Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling

Background Dupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model. Methods Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items. Results DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ2 = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study. Conclusions The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population

La réadaptation en ergothérapie à la suite de l’injection de toxine botulique chez les personnes présentant de la spasticité à un membre supérieur : revue de portée

Introduction. La spasticité du membre supérieur liée à un accident vasculaire cérébral (AVC) ou à l’infirmité motrice cérébrale (IMC) limite l’exécution des habitudes de vie. Un traitement efficace pour limiter cette spasticité est l’injection de toxine botulique dans les muscles atteints. Cependant, l’effet de la toxine ne dure généralement qu’entre deux et quatre mois. D’autres modalités thérapeutiques sont alors nécessaires pour maximiser le traitement. Objectif. L’objectif de cette revue de portée est de déterminer les interventions efficaces en ergothérapie suivant l’injection de toxine botulique au membre supérieur spastique afin d’augmenter la fonctionnalité de ce dernier. Méthodes. Les écrits scientifiques de 2000 à 2016 ont été recensés dans les bases de données CINAHL, Medline, Embase, PubMed et Cochrane Database of Systematic Reviews. Une recherche manuelle dans la bibliographie des articles retenus a également été effectuée. Les articles ont été analysés et résumés. Résultats. Seize articles ont été retenus pour l’analyse. Plusieurs interventions d’ergothérapie pouvant améliorer les effets bénéfiques de l’injection de toxine botulique ont été identifiées. Conclusion. Les résultats tendent à indiquer que les interventions utilisées dans les études sont toutes efficaces. Toutefois, bien que le nombre d'articles analysés soit modeste, il semble qu'une réadaptation combinant de la thérapie par contrainte induite du mouvement modifié, des activités fonctionnelles bimanuelles et le port d'une orthèse permet de maximiser l'augmentation des capacités physiques et fonctionnelles à la suite de l'injection de toxine botulique, Les ergothérapeutes doivent cependant bâtir leur plan d'intervention en fonction des capacités de la personne et de ses objectifs. Mots-clés. Réadaptation, ergothérapie, toxine botulique, spasiticté, AVC, paralysie cérébrale, revue de portée ____________________________________________ Rehabilitation in occupational therapy following injection of botulinum toxin for upper extremity spasticity: Scoping review Abstract Introduction. Upper limb spasticity following stroke or related to cerebral palsy limits the execution of life habits. One treatment to reduce the spasticity is the injection of botulinum toxin in the affected muscles. However, the effect of the toxin generally lasts between two and four months. Other modalities are necessary to increase the beneficial effects of the toxin. Objective. The objective of this scoping review is to identifiy effective occupational therapy interventions to promote the beneficial effects of the injection of botulinum toxin in the spastic upper limb. Methods. Articles from 2000 to 2016 were gathered from the databases CINAHL, Medline, Embase, PubMed and Cochrane Database of Systematic Reviews. Also, a manual search of the bibliography of selected articles was done. The articles were analysed and summarised. Results. 16 articles were selected for analysis. Several occupational therapy interventions that can enhance the beneficial effects of botulinum toxin injections were identified. Conclusion. The results suggest that all the interventions used in the studies are effective. However, despite the small number of articles analysed, it appears that the combination maximises the physical and functional capacities after the injection of botulinum toxin. Occupational therapists msut nevertheless create their own intervention plan based on the person's capacities and objectives. Keywords. Rehabilitation, occupational therapy, botulinum toxin, spasticity, stroke, cerebral palsy, scoping stud

Somesthetic, Visual, and Auditory Feedback and Their Interactions Applied to Upper Limb Neurorehabilitation Technology: A Narrative Review to Facilitate Contextualization of Knowledge

