From function to participation : illustration through the development and validation of three measurement tools in physical medicine and rehabilitation

La médecine physique et de réadaptation (MPR) s’est développée autour d’une approche globale de l’individu et des multiples conséquences des déficiences et incapacités résultant d’un problème de santé. La détermination de ces conséquences nécessite le recours à l’évaluation, concept largement utilisé en médecine lors de la pratique clinique, la thérapeutique, la recherche… Cette évaluation, qui repose elle-même sur la nécessaire évaluation de l’outil de mesure et de ses modalités d’utilisation, constitue le corps de notre travail de thèseLa vision MPR s’est construite sur la Classification internationale du fonctionnement, du handicap et de la santé (CIF) qui fournit un cadre biopsychosocial pour la description des états de santé, pouvant ainsi servir à la définition du mesuré. Les liens étroits entre MPR et CIF nous ont amenés à nous interroger sur les différentes manières de développer des outils d’évaluation adaptés à chacune des dimensions de la CIF : la fonction, l’activité et la participation.À travers différents états de santé, nous avons donc exploré ces trois dimensions cliniques en utilisant des méthodes valides en métrologie, via trois outils de mesure : (1) de la fonction neurologique chez des enfants ayant eu un accident vasculaire cérébral néonatal, (2) d’activité physique et cognitive chez des patients hospitalisés en soins de suite et de réadaptation et (3) de la participation d’enfants ayant une maladie neuromusculaire. Les résultats et leur interprétation placent la participation comme critère principal des actions en MPR tout en soulignant l’importance de maitriser la limite de chaque outil de mesure bien avant de valoriser de leurs avantages.Physical and Rehabilitation Medicine (PRM) has been developed around a holistic approach of the individual and the multiple consequences of impairments and disabilities resulting from a health problem. Determining these consequences requires the use of assessment, which is a concept widely used in medicine in clinical practice, therapy, research, and which is based on the use of measuring tools. The PRM vision was built on the International Classification of Functioning, Disability and Health (ICF) which is a biopsychosocial framework for the description of the health state, which can thus be used to define of the measured. The close links between PRM and ICF led us to question the different ways of developing assessment tools adapted to each of the dimensions of the ICF: function, activity and participation. We have therefore through various health states, explored these three dimensions in clinical practice using valid methods in metrology, via three measurement tools: (1) neurological function in French-speaking children with a neonatal stroke, (2) a score of physical and cognitive activity in patients hospitalized in follow-up care and rehabilitation, (3) participation of children with neuromuscular disease. The results and their interpretation stemming from this work, clearly place participation as the main criterion for actions in PRM while highlighting the importance of mastering the limits of measurement tools before taking into account their advantages

De la fonction à la participation : illustration par le développement et la validation de trois outils de mesure en médecine physique et de réadaptation

Physical and Rehabilitation Medicine (PRM) has been developed around a holistic approach of the individual and the multiple consequences of impairments and disabilities resulting from a health problem. Determining these consequences requires the use of assessment, which is a concept widely used in medicine in clinical practice, therapy, research, and which is based on the use of measuring tools. The PRM vision was built on the International Classification of Functioning, Disability and Health (ICF) which is a biopsychosocial framework for the description of the health state, which can thus be used to define of the measured. The close links between PRM and ICF led us to question the different ways of developing assessment tools adapted to each of the dimensions of the ICF: function, activity and participation. We have therefore through various health states, explored these three dimensions in clinical practice using valid methods in metrology, via three measurement tools: (1) neurological function in French-speaking children with a neonatal stroke, (2) a score of physical and cognitive activity in patients hospitalized in follow-up care and rehabilitation, (3) participation of children with neuromuscular disease. The results and their interpretation stemming from this work, clearly place participation as the main criterion for actions in PRM while highlighting the importance of mastering the limits of measurement tools before taking into account their advantages.La médecine physique et de réadaptation (MPR) s’est développée autour d’une approche globale de l’individu et des multiples conséquences des déficiences et incapacités résultant d’un problème de santé. La détermination de ces conséquences nécessite le recours à l’évaluation, concept largement utilisé en médecine lors de la pratique clinique, la thérapeutique, la recherche… Cette évaluation, qui repose elle-même sur la nécessaire évaluation de l’outil de mesure et de ses modalités d’utilisation, constitue le corps de notre travail de thèseLa vision MPR s’est construite sur la Classification internationale du fonctionnement, du handicap et de la santé (CIF) qui fournit un cadre biopsychosocial pour la description des états de santé, pouvant ainsi servir à la définition du mesuré. Les liens étroits entre MPR et CIF nous ont amenés à nous interroger sur les différentes manières de développer des outils d’évaluation adaptés à chacune des dimensions de la CIF : la fonction, l’activité et la participation.À travers différents états de santé, nous avons donc exploré ces trois dimensions cliniques en utilisant des méthodes valides en métrologie, via trois outils de mesure : (1) de la fonction neurologique chez des enfants ayant eu un accident vasculaire cérébral néonatal, (2) d’activité physique et cognitive chez des patients hospitalisés en soins de suite et de réadaptation et (3) de la participation d’enfants ayant une maladie neuromusculaire. Les résultats et leur interprétation placent la participation comme critère principal des actions en MPR tout en soulignant l’importance de maitriser la limite de chaque outil de mesure bien avant de valoriser de leurs avantages

