The psychometric properties of the Childhood Health Assessment Questionnaire (CHAQ) in children with cerebral palsy.

BACKGROUND: The evaluation of children with cerebral palsy (CP) focuses on activity level measurement to examine the effect of health-care interventions on their physical functioning in the home, school, and community settings. This study aimed to identify the psychometric properties of the Korean version of the Childhood Health Assessment Questionnaire (CHAQ) by applying the Rasch model. The use of the Rasch model has an advantage in that item characteristic curve estimation is not affected by the characteristics of subject groups. METHODS: Data were collected from 65 children with CP aged 75-190 months using the Korean version of the CHAQ. Response data were analyzed according to the Rasch model, and item fitness and difficulty and the appropriateness and reliability of the rating scale were evaluated. RESULTS: Among the 30 items of the Korean version of the CHAQ, two items (nail-cutting and opening a bottle cap that was already opened) were shown to be misfit items with low fitness. The analysis results for item difficulty indicated the requirement for modification of item difficulty, pointing out the need for the addition of question items with both higher and lower difficulty. The use of 4-point rating scale in the evaluation questionnaire was shown to be appropriate. With respect to analysis outcomes, the subjects' separation reliability value and separation index were 0.97 and 5.92, respectively. In contrast, the separation reliability value and separation index for the question items were 0.95 and 4.51, respectively. CONCLUSIONS: The results of this study suggest the need for the modification of item fitness and difficulty. The psychometric properties of the Korean version of the CHAQ were identified using the item response theory-based Rasch analysis.

The sensitivity and specificity of the Falls Efficacy Scale and the Activities-specific Balance Confidence Scale for hemiplegic stroke patients.

[Purpose] This study attempted to investigate the sensitivity and specificity of the Falls Efficacy Scale (FES) and the Activities-Specific Balance Confidence Scale (ABC) for community residents with hemiplegic stroke. [Subjects and Methods] The FES and the ABC data were collected for a sample of 99 community-dwelling hemiplegic stroke patients in Korea. The Receiver Operating Characteristic (ROC) curve was used to determine the cut-off values, and the area under the curve (AUC) was used to assess the overall accuracy of each balance test. Multivariate logistic regression analysis was employed to identify the predictors of falling. [Results] The cut-off value was 63.75 in the ABC and 66.50 in the FES. The sensitivity and specificity of the ABC was 41.3% and 92.0%, respectively. The sensitivity and specificity of the FES was 69.8% and 63.9%, respectively. The AUC was 0.691 for the ABC and 0.678 for the FES. The ABC explained 28.0% of the variance in the experience of falls. [Conclusion] The ABC has the ability to determine non-fallers, and it was a good explanatory factor of experience of falls.

Activities of daily living and manual hand dexterity in persons with idiopathic parkinson disease.

[Purpose] The purpose of this study was to evaluate the relationship between daily activities and manual dexterity in persons with Parkinson disease. [Subjects and Methods] The study participants were 25 patients with idiopathic Parkinson disease. This study used two clinical tools, the box-and-block test and Schwab and England Activities of Daily Living scale, to investigate the relationship between manual dexterity and Schwab and England Activities of Daily Living score. [Results] A positive correlation was observed between the Schwab and England Activities of Daily Living and the box-and-block test scores on the more and less affected sides. Moreover, the Schwab and England Activities of Daily Living score had a greater correlation with the box-and-block test score on the less affected side than that on the more affected side. [Conclusion] Manual dexterity and activities of daily living showed a positive correlation in individuals with Parkinson disease. The results of this study suggest that manual dexterity is an important factor for predicting physical performance in daily living in persons with Parkinson disease.

Validity and reliability of the safe driving behavior measure in community-dwelling self-drivers with stroke.

