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To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

This paper aims to analyze the levels and trajectories of physical rehabilitation needs across five resource-poor world regions, against global and key country-specific benchmarks. This comparative, secondary cross-region analysis uses data from the Global Burden of Diseases study 2017 [1990–2017], specifically varied metrics of the Years Lived with Disability (YLD) measure from the health conditions likely benefiting from physical rehabilitation. All the resource-poor world regions had significant increases (p < 0.01) in the absolute, relative, and percentage of physical rehabilitation needs [1990–2017]. Nonetheless, The Asia-Pacific region stood out with the greatest YLD Rates (i.e., per population size) in 2017, the greatest growth in YLD Rates since 1990 (38%), and an exponential growth in the rehabilitation-sensitive YLD Rates. The Asia-Pacific region also had the greatest portion of their YLDs coming from rehabilitation-sensitive conditions (72% in 2017), closely followed by the Latin America & Caribbean (67%). Nonetheless, in South Asia and Sub-Saharan Africa, we observed the greatest percent increases in the portion of physical rehabilitation needs among all YLDs, out of lower initial values. An overall growth but differential patterns were observed in the evolution of physical rehabilitation needs across the resource-poor world regions. Asia-Pacific and Latin America & Caribbean regions had over than two-thirds of their non-fatal health loss arising from conditions sensitive to physical rehabilitation, and important growths in rehabilitation need indicators have been observed also for South Asia and Sub-Saharan Africa. The scale-up and strengthening of rehabilitation services and resources should be informed by needs-based data. The needs-based data from this study can inform trans-national developments and the planning of rehabilitation resources, inclusively at the world-region level. [ABSTRACT FROM AUTHOR]

Purpose:The construct validity, test–retest reliability, and measurement error of the Arm Function in Multiple Sclerosis Questionnaire (AMSQ) were examined. Additionally, the influence of administration-method on reliability and measurement error was investigated. Method:112 Dutch adult MS-patients from an academic- and a residential care-facility participated. Questionnaires were administered on paper, online or as interview, and patients performed several performance tests. Construct validity was assessed by testing pre-defined hypotheses. Reliability was assessed using Intraclass Correlation Coefficients (ICCs), Standard Error of Measurements (SEMs) and Smallest Detectable Changes (SDCs). Results:For construct validity (N = 105) 9 of 13 hypotheses were confirmed (69%). As expected, the AMSQ showed moderate to strong relationships with the instruments measuring similar constructs. The test–retest reliability coefficient was 0.96 (95% Confidence Interval 0.94–0.97); SEM was 6.3 (6.3% of scale range); SDC was 17.5 (on a sale from 0 to 100). Different administration-methods showed good reliability (ICC 0.88–0.94) and small standard errors (SEM 5.6–7.2). Conclusion:The AMSQ shows satisfying results for validity and excellent reliability; allowing for proper use in research. Due to a large SDC value, caution is needed when using the AMSQ in individual patient care. Further research should determine whether the SDC is smaller than the minimal important change.Implications for RehabilitationThe Arm Function in Multiple Sclerosis Questionnaire (AMSQ) measures activity limitations due to hand and arm functioning in patients with Multiple Sclerosis (MS).Results of this study confirm adequate validity and reliability of the AMSQ in patient with MS.The equivalence of scores from online, paper or interview administration is supported.A change score of ≥18 points on the scale of the AMSQ (on a scale 0–100) needs to occur to be certain a change beyond measurement error has occurred in an individual patient. [ABSTRACT FROM AUTHOR]

Purpose: Media-based rehabilitation provides a powerful opportunity to examine vocational behaviors in the disability sector. However, this research is preliminary at best. This paper reports pilot data. Method: Eighteen adults with multiple sclerosis (MS) accessed an email-delivered, resource-based package, Work and MS. Pre- and post-access vocational self-efficacy and identity (Job-Procurement Self Efficacy Scale, My Vocational Situation Scale- primary outcomes), life orientation and depressed mood (Life Orientation Test – revised and Patient Health Questionnaire-9 – secondary outcomes) were assessed. Pre- and post-change scores were examined with Wilcoxon signed ranks tests and Hedges g effect sizes with associated 95% confidence intervals. Reliable change analyses were additionally calculated to determine the clinical significance of individual change scores. Results: Significant and positive effects were reported for vocational self-efficacy, identity, and optimism. Reliable change scores in one or more of these key outcomes were reported by 30% of the sample. Satisfaction with the content and delivery of the email-based intervention was also noted. Conclusions: Preliminary evidence suggests that Work and MS can help to promote vocational goals, interests and strengths among job seekers with a disability by providing a set of tools, information and linkages relating to vocational pursuits and career development. Replication with a randomized control design is indicated. Research indicates a high unemployment rate among working-age adults with MS. A combination of disease-specific, psychological, programmatic and societal variables contribute to employment instability in this group. This pilot study demonstrates that an e-mail-based resource package, Work and MS, provides an innovative and feasible option for promoting consumer engagement with vocational services and, potentially, improving vocational outcomes. Work and MS has potential applicability to other disability groups. [ABSTRACT FROM AUTHOR]

To explore footwear characteristics and foot problems in community dwelling people with stroke as most research to date focused on the general elderly population. Thirty people with mild to moderate stroke (nine men, mean age 68, mean time since onset 67 months) attended a single session to assess footwear and foot problems using established podiatry foot (wear) and ankle assessments. Most participants wore slippers indoors (n = 17, 57%) and walking shoes outdoors (n = 11, 37%). Over half wore unsupportive ill-fitting shoes indoors and 47% of outdoor shoes fitted badly. All participants had foot problems (mean 6.5 (3.1), 95% CI: 5.4–7.7), including impaired single limb heel raise (93%), reduced range of movement (77%), sensation (47%), and muscle strength (43%). Many had foot-pain, hallux valgus (both 50%), or swollen feet (40%). Foot problems were associated with reduced balance confidence, activity, and community participation (all p < 0.05). A greater proportion of fallers (13/16) than non-fallers (4/14) reported foot problems (p = 0.029). Many community-dwelling people with stroke wore poorly fitting shoes; all had foot problems. Foot problems were linked to reduced mobility. Finding more effective pathways to support people with stroke to select supportive, well-fitting indoor and outdoor footwear is indicated. People with stroke often wear unsupportive ill-fitting shoes and experience foot problems. Assessment of foot problems and footwear advice should be considered during stroke rehabilitation particularly when interventions target fall prevention or improvements in balance and mobility. Information on appropriate footwear and signposting that new shoe purchases should include measuring feet to ensure a good fit is recommended. [ABSTRACT FROM AUTHOR]

To understand the role of affected upper extremity (UE) self-efficacy for explaining daily-hand-use in individuals post-stroke. Specifically, to describe UE self-efficacy and to assess the associations between UE self-efficacy to UE motor and functional capacity and daily hand-use. This cross-sectional study included individuals post-stroke receiving rehabilitation with high UE functional capacity [Action Research Arm Test (ARAT) > 50]. The Rating of Everyday Arm-Use in the Community and Home (REACH) assessed perceived UE daily use and the Confidence in Arm and Hand Movement scale (CAHM) assessed UE self-efficacy. Functional capacity was assessed by the ARAT and the Fugl-Meyer-motor-assessment assessed motor impairment. Correlations between measures were assessed. Twenty-two individuals, aged 19–80, with high UE functional capacity [median (IQR) ARAT-56.5 (54–57)] and varying UE self-efficacy [median (IQR) CAHM-76.7 (58–84.4)], were included. UE self-efficacy was significantly correlated with the ARAT (rs = 0.53, p < 0.01) and REACH (rs = 0.51, p < 0.01) but ARAT was not significantly correlated with REACH. UE self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity. Further research and a deeper understanding of the clinical implications of UE self-efficacy are warranted. UE self-efficacy should perhaps be assessed during rehabilitation. Individuals with stroke with high affected upper extremity functional capacity do not necessarily use this hand for daily living. Upper extremity self-efficacy is correlated with perceived daily hand-use in individuals with high functional capacity; participants with higher upper extremity self-efficacy also reported more daily hand-use. Upper extremity self-efficacy seems to be upper extremity task or situation-specific. Upper extremity self-efficacy should be assessed during rehabilitation and the clinical implications of (low) upper extremity self-efficacy should be further researched. [ABSTRACT FROM AUTHOR]

To investigate: (1) the interrater, and test–retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD. This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale. The F8WT showed good interrater and test–retest reliability (ICC = 0.964–0.978 and ICC = 0.905–0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD. The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD. The figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD). The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention. The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD. The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD. [ABSTRACT FROM AUTHOR]

Hearing-impaired individuals experience higher levels of listening effort in challenging situations, affecting their communication in daily life. The purpose of this study was to linguistically and culturally adapt the Effort Assessment Scale (EAS) into Danish (D-EAS) and to investigate its reliability and validity in normal-hearing and hearing-impaired listeners. The translation and cross-cultural adaptation of the EAS aligns with recommendations to adapt hearing-related questionnaires for different languages and cultures. Participants were 157 listeners (85 females) aged 20–86 years (Mage = 62.5, SD = 16.8), with (non-hearing aid and hearing aid users) and without hearing loss. Reliability analysis showed good internal consistency for the six items in the D-EAS (Cronbach's α= 0.93). Exploratory and confirmatory factor analyses showed that D-EAS is a one-dimensional instrument. Significant differences were observed across items and overall scores between normal hearing (NH) and hearing loss groups. The D-EAS reliably estimates self-perception of listening effort in adults with and without hearing loss and is sensitive to the impact of hearing loss. Thus, the D-EAS can provide hearing care professionals and hearing researchers with valuable insights into people's self-perception of listening effort to help guide clinical and other rehabilitation decisions. The Effort Assessment Scale (EAS) into Danish (D-EAS) is a reliable tool to estimate self-perception of listening effort in hearing-impaired adults. The D-EAS could be a helpful tool providing insights about aspects of hearing disability that is not commonly addressed with the traditional hearing assessments. The D-EAS can be incorporated in the hearing rehabilitation process as a tool for evaluating self-perception of listening effort in daily life situations. The D-EAS is easy to administer and requires a short time to answer, allowing its use by clinicians and hearing researchers in different settings. [ABSTRACT FROM AUTHOR]

