Measures Of Activity Limitations Research Articles

Smaller spared subcortical nuclei are associated with worse post-stroke sensorimotor outcomes in 28 cohorts worldwide.

Up to two-thirds of stroke survivors experience persistent sensorimotor impairments. Recovery relies on the integrity of spared brain areas to compensate for damaged tissue. Deep grey matter structures play a critical role in the control and regulation of sensorimotor circuits. The goal of this work is to identify associations between volumes of spared subcortical nuclei and sensorimotor behaviour at different timepoints after stroke. We pooled high-resolution T1-weighted MRI brain scans and behavioural data in 828 individuals with unilateral stroke from 28 cohorts worldwide. Cross-sectional analyses using linear mixed-effects models related post-stroke sensorimotor behaviour to non-lesioned subcortical volumes (Bonferroni-corrected, P < 0.004). We tested subacute (≤90 days) and chronic (≥180 days) stroke subgroups separately, with exploratory analyses in early stroke (≤21 days) and across all time. Sub-analyses in chronic stroke were also performed based on class of sensorimotor deficits (impairment, activity limitations) and side of lesioned hemisphere. Worse sensorimotor behaviour was associated with a smaller ipsilesional thalamic volume in both early (n = 179; d = 0.68) and subacute (n = 274, d = 0.46) stroke. In chronic stroke (n = 404), worse sensorimotor behaviour was associated with smaller ipsilesional putamen (d = 0.52) and nucleus accumbens (d = 0.39) volumes, and a larger ipsilesional lateral ventricle (d = −0.42). Worse chronic sensorimotor impairment specifically (measured by the Fugl-Meyer Assessment; n = 256) was associated with smaller ipsilesional putamen (d = 0.72) and larger lateral ventricle (d = −0.41) volumes, while several measures of activity limitations (n = 116) showed no significant relationships. In the full cohort across all time (n = 828), sensorimotor behaviour was associated with the volumes of the ipsilesional nucleus accumbens (d = 0.23), putamen (d = 0.33), thalamus (d = 0.33) and lateral ventricle (d = −0.23). We demonstrate significant relationships between post-stroke sensorimotor behaviour and reduced volumes of deep grey matter structures that were spared by stroke, which differ by time and class of sensorimotor measure. These findings provide additional insight into how different cortico-thalamo-striatal circuits support post-stroke sensorimotor outcomes.

The Effectiveness of Acceptance and Commitment-Based Therapy on the Immune Function and Activity Limitations in Patients With Irritable Bowel Syndrome

Introduction: Irritable bowel syndrome is the most common, costly, and disabling dysfunction of the gastrointestinal tract. Mental disorders can be one of the main factors in the onset, continuation, or exacerbation of gastrointestinal signs and symptoms in people with this syndrome. Commitment and acceptance therapy is a mixture of four approaches of awareness, acceptance, commitment, and behavior change, and its overall goal is to achieve psychological flexibility to move towards thought-based behavior. This treatment focuses less on reducing symptoms and more on improving the quality of life. Objective: This study aimed to determine the effectiveness of acceptance and commitment-based therapy on the immune function and activity limitations in patients with irritable bowel syndrome. Materials and Methods: This study was a quasi-experimental research with a pre-test, post-test design and a control group. Thirty patients with irritable bowel syndrome were randomly selected from those referred to a hospital clinic in Tabriz City, Iran. They were randomly divided into the intervention and control groups (15 in each group). The intervention group received acceptance and commitment group therapy for 8 sessions, while the control group did not receive any intervention. Both groups were assessed before and after the intervention, and in the follow-up phase using the activity limitations subscale of quality of life questionnaires (to measure activity limitations) and stool calprotectin test to assess safety performance. Data analysis was performed using descriptive statistics indices (mean and standard deviation) and analysis of variance with repeated measures, Bonferroni test, and analysis of covariance to test the study hypotheses. Results: The Mean±SD age of the intervention group was 34.53±18.38 years, and the Mean±SD age of the control group was 42.80±17.97 years. The significance levels of Levene’s and the Shapiro-Wilk test for all variables were greater than 0.05. Based on the results, the Mean±SD score of the activity limitations variable in the intervention group was 7.53±4.24 in the pre-test, 17.66±3.41 in the post test, and 17.26±3.65 in the follow-up. According to the results, activity limitations (P=0.027) and safety performance (P=0.034) were significantly different before and after the intervention. Conclusion: The present study’s findings show that acceptance and commitment-based therapy can play an influential role in improving patients’ immune function and promoting their activity limitations. Therefore, this treatment is recommended as a complementary therapy in patients with irritable bowel syndrome.

