Validation of the Activities-Specific Balance Confidence Scale With 5-Option Response Format in Slovene Lower-Limb Prosthetic Users.

OBJECTIVE: To examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale administered in the Slovene version with a simplified 5-option response format (ABC-5/SLO) using Rasch analysis. DESIGN: Methodological research on data gathered in a cross-sectional study. SETTING: Outpatient university rehabilitation clinic. PARTICIPANTS: A convenience sample of adults with unilateral lower-limb amputation (N=138; 75% men) longer than 6 months who regularly wear a prosthesis. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: We evaluated functioning of rating scale categories, internal construct validity, reliability indices, and dimensionality using the ABC-5/SLO (0=no confidence to 4=complete confidence). RESULTS: The ABC-5/SLO rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct (balance confidence) except item 8 ("walk outside the house to a car parked in the driveway"), which was overfitting. The person abilities-item difficulty matching (targeting) was good. The person separation reliability was .92, and the item separation reliability was .99. Analysis of the standardized Rasch residuals showed the scale's unidimensionality and absence of high item dependency (residual correlations, <.30). The correlation between the ABC-5/SLO and the Prosthetic Mobility Questionnaire (Rasch measures) was high (ρ=.84), as expected. Minor signs of item redundancy were found. CONCLUSIONS: The simplified ABC-5/SLO scale is a valid and reliable measure of balance confidence for individuals with lower-limb amputation. It is possible to transform the ordinal summed raw scores of the ABC-5/SLO into interval-level measurements using a nomogram.

The 88-item Multiple Sclerosis Spasticity Scale: a Rasch validation of the Italian version and suggestions for refinement of the original scale.

BACKGROUND: In multiple sclerosis (MS), the impact of spasticity on the patient's life is a key issue, and it is fundamental that existing tools measuring the patient's perspective undergo psychometric analysis and refinement to optimize confidence in their use in clinical practice and research. OBJECTIVE: We examined-by Rasch analysis (RA)-the main metric characteristics of the 88-item Multiple Sclerosis Spasticity Scale (MSSS-88) to: (i) further validate its Italian version (MSSS-88-IT), previously validated through classical test theory methods only and (ii) independently verify the measurement properties of the original scale. METHODS: MSSS-88 data from a convenience sample of 232 subjects with MS underwent RA, mainly examining item fit, reliability indices, test information function, dimensionality, local item independence, and differential item functioning (DIF). RESULTS: Most items fitted the Rasch model, but 13/88 items showed a misfit in infit and/or outfit values. Rasch reliability indices were high (> 0.80). Test information functions in most subscales showed a sharp decrease in measurement precision as the ability level departs from the quite limited central range of maximal information. The unidimensionality of each subscale was confirmed. Thirteen item pairs showed local dependency (residual correlations > 0.30) and three items presented DIF. CONCLUSION: Reliability, dimensionality and some internal construct validity characteristics of the MSSS-88-IT were confirmed. But, drawbacks of the original MSSS-88 emerged related to some item misfit, redundancy, or malfunctioning. Thus, further large independent studies are recommended, to verify the robustness of previous findings and examine the appropriateness of a few targeted item replacements.

[The burden of disability in Cameroon]. / Il peso della disabilità in Camerun.

AIM: Rehabilitation services for disabled persons are lacking in countries with limited economic resources. Reliable and objective data are needed to plan for their implementation and to determine the burden of disability in these countries. METHODS: A descriptive cross-sectional study conducted in June 2013 among people living in Dschang Health District, in the West region of Cameroon, to collect information about socio-demographic aspects of physically disabled subjects and health determinants of disabilities. Data was collected using a standard questionnaire in French. RESULTS: In total, 159 physically disabled subjects were enrolled in the study. Mean age was 36 years [± SD 17.26], 55.9% of subjects were female, and 33.8% had a low educational-level. The most frequently reported disabilities were orthopaedic problems (mainly fractures) [45.8%], infectious diseases [29.1%]), and neurological disabilities (mainly hemiplegia [33.3%], hemiparesis [23.8%], and monoplegia [23.8%]). The main causes of disability were trauma due to traffic accidents (17.8%) and inappropriate medical interventions (14.5%). Disability was related to age and 50% of participants experienced social discrimination. Disabled subjects with low-incomes (from 50.000 to 200.000 XAF) were required to pay for rehabilitative care (XAF 10.000 to 100.000), and up to 83% had appealed for improved quality of Rehabilitation Medicine. CONCLUSION: Although Law n. 83/013 for the protection of persons with disabilities in Cameroon dates back to 1983, the results of this study show that disabled people, and children in particular, are still marginalized, vulnerable and have little chance of recovery. Therefore, there is a clear need to improve the quality and availability of rehabilitative care services , with programmatic interventions that ensure implementation of existing laws, improve access to rehabilitative services, provide disabled persons with the necessary specialty medical products, and eliminate barriers to their social participation.