Reduced hand dexterity is a common component of sensorimotor impairments for individuals after stroke. To improve hand function, innovative rehabilitation interventions are constantly developed and tested. In this context, technology-based interventions for hand rehabilitation have been emerging rapidly. This paper offers an overview of basic knowledge on post lesion plasticity and sensorimotor integration processes in the context of augmented feedback and new rehabilitation technologies, in particular virtual reality and soft robotic gloves. We also discuss some factors to consider related to the incorporation of augmented feedback in the development of technology-based interventions in rehabilitation. This includes factors related to feedback delivery parameter design, task complexity and heterogeneity of sensory deficits in individuals affected by a stroke. In spite of the current limitations in our understanding of the mechanisms involved when using new rehabilitation technologies, the multimodal augmented feedback approach appears promising and may provide meaningful ways to optimize recovery after stroke. Moving forward, we argue that comparative studies allowing stratification of the augmented feedback delivery parameters based upon different biomarkers, lesion characteristics or impairments should be advocated (e.g., injured hemisphere, lesion location, lesion volume, sensorimotor impairments). Ultimately, we envision that treatment design should combine augmented feedback of multiple modalities, carefully adapted to the specific condition of the individuals affected by a stroke and that evolves along with recovery. This would better align with the new trend in stroke rehabilitation which challenges the popular idea of the existence of an ultimate good-for-all intervention

Bringing patient advisors to the bedside: a promising avenue for improving partnership between patients and their care team

This paper presents an innovative model of care, which brings patients who have already been through a similar experience of illness (patient advisors) directly to the bedside of patients, where they are viewed as full-fledged members of the clinical team. As part of a pilot project, three patient advisors were recruited and met with patients who had sustained a traumatic amputation and were admitted to the only center of expertise in replantation of the upper limb in Canada. Several individual interviews and focus groups with patients and patient advisors have revealed very promising results. Indeed, patients have expressed tremendous appreciation for their meetings and interactions with patient advisors. They have stated feeling less isolated, having a better morale and increased hopefulness regarding the outcome of the care pathway. Patient advisors also felt a positive impact of their involvement. A larger study needs to be conducted to determine the impact of this model of care on patient adherence to treatment and on members of the health care team

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reliability and minimal detectable change of the mini-BESTest in adults with spinal cord injury in a rehabilitation setting

Background: The mini-Balance Evaluation Systems Test (mini-BESTest) is a valid tool for assessing standing balance in people with spinal cord injury (SCI). Its reliability has not yet been investigated with this population. Objective: To assess the test-retest and inter-rater reliability of the mini-BESTest in adults with SCI in a rehabilitation setting. Methods: Twenty-three participants admitted in a rehabilitation center following an SCI (mean age = 52.2 years, SD = 14.5; 13/23 tetraplegia; 14/23 traumatic injury) and able to stand 30 seconds without help were recruited. They were evaluated twice with the mini-BESTest to establish the test-retest reliability (interval of 1 to 2 days). One of the two sessions was video-recorded to establish the inter-rater reliability (3 physiotherapists). Intraclass correlation coefficients (ICC2,1), weighted kappa (Kw) and Kendall’s W were used to determine reliability of total score and individual items. Minimal detectable changes (MDC) were computed. Results. The mini-BESTest total scores showed excellent test-retest (ICC = 0.94) and inter-rater (ICC = 0.96) reliability. Reliability of 50% of the individual items was acceptable to excellent (Κw and W = 0.35–1.00). The MDC of the mini-BESTest total score was 4 points. Conclusion: The mini-BESTest is a reliable tool to assess standing balance in adults with an SCI. A minimal change of 4 points on the total scale is needed to be confident that the change is not a measurement error between two sessions or two raters

Correlates of recovery of upper extremity function in the acute phase post stroke

Despite its importance in activities of daily living, little research has been done on the recovery of upper extremity (UE) function in acute stroke. The objectives of this prospective study were to quantify the recovery of UE function during the first five weeks post-stroke; to compare the recovery of UE function with the recovery of lower extremity (LE) function; and to identify predictors of recovery of UE function.Fifty-five first-time stroke patients were evaluated using measures of UE and LE function at the first and fifth week post-stroke. Standardized response means were used to compare the recovery of UE and LE. Multiple linear regression was used to identify predictors of UE function. There was no evidence that the recovery of the UE was different from that of the LE. Measures of UE function at the first week post-stroke were the most important predictors of UE function one month post-stroke