Physical Performance is Significantly More Important Than Health Condition When Considering Rehabilitation Outcome

<h3>Research Objectives</h3> To determine the most important features in a rehabilitation prediction model using machine learning. <h3>Design</h3> Physical performance data were collected at evaluation and discharge from physical (PT) and occupational therapy (OT) in skilled nursing (SNF). These data along with the patient's prior living situation, medical diagnosis (grouped in broad categories), prior living situation, and age were used in a retrospective k-means cluster analysis. A profile of each group was developed using additional demographic and clinical process data. A predictive model was generated using an XGboost model with hyperparameters tuning. <h3>Setting</h3> Infinity Rehab is a post-acute therapy provider in over 150 skilled nursing facilities (SNF) treating approximately 13000 patients/year. <h3>Participants</h3> Data from 25000 older adult patients admitted to skilled nursing facilities were used for model development. <h3>Interventions</h3> The model was trained on 80% of the cases and tested on the remainder. <h3>Main Outcome Measures</h3> Time to rise from a chair 5 times (5xSTS), gait speed over 4 meters, 6-minute Walk Test (6MWT), grip strength (Grip), the Continuity Assessment Record Evaluation (CARE) mobility and self-care item set, and the St. Louis Mental Status Examination (SLUMS). <h3>Results</h3> The cluster analysis yielded 5 patient groupings who were different in baseline and discharge characteristics, change values, rehabilitation value, and prior and discharge living situation. 20 features were identified as contributing to the group assignment. The 3 most important features were initial 5xSTS, 6MWT, and gait speed, followed by measures of activity limitation. Of the 20 features, only 7 were medical diagnosis categories with the highest of these (non-stroke, tumor, or degenerative brain disorders) in the 13th position. Of the 7 medical diagnosis categories, 4 were neurological in nature. <h3>Conclusions</h3> When considering outcomes from rehabilitation in SNF, measures reflecting impairment in functional strength, activity tolerance, and speed are more important than activity limitations and much more important than medical diagnosis. Medical diagnosis impacted cluster group assignment the most when it was a neurological condition. <h3>Author(s) Disclosures</h3> The authors have nothing to disclose.

Cross-cultural adaptation and validation of the Arabic version of the upper extremity functional index

Purpose The purpose of this study was to translate and cross-culturally adapt the UEFI into Modern Standard Arabic language and to examine its psychometric properties among patients with upper extremity musculoskeletal disorders. Materials and Methods Translation and cross-cultural adaptation were done following Beaton’s guidelines. Internal consistency, test-retest reliability, measurement error and floor and ceiling effects for the Arabic UEFI were tested among 109 patients with upper extremity musculoskeletal disorders. Construct validity of the Arabic UEFI was also examined. Results Translation and cross-cultural adaptation processes were generally smooth with no major issues. The Arabic UEFI was considered appropriate and comprehensible by the participants. Internal consistency for Arabic UEFI was adequate (Cronbach's alpha = 0.96). Test-retest reliability for Arabic UEFI was excellent with ICC2,1=0.92. Measurement error was acceptable with a standard error of measurement of 5.5 and minimal detectable change of 12.8 points. Arabic UEFI shows no floor or ceiling effects. The results supported the majority of the construct validity predefined hypotheses (78%) supporting the construct validity of Arabic UEFI as a measure of upper extremity function. Conclusion The Arabic UEFI is an appropriate, valid and reliable outcome measure for Arabic-speaking patients with upper extremity musculoskeletal disorders. Implication for Rehabilitation: The Arabic UEFI is an acceptable, clear and comprehensible outcome measure. The Arabic UEFI has excellent internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects. The Arabic UEFI is a valid measure of upper extremity activity limitation.

Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders

Purpose To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders. Materials and methods The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton’s guidelines. Patients with lower extremity musculoskeletal disorders (N = 116) were recruited to examine the test–retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses. Results Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test–retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS. Conclusions The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test–retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders. Implications for rehabilitation Rehabilitation specialist can confidently interpret patient’s score in the Arabic PSFS to represent the extent of activity limitation. Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time. The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders. The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Stroke Lesion Impact on Lower Limb Function.

The impact of stroke on motor functioning is analyzed at different levels. ‘Impairment’ denotes the loss of basic characteristics of voluntary movement. ‘Activity limitation’ denotes the loss of normal capacity for independent execution of daily activities. Recovery from impairment is accomplished by ‘restitution’ and recovery from activity limitation is accomplished by the combined effect of ‘restitution’ and ‘compensation.’ We aimed to unravel the long-term effects of variation in lesion topography on motor impairment of the hemiparetic lower limb (HLL), and gait capacity as a measure of related activity limitation. Gait was assessed by the 3 m walk test (3MWT) in 67 first-event chronic stroke patients, at their homes. Enduring impairment of the HLL was assessed by the Fugl–Meyer Lower Extremity (FMA-LE) test. The impact of variation in lesion topography on HLL impairment and on walking was analyzed separately for left and right hemispheric damage (LHD, RHD) by voxel-based lesion-symptom mapping (VLSM). In the LHD group, HLL impairment tended to be affected by damage to the posterior limb of the internal capsule (PLIC). Walking capacity tended to be affected by a larger array of structures: PLIC and corona radiata, external capsule and caudate nucleus. In the RHD group, both HLL impairment and walking capacity were sensitive to damage in a much larger number of brain voxels. HLL impairment was affected by damage to the corona radiata, superior longitudinal fasciculus and insula. Walking was affected by damage to the same areas, plus the internal and external capsules, putamen, thalamus and parts of the perisylvian cortex. In both groups, voxel clusters have been found where damage affected FMA-LE and also 3MWT, along with voxels where damage affected only one of the measures (mainly 3MWT). In stroke, enduring ‘activity limitation’ is affected by damage to a much larger array of brain structures and voxels within specific structures, compared to enduring ‘impairment.’ Differences between the effects of left and right hemisphere damage are likely to reflect variation in motor-network organization and post-stroke re-organization related to hemispheric dominance. Further studies with larger sample size are required for the validation of these results.

Reliability and validity of upper limb short questionnaire for Duchenne muscular dystrophy

Purpose In patients with Duchenne muscular dystrophy (DMD), weakness of the upper limb (UL) muscles has a significant impact on daily activities and body functions. This problem necessitates a screening tool that can be used quickly and easily in clinical situations, such as the Upper Limb Short Questionnaire (ULSQ). However, its validity and reliability as a clinical measure have not yet been evaluated. Materials and methods The ULSQ was initially administered in face-to-face interviews, and then by telephone four weeks later. Lower limb and UL body functions were assessed by the Vignos and modified Brooke scales, respectively. Results A total of 160 patients participated in the initial ULSQ interview; 132 patients completed the follow-up interview. Construct validity was confirmed by exploratory and subsequent confirmatory factor analyses. The UL function component sum score correlated with the modified Brooke scale score (Kendall’s Tau 0.64, p < 0.001). The total and component (UL function, pain, and stiffness) sum scores were higher in non-ambulators than in ambulators. The reliability was acceptable, as determined by internal consistency and test-retest agreement. Conclusion The ULSQ is a valid and reliable measurement tool for screening UL function, pain, and stiffness in patients with DMD in clinical settings. IMPLICATIONS FOR REHABILITATION The Upper Limb Short Questionnaire (ULSQ) for patients with Duchenne muscular dystrophy (DMD) can be easily used in clinical settings. The ULSQ comprises 14 items that assess upper limb function, pain, and stiffness in patients with DMD and is a valid and reliable assessment tool for screening purposes. The sum score of the upper limb function component (ULSQ 1–5; 1 point per item) could be used to measure activity limitations.

