Construction and pilot assessment of the Upper Limb Assessment in Daily Living Scale.

OBJECTIVE: The upper limb function of hemiplegic patients is currently evaluated using scales that assess physical capacity or daily activities under test conditions. The present scale, the Upper Limb Assessment in Daily Living (ULADL) Scale, was developed to explore the subjective and objective functional capacities of such patients in a proximal to distal sequence. METHODS: A group of experts constructed a scale addressing 17 upper limb functions (five active passive and 12 active) which could be explored by a questionnaire (Q) and a test (T). Reproducibility, internal consistency, concurrent validity (Rivermead Motor Assessment (RMA)) and learning effect were estimated in a multicentre study. RESULTS: 49 stroke patients were each rated three times within 7 days by a total of 21 physicians, yielding a total of 142 ratings. The ULADL took 16±8 min to complete compared with 9±5 min for the RMA. Cronbach's alpha coefficient was 0.95 for Q and 0.97 for the practical tests (T). The global Q and T scores, and in particular the global Q score, were slightly higher at the second rating. The intra-rater intraclass correlation coefficient (ICC) was 0.65 (95% CI (0.44 to 0.79)) for Q and 0.97 (0.95 to 0.98) for T, and the inter-rater ICC was 0.95 for both Q and T. The Bland and Altman method showed good intra- and inter-rater reliability with no systematic trend. Correlation coefficients for ULADL versus RMA were >0.80 for both Q and T. CONCLUSIONS: The ULADL Scale has good psychometric properties and can explore patients with different degrees of upper limb impairment.

Qualiveen, a urinary-disorder specific instrument: 0.5 corresponds to the minimal important difference.

OBJECTIVE: This study assessed the interpretability of changes in Qualiveen, a specific health-related quality-of-life (HRQOL) questionnaire for urinary disorders (UD) in multiple sclerosis (MS) patients. Qualiveen has 30 items focusing on four aspects of patients' lives related to their urinary problems: bother with limitations (nine items), frequency of limitations (eight items), fears (eight items), and feelings (five items). Response options are framed as 5-point Likert-type scales, and scores on each domain range from 0 to 4. STUDY DESIGN AND SETTING: One hundred twenty-one MS patients with UD completed Qualiveen at baseline and 2-10 weeks later. At the second visit, patients also made global ratings of change in urinary HRQOL (GRC) with a 15-point scale from -7 to +7. We addressed the validity of GRC by examining its relationships with pre- and post-Qualiveen scores and determined the mean change in score on each Qualiveen domain associated with small, moderate, and large changes in the corresponding GRC. RESULTS: The correlation of the change score with the corresponding GRC was substantially stronger than the correlation with either pre- or post-Qualiveen score, establishing the validity of the GRC. In all domains, a within-patient change in Qualiveen score of approximately 0.5 (range: 0.36-0.72) represents the minimal important difference. A change in score of approximately 0.7 corresponds to a moderate change in quality of life (range: 0.55-0.86). CONCLUSIONS: These estimates will help in interpreting the results of subsequent studies that use Qualiveen to examine the impact of interventions designed to improve urinary-specific HRQOL.