Fixed-distance walk tests at comfortable and fast speed: Potential tools for the functional assessment of coronary patients?

International audienceObjectivesThere is ambiguity concerning the walk tests available for functional assessment of coronary patients, particularly for the walking speed. This study explores the psychometric properties of two walking tests, based on fixed-distance tests, at comfortable and fast velocity, in stabilized patients at the end of a cardiac rehabilitation program.MethodsAt a three-day interval 58 coronary patients (mean age of 64.85 ± 6.03 years, 50 men) performed three walk tests, the first two at a comfortable speed in a random order (6-minute walk test – 6MWT – and 400-metre comfortable walk test – 400mCWT) and the third at a brisk speed (200-metre fast walk test – 200mFWT). A modified Bruce treadmill test was associated at the end of the second phase. Monitored main parameters were: heart rate, walking velocity, VO2.ResultsTolerance to the 3 tests was satisfactory. The reliability of the main parameters was good (intraclass correlation coefficient > 0.8). The VO2 concerning 6MWT and 400mCWT were not significantly different (P = 0.33) and were lower to the first ventilatory threshold determined by the stress test (P < 0.001): 16.2 ± 3.0 vs. 16.5 ± 2.6 vs. 20.7 ± 5.1 mL·min−1·kg−1 respectively. The VO2 of the 200mFWT (20.2 ± 3.7) was not different from the first ventilatory threshold.Conclusions400mCWT and 200mFWT are feasible, well-tolerated and reliable. They explore two levels of effort intensity (lower and not different to the first ventilatory threshold respectively). 400mCWT is a possible alternative to 6MWT. Associated with 200mFWT it should allow a better measurement of physical capacities and better customization of exercise training

SMA: Des échelles d’évaluation motrice pour le public francophone

À l’heure des nouvelles thérapeutiques chez les personnes présentant une amyotrophie spinale antérieure ou spinal muscular atrophy (SMA), la mesure régulière, précise et fiable des capacités motrices est devenue indispensable. Différents outils ont été développés dans la littérature et peuvent être utilisés pour cela. Le choix d’une échelle/ d’un outil se fait en fonction du type de SMA, de l’âge de la personne et des éléments spécifiques de la motricité que l’on souhaite évaluer. En France, l’échelle MFM est utilisée en pratique clinique dans de nombreux centres de référence de Maladies Neuromusculaires (MNM). Les autres échelles fréquemment utilisées au niveau international ne sont cependant pas disponibles en français rendant leur utilisation plus difficile en pratique clinique courante. Cet article présente le processus de traduction en français des échelles les plus fréquemment utilisées chez la personne avec SMA (CHOP INTEND, HFMSE, RULM, 6-minute walk test et HINE-2). Différentes étapes ont été respectées, notamment les étapes de traduction en français, traduction inversée en anglais, comparaison des versions anglaises, harmonisation et obtention de la version finale en français. Un programme de formation et sensibilisation des différents professionnels des consultations MNM des centres de référence français avec proposition d’ateliers en présence des membres du comité scientifique suivra l’étape de traduction afin de les faire connaître, expliciter leur utilisation et participer à la diffusion de ce travail

