Minimal clinically important difference and minimal detectable change of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) amongst patients with chronic musculoskeletal pain

Objectives: The aim of this study is to estimate a minimal clinically important difference (MCID) and a minimal detectable change (MDC) of the 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. Design: Cross-sectional cohort study. Setting: Outpatient Physical and Rehabilitation Medicine clinic. Subjects: A total of 1988 consecutive patients with musculoskeletal pain. Interventions: A distribution-based approach was employed to estimate a minimal clinically important difference, a minimal detectable change, and a minimal detectable percent change (MDC%). Results: The mean age of the patients was 48 years, and 65% were women. The average intensity of pain was 6,3 (2.0) points (0-10 numeric rating scale) and the mean WHODAS 2.0 total score was 13 (9) points out of 48. The minimal clinically important difference ranged between 3.1 and 4.7 points. The minimal detectable change was 8.6 points and minimal detectable % change was unacceptably high 66%. Conclusions: Amongst patients with chronic musculoskeletal pain, the 12-item WHODAS 2.0 demonstrated a high minimal detectable change of almost nine points. As the minimal detectable change exceeded the level of minimal clinically important difference, nine points were considered to be the amount of change perceived by a respondent as clinically significant.</div

Psychometric properties of 12-item self-administered World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) among general population and people with non-acute physical causes of disability - systematic review

Objective: WHODAS 2.0 is a unified scale to measuring disability across diseases, countries, and cultures. The objective was to explore the available evidence on the psychometric properties of 12-item self-administered WHODAS 2.0 among a general population and people with non-acute physical causes of disability.Methods: Five databases Medline, Embase, Web of Science, Scopus, and PsycINFO were searched for papers related to the validity, reliability, responsiveness, minimal clinically important difference or minimal detectable change of 12-item self-administered WHODAS 2.0. In order to avoid missing any potentially relevant studies, the search clauses were left as generic as possible and the refining search was conducted manually. As the review was focusing on chronic physical disorders and general adult population, major psychiatric diagnoses, acute traumas, other acute conditions (e.g., postpartum or pregnancy), hearing loss, progressive neurological disorders, and age Results: The 14 out of 191 observational studies were considered relevant. The sample sizes varied from 80 up to 31,251 participants. Great diversity was observed in the participants’ health problems. The Cronbach’s alpha was high – up to 0.96. The correlations between WHODAS 2.0 and other disability scales were high. Substantial floor without ceiling effect was reported by two studies. Exploratory factor analysis resulted in a multidimensional structure – up to five factors. The discriminative ability and test–retest reliability of the scale was good.Conclusions: It seems, that the 12-item self-administered WHODAS 2.0 is internally consistent and a reliable scale demonstrating overall good correlation with other measures of disability. However, it appears that it is a multidimensional scale and its total score may represent different combinations of several contributing factors. Thus, the 12-item WHODAS 2.0 can be more reliable when creating a person’s functional profile formed by the 12 individual item scores instead of a single total sum.</p

Impact of Serious Games on Health and Well-being of Elderly: A Systematic Review

Besides their entertainment value, serious games can have beneficial therapeutic effects for elderly people that improve their health and well-being. Games are likely to be accepted by elderly persons who have enjoyed games their lives, and because there are more and more of such elderly, it is important to investigate games as a therapeutic device. This research reviewed the literature focusing on the effects of games on elderly persons in three main types of effects: physical, cognitive, and social effects. The majority of reviewed papers focused on physical and cognitive effects, and were published in recent years, which emphasizes the relative novelty of this topic and suggests that future research will need to address social impact as well. In addition, while many papers claimed positive impacts as a result of using games, our review found that more attention should be given to research designs

Gamified Solutions in Healthcare - Testing Rehabilitation Games in Finland and Asia

This paper presents a comprehensive summary of the Gamified Solutions in Healthcare (GSH) research project, which is a joint research project between Turku University of Applied Sciences and the University of Turku. The goal of the project is to promote exercise, social inclusiveness and enhance quality of life, aiming at developing new services and effective activity solutions for the elderly through gamification. During the research project elderly people were included in the development and testing of games so that they could be used for more than just entertainment purposes. According to all of our tests elderly enjoy playing exergames, and digital games can be an effective way to enhance the quality of life of the elderly. In the case studies it was observed that the players where motivated while playing but motivation should also be maintained throughout the gameplay. The elderly gave overall positive feedback for the idea of using digital activity games for exercising. </div