[Purpose] Driving is a vital component of recovery for stroke survivors facilitating restoration of their family roles and reintegration back into their communities and associations. The purpose of this study was to evaluate the validity and reliability of the Safe Driving Behavior Measure (SDBM) in community-dwelling self-drivers post-stroke. [Subjects and Methods] Participants were sixty-seven community-dwelling self-drivers who had received a diagnosis of first stroke in the past twelve months. To investigate the validity and reliability of the SDBM, this study evaluated two sessions, held three days apart in a quiet and well-organized assessment room. Cronbach's alpha and the Intraclass Correlation Coefficient [ICC (2.1)] were used to evaluate statistically concurrent validity and reliability of the overall and three domain scores. Pearson's correlations were used to quantify the bivariate associations among the three domains. [Results] The Cronbach's alpha coefficients for the three domains of person-vehicle (0.989), person-environment (0.997), and person-vehicle-environment (0.968) of the SDBM indicated high internal consistency in community-dwelling self-drivers with stroke, in addition to excellent rest-retest reliability. [Conclusion] The results of this study suggest that the SDBM could be a reliable measure to evaluate automobile driving in community-dwelling self-drivers with stroke.

Investigation of psychometric properties of the Falls Efficacy Scale using Rasch analysis in patients with hemiplegic stroke.

[Purpose] The purpose of this study was to investigate the psychometric properties of the Falls Efficacy Scale using Rasch analysis in patients with hemiplegic stroke. [Subjects] Fifty-five community-dwelling hemiplegic stroke patients were selected as participants. [Methods] Data were analyzed using the Winsteps program (version 3.62) with the Rasch model to confirm the unidimensionality through item fit, reliability, and appropriateness of the rating scale. [Results] There were no misfit persons or items. Furthermore, infit and outfit statistics appeared adjacent. The person separation value was 3.07, and the reliability coefficient was 0.90. The reliability of all items was at an acceptable level for patients with hemiplegic stroke. [Conclusion] This was the first study to investigate the psychometric properties of the Falls Efficacy Scale using Rasch analysis. The results of this study suggest that the 6-point Falls Efficacy Scale is an appropriate tool for measuring the self-perceived fear of falling in patients with hemiplegic stroke.

The influence of fathers' parenting participation with disabled children on parenting stress in mothers.

[Purpose] The purpose of this research was two-fold: (1) to evaluate the effects of father's parenting participation on parenting stress among mothers with disabled children and (2) more specifically, to investigate the importance of fathers' parenting participation in decreasing mothers' parenting stress. [Subjects and Methods] To examine these relationships, this study recruited 82 mothers with disabled children from rehabilitation centers in the Gwangju city. The common characteristics of parents and children, father's parenting participation, and mother's parenting stress were assessed using standard questionnaires. [Results] Based on mother reports, findings suggest that as fathers' parenting participation increases mothers' parenting stress decreases. [Conclusion] The present study reveals a need for improvement in parenting education and in providing fathers of disabled children with a temporary leave of absence from work. Specifically, this research highlights the importance of shared parenting responsibilities among family members. Finally, our findings suggest that developing a standardized national program for assisting parents with disabled children may help decrease parenting stress in mothers.

Rasch analysis of the London Handicap Scale in stroke patients: a cross-sectional study.

BACKGROUND: Although activity and participation are the target domains in stroke rehabilitation interventions, there is insufficient evidence available regarding the validity of participation measurement. The purpose of this study was to investigate the psychometric properties of the London Handicap Scale in community-dwelling stroke patients, using Rasch analysis. METHODS: Participants were 170 community-dwelling stroke survivors. The data were analyzed using Winsteps (version 3.62) with the Rasch model to determine the unidimensionality of item fit, the distribution of item difficulty, and the reliability and suitability of the rating process for the London Handicap Scale. RESULTS: Data of 16 participants did not fit the Rasch model and there were no misfitting items. The person separation value was 2.42, and the reliability was .85; furthermore, the rating process for the London Handicap Scale was found to be suitable for use with stroke patients. CONCLUSIONS: This was the first trial to investigate the psychometric properties of the London Handicap Scale using Rasch analysis; the results supported the suitability of this scale for use with stroke patients.