Capturing the costs of acute hand and wrist injuries: Lessons learnt from a prospective longitudinal burden of injury study

Introduction Given the high incidence of hand and wrist injuries, they are exceptionally costly to the economy. This prospective, longitudinal study aimed to establish methods for capturing the burden of acute hand and wrist injury from an individual and societal perspective. Methods A prospective longitudinal design with baseline measures of injury type and severity, and repeated measures of disability, cost, and activity limitations and participation restrictions at six weeks, three months, and six months was selected. Participants were recruited from two large urban Australian public health care services. We sought to establish methods for capturing the burden of acute hand and wrist injury from an individual and societal perspective and compare survey completion by the method of administration. Results A total of 206 patients consented to participate in this study, representing 54% of those invited to participate. The survey completion rates were 18% at six weeks, 2.4% at twelve weeks, and 0.004% at six months following injury. From the limited data collected at six weeks, it was noted that nearly half of the patients reported a decrease in usual financial income, 14% reported absenteeism, and 62% reported presenteeism. Participants who elected to have data collected via phone call had the highest survey completion rate ( n = 6/10; 30%) at six-week’s follow-up. Discussion The study findings highlight the difficulties of completing longitudinal survey research investigating individual and societal burden with this population. Future research should be carefully designed to encourage participation and retention by considering patient and public involvement in study design, the time burden placed on the participants within and across selected survey time points, providing participants with incentives to participate, and highlighting the relevance and real-world applications of the findings.

Is the St. George's Respiratory Questionnaire an Appropriate Measure of Symptom Severity and Activity Limitations for Clinical Trials in COPD? Analysis of Pooled Data from Five Randomized Clinical Trials.

PurposeThe objective of this study was to examine the psychometric properties of the St. George’s Respiratory Questionnaire (SGRQ) in patients with chronic obstructive pulmonary disease (COPD) using Rasch measurement theory (RMT) analyses.Materials and MethodsRMT analysis was conducted on the baseline SGRQ data from five multi-national, Phase III randomized trials investigating a fixed-dose combination of a long-acting β2-agonist and a long-acting muscarinic antagonist in COPD patients. Analysis was performed for the SGRQ “Symptoms” and “Activity” domains. An exploratory analysis was also conducted using the different specific symptoms as defined in the reconceptualization of the SGRQ “Symptoms” domain. Differential item functioning (DIF) analysis was performed for geographical regions on the “Activity” domain, in order to explore cross-cultural validity of the SGRQ.ResultsOverall, the SGRQ “Activity” domain showed good measurement property, but two items (“Sitting or lying still making feel breathless” and “Playing sports or game making feel breathless”) showed very high fit residuals. The SGRQ “Symptoms” domain demonstrated good targeting; however, two items showed disordered thresholds (“Coughed” and “Brought up phlegm”). In an exploratory RMT analysis, measures for “Cough and Sputum”, “Breathing difficulties” or “Wheezing attacks” showed unsatisfactory measurement properties with poor reliability (person separation index = 0.35, 0.66 and 0.16, respectively) and targeting issues. The examination of cross-cultural performances of the SGRQ “Activity” items showed a great variability in the responses to these items in different global regions.ConclusionOur results indicated that SGRQ may not be an appropriate instrument to measure symptom severity or activity limitations in patients with COPD. Hence, there is a need to develop other relevant PRO instruments that can be used in conjunction with SGRQ to provide a holistic assessment of the health status of COPD patients in clinical research.