To study psychological distress and fatigue among persons with spina bifida (SB) 50 years or older and living in Norway. In 2017, cross-sectional data were collected (n = 30). The Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were used. Descriptive statistics, non-parametric tests, and Spearman correlations were performed. Relevant information from previous studies on adults with chronic spinal cord injury (SCI) and the general population, were collected for comparison. Participants were 18 women and 12 men, mean age 57.5 (SD 5.6), 26 with myelomeningocele, and six with hydrocephalus. Thirty percent scored above the HADS-A- and 20% above the HADS-D thresholds, thus in the same range as previous studies of SB, but higher compared to persons with SCI and norms. HADS-D correlated with pain and FSS scores. Forty percent reported fatigue symptoms (9/15 without hydrocephalus, 3/6 with hydrocephalus). The study revealed a high prevalence of fatigue symptomatology among middle-aged and older adults with SB. Symptoms of anxiety and depression were more common than among persons with chronic SCI and norms. SB follow-ups should include awareness of psychological distress and fatigue, and investigate pain and medication side effects among possible influencing factors. Clinicians treating adult persons with SB should be aware of possible psychological distress and fatigue symptomatology among these patients. We suggest an initial screening for psychological distress and fatigue in persons with SB during follow-up visits and rehabilitation. Interventions to reduce pain may influence levels of psychological distress and/or fatigue in patients with SB. Clinicians should enquire about the effects of medication on fatigue when assessing and prescribing new medications; a thorough medication review helps to assess the benefits and risks. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the effectiveness of an Acceptance and Commitment Therapy-based group resilience intervention (The REsilience and Activities for every DaY program, READY) delivered to people with MS (PwMS) via frontline Italian services. This is a single-arm longitudinal study (with a nested qualitative study). READY is composed of seven weekly in-person sessions (2.5-h each) plus a booster session five weeks later. Data were collected immediately before the program, after the booster session, and at 3-months follow-up. Thirty-three READY groups (237 participants) were run by thirty-three trained psychologists. Participants improved in resilience (primary outcome), anxiety, depression, stress, health-related quality of life (HRQoL), and psychological flexibility and associated processes (acceptance, defusion, and values). Improvements on most outcomes occurred post-intervention and were maintained at a 3-month follow-up. No demographic or illness variables predicted these improvements. Psychological flexibility mediated improvements in resilience, anxiety, depression, stress, and HRQoL. Qualitative data confirmed READY feasibility and the positive psychological impacts on participants. Study findings support READY effectiveness with PwMS, its broad applicability in this population, and its delivery through frontline services. READY for MS is a highly structured, brief manualized group intervention. It is effective in improving participants' psychological functioning (resilience, anxiety, depression, stress, HRQoL, psychological flexibility, and related ACT processes). Psychological flexibility mediated the improvements in resilience, anxiety, depression, stress, HRQoL. READY can be effectively delivered through frontline services for PwMS without limitation in terms of participants' demographic and illness characteristics. [ABSTRACT FROM AUTHOR]

In this study, we aimed to translate, cross-culturally adapt, and validate the Persian version of the Neuropathic Pain Questionnaire (NPQ-P). We translated the NPQ to the Persian language based on the recommended guidelines. Measurement properties (internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient), construct validity (compared to DN4 questionnaire), and discriminant ability (Receiver operating curve analysis)) of the NPQ-P were evaluated. A total of 101 patients were enrolled in the study. No modification was needed in the translation and cultural adaptation process. High Cronbach's alpha (0.81) and ICC (0.94) supported good reliability of the NPQ-P. The correlation coefficient between the NPQ-P and DN-4 questionnaires was 0.42, indicated moderate construct validity of the NPQ-P. The NPQ-P demonstrated acceptable discriminant ability (AUC: 0.76 (95% CI: 0.66–0.84)). A total score of −0.3 indicated the highest Youden index with a corresponding sensitivity of 0.84 and specificity of 0.64 for the NPQ-P. The NPQ was successfully translated to the Persian language and indicated acceptable reliability, diagnostic accuracy, and discriminant ability. The NPQ-P can be used in a clinical setting adjunct to physical examinations and electrodiagnostic tests for a quick screening to distinguish between patients with neuropathic and non-neuropathic pain. Neuropathic Pain Questionnaire (NPQ) can be used for a quick screening to discriminate between patients with neuropathic and nociceptive pain. Persian version of the NPQ (NPQ-P) is a reliable and accurate tool with acceptable discriminant ability. The NPQ-P should be used in clinical setting adjunct to physical examinations and electrodiagnostic tests. [ABSTRACT FROM AUTHOR]

To determine the clinical relevance of the effects that Massage-Therapy (MT) and Abdominal-Hypopressive-Gymnastics (AHG) and the combination of both procedures have on the disability, pain intensity, quality of life, and lumbar mobility of patients with chronic nonspecific low back pain (CNSLBP). A randomized controlled-trial with parallel-groups, concealed allocation, assessor blinding, and intention-to-treat analysis was carried out. The sample included 60 adults with CNSLBP. The participants received MT (n = 20), AHG (n = 20), or MT + AHG (n = 20). Each group received 8 interventions. The ODI change scores were significantly higher (p < 0.05) in the MT + AHG group than in the other two groups. Significant differences were found in the results of NRS, Schober's test, and SF-12 PCS (p < 0.05) in each group. There were significant differences (p < 0.05) between the values of SF-12 MCS in AHG and MT + AHG groups. Massage Therapy and Abdominal Hypopressive Gymnastics reduce pain levels, increase the mobility of the lumbar spine, and improve disability and quality of life (PCS) in patients with CNSLBP in the short term. Likewise, AHG and MT + AHG improve quality of life (MCS). The combination of both therapies provides more benefits in terms of lumbar disability in patients with CNSLBP in the short term. This improvement is clinically relevant. ClinicalTrials.gov (NCT02721914). Massage Therapy (MT) and Abdominal Hypopressive Gymnastics (AHG), reduce pain, improve mobility and quality of life, and reduce disability in the short term. These results are clinically relevant. The combination of manual and active therapy (MT + AHG) seems to be more effective and produces clinically relevant changes. [ABSTRACT FROM AUTHOR]

Elucidating the complex interactions between physical activity (PA), a multidimensional concept, and physical capacity (PC) may reveal ways to improve rehabilitation interventions. This cross-sectional study aimed to explore which PA dimensions are related to PC in people after minor stroke. Community dwelling individuals >6 months after minor stroke were evaluated with a 10-Meter-Walking-Test (10MWT), Timed-Up & Go, and the Mini Balance Evaluation System Test. The following PA outcomes were measured with an Activ8 accelerometer: counts per minute during walking (CPMwalking; a measure of intensity), number of active bouts (frequency), mean length of active bouts (distribution), and percentage of waking hours in upright positions (duration). Multivariable linear regression models, adjusted for age, sex and BMI, were used to assess the relationships between PC and PA outcomes. Sixty-nine participants [62.2 ± 9.8 years, 61% male, 20 months post onset (IQR 13.0–53.5)] were included in the analysis. CPMwalking was significantly associated to PC in the 10MWT (std. ß = 0.409, p = 0.002), whereas other associations between PA and PC were not significant. The PA dimension intensity of walking is significantly associated with PC, and appears to be an important tool for future interventions in rehabilitation after minor stroke. It is recommended to express physical activity after minor stroke in multiple dimensions such as intensity, frequency, duration and distribution. In particular, intensity of physical activity measured with accelerometer counts is most closely related to physical capacity. The findings of this study underline the importance of being physically active beyond a certain intensity. In future development of interventions and guidelines that aim to promote daily physical activity, intensity should be taken into account. [ABSTRACT FROM AUTHOR]

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. 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. 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. The ULSQ is a valid and reliable measurement tool for screening UL function, pain, and stiffness in patients with DMD in clinical settings. 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. [ABSTRACT FROM AUTHOR]

Purpose: The effectiveness of a 12-month home-exercise program on trunk muscle strength after lumbar spine fusion surgery was evaluated. Three months postoperatively, 98 patients were randomized either to the exercise group (EG), with a progressive 12-month home-based exercise program, or to usual care group (UCG), with one guidance session for light home-exercises. Maximal trunk muscle strength was measured by a strain-gauge dynamometer and trunk extensor endurance was measured by Biering-Sørensen's test at baseline and after the intervention. The mean change in extension strength during the intervention was 75 N in EG and 58 N in UCG. Flexion strength improved 50 N in UCG and 45 N in EG. Trunk extension/flexion strength ratio changed from 0.90 to 1.02 in EG and from 0.98 to 1.00 in UCG. In EG, Biering-Sørensen's test improved by 17 s, and in UCG, it improved by 24 s. No statistically significant between-group differences were found in any variables. Median exercise frequency in EG decreased from 2.5×/week during the first two intervention months to 1.7×/week during the last two intervention months. Twelve-month progressive exercise program was equally effective as usual care in improving trunk muscle strength. Home exercise adherence decreased, which may have influenced the strength changes. The 12-month home-based exercise program was equally as effective as usual care after lumbar spine fusion (LSF) in improving trunk muscle strength, however, the back-specific exercises led to better trunk muscle strength balance in exercise group only. The adherence to the home based exercise program is a challenge; therefore, different techniques could be implemented to provide purposeful support for each individual in their long-term exercising. It is important to recognize those who need more individualized rehabilitation in recovery of the spine function, while others may manage with subtle intervention after LSF. [ABSTRACT FROM AUTHOR]

