The reliability and validity of the English version of the Evaluation of Daily Activity Questionnaire in people with rheumatoid arthritis

Objectives: The Evaluation of Daily Activity Questionnaire (EDAQ) includes 138 items in 14 domains identified as important by people with RA. The aim of this study was to test the validity and reliability of the English EDAQ. Methods: A total of 502 participants completed two questionnaires 3 weeks apart. The first consisted of the EDAQ, HAQ, RA Quality of Life (RAQoL) and the Medical Outcomes Scale (MOS) 36-item Short-Form Health Survey (SF-36v2), and the second consisted of the EDAQ only. The 14 EDAQ domains were tested for: unidimensionality—using confirmatory factor analysis; fit, response dependency, invariance across groups (differential item functioning)—using Rasch analysis; internal consistency [Person Separation Index (PSI)]; concurrent validity—by correlations with the HAQ, SF-36v2 and RAQoL; and test–retest reliability (Spearman’s correlations). Results: Confirmatory factor analysis of the 14 EDAQ domains indicated unidimensionality, after adjustment for local dependency in each domain. All domains achieved a root mean square error of approximation <0.10 and satisfied Rasch model expectations for local dependency. DIF by age, gender and employment status was largely absent. The PSI was consistent with individual use (PSI = 0.94 for all 14 domains). For all domains, except Caring, concurrent validity was good: HAQ (rs = 0.72–0.91), RAQoL (rs = 0.67–0.82) and SF36v2 Physical Function scale (rs = −0.60 to −0.84) and test–retest reliability was good (rs = 0.70–0.89). Conclusion: Analysis supported a 14-domain, two-component structure (Self care and Mobility) of the EDAQ, where each domain, and both components, satisfied Rasch model requirements, and have robust reliability and validity

Is pain disabling adults with musculoskeletal conditions?

Background: Pain is the most common symptom of musculoskeletal (MSK) conditions, affecting two thirds of adults aged ≥50 years in the UK (1). MSK pain often becomes chronic and significantly reduces people’s ability to participate in daily activities, leading to disability (2). Objectives: To describe the extent of pain and disability in adults with MSK conditions and explore the relationship with physical and mental health, activity limitation, personal and environmental factors. Methods: Participants with Osteoarthritis (OA), Ankylosing Spondylitis (AS), Systemic Lupus Erythematosus (SLE) or Systemic Sclerosis (SS) over 18 years of age were recruited from hospitals and patient groups. They completed a postal questionnaire including demographic questions, pain, stiffness and fatigue numeric rating scales (0-10), the Evaluation of Daily Activity Questionnaire (EDAQ), and SF-36v2. Disability was measured through a single item asking “Do you consider yourself to have a disability? (Yes/No). The prevalence of person-perceived disability was calculated overall and for age and gender for each condition using the chi-squared test. Binary logistic regression was used to estimate the association between pain and disability, before and after adjusting for covariates associated with person-perceived disability for each MSK condition. Results were summarised as odds ratios (OR) with 95% confidence intervals (CI). Results: 683 people responded (AS n=165; OA n=184; SLE n=164; SS n=170). One in two people considered themselves to have a disability (47% in AS; 43% in OA; 50% in SLE; 53.5% in SS). Older age and female gender was associated with person-perceived disability in OA, SLE and SS, and older age and male gender was associated with disability in AS. High to severe pain when moving was strongly linked to person-perceived disability in all MSK conditions. (Age and gender adjusted Odds Ratio (OR): 6.9 with 95% Confidence Interval (CI) 3.0, 15.8 for AS; OR: 3.4; CI: 1.8, 6.2 for OA; OR: 3.7; CI: 1.7, 7.8 for SLE; OR: 2.8; CI: 1.3, 5.8 for SS). Adjusting for key variables reduced the associations between pain and disability in those with AS and OA to OR: 4.7 CI: 1.9, 11.3; OR: 2.6 CI: 1.0, 7.0 respectively, whilst strengthening in those with SLE (OR: 3.2 CI: 1.5, 7.1). In those with SS, the relationship between pain and disability was through living alone (OR: 2.3 CI: 1.0, 5.3) and fatigue (OR: 3.9 CI: 1.7, 9.1). Conclusion: Half of adults with MSK conditions in this study considered themselves to have a disability. People with severe pain when moving, had higher odds of reporting person-perceived disability, with living alone and experiencing high levels of fatigue being the contributing factors. Strategies to reduce pain and fatigue, such as joint protection education, and providing help and assistance for those who live alone may help those with MSK conditions feel less disabled

Cross-cultural adaptation and psychometric testing of the Dutch and German versions of the Evaluation of Daily Activity Questionnaire in people with rheumatoid arthritis