Psychometric Properties of the Lower Extremity Subscale of the Fugl-Myer Assessment for Community-dwelling Hemiplegic Stroke Patients.

[Purpose] The purpose of this study was to investigate the psychometric properties of the lower extremity subscale of the Fugl-Meyer Assessment lower extremity (FMA-LE) for community-dwelling hemiplegic stroke patients. [Subjects] The participants were 140 community-dwelling hemiplegic stroke patients. [Methods] To determine the psychometric properties of the FMA-LE, we examined construct validity, response characteristics, item discrimination, and internal consistency. [Results] Factor analysis of the FMA-LE revealed that the first factor explained 61.73% of the variance and provided evidence of unidimensionality. The FMA-LE did not show ceiling or floor effects; Cronbach's α was 0.935 (95% CI: 0.919-0.950). [Conclusion] Because the FMA-LE seems to be both valid and reliable, we conclude that it is appropriate for the measurement of the lower extremity motor impairment of community-dwelling hemiplegic stroke patients.

Psychometric Properties of the Korean Dispositional Hope Scale Using the Rasch Analysis in Stroke Patients.

BACKGROUND: It is reported that hopeful thinking plays a positive role in encouraging patients to achieve functional goals during the rehabilitation process. Hope is a key concept in evaluating stroke outcomes in research and rehabilitation practice. AIMS: The purpose of this study was to investigate the psychometric properties of the Korean Dispositional Hope Scale (K-DHS) using the Rasch analysis in patients with hemiplegic stroke. METHODS: The K-DHS was completed by 166 community-dwelling hemiplegic stroke patients in Korea. Data were analyzed according to item fit, item difficulty, and the appropriateness of the rating scale using the Rasch analysis. RESULTS: Item fit analysis showed that 8 items of the K-DHS are appropriate because the infit MSNQ was between 0.7 and 1.3. Item difficulty results revealed that there is a difference in distribution between personal attributes and item difficulty. It shows that the item fit statistics of the 4-point Likert scale of K-DHS are all good. The person separation index demonstrated that the K-DHS could differentiate two or three hope status strata in stroke patients. The item separation index indicated that the items were useful with high reliability. CONCLUSION: The K-DHS comprises appropriate items for measuring the hope of stroke patients living in the community, and the rating scale of the K-DHS is also appropriate. This study is the first to conduct an analysis of the rating scale and its appropriateness, as well as the difficulty of items based on item response theory, and offers new insights for enhancing hope and improving well-being following stroke.

Comparison of Cognitive Orientation to daily Occupational Performance and conventional occupational therapy on occupational performance in individuals with stroke: A randomized controlled trial.

BACKGROUND: Cognitive Orientation to daily Occupational Performance (CO-OP) approach based on cognitive strategy in occupational therapy. OBJECTIVES: To investigate the effects of CO-OP approach on occupational performance in individuals with hemiparetic stroke. METHODS: This study was designed as a 5-week, randomized, single-blind. Forty-three participants who had a diagnosis of first stroke were enrolled in this study. The participants were randomly assigned to the experimental group (n = 20) or the control group (n = 23). The experimental group conducted CO-OP approach while the control group conducted conventional occupational therapy based on occupational performance components. This study measured Canadian Occupational Performance Measure (COPM) and Performance Quality Rating Scale (PQRS). Outcome measurements were performed at baseline and post-intervention. RESULTS: After training, the scores of COPM and PQRS in trained task were significantly higher for the score in the experimental group than the control group. In addition, the non-trained task was significantly higher for the score in the experimental group than the control group in COPM and the PQRS. CONCLUSIONS: This study suggests that the CO-OP approach is beneficial effects on the occupational performance to improvement in individuals with hemiparetic stroke, and have positive effects on generalization and transfer of acquired skills.

Psychosocial predictors of participation restriction poststroke in Korea: A path analysis.