To investigate modifiable child and caregiver factors influencing community participation among children with Down syndrome. Cross-sectional data from a study investigating quality of life of children with intellectual disability were analysed. Participants were caregivers of 89 children with Down syndrome (54 females; 83 school attenders) (mean age 11 y 1 mo; SD 4 y 1 mo). Components of participation (attendance, involvement) were measured using the Participation and Environment Measure for Children and Youth, community module. Caregiver factors were time, mood, transport, and disability funding. Child factors were sleep, behaviour, communication, and health. Multivariate linear regression analyses examined if (i) caregiver factors were associated with attendance and (ii) child factors were associated with involvement. Increased caregiver time availability was associated with higher frequency of attendance. Higher frequency of attendance was associated with greater child involvement, and having a sleep breathing disorder and less verbal communication ability was associated with less child involvement. These factors combined explained 21% of the variance. Children with Down syndrome who participated in the community more frequently enjoyed greater involvement. Supporting participation of children with poorer verbal communication and/or sleep breathing disorders could further the participation of children with Down syndrome. Children with Down syndrome who more frequently attended opportunities for participation were more likely to be involved in those experiences. Healthcare providers and educators could foster involvement in participation opportunities of children with poorer verbal ability by supporting the development of prerequisite communication strategies. Rehabilitation programs and policies pertaining to accessibility of community activities need to align with modifiable determinants of participation in children, including availability of caregivers' time. [ABSTRACT FROM AUTHOR]

To compare the immediate effects of voluntary-induced stepping response training (VSR) and DynSTABLE perturbation training (DST) on protective stepping in patients with stroke. A randomized controlled trial (registration number: TCTR20170827001) was conducted in 34 patients with chronic stroke who were randomly allocated to the VSR (n = 17) or DST (n = 17) group. The VSR group was instructed to lean forward to induce protective stepping, while the DST group experienced support surface translation. All participants received one session of training (3 set, 10 min for each set with 10-minute rest in between). Step length, step width, number of steps and center of mass (CoM) position during protective stepping were assessed using a computer-assisted rehabilitation environment (CAREN) system prior to and immediately after training. Two-way ANOVA was used to compare between groups and times. Both types of training resulted in an increase in step width, but step length increased and there was a more positive COM position exhibited following DST (p <.05) than following VSR. Single-step incidence increased, whereas multiple-step incidence decreased significantly in both groups. Only participants in the VSR group generated protective stepping with the affected leg in a larger percentage of trials (27%) after training than before training. Both DST and VSR led to changes in protective stepping parameters after a single session of training. VSR may be a feasible alternative to equipment-based training but requires further study. VSR and DST trainings improved protective stepping in stroke. Step length and CoM control at foot touchdown increased after DST training. VSR training for 50 minutes led to increase affected stepping and reduce grasping. Step width, affected step length, and single step increased after both trainings. Without instrument, VSR increased steps execution and performance similar to DST. [ABSTRACT FROM AUTHOR]

To examine associations between neurosegmental and functional level classifications in children with Spina Bifida, and determine which classification best reflects daily walking activity. A prospective correlational study was conducted. Children with Spina Bifida were given ratings for lesion level [X-ray and International Myelodysplasia Study Group (IMSG) level determined by muscle strength] and functional level [Hoffer ambulatory level and Dias functional classification of myelomeningocele (FCM), Functional Mobility Scale (FMS)]. Daily walking activity was measured with a StepWatch monitor. Data were analyzed using Spearman rank correlation. Sixty-one children were included, [56% male, average age 9.8 (SD 2.7) years]. The neurosegmental level classifications, X-ray lesion level and IMSG level showed little to no correlation with each other (r = 0.17). Among functional classifications, the Dias FCM correlated strongly with the FMS (r = 0.80−0.87). Correlations with steps per day were moderate to good for the Dias FCM and the FMS (r = 0.53−0.62), fair for IMSG level (r = 0.45), and little to none for X-ray lesion level (r = 0.03). The Dias FCM is comprehensive, including elements of neurosegmental level and function, and correlates well with walking activity. We recommend its use for classifying function in patients with Spina Bifida. Functional classifications correlate better with daily walking activity than neurosegmental level classifications for patients with Spina Bifida. The Dias FCM includes neurosegmental and functional level elements, correlates well with daily activity, and is recommended for use in classifying Spina Bifida patients. Combined use of the FMS and activity monitoring is recommended for research and clinical assessment. [ABSTRACT FROM AUTHOR]

In children with Brachial Plexus Birth Injury, a non-use of the affected upper limb despite sufficient capacity, is sometimes observed, called developmental disregard. The combination of modified constraint-induced-movement-therapy with bimanual training is frequently applied to overcome developmental disregard in unilateral Cerebral Palsy. In the current study the effects of the combination of modified constraint-induced-movement-therapy with bimanual training are investigated in children with Brachial Plexus Birth Injury in comparison to children with unilateral Cerebral Palsy. We hypothesize that the combination of modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. Data of 19 children with Brachial Plexus Birth Injury (Mage: 4.1 years) and 18 with unilateral Cerebral Palsy (Mage: 4.5 years) were compared. The effects of modified constraint-induced-movement-therapy with bimanual training (54 h modified constraint-induced-movement-therapy, 18 h bimanual training, 8–10 weeks) was investigated by assessing spontaneous affected-upper-limb-use ("Assisting Hand Assessment"), manual abilities ("ABILHAND-kids") and subjective performance and satisfaction of problematic bimanual activities ("Canadian Occupational Performance Measure") at three time points (pre-treatment, post-treatment, follow-up). This data was analyzed using repeated-measures analysis. Children with Brachial Plexus Birth Injury showed significant improvements on all outcome measures following modified constraint-induced-movement-therapy with bimanual training. These results were comparable to those observed in the group of children with unilateral Cerebral Palsy. These results suggest that modified constraint-induced-movement-therapy with bimanual training is effective in Brachial Plexus Birth Injury. They indicate a comparable improved bimanual performance in children with Brachial Plexus Birth Injury than in unilateral Cerebral Palsy and suggests that both groups of children have affectively overcome their developmental disregard. Children with Brachial Plexus Birth Injury frequently experience difficulties in activities of daily living. It has recently been suggested that children with Brachial Plexus Birth Injury may also show a non-use of the affected upper limb despite sufficient capacity, called developmental disregard. Children with Brachial Plexus Birth Injury and developmental disregard might therefore benefit from intensive therapies aimed at overcoming developmental disregard, originally developed for children with unilateral Cerebral Palsy. A combination of modified Constrained-Induced Movement Therapy with intensive Bimanual Training has shown to be affective in children with unilateral Cerebral Palsy. In a small sample, this study shows that a combination of modified Constrained-Induced Movement Therapy with intensive bimanual training is effective in children with Brachial Plexus Birth Injury, comparable and even more than in unilateral Cerebral Palsy. [ABSTRACT FROM AUTHOR]

Trunk muscle endurance may be associated with balance and falls self-efficacy for people with osteoporosis. However, all previous studies have examined trunk muscle strength rather than endurance. To explore the relationships between trunk muscle endurance and standing balance and falls self-efficacy for women with vertebral fractures. This is an exploratory, secondary analysis of baseline data of a pilot randomized controlled trial in Ontario, Canada. Thirty-one women with osteoporosis, aged 65 years or older, with at least one vertebral fracture were included. The associations between balance (Balance Outcome Measure for Elder Rehabilitation) and trunk muscle endurance (Timed Loaded Standing Test) and falls self-efficacy (Falls Efficacy Scale International) and trunk muscle endurance were tested via Spearman rank order correlation with Fisher's z transformations. Trunk muscle endurance was correlated with better balance performance on the Balance Outcome Measure for Elder Rehabilitation [Spearman correlation coefficient, 0.71; 95% confidence interval: 0.47–0.85; p < 0.001], but not with falls self efficacy (Spearman correlation coefficient; –0.22; 95% confidence interval: –0.53 to 0.14; p = 0.23). Trunk muscle endurance was moderately associated with better standing balance performance but not falls self-efficacy, highlighting the importance of trunk muscle endurance for standing balance for older adults with osteoporosis and vertebral fractures. Older adults with osteoporosis and vertebral fractures who have better trunk muscle endurance may also have better standing balance. There was no association between trunk muscle endurance and how confident a person is that they will not fall while completing various activities of daily living. Trunk muscle endurance training could be included as part of a standing balance rehabilitation program for this population. [ABSTRACT FROM AUTHOR]

