Measuring psychological pain: psychometric analysis of the Orbach and Mikulincer Mental Pain Scale

Background: Suicide is a public health concern, with an estimated 1 million individuals dying each year worldwide. Individual psychological pain is believed to be a contributing motivating factor. Therefore, establishing a psychometrically sound tool to adequately measure psychological pain is important. The Orbach and Mikulincer Mental Pain Scale (OMMP) has been proposed; however, previous psychometric analysis on the OMMP has not yielded a consistent scale structure, and the internal consistency of the subscales has not met recommended values. Therefore, the primary purpose of this study was to assess the psychometric properties of the OMMP in a diverse sample. Methods: A confirmatory factor analysis (CFA) on the 9-factor, 44-item OMMP was conducted on the full sample (n = 1151). Because model fit indices were not met, an exploratory factor analysis (EFA) was conducted on a random subset of the data (n = 576) to identify a more parsimonious structure. The EFA structure was then tested in a covariance model in the remaining subset of participants (n = 575). Multigroup invariance testing was subsequently performed to examine psychometric properties of the refined scale. Results: The CFA of the original 9-factor, 44-item OMMP did not meet recommended model fit recommendations. The EFA analysis results revealed a 3-factor, 9-item scale (i.e., OMMP-9). The covariance model of the OMMP-9 indicated further refinement was necessary. Multigroup invariance testing conducted on the final 3-factor, 8-item scale (i.e., OMMP-8) across mental health diagnoses, sex, injury status, age, activity level, and athlete classification met all criteria for invariance. Conclusions: The 9-factor, 44-item OMMP does not meet recommended measurement criteria and should not be recommended for use in research and clinical practice in its current form. The refined OMMP-8 may be a more viable option to use; however, more research should be completed prior to adoption

Psychometric analysis of the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR)

Objective: Centers for Medicare and Medicaid Services (CMS) has requested hospitals collect and report patient-reported outcomes (PROs) beginning in 2024 including the Hip Disability and Osteoarthritis Outcome Score Joint Replacement (HOOS-JR). However, scale structural validity of the HOOS-JR has minimally been assessed. The purpose of this study was to assess internal consistency, structural validity, and multi-group invariance properties of the HOOS-JR in a large sample of patients who underwent a total hip arthroplasty (THA). Methods: A cross-sectional study using the Surgical Outcomes System was retrospectively queried for patients who underwent a THA. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. A confirmatory factor analysis (CFA) was performed on the HOOS-JR using a priori cut-off values. Multi-group invariance testing was also performed on the sample of patients across sex and age groups. Results: Internal consistency was acceptable for 6-item (alpha ​= ​0.88; omega ​= ​0.88) and 5-item (alpha ​= ​0.86; omega ​= ​0.86) HOOS-JR. The one-factor, 6-item CFA did not meet the recommended fit indices. The one-factor, 5-item CFA had acceptable fit for the sample data. Invariance testing criteria were met between the age groups; however, scalar invariance was not met for sex. Conclusion: The 6-item HOOS-JR did not meet contemporary model fit indices indicating that scale refinement is warranted. The 5-item met most goodness-of-fit indices and invariance criteria. However, further scale refinement may be warranted as localized fit issues were identified

Confirmatory Factor Analysis of the Hip Disability and Osteoarthritis Outcome Score (HOOS) and Associated Sub-scales

# Background Hip Disability and Osteoarthritis Outcome Score (HOOS), HOOS-Joint Replacement (JR), HOOS Physical Function (PS), and HOOS-12 item scale have been suggested as reliable and valid instruments for assessing hip disability. However, factorial validity, invariance across subgroups, and repeated measures of the scale across different populations have not been well supported in the literature. # Purpose The primary study objectives were to: (1) assess model fit and psychometric properties of the original 40-item HOOS scale, (2) assess model fit of the HOOS-JR, (3) assess model fit of the HOOS-PS, and (4) assess model fit of the HOOS-12. A secondary objective was to perform multigroup invariance testing across physical activity level and hip pathology subgroups for models that met recommended fit indices. # Study Design Cross-Sectional Study # Methods Individual confirmatory factor analyses (CFAs) were conducted for the HOOS, HOOS-JR, HOOS-PS, and HOOS-12. Additionally, multigroup invariance testing (i.e., activity level, injury type) was conducted on the HOOS-JR and HOOS-PS. # Results Model fit indices did not meet contemporary recommendations for the HOOS and the HOOS-12. Model fit indices for the HOOS-JR and the HOOS-PS met some, but not all, contemporary recommendations. Invariance criteria was met for the HOOS-JR and HOOS-PS. # Conclusion The scale structure of the HOOS and HOOS-12 were not supported; however, preliminary evidence to support the scale structure of the HOOS-JR and HOOS-PS was found. Clinicians and researchers who utilize the scales should do so with caution due to their limitations and untested properties until further research establishes the full psychometric properties of these scales and recommendations for their continued use