Transcultural adaptation and validation of the Spanish-language version of ACTIVLIM in adults with inherited myopathies using the Rasch model

IntroductionACTIVLIM is an instrument for the measurement of activity limitations in patients with neuromuscular disorders. The aim of this study is to establish a transcultural adaptation and psychometric validation of the Spanish-language version of ACTIVLIM in a sample of Spanish patients with inherited myopathies. Patients and methodA Spanish-language version of ACTIVLIM was developed using the translation/back translation method. The questionnaire was administered to 135 patients with inherited myopathies. The psychometric properties of the questionnaire were assessed using the Rasch model. Floor and ceiling effects were estimated. Unidimensionality was evaluated with a principal component analysis of the residuals of the model, and using infit and outfit statistics. We estimated reliability with the person separation reliability index and invariance with differential item functioning. External construct validity was tested through correlation with the Brooke scale, the Vignos scale, the Functional Independence Measure scale, and floor-to-stand time. Test–retest reliability was evaluated with the intraclass correlation coefficient and differential item functioning. ResultsThe psychometric analysis of the Spanish-language version of ACTIVLIM demonstrated that floor effect was absent, although a modest ceiling effect was identified. The instrument displayed unidimensionality, good internal consistency, external construct validity, and good test–retest reliability. ConclusionThe Spanish-language version of ACTIVLIM is a valid and reliable measurement instrument for assessing activity limitations in patients with inherited myopathies.

Biases in health expectancies due to educational differences in survey participation of older Europeans: It\u2019s worth weighting for

Health expectancies are widely used by policymakers and scholars to analyse the number of years a person can expect to live in good health. Their calculation requires life tables in combination with prevalence rates of good or bad health from survey data. The structure of typical survey data, however, rarely resembles the education distribution in the general population. Specifically, low-educated individuals are frequently underrepresented in surveys, which is crucial given the strong positive correlation between educational attainment and good health. This is the first study to evaluate if and how health expectancies for 13 European countries are biased by educational differences in survey participation. To this end, calibrated weights that consider the education structure in the 2011 censuses are applied to measures of activity limitation in the Survey of Health, Ageing and Retirement in Europe. The results show that health expectancies at age 50 are substantially biased by an average of 0.3 years when the education distribution in the general population is ignored. For most countries, health expectancies are overestimated; yet remarkably, the measure underestimates health for many Central and Eastern European countries by up to 0.9 years. These findings highlight the need to adjust for distortion in health expectancies, especially when the measure serves as a base for health-related policy targets or policy changes.

Combining aquatic physiotherapy with usual care physiotherapy for people with neurological conditions: A systematic review.

The objective of this review was to determine whether the combination of aquatic physiotherapy with usual care and results in greater improvements in activity limitations and neurological-related impairments in individuals with neurological conditions than usual care physiotherapy alone. A systematic review of controlled trials was utilized to compare usual care physiotherapy with usual care physiotherapy combined with aquatic physiotherapy for adults with any neurological condition. Standardized mean differences and 95% confidence intervals were calculated from postintervention means and standard deviations. Ten trials with a total of 490 participants met the inclusion criteria. Of the included trials, combined aquatic and usual care physiotherapy was evaluated in people with stroke in eight trials and in people with Parkinson's disease in two trials. Trial and outcome heterogeneity prevented the completion of meta-analyses. Data from five trials (n = 259) in people with stroke suggest that aquatic physiotherapy improves measures of balance, walking, mobility, and activities of daily living. No significant differences were detected in measures of activity limitation for people with Parkinson's disease nor measures of impairment for people with stroke or Parkinson's disease. This review provides preliminary evidence that the combination of aquatic physiotherapy with usual care physiotherapy may improve activity limitations in people with stroke. This review found no evidence to support the combination of aquatic physiotherapy with usual care physiotherapy to improve activity limitations in Parkinson's disease or other neurological populations. These results should be interpreted with caution due to the mixed quality of the included trials.

