Rasch validation of the Activities-specific Balance Confidence Scale and its short versions in patients with Parkinson's disease.

Accepted Jan 10, 2014; Epub ahead of print Mar 28, 2014IntroductIonPostural instability is a key feature of advanced Parkinson's dis-ease (PD) (1), often leading to falls with dramatic consequences (2). Balance impairment can also induce psychological reactions, such as reduced balance confidence and increased fear of fall-ing. Balance confidence (a construct exploring fall-related self-efficacy) and fear of falling may be protective if they interfere only with hazardous activity and increase caution in performing daily living tasks. On the other hand, they can be maladaptive if their effect is to restrict mobility, independence and social par -ticipation, leading to further deconditioning, functional decline and poorer quality of life (3). Therefore, balance confidence is a construct that needs to be clearly understood, accurately meas-ured, and requires timely, appropriate management within fall risk assessment and fall prevention programmes (4).Balance confidence is often analysed with the Activities-specific Balance Confidence scale (ABC) (5), which has been shown to have sound psychometric properties in older adults (5, 6) and people with lower-limb amputations (7, 8) and stroke (9). In subjects with PD, the ABC has only recently been validated (10), by means of a Classical Test Theory approach, while the short versions of ABC proposed for PD (11–13) have undergone only preliminary validation.However, the Classical Test Theory approach does not take into account some standard criteria and attributes (concerning both single items and total score) that need to be considered when evaluating the measurement properties of a tool (14). Rasch analysis is being increasingly recommended in the development and evaluation of clinical tools for healthcare to verify if they comply with the theoretical requirements of measurement, including dimensionality analysis and item-level scale evaluation (15).The aim of this study was to analyse the psychometric prop-erties of the ABC and its 3 short versions in subjects with PD, using both Classical Test Theory and Rasch analysis, in order to determine whether fundamental measurement properties are satisfied and to provide insights into the optimal use of these questionnaires. METHOD

“New Cardiac Devices: from adults to children”

Il presente simposio internazionale, con il supporto di professionisti italiani ed europei, ognuno con comprovata esperienza non solo clinica ma anche scientifica, ha lo scopo di fornire un aggiornamento sulle più rilevanti novità in tali ambiti, di cui possono usufruire attualmente i pazienti cardiopatici. Il simposio è articolato in tutti gli ambiti che articolano l'uso dei nuovi device, dalla diagnosi, all'indicazione terapeutica, l'impianto e la gestione post-procedurale. Il convegno è indirizzato sopratutto ai cardiologi, medici di base del territorio, infermieri di cardiologia, tecnici di emodinamica e cardio-tecnici

Assessment and correlation between clinical patterns, disability and health-related quality of life in patients with low back pain

AIM: Low back pain (LBP) is the main symptom of most lumbar spine diseases. This symptom, due to physical, psychological and social factors, is correlated to a real disability which can affect the quality of life (QoL.) The aim of this study is to evaluate the QoL and the disability in patients with LBP and to correlate them to clinical patterns. METHODS: In this prospective multidimensional study, 108 patients underwent the following protocol: 1. collection of patient-oriented and disability data with the use of SF-36 and North American Spine Society (NASS); 2. collection of clinical, anamnestic and instrumental data (MRI, CT) with the use of DOVAC files; 3. assessment of disability with the use of Barthel index (BI) and deambulation index (DI). RESULTS: A significant correlation was found between the BI and the physical composite score (PCS), but no significant correlation was noticed between BI and the mental composite score (MCS). DI was not correlated to the SF-36. A positive Lasegue and the absence of the osteo-tendinous reflexes are significantly correlated to the disability and QoL. CONCLUSIONS: This study shows that there is no simple, linear correlation between QoL and disability

Role of spiritual beliefs on disability and health-related quality of life in acute inpatient rehabilitation unit

The influence of spirituality and religious beliefs on health-related quality of life and disability in the rehabilitation field is discussed in literature