Effects of a Total Motion Release (TMR®) Protocol for the Single Leg Squat on Asymmetrical Movement Patterns

# BACKGROUND Improving single leg squat (SLS) movement symmetry may benefit rehabilitation protocols. The Total Motion Release® (TMR®) protocol has been theorized to evaluate and improve patient-perceived movement asymmetries. # HYPOTHESIS/PURPOSE The purpose of this study was to evaluate whether perceived asymmetries identified by a TMR® scoring protocol were related to biomechanical asymmetries and whether improving perceived asymmetries influenced movement mechanics. It was hypothesized that participants with perceived asymmetries would also present with biomechanical asymmetries. A secondary hypothesis was that participants would reduce their perceived asymmetries after performing the TMR® protocol and subsequently have greater biomechanical symmetry. # STUDY DESIGN Descriptive Cohort (Laboratory Study). # METHODS Twenty participants (10 female, 10 male) with self-identified bilateral differences of 10 points or greater on the TMR® scoring scale were recruited for the study. The non-preferred side was defined as the side that scored higher. 3Dimensional motion capture was used to bilaterally assess baseline SLS depth as well as hip, knee, and ankle kinematics and kinetics. For the TMR® protocol, sets of 10 SLSs were performed on the preferred leg until their perceived asymmetries were resolved (i.e., both sides scored equally), or four sets had been completed. Kinematics and kinetics were collected immediately after the intervention and after a 10-minute rest period. # RESULTS Participants had biomechanical asymmetries at baseline for knee flexion, ankle flexion, and knee moments. Following the intervention, participants had reduced TMR® scores on the non-preferred leg, and this coincided with increased knee joint moments on that side. Although perceived asymmetries were resolved after the intervention, kinematic and kinetic asymmetries at the knee and ankle were still present. # CONCLUSIONS A TMR® intervention could benefit rehabilitation protocols by reducing factors of dysfunction and increasing the ability of patients to load the non-preferred knee. Further investigations are necessary to elucidate the importance of asymmetrical movement patterns. # LEVEL OF EVIDENCE 3

Comparison of Three Single Leg Weightbearing Tasks with Statistical Parametric Mapping

The single leg squat (SLS), forward step down (FSD), and lateral step down (LSD) are clinically reliable movement screens for identifying motion imbalances. The current understanding for the kinematic profiles of each task is limited to discrete time points such as peak knee flexion. However, analyses of the entire movement would better aid clinicians when selecting the appropriate task for rehabilitation or movement screen purposes. The current study used Statistical Parametric Mapping to ascertain differences in the kinematic waveforms for the entire duration of each task. The trunk, pelvis, hip, and knee were analyzed in the sagittal and frontal planes. Data for each variable and task were analyzed from 0–100% of the movement. Primary findings indicated that the FSD provoked a greater magnitude of knee abduction than the SLS and LSD from 26–66% of the movement. The SLS generated the greatest amounts of trunk, pelvic, and hip flexion for the entirety of the movement. The LSD elicited the least amount of ipsilateral trunk lean (90–100%). Thus, the FSD may be optimal for assessing frontal plane knee motion as a screen for injury risk, while the SLS has potential to place increased sagittal plane demand on the muscles of the hip

Comparison of Three Single Leg Weightbearing Tasks with Statistical Parametric Mapping

The single leg squat (SLS), forward step down (FSD), and lateral step down (LSD) are clinically reliable movement screens for identifying motion imbalances. The current understanding for the kinematic profiles of each task is limited to discrete time points such as peak knee flexion. However, analyses of the entire movement would better aid clinicians when selecting the appropriate task for rehabilitation or movement screen purposes. The current study used Statistical Parametric Mapping to ascertain differences in the kinematic waveforms for the entire duration of each task. The trunk, pelvis, hip, and knee were analyzed in the sagittal and frontal planes. Data for each variable and task were analyzed from 0–100% of the movement. Primary findings indicated that the FSD provoked a greater magnitude of knee abduction than the SLS and LSD from 26–66% of the movement. The SLS generated the greatest amounts of trunk, pelvic, and hip flexion for the entirety of the movement. The LSD elicited the least amount of ipsilateral trunk lean (90–100%). Thus, the FSD may be optimal for assessing frontal plane knee motion as a screen for injury risk, while the SLS has potential to place increased sagittal plane demand on the muscles of the hip