Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients.

BACKGROUND: Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). OBJECTIVE: To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. METHODS: The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. RESULTS: The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. CONCLUSION: The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

ANTECEDENTES: O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico). OBJETIVO: Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC. MéTODOS: A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas. RESULTADOS: A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador. CONCLUSãO: A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients / Propriedades de medida da versão brasileira da Lower-Extremity Motor Activity Log para pacientes hemiparéticos crônicos pós-AVC

Abstract Background Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment). Objective To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals. Methods The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested. Results The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators. Conclusion The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

Resumo Antecedentes O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico). Objetivo Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC. Métodos A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas. Resultados A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador. Conclusão A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

Selecting assessment tools to characterize upper limb function of children with cerebral palsy: A mega-review of systematic reviews.

AIM: A mega-review of published systematic reviews without restriction on year of publication was implemented to summarize available assessment tools of upper limb (UL) function in children with Cerebral Palsy (CP). METHOD: A multi-prong search strategy was used to identify 12 systematic literature reviews for inclusion in the mega-review. Included reviews were coded by descriptive analyses, which included methodological and reported measurement property description. Methodological quality of the selected systematic reviews was evaluated with the AMSTAR-2. We synthetized the measurement properties of the revised assessment tools and their coverage within the International Classification of Functioning, Disability and Health (ICF) domains. RESULTS: The 12 systematic reviews addressed 84 assessment tools. Systematic reviews' methodological quality varied between critically low to moderate. Suggested assessment tools covered ICF domains of body structure and function, and activities and participation. Measurement property data analysis was based mostly on reliability and validity. INTERPRETATION: Based on the findings of the mega-review, the ABILHAND-Kids, Assisting Hand Assessment (AHA) and Melbourne Assessment of Unilateral Upper Limb Function (MUUL) are the most suitable tools to evaluate children between 6 and 12 years of age with unilateral CP.

Functional Outcomes Associated With Independence in Walking Among People With Hereditary Ataxias: An Exploratory Cross-sectional Study.

OBJECTIVE: This study aimed to identify functional outcomes related to independence in walking among people affected by hereditary ataxias. METHODS: Sixty participants were selected by convenience in a list provided by an organization of people with ataxia. Sociodemographic and clinical data were collected using a semistructured questionnaire. The Assessment and Rating of Ataxia was used to assess and rate cerebellar ataxia. Changes in body structure and function, limitation in activities, and restriction in participation were evaluated with specific outcome measures. Participants were classified as independent in walking if they were able to walk without walking aids or human assistance and as dependent in walking if they have been using walking aids (sticks, crutches, or walkers) for more than 6 months, using a wheelchair for locomotion most of the day, or both. Multivariate logistic regression analyses were conducted hierarchically and in blocks considering upper limbs function, balance systems, sensory functions, postural control, walking, independence, cognition, and perception as independent variables. The prevalence ratio for walking independence was determined. RESULTS: The final regression model pointed out that gait capacity assessed by the 6-Minute Walk Test and dexterity assessed by the Box and Blocks test were the main markers related to walking independence in individuals with hereditary ataxias. CONCLUSION: The distance covered in 6 minutes of walking (walking endurance) and upper extremity dexterity can be used to better assess the progression of cerebellar disease related to walking independence in individuals with hereditary ataxias. IMPACT: This study supports early detection of individuals who are at risk of loss of walking independence and an optimized rehabilitation plan.