New psychometric strategies for an appropriate selection and use of outcome measures in physical and rehabilitation medicine

In order to be useful for their intended purposes, outcome measures (rating scales and questionnaires) must provide information that allows valid inferences and decisions to be made. Basic classical test theory is still widely used in peer-reviewed, indexed journals for validating these tools. Classical test theory methods mainly focus on an instrument’s total score, whichis simply asserted as the relevant statistic. But, this approach neglects a series of criteria that need to be considered when evaluating the psychometric properties of a measurement tool, and that can be analysed by Rasch analysis. The validation activities performed by RA are numerous; the most important ones are those connected with the analysis of: a. dimensionality; b. functioning of rating scale categories; c. internal construct validity of the measure; d. reliability of the scale, in terms of ‘separation’ (i.e. the ratio of the true spread of the measures with their measurement error). Thus, RA is being increasingly used in the development and evaluation of clinical tools for health care. The purpose of the present paper is to describe the main features of Rasch analysis in assessing outcome measures, and summarize some results of our recent psychometric studieson outcome measures in Physical and Rehabilitation Medicine, in order to provide insights for the appropriate selection and use of outcome measures.Physiatrists have a responsibility to ensure that measures used in clinical settings are psychometrically sound, and that they are administered thoughtfully and analysed correctly. The contents of this article can bring the final users to critically inspect each outcome measure and the related literature before adopting it for clinical practice, decision making, or policy development

Measurement precision of the Pain Catastrophizing Scale and its short forms in chronic low back pain

The Pain Catastrophizing Scale (PCS) is a widely studied tool to assess pain catastrophizing for chronic low back pain (LBP). Short forms of the PCS exist, but their measurement precision at individual level is unclear. This study aimed to analyze the Rasch psychometric characteristics of the PCS and three of its short forms (two 4-item and one 6-item) in a sample of 180 Italian-speaking patients with chronic LBP, and compare their measurement precision at the individual level. We performed a Rasch analysis on each version of the PCS and calculated test information functions (TIFs) to examine conditional measurement precision. Rasch analysis showed appropriate rating category functioning, unidimensionality, and acceptable fit to the Rasch model for all PCS versions. This represented a prerequisite for performing further advanced psychometric analyses. According to TIFs, the PCS full scale showed-at any score level-higher measurement precision in estimating individual pain catastrophizing than its short forms (which had unacceptably high standard errors of measurement). Our results show acceptable conditional precision of the PCS full scale in estimating pain catastrophizing. However, further studies are needed to confirm its diagnostic accuracy at individual level. On the other hand, the study warns against use of the three PCS short forms for clinical decision-making at the individual level

Post-surgical scar assessment in rehabilitation: a systematic review

n/

Rasch validation of the Activities-specific Balance Confidence Scale and its short versions in patients with Parkinson's disease.

Accepted Jan 10, 2014; Epub ahead of print Mar 28, 2014IntroductIonPostural instability is a key feature of advanced Parkinson's dis-ease (PD) (1), often leading to falls with dramatic consequences (2). Balance impairment can also induce psychological reactions, such as reduced balance confidence and increased fear of fall-ing. Balance confidence (a construct exploring fall-related self-efficacy) and fear of falling may be protective if they interfere only with hazardous activity and increase caution in performing daily living tasks. On the other hand, they can be maladaptive if their effect is to restrict mobility, independence and social par -ticipation, leading to further deconditioning, functional decline and poorer quality of life (3). Therefore, balance confidence is a construct that needs to be clearly understood, accurately meas-ured, and requires timely, appropriate management within fall risk assessment and fall prevention programmes (4).Balance confidence is often analysed with the Activities-specific Balance Confidence scale (ABC) (5), which has been shown to have sound psychometric properties in older adults (5, 6) and people with lower-limb amputations (7, 8) and stroke (9). In subjects with PD, the ABC has only recently been validated (10), by means of a Classical Test Theory approach, while the short versions of ABC proposed for PD (11–13) have undergone only preliminary validation.However, the Classical Test Theory approach does not take into account some standard criteria and attributes (concerning both single items and total score) that need to be considered when evaluating the measurement properties of a tool (14). Rasch analysis is being increasingly recommended in the development and evaluation of clinical tools for healthcare to verify if they comply with the theoretical requirements of measurement, including dimensionality analysis and item-level scale evaluation (15).The aim of this study was to analyse the psychometric prop-erties of the ABC and its 3 short versions in subjects with PD, using both Classical Test Theory and Rasch analysis, in order to determine whether fundamental measurement properties are satisfied and to provide insights into the optimal use of these questionnaires. METHOD

New psychometric strategies for an appropriate selection and use of outcome measures in physical and rehabilitation medicine