Speech impairment is common in patients affected by head and neck cancer and impact on quality of life. Therefore, specific instruments are required for its evaluation. The aim of this study is to evaluate the psychometric properties of the Italian Speech Handicap Index. Data were obtained from 50 patients and 75 asymptomatic subjects. The study consisted of five phases: (1) item generation, (2) internal consistency and reliability analysis, (3) normative data generation, (4) validity analysis, performed by comparing the Italian Speech Handicap Index scores obtained in patients and asymptomatic subjects, and by correlating its scores with the results of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Head and Neck Module, and (5) cut-off value. Internal consistency was good (Cronbach α = 0.9) and the test–retest reliability was strong. A significant difference in Italian Speech Handicap Index total score between patients and asymptomatic subjects was found. Moderate correlations between the two questionnaires were observed. A cut-off value of 14.5 demonstrated a sensitivity of 96% and a specificity of 100%. The Italian Speech Handicap Index is a reliable and valid clinical tool. Its application in everyday practice and outcome research is recommended. Rehabilitation of speech in head and neck cancer patients is frequently needed, especially after surgical treatment. Speech impairment represents one of the most essential factors influencing the quality of life in head and neck cancer patients. The evaluation of the speech impairment should be performed using dedicated assessment tools. [ABSTRACT FROM AUTHOR]

This audit aimed to increase understanding of the long-term outcomes of evidence-based medical and surgical interventions to improve gross motor function in children and adolescents with Cerebral Palsy. Retrospective audit of a birth cohort (2000–2009) attending a tertiary service in Western Australia. The cohort comprises 771 patients aged 8 to 17 years. Percentage of children receiving no Botulinum Toxin treatments in each Gross Motor Functional Classification System level was: I: 40%, II: 26%, III: 33%, IV: 28% and V: 46%. Of the total cohort, 53% of children received 4 or less Botulinum Toxin treatments and 3.7% received more than 20 treatments. Statistically significant difference in the rate of use of Botulinum Toxin pre and post-surgery (p < 0.001) was documented. Children levels IV and V had 5 times the odds of surgery compared to children levels I–III (Odds Ratio 5.2, 95% Confidence Interval 3.5 to 7.8, p < 0.001). For 578 (75%) of participants the last recorded level was the same as the first. This audit documents medical intervention by age and Gross Motor Functional Classification System level in a large cohort of children with cerebral palsy over time and confirms stability of the level in the majority. The information from this audit may be of use in discussions with families regarding the timing and use of Botulinum toxin and surgical intervention for motor function in children and adolescents with Cerebral Palsy. Long term use of Botulinum Toxin within an integrated evidence-based clinical program is not associated with loss of gross motor function in the long term as evidenced by the maintenance of Gross Motor Functional Classification System stability. [ABSTRACT FROM AUTHOR]

This study examined the degree to which goals perceived by occupational therapists (OTs) matched those perceived by their clients. A total of 100 clients and 79 OTs were recruited from seven subacute rehabilitation wards in Japan. Matched pairs of OTs and their clients were independently asked for their perception about the clients' occupational therapy goals through semi-structured interviews. Collectively, the OTs reported 239 goals, while the clients reported 161 goals. While both the OTs and the clients reported a high level of client engagement in the goal setting process, 79% of the goal statements were mismatched between pairs of OTs and their clients. Goal matching was slightly better for goals about activities of daily living or participation than for goals about body structure or body function. Although most OTs and their clients perceived that they engaged in goal-setting together, only 21% of reported goals actually matched between OTs and clients. It would also be worth investigating whether there is any correlation between the content of goals, patient engagement in goal setting, degree of goal matching, and health outcomes achieved by clients following discharge from rehabilitation services. Although most occupational therapists (OTs) and their clients perceived that they engaged in goal-setting together, 79% of the goals independently reported by OTs and their clients did not match in seven post-acute rehabilitation wards across Japan. Goals were slightly more likely to match if the topic of the goals related to instrumental activities of daily living or participation (30.3%) or basic activities of daily living (24.7%) than if the topic of the goals were about body structure or body function (11.2%); however, the overall rate of goal matching was low. Japanese OTs need to develop more effective methods for recording or communicating goals in ways that clients can understand; this may be the same for other countries. [ABSTRACT FROM AUTHOR]

To investigate the incidence and potential predictors of upper-limb contractures, three months after stroke. Prospective cohort study. Consecutive sample of individuals with hemiparesis due to stroke, admitted to a public hospital in Brazil. Contractures were measured by passive range of motion of lateral shoulder rotation, elbow extension, and wrist extension with a gravity inclinometer. Potential predictors included measures of muscle strength, spasticity of the upper-limb muscles, upper-limb function, dexterity, and pain. Measurements were obtained within four weeks and at three months after the stroke. A binomial regression analysis was employed. Out of the 76 individuals with hemiparesis, 28% developed at least one contracture on their paretic upper limb. The incidence of contracture varied across the joints from 6% to 16% and the wrist was the most affected joint. Individuals with moderate stroke showed higher incidence of contracture, compared with those with mild stroke. Dexterity (OR 0.009, 95% confidence intervals (95% CI) 0.00–0.19) and pain (OR 6.417, 95% CI 1.22–33.83) were significant predictors of shoulder, elbow, and wrist contractures. Individuals with mild and moderate stroke developed upper-limb contractures three months after the onset of the stroke, with an incidence of 28%. The predictors were the presence of pain and loss of dexterity. These impairments should be earlier targeted during rehabilitation interventions. The incidence of upper limb contracture 3 months after the stroke is high after mild to moderate stroke. Wrist contractures are the most common upper limb contracture. The presence of pain and loss of dexterity significantly contribute to the development of upper limb contractures. Health professionals should target on the control of pain and improvement of upper-limb dexterity to prevent contractures. [ABSTRACT FROM AUTHOR]

The Scoliosis Research Society (SRS-30) questionnaire proved valid in measuring health-related quality of life (HRQoL) in adult patients with spinal deformity or degenerative disease. This study further assesses the validity of the SRS-30 by comparing its results with other HRQoL instruments, such as Oswestry disability index (ODI) and the RAND-36, among unselected adult patients with degenerative spinal disorder. 628 consecutive patients completed the SRS-30, the ODI, the pain visual analog scale (VAS), and RAND-36 questionnaires. Using a 9 mm minimal important difference threshold of the VAS, patients were divided into three groups of symptom location: back pain (n = 226), lower extremity pain (n = 161), and combination of both (n = 241). Statistical and illustrative tests using beta coefficients, Rasch measurement analytics, and score distributions were used for analysis. The SRS-30 functioned well for all three subgroups. There were small differences in convergent validity of the SRS-30 compared to the ODI and the RAND-36 between the three subgroups. The SRS-30 performed similarly in different pain groups independent of age, gender, or deformity severity. The scale displayed good coverage and targeting for all three subgroups. The SRS-30 proved to provide valid HRQoL scores for all adult patients with degenerative spinal disorders. Degenerative spinal conditions associated with spinal deformities are common in patients over 60 years. Low back pain is globally the leading cause of disability. The applicability of the Scoliosis Research Society (SRS-30) questionnaire has not been tested in relation to different pain origins. The SRS-30 proved to provide valid health-related quality of life assessment among patients with degenerative spinal disease independent of pain location. The SRS-30 questionnaire can be used to assess the level of disability and rehabilitation of patients with degenerative spinal disease. [ABSTRACT FROM AUTHOR]

Purpose: To compare family and functional outcome in infants at very high risk of cerebral palsy, after receiving the family centred programme "Coping with and Caring for infants with special needs (COPCA)" or typical infant physiotherapy. Materials and methods: Forty-three infants at very high risk were included before 9 months corrected age and randomly assigned to one year COPCA (n = 23) or typical infant physiotherapy (n = 20). Family and infant outcome were assessed before and during the intervention. Physiotherapy intervention sessions were analysed quantitatively for process analysis. Outcome was evaluated with non-parametric tests and linear mixed-effect models. Results: Between-group comparisons revealed no differences in family and infant outcomes. Within-group analysis showed that family's quality of life improved over time in the COPCA-group. Family empowerment was positively associated with intervention elements, including "caregiver coaching." Conclusions: One year of COPCA or typical infant physiotherapy resulted in similar family and functional outcomes. Yet, specific intervention elements, e.g., coaching, may increase empowerment of families of very high risk infants and may influence quality of life, which emphasizes the importance of family centred services. One year of the family centred programme "Coping with and a Caring for infants with special needs" compared with typical infant physiotherapy resulted in similar family outcome and similar functional outcome for the infants at very high risk for cerebral palsy. Specific contents of intervention, such as caregiver coaching, are associated with more family empowerment and increased quality of life. Emphasis on family needs is important in early intervention for infants at very high risk for cerebral palsy. [ABSTRACT FROM AUTHOR]

Purpose: The validity, responsiveness, and clinical utility of the Canadian Occupational Performance Measure was investigated when used in a sub-acute setting. Materials and Methods: Fifty older adults (mean age 78.2 years, Standard Deviation = 7.2; 64% female) completed the Canadian Occupational Performance Measure, Functional Independence Measure and the Short-Form 36 Health Questionnaire. The Canadian Occupational Performance Measure was correlated with the Functional Independence Measure and Short-Form 36 Health Questionnaire and the admission and discharge Canadian Occupational Performance Measure Performance and Satisfaction scores were compared for significant differences. Qualitative interviews with were completed with six older adults and six occupational therapists to explore the utility of the Canadian Occupational Performance Measure. Results: The Canadian Occupational Performance Measure Satisfaction scale was significantly associated with the Functional Independence Measure and Short-Form 36 Health Questionnaire. Significant differences were found between the admission and discharge Canadian Occupational Performance Measure Performance and Satisfaction scale scores. From both the clients' and therapists' perspectives, four key qualitative themes emerged: (1) "Likes" about the Canadian Occupational Performance Measure; (2) Effects on practice; (3) Utility; and (4) Future use. Conclusions: This study provides evidence of the Canadian Occupational Performance Measure's validity, responsiveness and clinical utility when used in a sub-acute setting. The Canadian Occupational Performance Measure appears able to effectively evaluate the outcomes of occupational therapy interventions, including in sub-acute rehabilitation settings. It is an individualized outcome measure where clients are responsible for measuring their own progress and meaningful outcomes from therapy. Evidence of the Canadian Occupational Performance Measure's convergent validity, predictive validity and responsiveness to change was found which contributes to the body of knowledge of its psychometric properties. From a qualitative perspective, the Canadian Occupational Performance Measure was found to improve clinical decision making, facilitating client engagement, formulating clear treatment goals and making therapy more meaningful for clients. [ABSTRACT FROM AUTHOR]

