Effect of sense of coherence on long-term work participation among rehabilitation patients: a longitudinal study.

OBJECTIVE: To investigate the causal effect of sense of coherence on long-term work participation after rehabilitation, including stratification by age and diagnoses. DESIGN: Longitudinal cohort study. PARTICIPANTS: Patients aged ≤ 60 years, employed and accepted for somatic interprofessional rehabilitation in 2015 (n = 192). METHODS: Patients reported sense of coherence before rehabilitation in 2015 and mental and physical functioning in 2016. Register data were used to measure work participation during 2018 and days working without social security benefits during 2016-18. Regression models were used to explore the total effect of sense of coherence and the possible mediation of functioning. Results are reported as odds ratios (95% confidence intervals). RESULTS: During 2018, 77% of the total study cohort participated in work activities. The subgroup with musculoskeletal diagnoses had the fewest days of working without social security benefits. A causal relationship was found between sense of coherence and long-term work participation. Some of the effect of sense of coherence was mediated by mental functioning. The total effect of sense of coherence was strongest for patients with musculo-skeletal diagnoses (work participation: 1.11 (1.05, 1.17), days working without social security benefits: 1.05 (0.01, 109)). CONCLUSION: Improving coping resources may be beneficial to facilitate long-term work participation after injury or illness, especially for individuals with musculoskeletal diagnoses.

Clinimetric properties of a translated and culturally adapted Norwegian version of the Patient and Observer Scar Assessment Scale for use in clinical practice and research.

PURPOSE: To translate and culturally adapt the Patient and Observer Scar Assessment Scale, POSAS, to Norwegian and explore its test-retest, intra- and inter-tester reliability. METHODS: POSAS was translated into Norwegian following international guidelines in collaboration with an international translation bureau. Twenty-six adults and 24 children were recruited from a burns outpatient clinic. Three observer-categories: doctor, nurse and physiotherapist, assessed the patients' scars and scored the Observer scale for estimating inter-tester reliability. Photos of the scars were taken and used to score the Observer scale a second time for examining intra-tester reliability. The patients or parents/next of kin rated their scar on the Patient scale at the clinic and after two days at home for examining test-retest reliability. Intraclass correlation (ICC) and Kappa were used for statistical analysis. RESULTS: A Norwegian version of POSAS (POSAS-NV) was developed. Inter-tester ICC of the Observer parameters varied between 0.203 and 0.728, and for the total sum score, ICC=0.528 (0.280-0.708). Intra-tester ICC of the Observer scale ranged between 0.575 and 0.858. The Patient scale demonstrated high test-retest reliability. CONCLUSIONS: Intra-tester reliability of the Observer scale and test-retest reliability of the Patient scale of POSAS-NV were found satisfactory, but not inter-tester reliability of the Observer scale.

The Pain Assessment in Impaired Cognition scale (PAIC15): A multidisciplinary and international approach to develop and test a meta-tool for pain assessment in impaired cognition, especially dementia.

BACKGROUND: Over the last decades, a considerable number of observational scales have been developed to assess pain in persons with dementia. The time seems ripe now to build on the knowledge and expertize implemented in these scales to form an improved, "best-of" meta-tool. The EU-COST initiative "Pain in impaired cognition, especially dementia" aimed to do this by selecting items out of existing observational scales and critically re-assessing their suitability to detect pain in dementia. This paper reports on the final phase of this collaborative task. METHODS: Items from existing observational pain scales were tested for "frequency of occurrence (item difficulty)," "reliability" and "validity." This psychometric testing was carried out in eight countries, in different healthcare settings, and included clinical as well as experimental pain conditions. RESULTS: Across all studies, 587 persons with dementia, 27 individuals with intellectual disability, 12 Huntington's disease patients and 59 cognitively healthy controls were observed during rest and movement situations or while receiving experimental pressure pain, respectively. The psychometric outcomes for each item across the different studies were evaluated within an international and multidisciplinary team of experts and led a final selection of 15 items (5x facial expressions, 5x body movements, 5x vocalizations). CONCLUSIONS: The final list of 15 observational items have demonstrated psychometric quality and clinical usefulness both in their former scales and in the present international evaluation; accordingly, they qualified twice to form a new internationally agreed-on meta-tool for Pain Assessment in Impaired Cognition, the PAIC-15 scale. SIGNIFICANCE: Using a meta-tool approach by building on previous observational pain assessment scales and putting the items of these scales through rigorous empirical testing (using experimental as well as clinical pain studies in several European countries), we were able to identify the best items for pain assessment in individuals with impaired cognition. These selected items form the novel PAIC15 scale (pain assessment in impaired cognition, 15 items).