In order to be useful for their intended purposes, outcome measures (rating scales and questionnaires) must provide information that allows valid inferences and decisions to be made. Basic classical test theory is still widely used in peer-reviewed, indexed journals for validating these tools. Classical test theory methods mainly focus on an instrument’s total score, whichis simply asserted as the relevant statistic. But, this approach neglects a series of criteria that need to be considered when evaluating the psychometric properties of a measurement tool, and that can be analysed by Rasch analysis. The validation activities performed by RA are numerous; the most important ones are those connected with the analysis of: a. dimensionality; b. functioning of rating scale categories; c. internal construct validity of the measure; d. reliability of the scale, in terms of ‘separation’ (i.e. the ratio of the true spread of the measures with their measurement error). Thus, RA is being increasingly used in the development and evaluation of clinical tools for health care. The purpose of the present paper is to describe the main features of Rasch analysis in assessing outcome measures, and summarize some results of our recent psychometric studieson outcome measures in Physical and Rehabilitation Medicine, in order to provide insights for the appropriate selection and use of outcome measures.Physiatrists have a responsibility to ensure that measures used in clinical settings are psychometrically sound, and that they are administered thoughtfully and analysed correctly. The contents of this article can bring the final users to critically inspect each outcome measure and the related literature before adopting it for clinical practice, decision making, or policy development

The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis

Introduction: Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. Evidence acquisition: A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the "Consensus-based standards for the selection of health measurement instruments" checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. Evidence synthesis: A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in singleand cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). Conclusions: Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions

Animal assisted interventions in neurorehabilitation: a review of the most recent literature

Introduction: While conventional wisdom has always affirmed the value of animals in promoting human health and well-being, only recently has their therapeutic role in medicine become a topic for dedicated research. Animal assisted interventions (AAI) can be classified as animal-assisted activities, animal-assisted therapy, and service animal programmes. Objective: The aim of this review is to analyse original papers addressing AAI and neurological diseases and published in the most influential medical journals between 2001 and 2012, and discuss their findings in the light of what may be of interest in the field of neurology. Discussion: We selected a total of 23 articles on neurorehabilitation in cerebral palsy, pervasive developmental disorders, multiple sclerosis, spinal cord injury, stroke, and mental disorders. The main therapeutic results were improvement on the Gross Motor Function Classification Scale and in upper limb dexterity (cerebral palsy); improvement in social functioning and interaction; reductions in stress, anxiety, and loneliness (pervasive developmental disorders and mental disorders); and decreased spasticity with improved balance (multiple sclerosis, spinal cord injury, stroke). Conclusion: These interventions, performed with highly specialised animals in very specific neurological populations, deliver an increasing body of scientific evidence suggesting that they are an effective complement to other existing therapies. In these diseases, further high-quality studies are warranted in order to define the most appropriate programmes for therapy. Resumen: Introducción: Aunque siempre se ha afirmado el valor de los animales en la promoción del bienestar y la salud del ser humano, solo recientemente su papel terapéutico en medicina se ha convertido en el foco de investigación especializada. Las intervenciones asistidas por animales pueden dividirse en actividades asistidas por animales, terapia asistida por animales y programas de animales de servicio. Objetivo: El objetivo de esta revisión es analizar las publicaciones realizadas entre 2001 y 2012 en las revistas médicas más importantes, relacionadas con el campo de la rehabilitación de las enfermedades neurológicas, y discutir estos hallazgos a la luz de lo que pueda ser de interés para la neurología. Discusión: Se seleccionaron un total de 23 artículos de intervenciones en el campo de la parálisis cerebral infantil, trastornos generalizados del desarrollo, esclerosis múltiple, lesión medular, accidente cerebrovascular y trastornos mentales. Los principales resultados terapéuticos fueron: mejoría en la Gross Motor Function y en el manejo del miembro superior (parálisis cerebral infantil); aumento de la socialización y el contacto con el medio ambiente, reducción del estrés y la ansiedad y sentimientos de soledad (trastornos generalizados del desarrollo y trastornos mentales); disminución de la espasticidad y mejoría del equilibrio (esclerosis múltiple, lesión medular, accidente cerebrovascular). Conclusiones: Estas intervenciones asistidas con un tipo de animales muy limitado utilizadas en grupos clínicos neurológicos muy específicos muestran cada vez más pruebas científicas, como método complementario a otras terapias ya existentes. En estas enfermedades, se necesitan más estudios de alta calidad metodológica que permitan definir los programas más apropiados para la aplicación terapéutica. Keywords: Animal assisted therapy, Service animals, Nervous system diseases, Palabras clave: Terapia asistida por animales, Animales de servicio, Enfermedades del sistema nervios

Is the Rivermead Mobility Index a suitable outcome measure in lower limb amputees?--A psychometric validation study.

