Self-care Subscale Research Articles

Risk of behavioral and adaptive functioning difficulties in youth with previous and current sleep disordered breathing.

To examine the rates of behavioral and adaptive functioning difficulties among youth who never had sleep disordered breathing (SDB), had remitted SDB, had incident SDB, or had persistent SDB; and to determine if there were increased odds of behavioral difficulties among youth with varying SDB histories relative to those who never had SDB. 263 youth had valid polysomnography and neurobehavioral data at two time points approximately 5 years apart from the prospective Tucson Children's Assessment of Sleep Apnea study. Primary outcomes were the behavior assessment scale for children-2(nd) Edition parent report form (BASC-PRF) and Self-Report of Personality (SRP), and the Adaptive Behavior Assessment System-2(nd) Edition (ABAS-2). Compared to those who never had SDB, individuals with persistent SDB had significant odds and met more cutoff scores on the BASC-2-PRF externalizing problems composite (odds ratio [OR] 3.29; 8.92% vs. 35.3%), behavioral symptoms index (OR 6.82; 7.4% vs. 35.3%) and Hyperactivity subscale (OR 6.82; 11.1% vs. 41.2%). Similarly, greater difficulties was seen for the group with persistent SDB (relative to never) on the ABAS-2 social domain (OR 3.39; 22% vs. 50%), and Communication (OR 4.26; 15% vs. 42.9%) and Self-Care subscales (OR = 2.97; 25.2% vs. 50%). Relative to youth who never had SDB, youth who developed SDB at Time 2 had compromised adaptive skills as evidenced by the BASC-2 PRF adaptive behavior composite (OR 3.34; 15.6% vs. 38.1%) and the ABAS-2 general adaptive composite (OR 2.83; 20.5% vs. 42.1%). Youth with current SDB exhibited hyperactivity, attention problems, aggressivity, lower social competency, poorer communication, and/or diminished adaptive skills.

Quality of Life in Patients with Minimal Change Nephrotic Syndrome

Aim. The goal of the study was to investigate quality of life (QOL) in adult patients with minimal change nephrotic syndrome (MCNS) and to test the relationship of QOL with the level of self-care. Materials and Methods. We distributed two questionnaires to 30 outpatients with MCNS. The MOS 36-item Short Form Health Survey (SF-36v2) was used to examine health-related QOL in comparison with normative data from the general Japanese population and a population with two chronic diseases. SF-36v2 consists of 36 questions classified into 8 subscales. We also used the Self-Care Behavior Scale for patients with chronic kidney disease (CKD), which consists of 31 questions with 4 subscales. Results. The SF-36v2 social functioning subscale was most impaired and bodily pain was least affected in patients with MCNS. The self-care subscales of information/communication and positive behavior had positive correlations with the QOL subscales of mental health (P<0.05) and vitality (P<0.05). The correlation between social functioning and information/communication was close to significant (P=0.051). Conclusion. In MCNS, social functioning was particularly impaired. Our results suggest that better self-care can have a positive impact on QOL in patients with MCNS.

Development of the Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP): reviewing measurement specific to the upper limb in tetraplegia