Epistemological beliefs of European physiotherapists – a multi-countrycross-cultural adaptation for the DEBQ and the CAEB questionnaires

[Abstract] This article assumes that epistemological beliefs of physiotherapists are an important determinant in improving the concept of evidence-based practice. Little research has been done on epistemological beliefs in physiotherapy. In order to measure the sophistication of epistemological beliefs in future research, two complementary questionnaires (DEBQ and CAEB) were cross-culturally adapted in nine different countries and seven languages in Europe. A standardized seven-step guideline was used to translate and culturally validate the questionnaires. The questionnaires were distributed in the respective countries, resulting in 1386 participants. The psychometric values were analysed in order to verify consistency and validity. Based on the validation process, the instruments are considered to be validly adapted for the countries involved. The uniformity in the adaptation process allows for future comparison of the countries

Effects of a home-based, exergaming intervention on physical function and pain after total knee replacement in older adults : a randomised controlled trial

Objectives To investigate the effects of 4 months of customised, home-based exergaming on physical function and pain after total knee replacement (TKR) compared with standard exercise protocol. Methods In this non-blinded randomised controlled trial, 52 individuals aged 60-75 years undergoing TKR were randomised into an exergaming (intervention group, IG) or a standard exercising group (control group, CG). Primary outcomes were physical function and pain measured before and after (2 months and 4 months) surgery using the Oxford Knee Score (OKS) and Timed Up and Go (TUG) test. Secondary outcomes included measures of the Visual Analogue Scale, 10m walking, short physical performance battery, isometric knee extension and flexion force, knee range of movement and satisfaction with the operated knee. Results Improvement in mobility measured by TUG was greater in the IG (n=21) at 2 (p=0.019) and 4 months (p=0.040) than in the CG (n=25). The TUG improved in the IG by -1.9 s (95% CI, -2.9 to -1.0), while it changed by -0.6 s (95% CI -1.4 to 0.3) in the CG. There were no differences between the groups in the OKS or secondary outcomes over 4 months. 100% of patients in the IG and 74% in the CG were satisfied with the operated knee. Conclusion In patients who have undergone TKR, training at home with customised exergames was more effective in mobility and early satisfaction and as effective as standard exercise in pain and other physical functions. In both groups, knee-related function and pain improvement can be considered clinically meaningful. Trial registration number NCT03717727.publishedVersionPeer reviewe

Kuntoutuksen koulutuksen uudistamisessa ollaan askel edellä huomista

Aavistamatta pandemian vaikutuksia kuntoutuksessa tarvittavaan osaamisen muutokseen, selvitettiin kuntoutusalan osaamiskeskittymän jatkuvan oppimisen kehittämisohjelmassa askelmerkit kuntoutuksen osaamisen tarpeisiin vuoteen 2030

Psychometric properties of 12-item World Health Organization disability assessment schedule 2.0 (WHODAS 2.0) amongst people with chronic musculoskeletal pain