The cross-cultural adaptation and psychometric validation of the MSSS-88 for use in Italian patients with multiple sclerosis.

PURPOSE: To cross-culturally translate the Multiple Sclerosis Spasticity Scale into Italian and to evaluate its psychometric properties in patients with multiple sclerosis. METHODS: The Italian version of Multiple Sclerosis Spasticity Scale was developed in accordance with international standards and subsequently administered to 232 Italian adults with multiple sclerosis. The following psychometric properties were analyzed: internal consistency through Cronbach's α and item-to-total correlation, dimensionality with factor analysis, and convergent and criterion validity through hypotheses-testing, comparing the Multiple Sclerosis Spasticity Scale with other outcome measures (Fatigue Severity Scale, Multiple Sclerosis Quality of Life, Modified Ashworth Scale, Barthel Index, and Expanded Disability Status Scale) and analyzing related constructs. Finally, we correlated the MSSS-88 subscales with each other. RESULTS: The final Multiple Sclerosis Spasticity Scale version was well-understood by all subjects. The internal consistency was good (Cronbach's α ≥0.90). Factor analysis revealed that each subscale was unidimensional. Convergent and criterion validity were supported by acceptable correlations with other disease-specific questionnaires, according to the a priori expectations. CONCLUSIONS: The final Italian Multiple Sclerosis Spasticity Scale version showed robust psychometric properties. Therefore, it can be recommended as an assessment tool for clinical and research use to evaluate spasticity in Italian patients with multiple sclerosis. Implications for rehabilitation The Multiple Sclerosis Spasticity Scale was developed to measure patients' perception of the impact of spasticity on life of subjects with multiple sclerosis. In a sample of Italian subjects with multiple sclerosis, the Multiple Sclerosis Spasticity Scale revealed good internal consistency and convergent and criterion validity. Factor analysis demonstrated that each subscale was unidimensional. Each subscale can be used to assess the impact of spasticity in Italian patients with multiple sclerosis.

Cross-cultural adaptation and Rasch validation of the Slovene version of the Orthotics and Prosthetics Users' Survey (OPUS) Client Satisfaction with Device (CSD) in upper-limb prosthesis users.

OBJECTIVE: To validate the Slovene version of the Orthotics and Prosthetics Users' Survey (OPUS) 8-item Client Satisfaction with Device (CSD) questionnaire in upper-limb prosthesis users and to further verify measurement properties of this tool with Rasch analysis. DESIGN: Participants consisted of a convenience sample of 76 adults (54 men) using a prosthesis after unilateral upper-limb amputation who consecutively attended a follow-up visit at our centre. METHODS: After translation and cross-cultural adaptation of the CSD into the Slovene language, we evaluated functioning of the rating scale categories, item fit (internal construct validity), reliability indices and dimensionality, as well as convergent and discriminant construct validity of the questionnaire. RESULTS: Rasch analysis indicated that: (1) functioning of the 4 response options was acceptable; (2) all items fitted the measured construct [information-weighted (infit) and outlier-sensitive (outfit) mean-square statistics 0.60 to 1.40]; (3) person separation reliability was 0.62 (and Cronbach α=0.76), item separation reliability was 0.83; (4) on principal component analysis (PCA) on the standardised residuals, the CSD showed borderline but acceptable unidimensionality and no local item dependency. Moreover, as expected, the CSD score showed good correlation with the QUEST 2.0 score (rs=0.57) and little to fair correlation with the OPUS Upper Extremity Functional Status score (rs=0.21). CONCLUSION: The metric properties of the Slovene version of CSD agree with previous studies. The present study confirms the validity of CSD for measuring patient satisfaction with an upper-limb device, enhances the confidence in this tool for assessing upper-limb prosthesis users, and contributes to further refining the technical quality of this measure.