Primary outcome measures for the upper limb in trials concerning human spinal cord injury (SCI) need to distinguish between functional and neurological changes and require satisfying psychometric properties for clinical application. The Graded Redefined Assessment of Strength, Sensibility and Prehension (GRASSP) was developed by the International GRASSP Research and Design Team as a clinical outcome measure specific to the upper limbs for individuals with complete and incomplete tetraplegia (that is, paralysis or paresis). It can be administered across the continuum of recovery after acute cervical SCI. An international multicenter study (involving centers in North America and Europe) was conducted to apply the measure internationally and examine its applicability. The GRASSP is a multimodal test comprising 5 subtests for each upper limb: dorsal sensation, palmar sensation (tested with Semmes-Weinstein monofilaments), strength (tested with motor grading of 10 muscles), and prehension (distinguishes scores for qualitative and quantitative grasping). Thus, administration of the GRASSP results in 5 numerical scores that provide a comprehensive profile of upper-limb function. The established interrater and test-retest reliability for all subtests within the GRASSP range from 0.84 to 0.96 and from 0.86 to 0.98, respectively. The GRASSP is approximately 50% more sensitive (construct validity) than the International Standards of Neurological Classification of SCI (ISNCSCI) in defining sensory and motor integrity of the upper limb. The subtests show concurrence with the Spinal Cord Independence Measure (SCIM), SCIM self-care subscales, and Capabilities of Upper Extremity Questionnaire (CUE) (the strongest concurrence to impairment is with self-perception of function [CUE], 0.57-0.83, p < 0.0001). The GRASSP was found to demonstrate reliability, construct validity, and concurrent validity for use as a standardized upper-limb impairment measure for individuals with complete or incomplete tetraplegia. Responsiveness (follow-up from onset to 1 year postinjury) is currently being tested in international studies (in North America and Europe). The GRASSP can be administered early after injury, thus making it a tool that can be administered in acute care (in the ICU), rehabilitation, and outpatient clinics.

Relationship Between Motor Recovery and Independence After Sensorimotor-Complete Cervical Spinal Cord Injury

Background. For therapeutics directed to the injured spinal cord, a change in neurological impairment has been proposed as a relevant acute clinical study end point. However, changes in neurological function, even if statistically significant, may not be associated with a functional impact, such as a meaningful improvement in items within the self-care subscore of the Spinal Cord Independence Measure (SCIM). Objective. The authors examined the functional significance associated with spontaneously recovering upper-extremity motor function after sensorimotor-complete cervical spinal cord injury (SCI). Methods. Using the European Multi-center Study about Spinal Cord Injury (EMSCI) data set, a retrospective analysis was undertaken of individuals with cervical sensorimotor-complete SCI (initial motor level, C4-C7). Specifically, changes in upper-extremity motor score (UEMS), motor level, and SCIM (total and self-care subscore) were assessed between approximately 1 and 48 weeks after injury (n = 74). Results. The initial motor level did not significantly influence the total UEMS recovered or number of motor levels recovered. SCIM self-care subscore recovery was significantly greater for those individuals regaining 2 motor levels compared with those recovering only 1 or no motor levels. However, the recovery in the SCIM self-care subscore was not significantly different between individuals recovering only 1 motor level and those individuals who showed no motor-level improvement. Conclusions. A 2 motor-level improvement indicates a clinically meaningful change and might be considered a primary outcome in acute and subacute interventional trials enrolling individuals with cervical sensorimotor-complete SCI.

Toronto rehabilitation institute-hand function test: assessment of gross motor function in individuals with spinal cord injury.

The objective of this study was to evaluate the interrater reliability, construct validity, and sensitivity of Toronto Rehabilitation Institute-Hand Function Test (TRI-HFT), within an interventional randomized control trial. Twenty-one participants with subacute C4 to C7 spinal cord injury (SCI) were recruited. Based on randomization, participants were allocated to either the functional electrical stimulation therapy group or the conventional occupational therapy group. Baseline and follow-up assessments of participants were videotaped. For testing interrater reliability, videotaped images were transferred to DVDs that were later observed by 2 observers. Construct validity was determined by comparing total scores on TRI-HFT to self-care subscore components of the Spinal Cord Independence Measure (SCIM) and FIM. To establish sensitivity of TRI-HFT, we compared pre- and posttreatment scores on all 3 measures (ie, TRI-HFT, FIM, and SCIM). TRI-HFT was found to have high interrater reliability with an intercorrelation coefficient (ICC) of 0.98. Moderate to strong correlations were found between TRI-HFT total scores and self-care components of FIM and SCIM for both hands individually post therapy. Due to a floor effect of the FIM and SCIM, there was weak correlation between pretherapy scores of the said measures and TRI-HFT. TRI-HFT was found to be highly sensitive in determining difference in function pre and post therapy. This study demonstrated that the TRI-HFT is a reliable and sensitive measure to assess unilateral hand gross motor function in persons with tetraplegia, with moderate to strong construct validity.