Activity Limitations Before and After Specialized Brain Injury Rehabilitation: NIDILRR TBI Model Systems Study

Evaluate characteristics of Activity Measure for Post-Acute Care (AM-PAC) as an outcome measure of activity limitations in individuals with TBI and apply it to evaluate changes in activity limitations in individuals receiving specialized brain injury rehabilitation.

Measuring Activity Limitations Within the National Health and Aging Trends Study (NHATS).

To better understand the disablement process among older adults, improved measures of activity limitations are needed. Traditional population-level measures lack the ability to distinguish precise gradations of activity limitation and are unable to detect degrees of differences over a wide range of ability levels. Therefore, we used contemporary measurement methods to improve upon current methodologies for characterizing activity limitations within the National Health and Aging Trends Study (NHATS) . We used the NHATS Round 1 cohort to assess the feasibility of constructing an Activity Limitations scale using Rasch item response theory methods. Factor analysis was used to develop the scale from a set of existing items in the NHATS Mobility, Self-Care, and Household Activity domains. Psychometric properties of the scale were evaluated and the scale was used to examine change in activity limitations among the sample from 2011 to 2015. Results supported an 18-item scale (N = 7,609). Rasch infit and outfit statistics were within acceptable range for all items (Cronbach's alpha = 0.95; sample score reliability = 0.83). From 2011 to 2015, 5.88% older adults demonstrated increase in function, 15% showed decrease in function, and 78% of the sample showed no change (did not exceed ± MDC90). Findings demonstrate that a unidimensional, interval scale of activity limitations can be constructed using traditional survey measures nested within the NHATS. Results revealed concerns regarding ceiling effects within the current self-report items of activity limitations suggesting future work is needed to expand the range of ability currently represented in the NHATS Activity Limitation items.

Cross-Cultural Adaptation, Validity, and Reliability Study of the Turkish Version of Back Performance Scale.

Validation of a performance scale. The purpose of this study is to investigate adaptation, validity, and reliability of the Turkish version of the Back Performance Scale (BPS). Low back pain affects people of all ages and causes pain, disability, and psychosocial problems. BPS is a condition-specific performance measure of activity limitation in patients with low back pain. The purpose of this study is to investigate the cross-cultural adaptation, validity, and reliability of the Turkish version of the BPS. The study included 180 patients with low back pain. For the reliability assessment of the scale, test-retest, and internal consistency analyses were performed. The results of the test-retest analysis were analyzed by Intraclass Correlation Coefficient (ICC) method. For the internal consistency, Cronbach Alpha value was calculated and to construct validity, total points of the BPS were compared with the total points of Roland Morris Disability Questionnaire (RMDQ) and Oswestry Disability Index (ODI) using Pearson correlation coefficient analysis. BPS was found to have high internal consistency (Cronbach alpha value 0.827). Test-retest results were found highly correlated (range from 0.723 to 0.899). Factor analysis indicated that the scale had one factor. BPS is well correlated with RMDQ and ODI (Pearson correlation coefficient with RMDQ 0.576 and with ODI 0.603). The Turkish version of BPS is valid and reliable. 3.

A systematic review of the psychometric properties of the Action Research Arm Test in neurorehabilitation.