The Evaluation of Daily Activity Questionnaire (EDAQ) is a detailed patient-reported outcome measure of activity ability. The objective of this research was to assess the linguistic and cross-cultural validity and psychometric properties of the EDAQ in rheumatoid arthritis for Dutch and German speakers. The EDAQ was translated into Dutch and German using standard methods. A total of 415 participants (Dutch n = 252; German n = 163) completed two questionnaires about four weeks apart. The first included the EDAQ, Health Assessment Questionnaire (HAQ) and 36-item Short-Form v2 (SF-36v2) and the second, the EDAQ only. We examined construct validity using Rasch analysis for the two components (Self-Care and Mobility) of the Dutch and German EDAQ. Language invariance was also tested from the English version. We examined internal consistency, concurrent and discriminant validity and test–retest reliability in the 14 EDAQ domains. The Self-Care and Mobility components satisfied Rasch model requirements for fit, unidimensionality and invariance by language. Internal consistency for all 14 domains was mostly good to excellent (Cronbach’s alpha ≥ 0.80). Concurrent validity was mostly strong: HAQ rs = 0.65–0.87; SF36v2 rs = − 0.61 to − 0.87. Test–retest reliability was excellent [ICC (2,1) = 0.77–0.97]. The EDAQ has good reliability and validity in both languages. The Dutch and German versions of the EDAQ can be used as a measure of daily activity in practice and research in the Netherlands and German- speaking countries

The strength of the corticospinal tract not the reticulospinal tract determines upper-limb impairment level and capacity for skill-acquisition in the sub-acute post-stroke period

Background. Upper-limb impairment in patients with chronic stroke appears to be partly attributable to an upregulated reticulospinal tract (RST). Here, we assessed whether the impact of corticospinal (CST) and RST connectivity on motor impairment and skill-acquisition differs in sub-acute stroke, using transcranial magnetic stimulation (TMS)–based proxy measures. Methods. Thirty-eight stroke survivors were randomized to either reach training 3-6 weeks post-stroke (plus usual care) or usual care only. At 3, 6 and 12 weeks post-stroke, we measured ipsilesional and contralesional cortical connectivity (surrogates for CST and RST connectivity, respectively) to weak pre-activated triceps and deltoid muscles with single pulse TMS, accuracy of planar reaching movements, muscle strength (Motricity Index) and synergies (Fugl-Meyer upper-limb score). Results. Strength and presence of synergies were associated with ipsilesional (CST) connectivity to the paretic upper-limb at 3 and 12 weeks. Training led to planar reaching skill beyond that expected from spontaneous recovery and occurred for both weak and strong ipsilesional tract integrity. Reaching ability, presence of synergies, skill-acquisition and strength were not affected by either the presence or absence of contralesional (RST) connectivity. Conclusion. The degree of ipsilesional CST connectivity is the main determinant of proximal dexterity, upper-limb strength and synergy expression in sub-acute stroke. In contrast, there is no evidence for enhanced contralesional RST connectivity contributing to any of these components of impairment. In the sub-acute post-stroke period, the balance of activity between CST and RST may matter more for the paretic phenotype than RST upregulation per se

Experiences and views of receiving and delivering information about recovery in acquired neurological conditions: a systematic review of qualitative literature

Objective To review and synthesise qualitative literature relating to the views, perceptions and experiences of patients with acquired neurological conditions and their caregivers about the process of receiving information about recovery; as well as the views and experiences of healthcare professionals involved in delivering this information. Design Systematic review of qualitative studies. Data sources MEDLINE, Embase, AMED, CINAHL, PsycINFO, Web of Science and the Cochrane library were searched from their inception to July 2019. Data extraction and synthesis Two reviewers extracted data from the included studies and assessed quality using an established tool. Thematic synthesis was used to synthesise the findings of included studies. Results Searches yielded 9105 titles, with 145 retained for full-text screening. Twenty-eight studies (30 papers) from eight countries were included. Inductive analysis resulted in 11 descriptive themes, from which 5 analytical themes were generated: the right information at the right time; managing expectations; it’s not what you say, it’s how you say it; learning how to talk about recovery and manage emotions; the context of uncertainty. Conclusions Our findings highlight the inherent challenges in talking about recovery in an emotional context, where breaking bad news is a key feature. Future interventions should focus on preparing staff to meet patients’ and families’ information needs, as well as ensuring they have the skills to discuss potential recovery and break bad news compassionately and share the uncertain trajectory characteristic of acquired neurological conditions. An agreed team-based approach to talking about recovery is recommended to ensure consistency and improve the experiences of patients and their families