Are Men More Intuitive When It Comes to Eating and Physical Activity?

The purpose of this study was to determine where men fall on the motivation continuum based on intuitive eating status and if motivation for physical activity and intuitive eating are correlated. Results indicate that being an intuitive eater was associated with a lower body mass index. In terms of demographic variables, as age increased, intuitive eating status decreased and body mass index increased. Men scored high on the antidieting and self-care subscales of the Intuitive Eating Scale. Men who were classified as intuitive eaters scored higher on the external and introjected regulation of the Behavioral Regulation in Exercise Questionnaire but no significant differences were reported by eating status and the identified and intrinsic motivation subscales. Intuitive eating holds promise as a weight management and weight loss tool for men. Intuitive eating may also influence initial motivation for physical activity for men.

The Graded Redefined Assessment of Strength Sensibility and Prehension: Reliability and Validity

With the advent of new interventions targeted at both acute and chronic spinal cord injury (SCI), it is critical that techniques and protocols are developed that reliably evaluate changes in upper limb impairment/function. The Graded Redefined Assessment of Strength Sensibility and Prehension (GRASSP) protocol, which includes five subtests, is a quantitative clinical upper limb impairment measure designed for use in acute and chronic cervical SCI. The objectives of this study were to: (1) establish the inter-rater and test-retest reliability, and (2) establish the construct and concurrent validity with the International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI), Spinal Cord Independence Measure II (SCIM), and the Capabilities of Upper Extremity Questionnaire (CUE). The study protocol included repeated administration of the GRASSP to a cross-section of individuals with tetraplegia who were neurologically stable (n=72). ISNCSCI, CUE, and SCIM assessments were also administered. Two assessors examined the individuals over a 7-day period. Reliability was tested with intra-class correlation coefficients; construct validity was established with agreement/discordance analysis between the GRASSP and ISNCSCI sensory and motor items; and concurrent validity was tested with Spearman correlation coefficients. Inter-rater and test-retest reliability for all subtests within the GRASSP were above the hypothesized value of 0.80 (0.84-0.96 and 0.86-0.98, respectively). The GRASSP is about 50% more sensitive (construct validity) than the ISNCSCI when defining sensory and motor integrity of the upper limb; the subtests showed concurrence with the SCIM, SCIM self-care subscale, and CUE. The strongest concurrence to impairment was with self-perception of function (CUE) (0.57-0.83, p<0.0001). The GRASSP was found to demonstrate reliability, construct validity, and concurrent validity for use as a standardized upper limb impairment measure for individuals with tetraplegia.

Functional Electrical Stimulation Therapy for Grasping in Traumatic Incomplete Spinal Cord Injury: Randomized Control Trial

The purpose of this single-site randomized control trial was to assess the short-term and long-term efficacy of functional electrical stimulation (FES) therapy over conventional occupational therapy in improving voluntary hand function in incomplete C4-C7 spinal cord injury individuals. All 22 participants recruited in this randomized control trial received treatment for both the left and right upper extremities. Every participant, irrespective of group allocation, received one dose (60 min per day, 5 days per week for the duration of 8 weeks) of conventional occupational therapy for hand function. Of the 22 participants, 12 individuals received an additional dose of conventional occupational therapy, while the remaining 10 participants received a dose of FES hand therapy. The primary outcome measure was Functional Independence Measure (FIM) self-care subscore. The secondary outcome measures were Spinal Cord Independence Measure (SCIM) self-care subscore and Toronto Rehabilitation Institute Hand Function Test (TRI-HFT). The participants who received FES therapy showed significantly greater improvements in hand function at discharge, and were able to maintain their gains at long-term follow-up as assessed using FIM self-care subscore, SCIM self-care subscore, and TRI-HFT. The FES therapy effectively increased independence and thereby improved quality of life of individuals with tetraplegia when compared with conventional occupational therapy.

