Psychometric properties of the Community Integration Questionnaire - Revised (CIQ-R) in an Italian population with spinal cord injury.

STUDY DESIGN: Psychometric study. OBJECTIVES: The aim of this study was to evaluate the internal consistency and validity of the Community Integration Questionnaire - Revised (CIQ-R) in Italian individuals with spinal cord injury (SCI). SETTING: Patients' associations, foundations, sport clubs, and federations in Italy. METHODS: The psychometric properties were evaluated following international guidelines. Internal consistency was assessed using Cronbach's alpha (α) coefficient, and test-retest reliability was assessed using intraclass correlation coefficient (ICC); concurrent validity was assessed through Pearson's Correlation Coefficient with the Short Form-12 health survey (SF-12). RESULTS: The test was administered to 80 people with SCI. Cronbach's α showed a value of 0.825 for the Home Integration subscale, while the other subscales and the total showed values <0.70. 30 of the 80 recruited individuals were submitted to test-retest, which showed ICC values ranging from 0.94 to 1. CIQ-R also showed a correlation between Physical Component Summary (PCS12) of the SF-12, and between Social Integration subscale's score and PCS12 and Mental Component Summary (MCS12). Correlations are also shown between Productivity subscale and PCS12 and MCS12, as well as between the total score and PCS12 and MCS12. CONCLUSION: This study provided Italian clinicians and researchers with the first international outcome measure for measuring community integration. The validation of this measurement tool for people with SCI allows to compare outcomes of various studies. It is useful for testing the effectiveness of a treatment in various diseases and define which treatment is more effective than others.

The Moorong Self Efficacy Scale: translation, cultural adaptation, and validation in Italian; cross sectional study, in people with spinal cord injury.

STUDY DESIGN: Psychometric study, transverse study. OBJECTIVE: To evaluate the psychometric properties of the Moorong Self Efficacy Scale (MSES) in the Italian population with Spinal Cord Injury (SCI). PARTICIPANTS: 65 people with SCI. SETTING: The Italian version of the MSES (MSES-IT) was administered to the participants recruited by two Italian Spinal Units. METHODS: MSES assesses confidence in the performance of daily activities. The original scale was translated from English into Italian using international guidelines. MSES-IT's internal consistency and inter-rater reliability were examined through the Cronbach alpha and intraclass correlation coefficient (ICC), respectively. Its concurrent validity was assessed using Pearson's correlation coefficients with the Italian version of the Spinal Cord Independence Measure-Self Reported (SCIM-SR) and the Italian version of the Quality-of-Life Assessment Questionnaire (SF-36). RESULTS: The MSES-IT was administered to 65 subjects. Cronbach's alpha for the MSES-IT was 0.87, and the test-retest reliability (ICC) was 0.99 (95% Confidence Interval). The validity analysis showed significant moderate correlations (0.30 < ρ < 0.44) between the MSES-IT and the following components of SF-36: Role limitations physical health; Role limitations emotional problems; Emotional well-being; General health. However, no correlations emerged between MSES-IT and SCIM-SR. CONCLUSIONS: This study showed strong values of Cronbach's alpha and ICC of MSES-IT that make it a useful clinical and research tool. Rehabilitation can improve quality of life by targeting low-efficacy factors in people with spinal cord injury, which is possible because an individual's self-efficacy related to SCI can help determine participation in daily activities and social activities, work, and other life events.

Development of the Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) for evaluating and measuring the impact of physical disability on pregnancy and the management of motherhood: a pilot study.