OBJECTIVE: The present cross-sectional study tested a hypothetical path model consisting of psychosocial factors in relation to activity participation restriction in chronic stroke. Motor and cognitive functions and age; psychological factors consisting of depressive symptoms, hopeful thinking, and self-esteem; and activities of daily living and social support served as psychosocial factors. METHOD: Data were collected from 171 community-dwelling individuals with chronic stroke in Korea. Path analysis was conducted to test the model fit between the obtained data and the hypothetical model to examine the direct and indirect effects of variables on participation restriction. RESULTS: Among the psychosocial factors, psychological factors and activities of daily living played the most significant role in predicting the degree of participation restriction, as well as mediating the relationship. Motor and cognitive functions were mediated by activities of daily living, and social support was mediated by psychological factors to affect participation restriction. Among the psychological factors, hopeful thinking exhibited the strongest relationship. CONCLUSION: To increase stroke survivors' participation during the course of rehabilitation, psychosocial factors as well as biological factors should be included in a multidimensional treatment approach.

Factor analysis of the WeeFIM in children with spastic cerebral palsy.

PURPOSE: Determining the psychometric properties such as reliability and validity of Functional Independence Measure for Children (WeeFIM) instrument would help health professionals to understand the comprehensive assessment of children with spastic cerebral palsy (CP). The purpose of this study was to investigate the factor structure of the WeeFIM in children with spastic CP. METHODS: Two hundred seven children (138 boys, 69 girls) with spastic CP were recruited in this cross-sectional study; their mean age (SD) was 9.10 (2.7) years. Data were collected through a questionnaire that included the WeeFIM. Of the 207 children, 57 (27%), 105 (51%), and 45 (22%) were quadriplegic, diplegic, and hemiplegic, respectively. In each of these groups, 49 (24%), 32 (15%), 31 (15%), 19 (9%), and 76 (37%) children were classified as Gross Motor Function Classification System (GMFCS) levels I-V, respectively. The factor structure of the WeeFIM was analyzed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) by using AMOS 20.0. The reliability of WeeFIM was assessed by calculating the internal consistency of Cronbach's α. RESULTS: The internal consistency of Cronbach's α was 0.98. The 1- and 2-factor models did not demonstrate adequate fit indices according to CFA. However, the 3-factor structure (i.e. self-care, motor, and cognitive factors) was supported by EFA and CFA, which explained 87.12% of the variance. The self-care factor included 6 items (eating, grooming, dressing upper, dressing lower, bathing, and toileting), the motor factor included 7 items (bladder and bowel management, bed/chair/wheelchair, toilet, tub/shower, walk/wheelchair, and stairs), and the cognitive factor included the same 5 items as the original cognitive domain. CONCLUSION: In children with spastic CP, 3 factors of the WeeFIM were determined by factor analysis. Therefore, self-care, motor, and cognitive domains should be treated as separate scales in children with spastic CP.

Neuromuscular electrical and thermal-tactile stimulation for dysphagia caused by stroke: a randomized controlled trial.

OBJECTIVE: The aim of this study was to assess the effectiveness of neuromuscular electrical stimulation in patients with dysphagia caused by stroke. METHODS: Thirty-six subjects were randomized into experimental and control groups. The control group was given thermal-tactile stimulation treatment only, while in the experimental group neuromuscular electrical stimulation and thermal-tactile stimulation treatments were applied simultaneously. Swallowing function was assessed before and 4 weeks after treatment, and evaluated via the swallow function scoring system, penetration-aspiration scale, and pharyngeal transit time. In addition, the discomfort score during the treatments and the satisfaction score 4 weeks after the treatments were measured. RESULTS: Twenty-eight persons with dysphagia completed the study, 16 in the experimental group and 12 in the control group. Both groups showed improvement, but the experimental group showed more significant improvement in the swallow function scoring system, penetration-aspiration scale and pharyngeal transit time than the control group. The patient's discomfort score did not show statistically significant differences in either group, but the satisfactory score was higher in the experimental group. CONCLUSION: The results suggest that neuromuscular electrical stimulation combined with thermal-tactile stimulation is a better treatment for patients with swallowing disorders after stroke than thermal-tactile stimulation alone.