p < .001), better mental function (r = 0.55, p < .001), lower symptom intensity (r = -0.57, p < .001), and fewer depressive symptoms (r = -0.68, p < .001). The VAI-AC demonstrated evidence of test-retest reliability and convergent validity in this convenience sample of older adults undergoing chemotherapy for cancer.

Validation of New Measures of Disability and Functioning in the National Health and Aging Trends Study

Measurement gaps continue to hamper fuller understanding of late-life disability trends and dynamics. This article reports findings that validate the self-reported components of the disability protocol to be used in the new National Health and Aging Trends Study. The protocol was designed to redress existing measures by attending to environmental aspects of disability, capturing a broader range of capacity to perform tasks and including participation restriction items. We undertook an in-person validation study to determine the reliability, validity, and initial measurement properties of the National Health and Aging Trends Study self-reported disability protocol (n = 326). A random subset (n = 111) was readministered the protocol within 2-4 weeks. The interview and reinterview included new self-reported measures of physical capacity, activity limitations, and participation restrictions, as well as established performance and cognitive tests. We calculated percent agreement and kappa between interviews for all self-reported items and summary measures. We also assessed the construct validity of summary measures through correlations with demographic characteristics, frailty, memory, and performance-based mobility and confirmed whether activity limitations and participation restrictions were distinct domains. New items and derived summary measures demonstrate robustness over a short time period, with kappas for retained/recommended items in the .60-.80 range. The summary measures correlate as expected with age, sex, residential status, and established performance-based constructs. Two factors, representing activity limitations and participation restrictions, were confirmed. The National Health and Aging Trends Study protocol preserves the ability to examine more traditional measures of functioning while offering new insights into how activities are performed and preserving key conceptual distinctions.

Reliability and validity of milliken activities of daily living scale (MAS) in measuring activity limitations of a turkish population

Aim: The Milliken Activities of Daily Living Scale (MAS) is a self-report scale to address limitation of ability to perform daily tasks in upper extremity injuries. It can address the necessity of each task, which makes MAS useful while planning individual treatment. The objective of this study was to perform cross-cultural adaptation of the MAS TURKISH and to evaluate its reliability and validity for Turkish-speaking patients with upper extremity conditions. Method: A total of 99 patients were asked to complete the adapted MAS and DASH at baseline and one week after the initial assessment. Also grip strength was evaluated with an interval of one week. Results: The reliability of the adapted version was good, with high internal consistency (Cronbach's alpha = 0.964) and test–retest reliability (interclass correlation coefficient (ICC) = 0.772) for the total score. A statistically significant correlation between MAS and DASH scores and grip strength scores of the injured side was obtained. Conclusion: The results of the study have shown that the Turkish version of MAS has excellent test–retest reliability and validity. It is a suitable assessment for evaluating function and giving an overview of activity limitations in many performance areas in a Turkish population.

Exploring the relationships between International Classification of Functioning, Disability and Health (ICF) constructs of Impairment, Activity Limitation and Participation Restriction in people with osteoarthritis prior to joint replacement

BackgroundThe International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The ICF model allows for all paths between the constructs to be explored, with significant paths likely to vary for different conditions. The relationships between I, A and P have been explored in some conditions but not previously in people with osteoarthritis prior to joint replacement. The aim of this paper is to examine these relationships using separate measures of each construct and structural equation modelling.MethodsA geographical cohort of 413 patients with osteoarthritis about to undergo hip and knee joint replacement completed the Aberdeen measures of Impairment, Activity Limitation and Participation Restriction (Ab-IAP). Confirmatory factor analysis was used to test the three factor (I, A, P) measurement model. Structural equation modelling was used to explore the I, A and P pathways in the ICF model.ResultsThere was support from confirmatory factor analysis for the three factor I, A, P measurement model. The structural equation model had good fit [S-B Chi-square = 439.45, df = 149, CFI robust = 0.91, RMSEA robust = 0.07] and indicated significant pathways between I and A (standardised coefficient = 0.76 p < 0.0001) and between A and P (standardised coefficient = 0.75 p < 0.0001). However, the path between I and P was not significant (standardised coefficient = 0.01).ConclusionThe significant pathways suggest that treatments and interventions aimed at reducing impairment, such as joint replacement, may only affect P indirectly, through A, however, longitudinal data would be needed to establish this.

Botulinum Toxin for the Upper Limb After Stroke (BoTULS) Trial

Botulinum toxin is increasingly used to treat upper limb spasticity due to stroke, but its impact on arm function is unclear. We evaluated botulinum toxin for upper limb spasticity and function poststroke. Three hundred thirty-three patients with stroke with upper limb spasticity and reduced arm function participated in a multicenter randomized controlled trial. The intervention group received botulinum toxin type A injection(s) plus a 4-week therapy program. The control group received the therapy program alone. Repeat injection(s) and therapy were available at 3, 6, and 9 months. The primary outcome was upper limb function at 1 month (Action Research Arm Test). Secondary outcomes included measures of impairment, activity limitation, and pain at 1, 3, and 12 months. Outcome assessments were blinded and analysis was by intention to treat. There was no significant difference in achievement of improved arm function (Action Research Arm Test) at 1 month (intervention group: 42 of 167 [25.1%], control group 30 of 154 [19.5%]; P=0.232). Significant differences in favor of the intervention group were seen in muscle tone at 1 month; upper limb strength at 3 months; basic arm functional tasks (hand hygiene, facilitation of dressing) at 1, 3, and 12 months; and pain at 12 months. Botulinum toxin type A is unlikely to be useful for improving active upper limb function (eg, reaching and grasping) in the majority of patients with spasticity after stroke, but it may improve basic upper limb tasks (hand hygiene, facilitation of dressing) and pain.