Purpose: The Weekly Calendar Planning Activity is a performance test aiming to examine how subtle problems with executive functioning influence the performance of multi-step activities in daily life. The purpose of this study was to explore the Swedish version of the Weekly Calendar Planning Activity, regarding test–retest reliability and possible learning effects. Material and methods: Twenty-four adults with psychiatric, neurodevelopmental or mild intellectual disorders and with difficulties in executive functioning performed the test on three separate occasions, with two weeks apart. Test–retest reliability was determined using intraclass correlation coefficients. Possible learning effects were evaluated. The smallest detectable change was calculated to determine the precision of individual scores. Results and conclusion: The intraclass correlation coefficients between the first two test occasions were weak (0.42–0.66), but were acceptable to excellent (0.65–0.91) between test occasions 2 and 3. There was a considerable amount of random variation in the results, but little systematic variation, indicating no or possibly a small learning effect in the total number of accurately recorded appointments. This variation indicates a need to use two consecutive baseline measurements when the Swedish version of the Weelky Calendar Planning Acitivity is used as an outcome measure. Together, our results suggest that the Swedish version of the Weelky Calendar Planning Acitivity is a useful performance-based measure of how subtle problems in executive functioning affects activity performance. Executive functioning is crucial for managing daily life, and ecologically valid tests are needed to measure such functioning. The Weekly Calendar Planning Activity is a new performance-based test using a task that is relevant to daily life. The outcomes obtained in the Weekly Calendar Planning Activity are highly useful in clinical practice. The day-to-day variation in the Weekly Calendar Planning Activity results warrants the need for two consecutive baseline measurements when it is used to measure change. [ABSTRACT FROM AUTHOR]

Purpose: To examine the nature of occupational gaps and desired re-engagement following severe traumatic brain injury (TBI), and the relationship to mood, self-discrepancy, and psychosocial functioning. Materials and methods: Fifty-nine adults with severe TBI (73% male, M age = 36.50, SD = 12.54) were administered measures of past, current, and desired occupations (Occupational Gaps Questionnaire), mood (Depression Stress and Anxiety Scale – 21), and self-discrepancy (Head Injury Semantic Differential Scale – version 3). Psychosocial functioning was rated by relatives on the Sydney Psychosocial Reintegration Questionnaire. Results: Participants reported that they engaged in significantly fewer occupations than prior to their injury (p < 0.001). Further, they participated in fewer occupations than they desired (p < 0.001). Desired re-engagement was identified for 18 of the 30 occupations (e.g., working, sports, managing personal finances, and supporting others). A higher number of these re-engagement gaps was significantly related to greater anxiety (r = 0.30, p < 0.05) and lower psychosocial functioning (r = −0.29, p < 0.05). A mediation analysis revealed that re-engagement gaps were indirectly related to self-discrepancy through an association with anxiety. Conclusions: Occupational gaps are commonly experienced after severe traumatic brain injury. Lack of engagement in desired occupations is associated with greater anxiety and poorer psychosocial functioning. Anxiety regarding these gaps may contribute to negative comparisons between one's pre-injury and post-injury self. Identification of occupational gaps and their psychological impact may guide the focus of client-centred rehabilitation approaches. Gaps between current activity engagement (i.e., post injury) and desired activity engagement are commonly experienced after severe traumatic brain injury. Greater desired re-engagement gaps (i.e., when individuals report they are not completing activities that they would like to do) are associated with greater anxiety and poorer psychosocial functioning. Individuals who are unable to re-engage in desired activities are more likely to experience anxiety, which in turn may contribute to negative self-discrepancy. It may be beneficial to explore the personal meaning of changes in occupation after traumatic brain injury. [ABSTRACT FROM AUTHOR]

Background: The Mesure de l'impact de la déficience visuelle dans les activités quotidiennes (MIDVAQ) is the Canadian–French adaptation of the Melbourne Low-Vision ADL Index. It measures performance, personal importance and handicap situation in 16 instrumental activities requiring near vision (standardized material, part A) and in 9 self-care and domestic activities (self-report questionnaire, part B). This study aimed at measuring the MIDVAQ reliability and its relationship with measures of visual functions and functional vision. Methods: The MIDVAQ was administered twice to 100 visually impaired participants, at home, with their personal visual and non-visual aid. A second rater was present at T1. Two different versions of part A were used alternately at T1 and T2. Results: The total Handicap scale demonstrates good internal reliability (Cronbach's alpha coefficient = 0.82) and very high inter-rater and test-retest reliability (ICCs = 1.00 and 0.86). Part A alternative versions are highly comparable. Vision function measures are significantly correlated with total Handicap score, for which 48% of the variance is explained by functional vision estimates, age, and education. Conclusions: The MIDVAQ is highly valid and reliable. It can be useful to measure the functional impact of the visual impairment, its progression, and the outcomes of low vision rehabilitation services. Even if administered at home in an ecological way, this measure of the impact of the visual impairment in daily activities is very reliable. Given its good metric properties, this tool can be confidently used to assess the functional impact of visual impairment, outcomes of the low vision rehabilitation services, etc. This measurement tool provides complementary information to those obtained from clinical measures of visual functions, by reflecting the interaction between the functional abilities with the requirements of the environment. [ABSTRACT FROM AUTHOR]

Purpose: Sedentary behavior is common in people with stroke and has devastating impact on their health. Quantifying it is important to provide people with stroke with adequate physical behavior recommendations. Sedentary behavior can be quantified in terms of posture (sitting) or intensity (low energy expenditure). We compared the effect of different operationalizations of sedentary behavior on sedentary behavior outcomes (total time; way of accumulation) in people with stroke. Methods: Sedentary behavior was analyzed in 44 people with chronic stroke with an activity monitor that measured both body postures and movement intensity. It was operationalized as: (1) combining postural and intensity data; (2) using only postural data; (3) using only intensity data. For each operationalization, we quantified a set of outcomes. Repeated measures ANOVA and Bland–Altman plots were used to compare the operationalizations. Results: All sedentary behavior outcomes differed significantly between all operationalizations (p < 0.01). Bland–Altman plots showed large limits of agreement for all outcomes, showing large individual differences between operationalizations. Conclusions: Although it was neither possible nor our aim to investigate the validity of the two-component definition of sedentary behavior, our study shows that the type of operationalization of sedentary behavior significantly influences sedentary behavior outcomes in people with stroke. Reliable assessment of sedentary behavior after stroke is important in order to provide adequate physical behavior recommendations for people with stroke. Sedentary behavior can be operationalized in terms of body posture (sitting time) or in terms of movement intensity (time <1.5 MET) or as a combination of both criteria; this study reveals that the type of operationalization affects the different outcome measures used to quantify sedentary behavior. Comparing sedentary behavior outcomes requires caution and should only be done when sedentary behavior is operationalized in the same way. [ABSTRACT FROM AUTHOR]

Purpose: To describe the change in spatiotemporal gait asymmetry after discharge from stroke rehabilitation and examine the relationship with change in other clinical outcome measures. Methods: Secondary analysis of a prospective cohort study was conducted. Swing time and step length symmetry, balance, mobility, gait speed, and motor impairment were assessed at discharge and 6 months later. Participants (n = 61) were classified by shift in symmetry status (Asymmetric-to-Symmetric, Symmetric-to-Asymmetric, No Shift) and magnitude of difference scores (Improved, Worse, No Difference). Correlations between change in spatiotemporal symmetry and the other clinical measures of physical status were calculated. Results: At discharge, 61% (37/61) and 36% (22/61) of participants were asymmetric in swing time and step length, respectively. Of this subgroup, 43% (16/37) and 50% (11/22) shifted to symmetric gait by follow-up. In contrast, only six individuals significantly improved in swing and/or step symmetry according to minimal detectable change. Change in spatiotemporal symmetry was not significantly correlated with change in the clinical outcome measures. Conclusions: Despite overall gains in physical function and decreased prevalence of asymmetry, most individuals with stroke do not improve in swing or step symmetry following discharge from rehabilitation. Further research is necessary to elucidate factors that affect recovery of gait quality. Asymmetric gait after stroke is a major concern for patients and their therapists but can be resistant to intervention. Spatiotemporal asymmetry persists for many individuals following discharge from hospital stay despite improvement in other gait-related measures. While the determinants of change remain unclear, gait quality should be specifically monitored and addressed to avoid long-term negative effects. [ABSTRACT FROM AUTHOR]