A systematic review of conservative treatment of carpal tunnel syndrome

Objective: To assess the effectiveness of the conservative therapy in carpal tunnel syndrome. Data Sources: A computer-aided search of MEDLINE and the Cochrane Collaboration was conducted for randomized controlled trials (RCTs) from January 1985 to May 2006. Review methods: RCTs were included if: 1) the patients, with clinically and electrophysiologically confirmed carpal tunnel syndrome, had not previously undergone surgical release, 2) the efficacy of one or more conservative treatment options was evaluated, 3) the study was designed as a randomised controlled trial. Two reviewers independently selected the studies and performed data extraction using a standardized form. In order to assess the methodological quality, the criteria list of the Cochrane Back Review Group for systematic reviews was applied. The different treatment methods were grouped (local injections, oral therapies, physical therapies, therapeutic exercises and splints). Results: Thirty-three RCTs were included in the review. The studies were analysed to determine the strength of the available evidence for the efficacy of the treatment. Our review shows that: 1) locally injected steroids produce a significant but temporary improvement, 2) Vitamin B6 is ineffective, 3) steroids are better than NSAIDs and diuretics, but they can produce side effects, 4) ultrasounds are effective while laser therapy shows contrasting results, 5) exercise therapy is not effective, 6) splints are effective, especially if used full-time. Conclusion: There is a: 1) strong evidence (level 1) on efficacy of local and oral steroids; 2) moderate evidence (level 2) that Vitamin B6 is ineffective and splints are effective and 3) limited or conflicting evidence (level 3) that NSAIDs, diuretics, Yoga, laser and ultrasound are effective whereas exercise therapy and Botulinum toxin B injection are ineffective

Effects of local microwave diathermy on shoulder pain and function in patients with rotator cuff tendinopathy in comparison to subacromial corticosteroid injections: a single-blind randomized trial

STUDY DESIGN: Single-blind randomized clinical trial, with a follow-up of 24 weeks. OBJECTIVE: To determine the effects of hyperthermia via localized microwave diathermy on pain and disability in comparison to subacromial corticosteroid injections in patients with rotator cuff tendinopathy. BACKGROUND: Hyperthermia improves symptoms and function in several painful musculoskeletal disorders. However, the effects of microwave diathermy in rotator cuff tendinopathy have not yet been established. METHODS: Ninety-two patients with rotator cuff tendinopathy and pain lasting for at least 3 months were recruited from the outpatient clinic of the Department of Orthopaedics and Traumatology, University Hospital, Rome, Italy. Participants were randomly allocated to either local microwave diathermy or subacromial corticosteroids. The primary outcome measure was the short form of the Disabilities of the Arm, Shoulder and Hand Questionnaire (QuickDASH). Secondary outcome measures were the Constant-Murley shoulder outcome score and a visual analog scale for pain assessment. RESULTS: At the end of treatment and at follow-up, both treatment groups experienced improvements in all outcome measures relative to baseline values. Changes over time in QuickDASH, Constant-Murley, and visual analog scale scores were not different between treatment arms. CONCLUSION: In patients with rotator cuff tendinopathy, the effects of localized microwave diathermy on disability, shoulder function, and pain are equivalent to those elicited by subacromial corticosteroid injections. LEVEL OF EVIDENCE: Therapy, level 1

Short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate carpal tunnel syndrome: A double blind randomized sham-controlled trial.

OBJECTIVE: To determine the short-term effects of local microwave hyperthermia on pain and function in patients with mild to moderate idiopathic carpal tunnel syndrome. DESIGN: Double-blind randomized sham-controlled trial. SETTING: Outpatient clinic of the Department of Physical Medicine and Rehabilitation, University Hospital. PARTICIPANTS: Twenty-two patients with idiopathic carpal tunnel syndrome, 12 of whom had bilateral involvement, for a total of 34 wrists, divided into two groups: a hyperthermia active treatment group (number of wrists = 17) and a sham-controlled group (number of wrists = 17). INTERVENTION: Six sessions, two per week, of either hyperthermia or sham treatment were provided over a period of three weeks. MAIN MEASURES: Visual analogue scale, Levine-Boston Self-Assessment Questionnaire (part I: evaluation of pain intensity; part II: evaluation of functional status) and neurophysiological assessments, were determined at baseline and at the end of the treatment. RESULTS: The hyperthermia group experienced a significant improvement in pain (visual analogue scale: P = 0.002; Levine-Boston part I: P < 0.0001) and functional status (Levine-Boston part II: P = 0.002) relative to baseline. No improvements in pain intensity or functionality were observed in the sham-treated group. Changes in pain severity between baseline and the end of treatment were larger in the hyperthermia group than in the sham-controlled group (Δ visual analogue scale P = 0.004; Δ Levine-Boston part I: P = 0.009). No differences either intra or between groups were observed for median nerve conduction velocity. CONCLUSION: Hyperthermia provides short-term improvements in pain and function in patients with mild to moderate carpal tunnel syndrom