The Action Research Arm Test (ARAT) measures upper limb activity limitations in people with acquired brain injuries. Evidence relating to the use of this test in neurorehabilitation is scattered. This review identifies, rates and synthesises evidence on the original 1981 ARAT use within neurorehabilitation. Psychometric properties are reviewed, including specific examination of participants with upper limb spasticity. Systematic review of published articles describing psychometric properties and/or use of the original version of the ARAT in neurorehabilitation. COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) search strategy, reporting and methodological checklist with criterion-based appraisal of quality criteria for good measurement properties were applied. A best evidence synthesis for each psychometric property was completed. In 28 included studies, participants had suffered a stroke or traumatic brain injury, with 46% >6months post-injury. Six studies identified participants with upper limb spasticity. Methodological quality of psychometric properties ranged from poor to excellent. Best evidence synthesis determined moderate positive evidence for using the ARAT with people without limb spasticity: intra-rater reliability (ICC 0.71 (95% CI 0.53-0.89) to 0.99 (95% CI 0.98, 0.99)); responsiveness (ROC curve 0.72-0.88, SRM 0.89); and regarding construct validity, it is a valid measure of activity limitation. Limited evidence for psychometric properties of the ARAT were found when used with people with upper limb spasticity for construct validity and responsiveness (ES 0.55-0.78). Gaps in evidence were found for inter and test-retest reliability, measurement error, content validity, structural validity, floor and ceiling effects. The ARAT is an appropriate measure of activity limitation post-stroke and should be considered for use with people with TBI; evidence for people with upper limb spasticity is limited. Gaps and mixed limited to moderate evidence for psychometric properties in neurorehabilitation mean further research is required.

Responsiveness of the activity measure for post-acute care (AM-PAC) from discharge from inpatient stroke rehabilitation to six month follow-up

Functional stroke scales must detect significant change over time, but defining “significant” is difficult. The activity measure for post-acute care (AM-PAC) measures activity limitations in 3 domains: basic mobility (BM), daily activity (DA), and applied cognitive (AC). This study assesses the ability of the AM-PAC to detect change from inpatient rehabilitation facility (IRF) discharge (DC) to an outpatient setting 6 months (6 M) later. We analyzed data from a observational database for stroke patients treated at our academic IRF. We assessed AM-PAC domains at IRF DC and again by phone 6 M later. Change between DC and 6 M was calculated by: – standardized response mean (SRM, 0–0.4–0.6 = moderate effect); – proportion achieving the minimal clinically important difference (MCID, estimated as 0.5SD of baseline scores after Norman et al., 2003) with our data; – the published, mixed population minimal detectable change (MDC). Of 273 patients at DC, 139 (51%) had both AM-PAC scores and were included. Those included were not demographically different but were better on physical and cognitive measures at IRF admission. The mean age = 67.1 ± 14.8 y, NIHSS = 7.9 ± 7.5, discharge FIM = 84.1 ± 19.1, FIM Gain = 20.2 ± 10.6, and rehabilitation length of stay = 14.8 ± 7.6d. The mean DC/6 M scores for BM were 51.7 ± 11.2/56.0 + 12.1, DA = 44.4 ± 9.9/49.2 + 14.5 and AC = 40.0 ± 9.8/44.7 + 9.2. Change metrics for the 3 AM-PAC domains are given in Table 1 . Between 40%–50% of stroke patients were classified as “significantly” improved, depending on measure, suggesting the AM-PAC is able to capture “real life” change. The sample experienced change at the lower end of “moderate improvement” by SRM. Estimated MCID and the MDC were similar for DA and AC, not BM. Further research should explore factors, which predict functional success or failure.