Purpose: To develop a Singapore version of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to estimate the construct validity and inter-rater reliability. Materials and methods: The Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure was used to systematically adapt the CAHAI. We recruited 56 adults admitted to an inpatient stroke facility to evaluate the psychometric properties of the Singapore version of the CAHAI. The Singapore version of the CAHAI, Fugl-Meyer Assessment of Upper Extremity (FMA-UE), and the Action Research Arm Test (ARAT) were administered to all participants. We used Spearman's rank correlation coefficients to estimate convergent and discriminative validity, and reliability was estimated using the intra-class correlation coefficient and standard error of measurement. Results: Implementation of the Translation and Cross-Cultural Adaptation of Objectively Assessed Outcome measure procedure resulted in the modification to two test items. The Singapore version of the CAHAI demonstrated convergent validity with the FMA-UE (rs= 0.87; 95% CI: 0.76, 0.92) and ARAT (rs = 0.80; 95% CI: 0.63, 0.9). Discriminative validity between the Singapore version of the CAHAI and FMA-UE pain subscale was rs= 0.42 (95% CI: 0.22, 0.59). Reliability of the Singapore version of the CAHAI was 0.97 (95% CI: 0.94, 0.99) and standard error of measurement of 4.80 points (95% CI: 4.23, 5.55). Conclusion: The Singapore version of the CAHAI demonstrated good validity and reliability, similar to the properties of the original CAHAI. The Singapore version of the Chedoke Arm and Hand Activity Inventory demonstrates evidence of construct validity and inter-rater reliability. The Singapore version of the Chedoke Arm and Hand Activity Inventory can be used by clinicians and researchers to evaluate function in the affected upper extremity for persons with stroke in Singapore. [ABSTRACT FROM AUTHOR]

Purpose: To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke. Methods: This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke. Results: The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n = 109) and reliability (n = 51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p = 0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92–0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident. Conclusions: These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum. The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke. The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity. The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points. The lack of any floor or ceiling effects on hospital admission indicates applicability across the whole mobility spectrum of patients with sub-acute stroke. [ABSTRACT FROM AUTHOR]

Purpose: To examine clinimetric properties of the de Morton Mobility Index (DEMMI) in patients with hip fracture in comparison with the modified Barthel Index (BI), Cumulated Ambulation Score (CAS), and 30-s Chair Stand Test (30-s CST). Materials and methods: Two hundred and twenty two patients with a hip fracture admitted to a geriatric ward following surgery were assessed on day 1 and at discharge (mean of 9 [SD 5.1] post-surgery days). Results: Ninety eight percent and 89% of patients were not able to perform the 30-s CST at baseline and at discharge (large floor effect), respectively. Corresponding floor effects were 39% and 31% for DEMMI, 12% and 5% for BI, and 22% and 6%, respectively, for CAS. Convergent validity was strong between DEMMI and CAS (r = 0.76, 95% CI: 0.69–0.81), and moderate between DEMMI and BI (r = 0.58, 95% CI: 0.48–0.66) and CAS and BI (r = 0.49, 95% CI: 0.39–0.59). Responsiveness, as indicated by the effect size was 0.76 for DEMMI, 1.78 for BI and 1.04 for CAS. Baseline scores of DEMMI, BI, and CAS showed similar properties in predicting discharge destination of patients from own home. Conclusions: The value of using DEMMI and 30-s CST in patients with hip fracture during the acute hospitalization seems limited in comparison with BI and CAS. DEMMI and CAS seem to assess similar constructs. Outcome measures used for the evaluation of patients with hip fracture should be validated in the specific time-line and rehabilitation setting following surgery, before being implemented in daily clinical practice. We suggest the Cumulated Ambulation Score for monitoring basic mobility during the acute hospitalization for the entire group of patients recovering from a hip fracture, while DEMMI seems more feasible for the subgroup of patients with higher functional levels. The modified Barthel Index seems useful for the assessment of activities of daily living in the acute care setting of patients with hip fracture. We cannot recommend the original 30-s Chair Stand Test to be used for the evaluation of patients with hip fracture in the acute hospital setting. [ABSTRACT FROM AUTHOR]

Purpose: This first psychometric evaluation of the Patient Categorisation Tool examined its properties as an instrument to measure complexity of needs in a mixed population of patients presenting for specialist neurorehabilitation. Materials/methods: Analysis of a large multicentre cohort of patients (n = 5396) from the national clinical dataset representing 63 specialist rehabilitation services across England. Structural validity was examined using exploratory and confirmatory factor analysis. Concurrent and criterion-validity were tested through a priori hypothesized relationships with other validated measures of resource requirements and dependency. Results: All but two items loaded strongly onto a single principal component with Cronbach's alpha 0.88. A total score of ≥30 identified patients with complex (category A) needs with sensitivity 76% and specificity 75%. However, confirmatory factor analysis provided a better fit when the scale was split into two subscales – a 'Cognitive/psychosocial' and a 'Physical' sub-scale (alpha 0.83 and 0.84, respectively). Moderate convergent and discriminant correlations were consistent with hypothesized relationships. Conclusions: The findings provide some overall support for the Patient Categorisation Tool as a unidimensional tool for measuring complexity of needs for neurorehabilitation, but the subscales may be more suitable for certain groups of patients. Further analysis is now required to evaluate its performance in different conditions. A psychometrically robust tool for measuring the complexity of rehabilitation needs has potential value, both at an individual level for treatment planning, and at a population level for planning and commissioning rehabilitation services. The Patient Categorisation Tool now forms part of the United Kingdom national clinical dataset mandated by the National Health Service in England This psychometric analysis from a large national multicentre cohort representing a diverse range of conditions, provides evidence for its validity as a means to identity patients with complex rehabilitation needs requiring specialist rehabilitation. [ABSTRACT FROM AUTHOR]

Purpose: To cross-culturally adapt and verify the measurement properties of the Brazilian version of the Motor Assessment Scale (MAS). Methods: The process of cross-cultural adaptation followed standardized procedures. Construct validity of the MAS was investigated using Rasch analysis (n = 100), whereas inter-rater and test–retest reliabilities were evaluated using Kappa coefficients and Bland and Altman plots (n = 52). Results: The MAS demonstrated satisfactory measurement properties. The Kappa coefficients for the inter-rater and test–retest reliabilities were 0.73 (ranging from 0.79 to 1.00) and 0.82 (ranging from 0.86 to 1.00), respectively. The Bland and Altman plots showed adequate inter-rater and test–retest agreements. No ceiling or floor effects were observed and only one item exhibited misfit to the Rasch model expectations. Item 4 "sitting to standing" exhibited marginal misfit (infit MnSq = 1.44; Zstd = 2.6), but it did not affect the unidimensionality of the scale. Conclusions: The MAS demonstrated good indicators of validity and reliability to be used for the assessment of motor function of individuals with stroke within clinical and research contexts. The Motor Assessment Scale is a performance-based scale for the assessment of motor function of individuals with stroke, based on a task-oriented approach. The Motor Assessment Scale has shown good clinical utility indicators dues to its quick administration, objectivity, and clinical relevance as a functional predictor. The Motor Assessment Scale showed good indicators of validity and reliability to be used within clinical and research contexts for the evaluation of motor function of individuals after stroke. [ABSTRACT FROM AUTHOR]

Purpose: To determine the profile of the main informal caregivers, the evolution of the caregiver burden, and the influencing factors of caregiver burden at 1-year after hip fracture surgery. Methods: In this prospective cohort study, a total of 172 informal caregivers of patients were interviewed at four points during 1 year following hip fracture surgery in a regional hospital in southern Spain. The perceived caregiver burden was assessed using the Caregiver Strain Index (0-13 points). Results: The mean (Standard Deviation) age of the 172 caregivers was 56 (13) years, of which 133 (77%) were woman and 94 (55%) were daughters of the patient. Seventy-nine of the 172 (46%) caregivers perceived a high level of burden (≥ 7 points on the Caregiver Strain Index) at the hospital. The corresponding numbers with perceived high level of burden at 1-month, 3-months, and 1-year were 87 (50%), 61 (36%), and 45 (26%) caregivers. A low pre-fracture functional status, post-operative complications, older age of patients, and younger age of caregivers negatively influence caregiver burden at 1-year. Conclusions: The main caregiver is predominantly female and is most often the daughter of the patient. New treatment strategies such as the support and training of the caregivers in patient handling during hospital stay could be carried out to reduce caregiver burden. Implications for rehabilitation: The main caregiver of a hip fracture patient is usually a woman who is the daughter of the patient, and reducing her burden of care should be included as one of the objectives of rehabilitation treatment. The caregivers of hip fracture patients must be considered as part of the treatment during the patient's recovery period, and patient handling training should be provided to the caregivers of hip fracture patients during the hospital stay to prepare the process of going back home. The caregivers of older patients, those with a low pre-fracture functional level, and of those who suffered post-operative complications, should receive more attention prior to hospital discharge and receive more assistance at home to reduce caregiver burden. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to translate and culturally adapt the Leicester Cough Questionnaire into Swedish and to test the validity and reliability of the Swedish version, in patients with chronic obstructive pulmonary disease. Methods: The original Leicester Cough Questionnaire was translated into Swedish by a method, which followed an established forward-backward procedure, including cross-cultural adaptation and pretest. To test the validity of the final version of Leicester Cough Questionnaire in Swedish, the St George’s Respiratory Questionnaire and the COPD Assessment Test were used (n =112) and to test reliability, the questionnaire was repeated (n = 86). Results: The Leicester Cough Questionnaire in Swedish showed proof of construct validity and proof of internal consistency (Cronbach’s alpha coefficient 0.97). All domains and total scores had good-excellent test-retest reliability (intra-class correlation coefficient 2,1 > 0.94). The standard error of measurement, (standard error of measurement percent), for the Leicester Cough Questionnaire in Swedish was 0.84 (5.15%). The smallest real difference, (smallest real difference percent), derived from cross sectional standard error of measurement was 2.33 (14.25%). The Bland-Altman plot indicated no systemic change in the mean. Conclusion: The Leicester Cough Questionnaire in Swedish is a valid and reliable instrument to measure health-related quality of life in patients with chronic obstructive pulmonary disease and can be used in clinical settings. Implications for Rehabilitation: The Leicester Cough Questionnaire, has been translated into Swedish, following an established forward-backward procedure, including cross-cultural adaptation The Swedish version of the Leicester Cough Questionnaire, is a valid, reliable instrument for measuring health-related quality of life regarding cough in patients with chronic obstructive pulmonary disease The Swedish version of the Leicester Cough Questionnaire is easy to administer and can be used in clinical and rehabilitation settings and for research purposes The absolute reliability presented at group and individual levels to indicate a real improvement is an advantage to assist when interpreting a clinically relevant difference [ABSTRACT FROM AUTHOR]