Functional Electrical Stimulation Therapy of Voluntary Grasping Versus Only Conventional Rehabilitation for Patients With Subacute Incomplete Tetraplegia

Background. Functional electrical stimulation therapy (FET) has a potential to improve voluntary grasping among individuals with tetraplegia secondary to traumatic spinal cord injury (SCI). Objective. This single-site, randomized controlled trial examined the efficacy of 40 hours of FET with conventional occupational therapy (COT) compared with COT alone to improve grasping. Methods. Twenty-four subjects with subacute traumatic incomplete SCI (C4-C7, AIS B-D) consented to participate in 40 hours of therapy over 8 weeks, beyond the conventional rehabilitation program. Subjects were randomized to receive FET + COT (n = 9) or COT (n = 12). The key outcomes were changes in Functional Independence Measure (FIM) self-care subscores, Spinal Cord Independence Measure (SCIM) self-care subscores, and Toronto Rehabilitation Institute Hand Function Test (TRI-HFT) performed at baseline and follow-up. Results. At the end of the treatments, the change in mean FIM self-care subscore for the FET + COT group was 20.1 versus 10 (P = .015) for the COT group. Subjects randomized to FET + COT also had greater improvements in the SCIM and TRI-HFT. No longer term follow-up was feasible. Conclusion. FET significantly reduced disability and improved voluntary grasping beyond the effects of considerable conventional upper extremity therapy in individuals with tetraplegia.

Outcomes for Aging Adults Following Total Hip Arthroplasty in an Acute Rehabilitation Facility Versus a Subacute Rehabilitation Facility: A Pilot Study

The purpose of our study was to determine if aging adults who received rehabilitation following total hip arthroplasty (THA) due to osteoarthritis had better short-term outcomes in an Inpatient Rehabilitation Facility (IRF) compared with those currently receiving rehabilitation in subacute rehabilitation units. Thirty-six adults, aged 65 to 88 years, who received inpatient rehabilitation following THA secondary to osteoarthritis participated in this study. A prospective descriptive study of 4 aging adults receiving rehabilitation in 2 subacute rehabilitation facilities and a retrospective descriptive study of 32 aging adults who received rehabilitation in an IRF were conducted. Socioeconomic, medical, rehabilitative care, and demographic data were obtained by review of participants' medical charts. FIM scores of the aging adults in the IRF were obtained by chart review, while FIM scores of the aging adults in the subacute facilities were collected by one of the investigators. In this sample, the aging adults in the IRF appeared to have greater changes in total FIM score, motor subscale FIM score, and self-care subscale FIM score than the aging adults in the subacute facilities. In this sample, discharge setting appeared similar for the aging adults in the two rehabilitation settings. It is imperative that further research determine if rehabilitation provided in different settings that offer different intensities and durations of rehabilitation affects functional outcomes for aging adults following THA procedures.

Comparison of Caregiver and Occupational Therapist Ratings of Dementia Patients' Performance of Activities of Daily Living

Although proxy reports of activities of daily living (ADLs) are commonly used, especially when the care recipient has dementia, how well these caregiver reports correspond to professionals' ratings is not always clear. In this study, dementia caregivers completed an orally administered version of the Self-Care subscale of the Functional Independence Measure (FIM). ADL interactions were videotaped in the home, and independent raters assigned a FIM score to these interactions. An occupational therapist later viewed the videotaped ADLs and assigned FIM scores to those interactions. These three sets of scores were then compared. All possible correlations were significant (n = 21; p ≤ .005; r s = .620 to .933; Mdn = .862), and there were no significant differences among ratings obtained from the different sources. These results support earlier conclusions regarding the validity and clinical utility of caregiver proxy ratings of functional ability in elders with dementia.