The Danish version of Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors: Translation and cultural adaptation followed by validity and reliability testing.

PURPOSE: To translate and culturally adapt the Lymphoedema Functioning, Disability and Health Questionnaire (Lymph-ICF) for breast cancer survivors with arm lymphedema into Danish and examine its content validity and reliability. METHODS: (1) Translation and cultural adaptation was performed in 10 steps following international guidelines (International Society for Pharmacoeconomics and Outcome Research); (2) cognitive interviewing (step 7) was conducted in 15 women with breast cancer related arm lymphedema to explore understandability, interpretation, and cultural relevance; (3) after adjustments, content validity (N = 52) was explored by interviews; and (4) reliability (N = 50) examined by intraclass correlation coefficients (ICC) statistics and Cronbach alpha analysis. RESULTS: Cognitive interviewing lead to an adapted and improved version of the translated questionnaire. Content validity was supported. Internal consistency (α) for all questions was .98 and ranged for the different domains between 0.92 and 0.97. Test-retest reliability for the total score was highly satisfactory, ICC = 0.95, standard error of measurement (SEM) = 4.5 and smallest detectable change = 12.5. ICC values for the domains ranged from 0.84 to 0.94. SEM values differed for the domains, 6.4 (physical function), 5.7 (mobility activities), 7.09 (life and social activities), 9.1 (mental functions), and 10.2 (household activities). CONCLUSION: The translated and adjusted Lymph-ICF DK (Denmark) is reliable and valid, allowing for assessing self-reported impairments in function, activity limitations, and participation restrictions in Danish patients with breast cancer-related arm lymphedema.

Temporal and spatial gait parameters in patients dependent on walking assistance after stroke: reliability and agreement between simple and advanced methods of assessment.

The aim of this study was to investigate the reliability of temporal and spatial gait parameters in patients dependent on walking assistance after severe stroke, and to examine agreement between simple and advanced methods. Twenty-one patients, admitted for in-patient multidisciplinary rehabilitation, were assessed repeatedly for walking function, both in a test corridor and a gait laboratory (3D camera system) before and after 11 weeks of rehabilitation. The test-retest reliability was examined using intraclass correlation (ICC1.1), and measurement error was reported by within-subject standard deviation (Sw). The agreement between different methods for assessing walking speed, cadence and step length was explored by Bland-Altman plots. High to excellent test-retest reliability was found between trials, both when assessed in the corridor (ICC: 0.93-0.99) and in the laboratory (ICC: 0.88-0.99). Agreement between methods was satisfactory at baseline and was higher after the rehabilitation period. Agreement was found to be slightly better at lower walking speeds and for shorter step lengths. The results implicate that temporal-spatial gait parameters may be measured reliably by both simple and advanced methods in dependent walkers after stroke. A high level of agreement was found between the two methods for walking speed, cadence and average step length at both test points.

Reliability of the Norwegian version of the Children's Assessment of Participation and Enjoyment (CAPE) and Preferences for Activities of Children (PAC).

This study examined test-retest reliability of the Norwegian version of Children's Assessment of Participation and Enjoyment (CAPE), and Preferences for Activities of Children (PAC) in children with and without disabilities. Totally 141 children, 107 typically developing, mean age 11.1, and 34 with disabilities, mean age 14.2 years participated. A cross-sectional, test-retest design was applied. The participants completed CAPE and PAC twice within mean 19 days. Reliability was examined by Chronbach's alpha, intraclass correlation coefficients (ICC), and Kappa statistics. The alpha values for internal consistency varied between 0.53 and 0.87 for the CAPE and between 0.75 and 0.93 for the PAC. ICC coefficients varied from 0.49 to 0.83 for the CAPE and 0.50 to 0.85 for the PAC. Kappa coefficients varied from 0.30 to 0.66. The Norwegian CAPE and PAC demonstrated sufficient measurement properties of internal consistency and test-retest reliability. The reliability of the CAPE, however, was not entirely satisfactory.

Inter-observer reliability of the "Assessment of Motor Repertoire--3 to 5 Months" based on video recordings of infants.