Purpose: Rehabilitation professionals typically use motor imagery (MI) or action observation (AO) to increase physical strength for injury prevention and recovery. Here we compared hamstring force gains for MI during AO (AO + MI) against two pure MI training groups.Materials and methods: Over a 3-week intervention physically fit adults imagined Nordic hamstring exercises in both legs and synchronized this with a demonstration of the same action (AO + MI), or they purely imagined this action (pure MI), or imagined upper-limb actions (pure MI-control). Eccentric hamstring strength gains were assessed using ANOVAs, and magnitude-based inference (MBI) analyses determined the likelihood of clinical/practical benefits for the interventions.Results: Hamstring strength only increased significantly following AO + MI training. This effect was lateralized to the right leg, potentially reflecting a left-hemispheric dominance in motor simulation. MBIs: The right leg within-group treatment effect size for AO + MI was moderate and likely beneficial (d = 0.36), and only small and possibly beneficial for pure MI (0.23). Relative to pure MI-control, effects were possibly beneficial and moderate for AO + MI (0.72), although small for pure MI (0.39).Conclusions: Since hamstring strength predicts injury prevalence, our findings point to the advantage of combined AO + MI interventions, over and above pure MI, for injury prevention and rehabilitation. Implications for rehabilitation While hamstring strains are the most common injury across the many sports involving sprinting and jumping, Nordic hamstring exercises are among the most effective methods for building eccentric hamstring strength, for injury prevention and rehabilitation.In the acute injury phase it is crucial not to overload damaged soft tissues, and so non-physical rehabilitation techniques are well suited to this phase.Rehabilitation professionals typically use either motor imagery or action observation techniques to safely improve physical strength, but our study shows that motor imagery during observation of Nordic hamstring exercises offers a safe, affordable and more effective way to facilitate eccentric hamstring strength gains, compared with pure motor imagery.Despite using bilateral imagery and observation training conditions in the present study, strength gains were restricted to the right leg, potentially due to a left hemispheric dominance in motor simulation. [ABSTRACT FROM AUTHOR]

Purpose:To determine the prevalence of shoulder pain and to identify factors associated with shoulder pain in a nationwide survey of individuals living with spinal cord injury (SCI) in Switzerland. Methods:Data was collected through the 2012 community survey of the Swiss SCI Cohort Study (SwiSCI) (N = 1549; age 52.3 ± 14.8; 29% female). Sociodemographic and socioeconomic circumstances, SCI characteristics, health conditions as well as mobility independence and sporting activities were evaluated as predictor variables. Analyses were adjusted for item non-response (using multiple imputation) and unit-nonresponse (using inverse probability weighting). Results:The adjusted prevalence of shoulder pain was 35.8% (95% CI: 33.4–38.3). Multivariable regression analysis revealed higher odds of shoulder pain in females as compared to males (odds ratio: 1.89; 95% CI: 1.44–2.47), and when spasticity (1.36; 1.00–1.85) and contractures (2.47; 1.91–3.19) were apparent. Individuals with complete paraplegia (1.62; 1.13–2.32) or any tetraplegia (complete: 1.63; 1.01–2.62; incomplete: 1.82; 1.30–2.56) showed higher odds of shoulder pain compared to those with incomplete paraplegia. Conclusions:This survey revealed a high prevalence of shoulder pain. Sex, SCI severity, and specific health conditions were associated with having shoulder pain.Implications for rehabilitationIndividuals with spinal cord injury have a high prevalence of shoulder pain.Females, individuals with complete paraplegia or any tetraplegia and individuals with contractures and spasticity should receive considerable attention in rehabilitation programmes due to their increased odds of having shoulder pain. [ABSTRACT FROM PUBLISHER]

Purpose:The purpose of this study was to examine the internal construct validity of the Arabic version of the Lower Extremity Functional Scale (20-item Arabic LEFS) using Rasch analysis. Methods:Patients (n = 170) with lower extremity musculoskeletal dysfunction were recruited. Rasch analysis of 20-item Arabic LEFS was performed. Once the initial Rasch analysis indicated that the 20-item Arabic LEFS did not fit the Rasch model, follow-up analyses were conducted to improve the fit of the scale to the Rasch measurement model. These modifications included removing misfitting individuals, changing item scoring structure, removing misfitting items, addressing bias caused by response dependency between items and differential item functioning (DIF). Results:Initial analysis indicated deviation of the 20-item Arabic LEFS from the Rasch model. Disordered thresholds in eight items and response dependency between six items were detected with the scale as a whole did not meet the requirement of unidimensionality. Refinements led to a 15-item Arabic LEFS that demonstrated excellent internal consistency (person separation index [PSI] = 0.92) and satisfied all the requirement of the Rasch model. Conclusion:Rasch analysis did not support the 20-item Arabic LEFS as a unidimensional measure of lower extremity function. The refined 15-item Arabic LEFS met all the requirement of the Rasch model and hence is a valid objective measure of lower extremity function. The Rasch-validated 15-item Arabic LEFS needs to be further tested in an independent sample to confirm its fit to the Rasch measurement model. Implications for RehabilitationThe validity of the 20-item Arabic Lower Extremity Functional Scale to measure lower extremity function is not supported.The 15-item Arabic version of the LEFS is a valid measure of lower extremity function and can be used to quantify lower extremity function in patients with lower extremity musculoskeletal disorders. [ABSTRACT FROM PUBLISHER]

Purpose: Sickness certification implies that a health problem impairs ability to work. However, its assessment is seldom performed by physicians. Our objective was, therefore, to assess the specific influence of functional and environmental limitations on the length of sick-leave prescriptions. Method: We conducted a cross-sectional study in French general teaching practices and recorded 353 initial sick-leave certifications. For each of them, the functional and environmental limitations were collected using the ATCIF questionnaire, derived from the International Classification of Functioning. Data analysis was based on a linear regression multivariate model. Results: Among the functional limitations, "pain" was the main body function impairment (22% of impairments) and "mobility" the main activity limitation (48%). An environmental barrier was identified in 39% of sick-listed patients, mainly relating to "products and technology" (20%), which refers to workplace factors. The prescription was longer in cases of activity limitations relating to "mobility" and in cases of environmental barriers relating to "products and technology". The multivariate model explained 27% of the variability of sick-leave length through diagnosis elements and only 7% through functional and contextual elements. Conclusion: In sick-leave prescription, a functional and contextual approach, in addition to the traditional diagnosis-based approach, could better support patients' shared understanding and follow-up, and accountability towards health authorities. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of different exercise protocols on ataxia in patients with multiple sclerosis (MS). Method: A total of 42 MS patients, 17 male and 25 female (Expanded Disability Status Scale (EDSS): 3-5), were enrolled in this randomized controlled study. The patients were divided into three groups: a balance training (BT) group, a lumbar stabilization (LS) group and a task-oriented training (TT) group. All groups received balance training; additionally, the LS group received lumbar stabilization exercises, and the TT group received task-oriented training. The Berg Balance Scale (BBS), International Cooperative Ataxia Rating Scale (ICARS), Functional Reach Test (FRT), 2-Minute Walk Test (2MWT), Sensory Organization Test (SOT), and measurement of Somatosensory Evoked Potentials (SSEPs) were performed before and at the end of the 18 training sessions. Results: The BBS, ICARS, FRT, 2MWT, and composite balance score of the SOT were improved in all groups. The ICARS kinetic function sub-score and the left limb cortical onset amplitudes of SSEPs were increased significantly in both the TT and the LS groups. The ICARS total score, composite balance score, and 2MWT were different between groups (p < 0.05). According to multiple comparison analyses of the ICARS total score and the composite balance score, the LS, and the TT group were different from the BT group (p < 0.005), while the LS and the TT groups improved similarly (p > 0.005). The 2MWT results were better for the LS group than the BT group, while the BT and the TT groups improved similarly. Conclusion: Balance training alone is not sufficient for rehabilitation of ataxic MS patients. A combination of lumbar stabilization exercises or task-oriented training increases the success of balance rehabilitation. [ABSTRACT FROM AUTHOR]

Background:The repertoire of measures of walking in Rett syndrome is limited. This study aimed to determine measurement properties of a modified two-minute walk test (2MWT) and a modified Rett syndrome-specific functional mobility scale (FMS-RS) in Rett syndrome. Methods:Forty-two girls and women with Rett syndrome (median 18.4 years, range 2.4–60.9 years) were assessed for clinical severity, gross motor skills, and mobility. To measure walking capacity, 27 of this group completed a 2MWT twice on two different assessment days. To assess walking performance, the FMS-RS was administered to the total sample of parents (n = 42) on two occasions approximately one week apart. Results:There were negative correlations between clinical severity and 2MWT (r = −0.48) and FMS-RS (r = −0.60–0.66). There were positive correlations between gross motor skills and mobility and 2MWT (r = 0.51, 0.43) and FMS-RS (r = 0.71–0.93, 0.74–0.94), respectively. Test–retest reliability for the 2MWT was good with high intraday and interday correlations (ICC = 0.86–0.98). For the 2MWT, the standard error of measurement was 13.8 m and we would be 95% confident that changes greater than 38 m would be greater than within subject error. There was good test–retest reliability for all three distances on the FMS-RS (ICC = 0.94–0.99). Conclusions:Walking capacity as measured by the 2MWT showed expected but limited relationships with measures of different constructs, providing some support for concurrent validity. Walking performance as measured with the FMS-RS was more strongly consistent with other clinical measures supporting its concurrent validity. Test–retest reliability was good for both the FMS-RS and the 2MWT. Therefore, these measures have the potential to be used in clinical practice and research. Implications for RehabilitationWalking is one of the commonest daily physical activities in ambulant girls and women with RTT. Comprehensive knowledge about the walking abilities in this population is limited.Evidence of validity and test–retest reliability have been demonstrated for the modified two-minute walk test (2MWT) and the Rett syndrome-specific functional mobility scale (FMS-RS).The 2MWT and FMS-RS offer detailed information of the capacity and performance of walking, respectively, in girls and women with RTT [ABSTRACT FROM AUTHOR]