Transcultural adaptation and validation of the Pediatric Stroke Outcome Measure - summary of impressions (PSOM-SOI) into French

ObjectiveTo translate and validate a French version of the Pediatric Stroke Outcome Measure - summary of impressions (PSOM-SOI), for application in a population of French children after neonatal arterial ischemic stroke (NAIS). The PSOM measures deficiency of body functions and structures. On completion of this examination, the PSOM-SOI was developed containing and scoring 5 subscales: right sensorimotor, left sensorimotor (each with subcategories), language production, language comprehension and cognitive/behavioral.Materials/patients and methodsThe PSOM-SOI was translated into French and then, interobserver agreement of the tool was measured using weighted kappa in a multicenter cohort study of children 7 years after neonatal arterial ischemic stroke (NAIS). 2 raters scored retrospective PSOM-SOI from medical records and validated scales for each subscales.Results69 children (mean age = 7.0 years) were recruited. Interobserver agreement was substantial for items B and C, i.e. production and comprehension language deficits [k = 0.71 (95% CI = 0.57 to 0.83); k = 0.70 (95% CI = 0.55 to 0.82) respectively]; moderate for items A and D, i.e. sensorimotor and cognitive/behavioural deficits [k = 0.47 (95% CI = 0.34 to 0.60); k = 0.52 (95% CI = 0.36 to 0.67) respectively] and slight for the total score [k = 0.19 (95% CI = 0.08 to 0.30)].Discussion/conclusionThe PSOM-SOI can be used to reliably grade neurological examination for children following a stroke, besides raters with different level of clinical experience. However, additional development and validation work is required using a clinical exam to improve the prospective validation of the complete PSOM

Additional validation study and French cross-cultural adaptation of the Pediatric Stroke Outcome Measure–Summary of Impressions (PSOM-SOI)

International audienceBACKGROUND: The Pediatric Stroke Outcome Measure-Summary of Impressions (PSOM-SOI) measures neurological function across right and left sensorimotor domains (Item A), language production (Item B), language comprehension (Item C), and cognition/behaviour (Item D).OBJECTIVE: This study was a cross-cultural adaptation into French of the PSOM-SOI and an assessment of its reliability and limitations of use.MATERIAL AND METHODS: The translation and adaptation of the PSOM-SOI was followed by the assessment of its reliability in a cohort of 69 children with diagnosed acute neonatal arterial ischemic stroke. Three independent raters retrospectively scored the PSOM-SOI based on data from in-person neurological examination and results of standardized tests performed at age 7 in the cohort database. Comparison 1 (C1) involved a less experienced rater and an experienced rater and comparison 2 (C2) involved 2 experienced raters. Inter-rater reliability (IRR) was measured with Kappa coefficients.RESULTS: The cross-cultural adaptation was easily performed, and no rater had difficulties using the French PSOM-SOI. The IRR was better in C1 than C2. For Item A, the agreement in C1 (κ=0.47) and C2 (κ=0.44) was moderate. The C1 agreement was substantial for Items B (κ=0.71) and C (κ=0.70); the C2 agreement was fair for Item B (κ=0.23) and slight for Item C (κ=0.16). For Item D, the agreement was moderate in C1 (κ=0.52) and fair in C2 (κ=0.35). In all but one comparison, agreement or minor disagreement (≤0.5 points) was obtained for more than 90% of the item scores. Regarding the total score, agreement for normal function (≤0.5) versus abnormal function (>0.5) was achieved for 90% in C1 and 67% in C2.CONCLUSION: The IRR of the French PSOM-SOI gave variable results depending on the item and rater's experience, but the extent of disagreements was minor for individual items and total score. Additional prospective validation studies using the French PSOM-Short Neurological Exam to score the PSOM-SOI are needed. A dichotomised total score (cut-off≤0.5) could be used to define normal function versus poor outcome.Copyright © 2019 Elsevier Masson SAS. All rights reserved

Additional validation study and French cross-cultural adaptation of the Pediatric Stroke Outcome Measure–Summary of Impressions (PSOM-SOI)