OBJECTIVE: A detailed analysis of infant motor behaviour can show up indicators for later neurological impairment. The "Assessment of Motor Repertoire--3 to 5 Months", which is part of Prechtl's general movement assessment, could potentially be used for this purpose. The aim of the present study was to investigate inter-observer reliability in this instrument. METHOD: Video recordings of 24 infants (corrected ages 3 to 5 months, gestational ages 24 to 42 weeks) were analysed by four observers. Kappa and ICC statistics were applied in the reliability analysis. RESULTS: High to very high inter-observer reliability was found in the assessment of "Fidgety Movements" (kappa 0.75-0.91). Agreement on the "Movement Character" was also high (kappa 0.54-0.84), while the assessment of the "Posture" showed the lowest inter-observer reliability (kappa 0.39-0.56). Moderate to high inter-observer reliability (kappa 0.51-0.84) was achieved in the field "Quality of Other Movements", and moderate in "Repertoire of Co-Existent Other Movements" (kappa 0.51-0.69). Inter-observer reliability in the assessment of the total "Motor Optimality Score" was very high between all four observers as intraclass correlation coefficient (2,1) was 0.87, and ICCs for the pairwise analyses ranged between 0.80 and 0.94. CONCLUSION: Inter-observer reliability in the "Assessment of Motor Repertoire - 3 to 5 Months" was satisfactory in respect of the subcategories and in case of high and low total optimality scores in pairwise assessments. In the total optimality scores, however, there was some inconsistency in the middle range of the scale.

Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (MOBID): development and validation of a nurse-administered pain assessment tool for use in dementia.

Pain assessment in older persons with severe cognitive impairment (SCI) is a challenge due to reduced self-report capacity and lack of movement-related pain assessment instruments. The purpose of this article was to describe the development of the Mobilization-Observation-Behaviour-Intensity-Dementia Pain Scale (MOBID) and to investigate aspects of reliability and validity. MOBID is a nurse-administered instrument developed for use in patients with SCI, where presence of pain behavior indicators (pain noises, facial expression, and defense) may be observed during standardized active, guided movements, and then inferred to represent pain intensity. Initially, the MOBID contained seven items (observing at rest, mobilization of the hands, arms, legs, turn over in bed, sitting on bedside, and teeth/mouth care). This was tested in 26 nursing home patients with SCI. Their primary caregivers, five registered nurses and six licensed practical nurses (LPNs), rated the patients' pain intensity during regular morning care, and by MOBID, both at bedside and from video uptakes. Three external raters (LPNs), not knowing the patients, also completed the MOBID by rating the videos. Internal consistency of the MOBID indicated high Cronbach's alpha (alpha=0.90) after deleting the items for observation at rest and observation of teeth/mouth care. MOBID disclosed significantly more pain than did pain scorings during regular morning care, and video observation demonstrated higher pain intensity than bedside scoring. Intertester reliability for inferred pain intensity was high to excellent (intraclass correlation coefficient=0.70-0.96), but varied between poor and excellent for pain behavior indicators (kappa=0.05-0.84). These results suggest that registration of pain behavior indicators during active, guided movements, as performed by the MOBID procedure, is useful to disclose reliable and valid pain intensity scores in patients with SCI.

Back Performance Scale for the assessment of mobility-related activities in people with back pain.

BACKGROUND AND PURPOSE: Activities that require mobility of the trunk are often limited in patients with back problems. For this study, 5 tests (Sock Test, Pick-up Test, Roll-up Test, Fingertip-to-Floor Test, and Lift Test), all requiring sagittal-plane mobility, were performed, and the test scores were combined by the authors in a scale called the Back Performance Scale (BPS) to obtain a performance measure of mobility-related activities. SUBJECTS: The participants were 288 patients with long-lasting musculoskeletal pain. METHODS: The basis for constructing a sum scale (BPS), discriminative ability, and responsiveness to important change of the BPS were examined in patients with back pain. RESULTS: Bivariate correlations (rs) of scores among tests ranged from.27 to.50, and correlations between separate tests and the BPS ranged from.63 to.73. The Cronbach alpha was.73. The BPS sum scores discriminated between patients with different return to work status and were higher for back pain than for other musculoskeletal pain. Responsiveness was high (effect size=1.33) in patients who had changed and low (effect size=0.31) in patients who had not changed, using return to work as an external indicator of important change. The BPS was more responsive than the separate tests. DISCUSSION AND CONCLUSION: The BPS appears to measure an aspect of physical performance that is of clinical importance to patients with back pain.