Purpose:Sick leave and unemployment are highly prevalent among people with affective disorders. Their depression severity is disabling and inversely related to having employment. No evidence-based vocational rehabilitation exists for this target group. Knowledge is therefore needed to understand the psychosocial factors that affect depression severity in order to develop new rehabilitation interventions. This study examined relationships between depression severity and empowerment, working life aspirations, occupational engagement, and quality of life in unemployed people with affective disorders receiving mental healthcare. Method:In this cross-sectional study of 61 participants, instruments on psychosocial factors and questions on descriptive sociodemographic and clinical characteristics were administered. Descriptive, correlation, and regression statistics were applied. Results:Correlation and regression analyses showed significant inverse relations between depression severity and empowerment and quality of life. The odds for more severe depression decreased with higher empowerment and quality of life. However, neither extent of engagement in daily life nor working life aspiration was related to depression severity. Conclusions:An empowerment approach and strategies, which support the quality of life, are needed in development of vocational rehabilitation interventions, and bridging of mental healthcare and vocational services.Implications for RehabilitationEnhancing empowerment and quality life in the return to work process can decrease depression severity in unemployed people with affective disorder.There is a need to address work issues in addition to symptom reduction in primary and mental healthcare.Bridging the service and time gap between vocational rehabilitation and healthcare is recommended for mitigating long-term unemployment for people with affective disorders who want to work. [ABSTRACT FROM PUBLISHER]

Objective:To examine the hypothesis that change in pain self-efficacy is associated with observed and self-reported activity, pain intensity, catastrophizing, and quality of life after multi-disciplinary rehabilitation of fibromyalgia patients. Design:In-depth analyses of secondary outcomes of a randomized-controlled trial. Subjects:Women (N = 187) with fibromyalgia. Methods:Outcomes were Pain Self-Efficacy, Assessment of Motor and Process Skills (AMPS), SF-36 Physical Function (SF-36-PF), pain intensity, and SF-36 Mental Composite Score (SF-36-MCS) to assess quality of life and pain catastrophizing. Individual and group associations between outcomes were examined. Results:Individual changes in pain self-efficacy were not associated with changes in observed activity: AMPS motor (rs = 0.08,p = 0.27) and process (rs = 0.12,p = 0.11), not even in those patients with a clinically relevant improvement in observed functioning (38.5%), and only weakly or moderatly with changes in SF-36-PF; (rs = 0.31,p < 0.0001), SF-36-MSC; (rs = 0.41,p < 0.0001), and pain catastrophizing (rs = −0.31,p < 0.0001). No differences in pain self-efficacy were observed between the rehabilitated group and controls (difference: 1.61; 95% CI: −0.84 to 4.06;p = 0.24). However, a subgroup (34%) had a clinically relevant improvement in pain self-efficacy. This group was younger (mean age 41.4 vs. 45.8,p = 0.01), more recently diagnosed (1.8 vs. 2.8 years,p = 0.003), but had an unresolved welfare situation (59% vs. 40%,p = 0.02). Conclusion:The main hypothesis was falsified, as there was no association between pain self-efficacy and actual performance of activity. The relation to functioning may be limited to perceived, cognitive-emotional aspects, as indicated by the weak to moderate correlations to the self-reported measures.Implications for RehabilitationImprovement in observed activity post multi-disciplinary rehabilitation was not associated with change in pain self-efficacy.Patients performed better after rehabilitation, but did not perceive to have improved their capacity.The relationship between pain self-efficacy and functioning may be limited to cognitive-emotional aspects rather than actual activity.Both observational and self-reported measures should be included in evaluating outcomes of rehabilitation for patients with fibromyalgia. [ABSTRACT FROM PUBLISHER]

Purpose: To examine the fit between data from the Short Form McGill Pain Questionnaire (SF-MPQ-2) and the Rasch model, and to explore the reliability and internal responsiveness of measures of pain in people with knee osteoarthritis. Methods: Participants with knee osteoarthritis completed the SF-MPQ-2, Intermittent and Constant Osteoarthritis Pain questionnaire (ICOAP) and painDETECT. Participants were sent the same questionnaires 3 and 6 months later. Results: Fit to the Rasch model was not achieved for the SF-MPQ-2 Total scale. The Continuous subscale yielded adequate fit statistics after splitting item 10 on uniform DIF for gender, and removing item 9. The Intermittent subscale fit the Rasch model after rescoring items. The Neuropathic subscale had relatively good fit to the model. Test–retest reliability was satisfactory for most scales using both original and Rasch scoring ranging from fair to substantial. Effect sizes ranged from 0.13 to 1.79 indicating good internal responsiveness for most scales. Conclusions: These findings support the use of ICOAP subscales as reliable and responsive measure of pain in people with knee osteoarthritis. The MPQ-SF-2 subscales found to be acceptable alternatives. The McGill Pain Questionnaire short version 2 is not a unidimensional scale in people with knee osteoarthritis, whereas three of the subscales are unidimensional. The McGill Pain Questionnaire short version 2 Affective subscale does not have good measurement properties for people with knee osteoarthritis. The McGill Pain Questionnaire short version 2 and the Intermittent and Constant Osteoarthritis Pain scales can be used to assess change over time. The painDETECT performs better as a screening measure than as an outcome measure. [ABSTRACT FROM AUTHOR]

Purpose:To translate and cross-culturally adapt the Foot and Ankle Ability Measure (FAAM) questionnaire and verify the psychometric properties of the Brazilian–Portuguese version of this instrument. Methods:Analysis of validity was carried out by applying the Rasch model and evaluating correlations with the Short Form-36 (SF-36) Physical Function (PF) subscale. Test–retest reliability and internal consistency were analyzed with the intraclass correlation coefficient (ICC2,1) and Cronbach’s alpha tests, respectively. Results:Ninety subjects with various foot and ankle musculoskeletal disorders (age 37.05 SD 10.49 years) were included. The ICC2,1was 0.88 and 0.82 with Cronbach’s alphas of 0.93 and 0.90 for the “Activities of Daily Living” (ADL) and “Sports” subscales, respectively. Correlations with the SF-36 PF were 0.78 (p < 0.01, CI95: 0.62–0.87) and 0.65 (p < 0.01, CI95: 0.45–0.79) for the ADL and Sports subscales, respectively. Item reliability indices in Rasch analysis were 0.91 (ADL) and 0.84 (Sports). Three items from the ADL subscale (14.2%) did not match the expectations of the model. All items from the Sports subscale fit the model. Conclusions:There is evidence of validity and reliability of the FAAM-Brazil. Rasch analysis indicated that three items of the ADL subscale did not fit the model in the sample studied.Implications for RehabilitationSelf-report questionnaires are commonly used in both clinical practice and research because of their ability to efficiently collect information. If the instrument is created properly, the information collected can be used to interpret the effect of clinical conditions on physical function.The Foot and Ankle Ability Measure (FAAM) is an evaluative instrument that assesses functional limitations for those with foot- and ankle-related disorders. It was translated into four languages and has evidence of validity, reliability, and responsiveness.Evidence of validity and reliability is provided for the FAAM-Brazil when applied to subjects with a wide range of foot and ankle musculoskeletal disorders. [ABSTRACT FROM PUBLISHER]

Purpose:To evaluate changes in pain intensity and activity limitation, at group and individual levels, and their associations with the global impression of change after multimodal rehabilitation in patients with back pain. Method:Patients with long-term back pain (n = 282) participated in a 4-week programme with a follow-up after 6 months. Visual analogue scales (VAS) were used to rate pain intensity and activity limitation. Global impression of change (GIC) was rated on a 7-category scale. The sign test, the Svensson method and the Spearman rank correlation were used for analyses. Results:Significantly lower ratings in pain and activity limitation at follow-up were found at group level. However, a large individual variability was found by the Svensson method. The correlations between GIC and changes in pain and activity limitation werers  = 0.49 andrs  =  0.50, respectively. A rated GIC of at least “much better” on group level showed changes of  ≥20 mm on the VAS. Conclusions:At group level, lower VAS ratings were found in patients with back pain. However, a large individual variability in pain and activity limitation was also found resulting in low to moderate associations between GIC and the change in VAS ratings. The large individual variability might be due to the impreciseness in the ratings on the VAS. We have presented a critical discussion of statistical methods in connection with the VAS.Implications for RehabilitationThe use of VAS as a rating instrument may be questioned, especially for perceived pain intensity which is a too complex experience to be rated on a line without any visible categories.Single ratings of pain intensity should preferably be complemented with the ratings of activity limitation in patients with long-term back pain.Global impression of change is a suggested inclusive rating after rehabilitation.The improvement desired by the patient should preferably be determined before rehabilitation. [ABSTRACT FROM PUBLISHER]