Efficiency and sensitivity of multidimensional computerized adaptive testing of pediatric physical functioning

Purpose. Computerized adaptive tests (CATs) have efficiency advantages over fixed-length tests of physical functioning but may lose sensitivity when administering extremely low numbers of items. Multidimensional CATs may efficiently improve sensitivity by capitalizing on correlations between functional domains. Using a series of empirical simulations, we assessed the efficiency and sensitivity of multidimensional CATs compared to a longer fixed-length test.Method. Parent responses to the Pediatric Evaluation of Disability Inventory before and after intervention for 239 children at a pediatric rehabilitation hospital provided the data for this retrospective study. Reliability, effect size, and standardized response mean were compared between full-length self-care and mobility subscales and simulated multidimensional CATs with stopping rules at 40, 30, 20, and 10 items.Results. Reliability was lowest in the 10-item CAT condition for the self-care (r = 0.85) and mobility (r = 0.79) subscales; all other conditions had high reliabilities (r > 0.94). All multidimensional CAT conditions had equivalent levels of sensitivity compared to the full set condition for both domains.Conclusions. Multidimensional CATs efficiently retain the sensitivity of longer fixed-length measures even with 5 items per dimension (10-item CAT condition). Measuring physical functioning with multidimensional CATs could enhance sensitivity following intervention while minimizing response burden.

Profiles of Decline in Activities of Daily Living in Non-Alzheimer Dementia

Assessment of functional ability is an essential component in the clinical diagnosis of dementia. Most studies have primarily focused on disability due to Alzheimer disease (AD), and less is known about profiles of functional impairment in other dementia syndromes. Functional ability was assessed in individuals in the early stages of AD (N=100), the behavioral variant of frontotemporal dementia (FTD) (N=57), and primary progressive aphasia (PPA) (N=61), using the activities of daily living questionnaire (Johnson et al, 2004). The average duration of illness for the 3 groups ranged from 3.4 to 3.9 years. Overall level of functional impairment and the profile of abilities across subscales of Self-Care, Household Care, Employment and Recreation, Shopping and Money, Travel, and Communication were examined. Results showed that overall functional ability was moderately impaired in AD and FTD, and mildly impaired in PPA. For all groups, more complex ADLs were impaired early on, with relative preservation of self-care activities. The Communication score was the least impaired next to Self-Care for FTD and AD, and the most impaired for PPA patients. The activities of daily living questionnaire may capture aspects of preserved functioning that are not apparent from patients' scores on cognitive tests, especially for those with aphasia.

The Relationship between Aquatic Independence and Gross Motor Function in Children with Neuro-Motor Impairments

The purpose of this study was to investigate the relationship between motor performance in the aquatic setting as measured by the Aquatic Independence Measure (AIM) to motor performance on land as measured by the Gross Motor Function Measure (GMFM) and the Pediatric Evaluation of Disability Inventory (PEDI). Fourty- nine children with neuro-motor impairments ages 3 to 7 participated in the study. Pearson correlations were applied to determine the relationships between the AIM and the GMFM, PEDI, and Gross Motor Function Classification System (GMFCS). Significant correlations were found between the total AIM and GMFM scores (r = 69, p &lt; .01) and PEDI self-care sub-scale (r = .79, p &lt; .01) as well as the PEDI mobility sub-scale scores (r = .35, p &lt; .05). The water adjustment sub-scale as measured by the AIM showed the strongest relationship to motor performance on land as measured by the GMFM and PEDI in our sample of 49 children.

Object Perception Impairments Predict Instrumental Activities of Daily Living Dependence in Alzheimer's Disease

This study examined the contribution of object perception and spatial localization to functional dependence among Alzheimer's disease (AD) patients. Forty patients with probable AD completed measures assessing verbal recognition memory, working memory, object perception, spatial localization, semantic knowledge, and global cognition. Primary caregivers completed a measure of activities of daily living (ADLs) that included instrumental and basic self-care subscales (i.e., IADLs and BADLs, respectively). Stepwise multiple regressions revealed that global cognition accounted for significant portions of variance among the ADL total, IADL, and BADL scores. However, when global cognition was removed from the model, object perception was the only significant cognitive predictor of the ADL total and IADL subscale scores, accounting for 18.5% and 19.3% of the variance, respectively. When considering multiple cognitive components simultaneously, object perception and the integrity of the inferotemporal cortex is important in the completion of functional abilities in general and IADLs in particular among AD patients. This research was supported by F32-AG022773 (ALJ), K23-MH065857 (RPH), K24-NS002140 (GG), and P30-AG013846 (BU ADC). A portion of these data served in partial fulfillment of the PhD requirements from Drexel University for Angela L. Jefferson under the research mentorship of Dr. Guila Glosser. Portions of these data were presented in October 2003 at the 23rd annual meeting of the National Academy of Neuropsychology, Dallas, TX, and in February 2004 at the 32nd annual meeting of the International Neuropsychological Society in Baltimore, MD. The authors wish to thank the physicians who supported recruitment efforts at Brown Medical School (i.e., Dr. Norman Gordon) and the University of Pennsylvania Medical Center (i.e., Drs. Chris Clark, Jason Karlawish, and Branch Coslett). The authors also wish to thank Ms. Jennifer Gallo (Drexel) and Mr. Jay Lawrence (Brown) for their data collection efforts. Lastly, the authors wish to thank Dr. Adam Brickman for his insightful comments on earlier versions of this manuscript.

