Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

BACKGROUND: ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. AIM: The aim of this study was to perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post-stroke patients living in Benin, a West-African country. DESIGN: Observational cross-sectional study. SETTING: Outpatient rehabilitation centres. POPULATION: 223 Beninese chronic stroke patients. METHODS: The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM-Stroke. Data were analysed with the Rasch partial credit model. RESULTS: The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; P=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. CONCLUSIONS: The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. CLINICAL REHABILITATION IMPACT: This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country

Evaluation of manual ability in stroke patients in Benin: cultural adaptation and Rasch validation of the ABILHAND-Stroke questionnaire.

ABILHAND is a self-reported questionnaire assessing manual ability. It was validated and calibrated using the Rasch analysis for European stroke patients. After a stroke, performing upper limb activities of daily living is influenced by personal and environmental contextual factors. It is thus important to conduct a contextual validation to use this questionnaire outside of Europe. To perform a cross cultural validation of the ABILHAND-Stroke questionnaire for post- stroke patients living in Benin, a West-African country. Observational cross-sectional study. Outpatient rehabilitation centres. 223 Beninese chronic stroke patients. The experimental questionnaire was made of 59 items evaluating manual activities. Patients had to estimate their difficulty of performing each activity according to four response categories: impossible, very difficult, difficult and easy. For construct validity analysis, patients were also evaluated with other assessment tools: Box and Block Test, the motor subscale of the Functional Independence Measure, the Stroke Impairment Assessment Set, and ACTIVLIM- Stroke. Data were analysed with the Rasch partial credit model. The response categories very difficult and difficult were merged and the number of response categories was reduced from 4 to 3 (impossible, difficult and easy). The Rasch analyses selected 16 bimanual activities that fit the Rasch model (chi square=42.35; p=0.10). The item location ranged from -1.10 to 2.24 logits. The standard error ranged from 0.15 to 0.22 logits. There is no differential item functioning between subgroups (age, sex, dexterity, affected side, time since stroke). The person separation index is 0.82. The questionnaire can measure 3 levels of manual ability, similarly to the occidental version. The ABILHAND-stroke is a Rasch validated, unidimensional and invariant questionnaire to assess manual ability among Beninese patients. The ordinal score can be transformed into linear score using a conversion table. This assessment tool is clinically relevant in Benin, a developing country, since it requires no specific equipment or training. It should promote and standardize assessments for stroke patients in clinical practice and research in this African country

Design and Accuracy of an Instrumented Insole Using Pressure Sensors for Step Count

Despite the accessibility of several step count measurement systems, count accuracy in real environments remains a major challenge. Microelectromechanical systems and pressure sensors seem to present a potential solution for step count accuracy. The purpose of this study was to equip an insole with pressure sensors and to test a novel and potentially more accurate method of detecting steps. Methods: Five force-sensitive resistors (FSR) were integrated under the heel, the first, third, and fifth metatarsal heads and the great toe. This system was tested with twelve healthy participants at self-selected and maximal walking speeds in indoor and outdoor settings. Step counts were computed based on previously reported calculation methods, individual and averaged FSR-signals, and a new method: cumulative sum of all FSR-signals. These data were compared to a direct visual step count for accuracy analysis. Results: This system accurately detected steps with success rates ranging from 95.5 ± 3.5% to 98.5 ± 2.1% (indoor) and from 96.5 ± 3.9% to 98.0 ± 2.3% (outdoor) for self-selected walking speeds and from 98.1 ± 2.7% to 99.0 ± 0.7% (indoor) and 97.0 ± 6.2% to 99.4 ± 0.7% (outdoor) for maximal walking speeds. Cumulative sum of pressure signals during the stance phase showed high step detection accuracy (99.5 ± 0.7%⁻99.6 ± 0.4%) and appeared to be a valid method of step counting. Conclusions: The accuracy of step counts varied according to the calculation methods, with cumulative sum-based method being highly accurate

Validity of Instrumented Insoles for Step Counting, Posture and Activity Recognition: A Systematic Review

With the growing interest in daily activity monitoring, several insole designs have been developed to identify postures, detect activities, and count steps. However, the validity of these devices is not clearly established. The aim of this systematic review was to synthesize the available information on the criterion validity of instrumented insoles in detecting postures activities and steps. The literature search through six databases led to 33 articles that met inclusion criteria. These studies evaluated 17 different insole models and involved 290 participants from 16 to 75 years old. Criterion validity was assessed using six statistical indicators. For posture and activity recognition, accuracy varied from 75.0% to 100%, precision from 65.8% to 100%, specificity from 98.1% to 100%, sensitivity from 73.0% to 100%, and identification rate from 66.2% to 100%. For step counting, accuracies were very high (94.8% to 100%). Across studies, different postures and activities were assessed using different criterion validity indicators, leading to heterogeneous results. Instrumented insoles appeared to be highly accurate for steps counting. However, measurement properties were variable for posture and activity recognition. These findings call for a standardized methodology to investigate the measurement properties of such devices