ACTIVLIM: adaptación transcultural al castellano y validación en adultos con miopatías hereditarias utilizando el modelo Rasch

IntroductionACTIVLIM is an instrument for the measurement of activity limitations in patients with neuromuscular disorders. The aim of this study is to establish a transcultural adaptation and psychometric validation of the Spanish-language version of ACTIVLIM in a sample of Spanish patients with inherited myopathies. Patients and methodA Spanish-language version of ACTIVLIM was developed using the translation/back translation method. The questionnaire was administered to 135 patients with inherited myopathies. The psychometric properties of the questionnaire were assessed using the Rasch model. Floor and ceiling effects were estimated. Unidimensionality was evaluated with a principal component analysis of the residuals of the model, and using infit and outfit statistics. We estimated reliability with the person separation reliability index and invariance with differential item functioning. External construct validity was tested through correlation with the Brooke scale, the Vignos scale, the Functional Independence Measure scale, and floor-to-stand time. Test-retest reliability was evaluated with the intraclass correlation coefficient and differential item functioning. ResultsThe psychometric analysis of the Spanish-language version of ACTIVLIM demonstrated that floor effect was absent, although a modest ceiling effect was identified. The instrument displayed unidimensionality, good internal consistency, external construct validity, and good test-retest reliability. ConclusionThe Spanish-language version of ACTIVLIM is a valid and reliable measurement nstrument for assessing activity limitations in patients with inherited myopathies.

The CALI-9: A brief measure for assessing activity limitations in children and adolescents with chronic pain.

Pain-related functional limitations represent an important outcome domain to assess in children and adolescents with chronic pain. The aim of this study was to extend the empirical support of the 21-item Child Activity Limitations Interview (CALI-21), a well-validated measure of activity limitations, using a large, multisite sample and to develop a brief form of the measure with more interpretable scoring. A sample of 1616 youth and 1614 parents completed the CALI-21 at an initial appointment in 1 of 3 pain specialty clinics in the Midwest or Northwest United States, or as part of a research study after this initial visit. All youth also reported on usual pain intensity. The CALI-21 data from 1236 youth and parents were used in analyses. Results of the exploratory and confirmatory factor analyses supported a common 2-factor structure (Active and Routine factors) for both child- and parent-report versions. Using item reduction, the 9-item measure (CALI-9) was developed with both child and parent versions showing good internal consistency and high cross-informant reliability. Initial validity was shown by the ability of the CALI-9 to distinguish by level of pain intensity. Findings suggest that the CALI-9 is a promising brief tool for the evaluation of pain-related activity limitations in youth with chronic pain and for proxy report by parents. Advantages of the shortened scale include the revised 0 to 100-point scale, which increases interpretability, and further validation of the subscale scoring to assess specific limitations in Active and Routine physical functioning domains.

Healthy body, healthy mind: A mixed methods study of outcomes, barriers and supports for exercise by people who have chronic moderate-to-severe acquired brain injury

BackgroundFew people with chronic moderate-to-severe brain injury are following recommended physical activity guidelines. ObjectiveInvestigate effects of planned, systematic physical activity while cultivating social and emotional well-being of people with chronic moderate-to-severe brain injury. HypothesisModerate-to-intensive physical activity would be associated with improvements in impairment and activity limitation measures (endurance, mobility, gait speed) immediately post-intervention and six weeks later (study week 12). MethodsThe intervention was a single group pre-/post-intervention study with 14 people with chronic moderate-to-severe brain injury who live in brain injury group homes and exercised 60–90 min, 3 days per week for 6 weeks at a maximum heart rate of 50–80%. Pre-post measures (administered weeks 0, 6 and 12) were the 6 Minute Walk Test, High-level Mobility Assessment Tool and 10 Meter Walk Test. The qualitative component used a brief survey and semi-structured interview guide with participants, family members, and staff. ResultsFollowing program completion, post-intervention group changes were noted on all outcome measures and greater than minimal detectable change for people with brain injury. Three transitioned from low to high ambulatory status and maintained this change at 12 weeks. During interviews, participants agreed the program was stimulating. More than eighty percent liked working out in a group and felt better being active. ConclusionsProgram impact included physical, cognitive and social/emotional aspects. Social aspects (group format, trainers) were highly motivating and supported by residents, family, and staff. Investments in transportation and recruiting and training interns to assist participants are critical to program sustainability and expansion.