The long-term level of functioning in patients admitted for psychotic disorders with and without substance abuse

The main objective of this study was to compare life skills between psychotic patients with substance abuse problems and psychotic patients without substance abuse problems. This is a cross-sectional study of 48 patients (26 inpatients and 22 outpatients) in a clinic for early intervention in psychosis. Patients were grouped into two categories based on if they had a substance abuse problem or not. Twenty-one (43.8%) had a substance abuse problem and 27 (56.2%) had not. We used several scales to measure substance abuse and the Life Skills Profile to measure aspects of functioning. A parametric test (t-test) was used to compare continuous variables. A non-parametric chi-square test was used to compare frequencies. The self-care subscore and the non-turbulence subscore were higher in the group with psychosis alone. These results were not significant controlling for age. The social contact subscore, the communication subscore, the responsibility subscore and the Life Skills Profile total score did not differ significantly between the groups. The abusers did not differ from the non-abusers in functioning in any area measured.

Psychometric Properties of the Spanish Version of Two Mental Health Outcome Measures: World Health Organization Disability Assessment Schedule II and Lehman’s Quality of Life Interview

This study presents data on the cultural adaptation to Latino populations of two outcome measures that respond to the need for developing comprehensive instruments for outcome assessments in minority populations. We examined the psychometric properties of outcome measures designed to assess impairment in functioning, and quality of life. Impairment in functioning was measured with the Disability Assessment Schedule II (WHO-DASII) developed by the World Health Organization (1997) and quality of life was measured with A. F. Lehman's (A. F. Lehman, 1983; A. F. Lehman, 1988) shortened Quality of Life Interview (QOLI). Spanish speaking consumers (N = 198) from Fresno (CA), San Antonio (TX) and San Juan (PR) participated in this study. They were recruited from both mental health outpatient clinics and primary care rural clinics. The WHO-DASII showed good to excellent internal consistency in all sites (alpha = .72 to .97) except for one subscale (Self-Care alpha = .47). Test-retest reliability estimates were mostly moderate to substantial (.57 to .83), again with one exception, the Self-Care subscale (.46). For the QOLI internal consistency ranged from .34 to .98 and test-retest reliability ranged from .40 to .86 across all sites. An initial validation strategy using both known-groups and concurrent validity produced promising evidence of the construct validity of both measures. The Spanish versions of the WHO-DASII and the QOLI lend support to the translation and adaptation process to which these instruments were subjected.

Functional Performance and Grip Strength After Total Hip Replacement

Objective. The progress of adults after total hip replacement (THR) was measured baseline to discharge using the Functional Independence Measure (FIM). Measures of effectiveness and efficiency were investigated. Additionally, although grip strength is frequently evaluated, its relationship to impact on functional gains after THR is unknown and was explored in this study. Method. A retrospective chart review was conducted on 41 patients' progress in acute rehabilitation following THR. Baseline and discharge FIM subscales of self-care, mobility, and locomotion were compared using paired t-tests with post hoc correction for type I error. Effectiveness and efficiency indicators on FIM subscale improvement were calculated. Grip strength was compared to expected values by age and gender using one-sample t-tests. Then, grip strength and FIM subscale scores were correlated using Pearson correlation. Results. FIM subscale scores each improved 2.1 points on average. Statistically significant improvement was made in 10 subscales of self-care, mobility, and locomotion. Grip strength was significantly less than expected norms in six of 14 subgroups after surgery; four of eight were female subgroups. There were no significant correlations between grip strength and any FIM subscale. Conclusion. Improvement in functional performance, as measured by FIM, was made on all FIM subscales. Grip strength after THR was moderately decreased from the norm. Results suggest that loss of grip strength alone may not adversely affect functional performance.