Background: The Pediatric Stroke Outcome Measure-Summary of Impressions (PSOM-SOI) measures neurological function across right and left sensorimotor domains (Item A), language production (Item B), language comprehension (Item C), and cognition/behaviour (Item D). Objective: This study was a cross-cultural adaptation into French of the PSOM-SOI and an assessment of its reliability and limitations of use. Material and Methods: The translation and adaptation of the PSOM-SOI was followed by the assessment of its reliability in a cohort of 69 children with diagnosed acute neonatal arterial ischemic stroke. Three independent raters retrospectively scored the PSOM-SOI based on data from in-person neurological examination and results of standardized tests performed at age 7 in the cohort database. Comparison 1 (C1) involved a less experienced rater and an experienced rater and comparison 2 (C2) involved 2 experienced raters. Inter-rater reliability (IRR) was measured with Kappa coefficients. Results: The cross-cultural adaptation was easily performed, and no rater had difficulties using the French PSOM-SOI. The IRR was better in C1 than C2. For Item A, the agreement in C1 (κ = 0.47) and C2 (κ = 0.44) was moderate. The C1 agreement was substantial for Items B (κ = 0.71) and C (κ = 0.70); the C2 agreement was fair for Item B (κ = 0.23) and slight for Item C (κ = 0.16). For Item D, the agreement was moderate in C1 (κ = 0.52) and fair in C2 (κ = 0.35). In all but one comparison, agreement or minor disagreement (≤ 0.5 points) was obtained for more than 90% of the item scores. Regarding the total score, agreement for normal function (≤ 0.5) versus abnormal function (&gt; 0.5) was achieved for 90% in C1 and 67% in C2. Conclusion: The IRR of the French PSOM-SOI gave variable results depending on the item and rater's experience, but the extent of disagreements was minor for individual items and total score. Additional prospective validation studies using the French PSOM-Short Neurological Exam to score the PSOM-SOI are needed. A dichotomised total score (cut-off ≤ 0.5) could be used to define normal function versus poor outcome.</p

Determining the Interrater Reliability of the SOFMER Activity Score (version 2) for Individuals in Rehabilitation Centers

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Convergence of patient- and physician-reported outcomes in the French National Registry of Facioscapulohumeral Dystrophy

International audienceFacioscapulohumeral muscular dystrophy (FSHD) is among the most prevalent muscular dystrophies and currently has no treatment. Clinical and genetic heterogeneity are the main challenges to a full comprehension of the physiopathological mechanism. Improving our knowledge of FSHD is crucial to the development of future therapeutic trials and standards of care. National FSHD registries have been set up to this end. The French National Registry of FSHD combines a clinical evaluation form (CEF) and a self-report questionnaire (SRQ), filled out by a physician with expertise in neuromuscular dystrophies and by the patient, respectively. Aside from favoring recruitment, our strategy was devised to improve data quality. Indeed, the pairwise comparison of data from 281 patients for 39 items allowed for evaluating data accuracy. Kappa or intra-class coefficient (ICC) values were calculated to determine the correlation between answers provided in both the CEF and SRQ. Results Patients and physicians agreed on a majority of questions common to the SRQ and CEF (24 out of 39). Demographic, diagnosis- and care-related questions were generally answered consistently by the patient and the medical practitioner (kappa or ICC values of most items in these groups were greater than 0.8). Muscle function-related items, i.e. FSHD-specific signs, showed an overall medium to poor correlation between data provided in the two forms; the distribution of agreements in this section was markedly spread out and ranged from poor to good. In particular, there was very little agreement regarding the assessment of facial motricity and the presence of a winged scapula. However, patients and physicians agreed very well on the Vignos and Brooke scores. The report of symptoms not specific to FSHD showed general poor consistency. Conclusions Patient and physician answers are largely concordant when addressing quantitative and objective items. Consequently, we updated collection forms by relying more on patient-reported data where appropriate. We hope the revised forms will reduce data collection time while ensuring the same quality standard. With the advent of artificial intelligence and automated decision-making, high-quality and reliable data are critical to develop top-performing algorithms to improve diagnosis, care, and evaluate the efficiency of upcoming treatments