Objective: To examine the internal consistency, validity, responsiveness and test scalability of the Rivermead Mobility Index. Design: Methodological research (consecutive sampling, prospective longitudinal study). Patients: 140 unilateral lower limb amputees (79 above-knee and 61 below-knee). Methods: The Rivermead Mobility Index was administered to all patients at the beginning (T0) and at the end (T2) of the prosthetic training. In 70 of the patients, the Functional Independence Measure and a timed walking test were also carried out. Results: The Cronbach's alpha of the Rivermead Mobility Index was 0.85 and the item-to-total correlation coefficients rpb ranged from 0.33 to 0.74 (p 0.0001), for the items considered, at T0; 4 correlations were not calculated due to the extremely low variability of some item responses (mode 98%). The correlation (rs) of Rivermead Mobility Index score with the motor subscale of the Functional Independence Measure was 0.83 at T0 and 0.69 at T2 (p 0.0001, for both) and that with timed walking test 0.70 (p 0.0001) at T2. The effect size was 1.35. The scalability coefficients were below the limits of acceptability. Conclusion: When applied in lower limb amputees, the Rivermead Mobility Index is an ordinal measure with adequate levels of a series of psychometric properties, which seems more useful for epidemiological studies than for clinical decision-making in single patients. Further steps should be considered to improve its item selection, response format and scaling properties

Video-based Goniometer Applications for Measuring Knee Joint Angles during Walking in Neurological Patients: A Validity, Reliability and Usability Study

: Easy-to-use evaluation of Range Of Motion (ROM) during walking is necessary to make decisions during neurological rehabilitation programs and during follow-up visits in clinical and remote settings. This study discussed goniometer applications (DrGoniometer and Angles - Video Goniometer) that measure knee joint ROM during walking through smartphone cameras. The primary aim of the study is to test the inter-rater and intra-rater reliability of the collected measurements as well as their concurrent validity with an electro-goniometer. The secondary aim is to evaluate the usability of the two mobile applications. A total of 22 patients with Parkinson's disease (18 males, age 72 (8) years), 22 post-stroke patients (17 males, age 61 (13) years), and as many healthy volunteers (8 males, age 45 (5) years) underwent knee joint ROM evaluations during walking. Clinicians and inexperienced examiners used the two mobile applications to calculate the ROM, and then rated their perceived usability through the System Usability Scale (SUS). Intraclass correlation coefficients (ICC) and correlation coefficients (corr) were calculated. Both applications showed good reliability (ICC > 0.69) and validity (corr > 0.61), and acceptable usability (SUS > 68). Smartphone-based video goniometers could be used to assess the knee ROM during walking in neurological patients, because of their acceptable degree of reliability, validity and usability

Intra and inter-session reliability of rapid Transcranial Magnetic Stimulation stimulus-response curves of tibialis anterior muscle in healthy older adults

Objective: The clinical use of Transcranial Magnetic Stimulation (TMS) as a technique to assess corticospinal excitability is limited by the time for data acquisition and the measurement variability. This study aimed at evaluating the reliability of Stimulus-Response (SR) curves acquired with a recently proposed rapid protocol on tibialis anterior muscle of healthy older adults. Methods: Twenty-four neurologically-intact adults (age:55–75 years) were recruited for this test-retest study. During each session, six SR curves, 3 at rest and 3 during isometric muscle contractions at 5% of maximum voluntary contraction (MVC), were acquired. Motor Evoked Potentials (MEPs) were normalized to the maximum peripherally evoked response; the coil position and orientation were monitored with an optical tracking system. Intra- and inter-session reliability of motor threshold (MT), area under the curve (AURC), MEPmax, stimulation intensity at which the MEP is mid-way between MEPmax and MEPmin (I50), slope in I50, MEP latency, and silent period (SP) were assessed in terms of Standard Error of Measurement (SEM), relative SEM, Minimum Detectable Change (MDC), and Intraclass Correlation Coefficient (ICC). Results: The relative SEM was ≤10% for MT, I50, latency and SP both at rest and 5%MVC, while it ranged between 11% and 37% for AURC, MEPmax, and slope. MDC values were overall quite large; e.g., MT required a change of 12%MSO at rest and 10%MSO at 5%MVC to be considered a real change. Inter-sessions ICC were >0.6 for all measures but slope at rest and MEPmax and latency at 5%MVC. Conclusions: Measures derived from SR curves acquired in <4 minutes are affected by similar measurement errors to those found with long-lasting protocols, suggesting that the rapid method is at least as reliable as the traditional methods. As specifically designed to include older adults, this study provides normative data for future studies involving older neurological patients (e.g. stroke survivors)