Why is the functional independence measure used to identify some rehabilitation needs in stroke survivors when there are better tools?

CAROLEE WINSTEIN Department of Biokinesiology and Physical Therapy, University ofSouthern California, USAFollowing a stroke, once patients are stabi-lized, physiotherapists begin to focus ongetting them back to their normal activitiesand life roles as quickly as possible. But,since most strokes primarily affect one sideof the body, that job can become a compli-cated one. The question becomes whether toteach the individual to perform certainactivities using primarily the unaffected sideof the body — a compensatory approach —or to focus on ways to re-establish functionusing the affected side — a functionalrecovery approach (Barreca et al., 2003).With the shift toward evidence-basedpractice in twenty-first century physio-therapy, many therapists want to determinewhich approach is indicated for theirpatients. An examination of current practicepatterns, however, suggests that cliniciansare slow to incorporate the scientificevidence (De Weerdt and Feys, 2002). Thisis particularly true for determining whichapproach to take for upper extremity reha-bilitation after stroke (Van Vliet and Turton,2001). In most cases, the approach of choiceis determined by standard measures, such asthe functional independence measure(FIM), and is motivated primarily by thedesire to see quick changes in a person’sburden of care (that is, FIM change score).This situation has come about notbecause therapists are resistant to usingevidence to drive their practice, but becauseof the widespread adoption of the FIM asthe primary outcome measure for rehabilita-tion effectiveness. The FIM is designed tomeasure the burden of care, more so than‘function’. This is particularly true for theupper extremity. For example, we can obtaina perfect score (independent function) onthe upper extremity self-care subscale of theFIM by using only one arm and hand tocomplete tasks (Nakayama et al., 1994).The perfect score on self-care is interpretedas a positive outcome because the burden ofcare is reduced, but the paretic side has notchanged at all in this scenario (Oczkowskiand Barreca, 1993).In other words, if the therapist’s lonegoal is to see a patient improve his or herability to complete a limited set of tasksindependently, the therapist could train thatpatient to compensate for lost motor skillsby learning to do those tasks with the unaf-

Development of the Hong Kong Version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK)

To develop the Hong Kong version of the Functional Test for the Hemiplegic Upper Extremity (FTHUE-HK) for patients with stroke in a Hong Kong Chinese community. Content validity of the prototype was established by a panel of occupational therapists who are experts in the field of neurological rehabilitation. New items relevant to the local culture were constructed. All items were reviewed with regard to internal consistency, and false positive and negative rates after implementation in a preliminary sample of 40 stroke patients. Fifty-seven stroke patients were recruited from eight local hospitals to form a convenience sample in which the inter-rater and test-retest reliabilities, and concurrent validity of the final version of the FTHUE-HK could be established. There was high sensitivity and specificity for test items within each functional level (i.e. recovery stage). Satisfactory inter-rater agreement on both testing procedure and functional levels was documented. Significant correlations between the functional levels and the upper extremity and hand subscores of the Fugl-Meyer Assessment (FMA) ( r = 0.88 and r = 0.88, respectively), and the self-care subscore of the Functional Independence Measure (FIM) ( r = 0.46) were found. Regression analysis indicated that 86% of the variance of the functional levels could be explained by hand and upper extremity subscores of the FMA. However, there was no significant relationship with age, gender, side of hemiparesis, and duration post-stroke. The findings substantiate the psychometric properties of the instrument, and the application of this unique hemiplegic upper extremity functional test is highly indicated in the context of the local culture.