Trapeziometacarpal joint osteoarthritis: a prospective trial on two widespread conservative therapies.

INTRODUCTION: The trapeziometacarpal (TMC) joint osteoarthritis (OA) is at the origin of important secondary functional disability to pinch as well as a painful grip. Several conservative therapies are often considered in the early stages of TMC OA to decrease pain, recover function and slow the evolution of OA. They include massage therapy, heat applications, stretching of the first web span and assisted mobilization of the TMC joint. However, as with other arthritic joints, many physicians often suggest administering intra-articular corticosteroids. The aim of this study was to assess the effect of 10 sessions of physiotherapy versus a single corticoid intra-articular injection. Both treatments were associated with TMC splinting. METHODS: Two groups of twenty-five patients received either physiotherapy or a corticoid injection. They were followed over a one-year period. All of them were assessed for pain, function, strength at 2, 6 and 12 months and overall satisfaction at the end of the study. RESULTS: With the infiltrative therapy, the parameters improve more quickly, whereas patients treated with physiotherapy show longer persistence regarding remission of pain. The final functional evaluation scores at one year are similar to pretreatment scores. CONCLUSION: In early stages of TMC OA, corticosteroids articular injections and physiotherapy treatments can improve the painful symptoms but treatment with corticosteroids is faster. Although hand functions return to average scores similar to those of pre-treatment, physiotherapy program is associated with a longer remission of pain.

Functional leg length discrepancy between theories and reliable instrumental assessment: a study about newly invented NPoS system.

BACKGROUND: In spite the instinct social&financial impact of Leg Length Discrepancy (LLD), controversial and conflicting results still exist regarding a reliable assessment/correction method. For proper management it's essential to discriminate between anatomical&functional Leg Length Discrepancy (FLLD). With the newly invented NPoS (New Postural Solution), under the umbrella of the collaboration of PRM Department, Tor Vergata University with Baro Postural Instruments srl, positive results were observed in both measuring& compensating the hemi-pelvic antero-medial rotation in FLLD through personalized bilateral heel raise using two NPoS components: Foot Image System (FIS) and Postural Optimizer System (POS). This led our research interest to test the validity of NPoS as a preliminary step before evaluating its implementations in postural disorders. METHODS: After clinical evaluation, 4 subjects with FLLD have been assessed by NPoS. Over a period of 2 months, every subject was evaluated 12 times by two different operators, 48 measurements in total, results have been verified in correlation to BTS GaitLab results. RESULTS: Intra-Operator&inter-operator variability analysis showed statistically insignificant differences, while inter-method variability between NPoS and BTS parameters expressed a linear correlation. CONCLUSION: Results suggest a significant validity of NPoS in assessment&correction of FLLD, with high degree of reproducibility with minimal operator dependency. This can be considered a base for promising clinical implications of NPoS as a reliable cost effective postural assessment/corrective tool. LEVEL OF EVIDENCE: V.

Rasch validation and comparison of Slovenian, Croatian, and Italian versions of the Mini-BESTest in patients with subacute stroke.

We aimed to verify by Rasch analysis whether the Mini-BESTest, a balance measure, confirms its main psychometric properties in patients with subacute stroke undergoing rehabilitation in three different countries (Slovenia, Croatia, and Italy), and to examine the stability of item hierarchy and difficulty across the three national versions through a differential item functioning analysis. We investigated 159 patients with subacute stroke consecutively admitted to three rehabilitation facilities after screening for an intensive, tailored rehabilitation program. Balance function was tested within 36 h from admission and after ∼25 days. As no differential item functioning was found between admission and discharge data or among countries, all data were pooled. Rasch criteria for the functioning of rating scale categories were fulfilled. In terms of internal construct validity, all items except item #14 (Cognitive Get Up & Go; infit value=1.42) showed an acceptable fit to the Rasch model. The patient ability-item difficulty matching was very good. Reliability indices were high. The Principal Component Analysis of standardized residuals confirmed the unidimensionality of the test. On the basis of the item calibration, raw scores of the Mini-BESTest were transformed into linear estimates of dynamic balance and six statistically detectable levels of balance ability were defined. Good psychometric features of the Mini-BESTest were confirmed. The three different national versions showed stability in item hierarchy, indicating equivalence of their cross-cultural adaptations. Problems with item #14 in these patients warrant further study.