Aim of this thesis was to explore the floor and ceiling effect, differential item functioning (DIF), minimal clinically important difference (MCID) and minimal detectable change (MDC) of 12-item World Health Organization Disability Assessment Schedule (WHODAS) 2.0 amongst people with chronic musculoskeletal pain. Of the cross-sectional data of 1 988 patients seen at Physical and Rehabilitation Medicine (PRM) clinic, 65 % were women. The mean age was 48 years, and the average score of 12–item WHODAS 2.0 was 13/48 points. Of the participants, 88% had a primary diagnosis of ‘Diseases of the musculoskeletal system and connective tissue'. Of those, 39% had a diagnosis of ‘Dorsalgia’. Floor and ceiling effects were calculated as relative frequencies of the lowest or the highest scores for each item. The DIF was tested using logistic regression analysis and the Chi2 test and interpreted graphically based on item characteristic curves. The MDC and MCID were calculated based on the variance of the scores. A systematic review explored the evidence of the psychometric properties of 12-item WHODAS 2.0 among general population and people with non-acute physical causes of disability. The 12-item WHODAS 2.0 demonstrated high, almost nine points MDC. As the MDC exceeded the level of MCID, nine points were considered to be the amount of change perceived by a respondent as clinically significant. A significant floor effect (>15%) was seen in all 12 items. A significant uniform gender-related DIF was detected in 7 of 12 items. In conclusion, due to the floor effect, the 12-item WHODAS may have limitations in the lower end of the scale amongst people with milder disability. Seven items functioned differently between men and women and almost nine points MDC might complicate the use of WHODAS 2.0 total score. It appears that it is a multidimensional scale, and its total score may represent different combinations of several contributing factors. Therefore, all these findings should be taken into consideration while making the work ability or rehabilitation evaluations or interpreting the results based on the single total score instead of item scores in patients with chronic musculoskeletal pain.Tämä väitöskirjatutkimus selvitti 12-osaisen terveyden ja toimintarajoitteiden arviointimenetelmän WHODAS 2.0 -mittarin toimivuutta kroonisilla tuki– ja liikuntaelinkipupotilailla. Mittarin katto– ja lattiavaikutusta, mittarin osioiden muuttumattomuutta (DIF) sekä mittarin pienintä havaittavaa muutosta (MDC) ja pienintä kliinisesti tärkeää eroa (MCID) selvitettiin fysiatrian poliklinikalta poikkileikkausasetelmassa kerätyllä (N=1988) aineistolla. Tutkimusjoukko koostui naisista (65%) ja miehistä, joiden keskiarvoikä oli 48 vuotta. Mittarin kokonaispistemäärän keskiarvo oli 13/48. Tutkittavista 88 %:lla oli päädiagnoosi ’Tuki- ja liikuntaelimistön sairaus’ ja heistä 39 %:lla ’Selkäkipu’. Katto– ja lattiavaikutus laskettiin vastaajien kokonais- ja osiopistemäärien frekvensseistä. Mittarin DIF tarkasteltiin logistisella regressioanalyysillä sekä Chi2 testillä. Osioiden toimivuutta tarkasteltiin kahden parametrin osiovaste teorialla. MDC ja MCID laskettiin perustuen pistemäärän varianssiin. Systemaattisella kirjallisuuskatsauksella selvitettiin tietoa 12-osaisen WHODAS 2.0 -mittarin psykometrisista ominaisuuksista normaaliväestöllä ja ihmisillä, joilla oli fyysisiä sairauksia ja toimintarajoitteita. 12 osion WHODAS 2.0 -mittarin MDC oli 8,6 pistettä ylittäessä MCID: n kynnysarvon, joten vasta 9 pisteen muutos koetaan käytännössä toimintakyvyn muutokseksi. Mittarin kaikissa osioissa havaittiin tilastollisesti merkitsevä lattiaefekti (>15 %) ja erilainen osioiden toimivuus miesten ja naisten välillä 7:ssä osiossa. Johtopäätökset: lattiaefektistä johtuen mittarin erottelukyky asteikon matalammassa päässä saattaa olla huono lievissä toimintakyvyn rajoituksissa. Seitsemän mittarin osiota toimii eri tavalla miehillä ja naisilla. Lisäksi huomattavan korkea pienin havaittu muutos saattaa vaikeuttaa mittarin antaman kokonaispistemäärän käyttämistä ja tulosten tulkintaa kroonisilla tuki- ja liikuntaelinkipupotilailla. Näyttää siltä, että 12 osion WHODAS 2.0 on moniulotteinen mittari, jonka kokonaispistemäärän muodostumiseen vaikuttaa usea tekijä. Hyödyntäessä mittarin kokonaispistemäärää osiopistemäärän sijaan kroonisten tuki- ja liikuntaelinkipupotilaiden työkykyarviossa ja kuntoutusintervention vaikutusten arvioinnissa, edellä kuvatut löydökset tulee ottaa huomioon