PURPOSE: The aim of this study was to develop a questionnaire that allows researchers to investigate and measure the impact of physical disability on pregnancy and the management of motherhood. Such a questionnaire requires good internal consistency. METHODS: The tool was developed following a study conducted in 2013 in the United States consisting of a semi-structured interview with open-ended questions. A team of three experts drafted and refined the questions, generating 31 retrospective, self-rated, and predefined questions (answered using a 5-point Likert scale). A statistical analysis of the instrument was also included, to assess its reliability and internal consistency. RESULTS: The Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) was prepared. It is a self-administered questionnaire consisting of an initial section and three subscales. In this phase of the study, 35 women with different pathologies leading to physical disability were recruited and completed the questionnaire. The PMEQ was found to have a good internal consistency. Cronbach's α was 0.812 (p > 0.05). CONCLUSION: The PMEQ has proven to be a valid, reliable, and rapid administrative tool useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.IMPLICATION FOR REHABILITATIONThis study provides researchers and clinicians a new tool for the evaluation of motherhood and pregnancy in women with physical disabilities.The PMEQ has proven to be a valid, reliable, and rapid administrative tool (10 min) useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.It is a new tool useful in both clinical and research practice to underline the importance of carrying out preventive and woman-centered assistance interventions.This tool is useful for promoting the autonomous management of pregnancy and motherhood in women with physical disabilities, and improving these women's quality of life and sense of satisfaction and competence in managing maternal tasks.

Internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia.

STUDY DESIGN: Psychometric study. OBJECTIVES: This study aimed to evaluate the internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia. SETTING: Italian spinal units. METHODS: Psychometric properties of the JTHFT-IT were assessed following international guidelines. The internal consistency was examined using Cronbach's alpha coefficient. Pearson's correlation coefficient was calculated for the concurrent validity of JTHFT-IT with a dynamometer, while the construct validity was calculated in comparison to that of the Van Lieshout test short version in Italian (VLT-SV-IT). RESULTS: The test was administered to 48 right-hand dominant people with tetraplegia. Cronbach's alpha calculation resulted in a value of 0.96 for the right hand and 0.94 for the left hand. In terms of the validity of the scale, the Pearson's correlation, as measured in relation to the VLT-SV-IT and dynamometer, showed statistically significant results (range for the correlation coefficient of between -0.96 and -0.12, p < 0.05). CONCLUSIONS: The findings of this study support the internal consistency and validity of the JTHFT-IT and its use among a population with cervical SCI as a measure of hand functionality.

General Sleep Disturbance Scale (GSDS-IT) in people with spinal cord injury: a psychometric study.

STUDY DESIGN: Psychometric study. OBJECTIVE: This study sought to analyze the psychometric properties of the Italian version of the General Sleep Disturbance Scale (GSDS-IT) in a population of individuals with spinal cord injury (SCI). SETTING: Italy. METHODS: Its reliability was assessed using the Cronbach's alpha and intraclass correlation coefficient (ICC), while its concurrent validity was assessed using the Pearson's correlation coefficient in relation to the Pittsburgh Sleep Quality Index (PSQI). The obtained scores were compared with the cut-off score for the GSDS-IT among a healthy Italian population (38.5). RESULTS: The GSDS-IT was administered to 57 participants with SCI who were recruited from all over Italy. The GSDS-IT was found to have good internal consistency (Cronbach's α of 0.76) and good test-retest reliability (ICC of 0.7), and it showed positive and significant values for all the PSQI domains. Based on the cut-off score of 38.5, 56% of participants tested positive for sleep disturbances upon admission (t0), while among the randomized participants submitted for the test-retest after 24 h (t1), 75% tested positive for sleep disturbances. CONCLUSION: The GSDS-IT is a valid, reliable, and time-efficient tool for measuring sleep disturbances over the past week in a population with SCI.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): validation of the Italian version for individuals with spinal cord injury.

STUDY DESIGN: Psychometric study. OBJECTIVE: The aim of the study was to translate and culturally adapt the MSISQ-15 into Italian and to administer it to individuals with a spinal cord injury (SCI). SETTING: Rome's Wheelchair Rugby Team and three spinal units in Italy. METHODS: Translation and validation of the MSISQ-15 were performed based on international guidelines. The questionnaire, which was in a paper and online format, was administered with the Short Form-12 Health Survey (SF-12) and the Spinal Cord Independence Measure Self-Report. RESULTS: Sixty-five participants were recruited. Internal consistency coefficient of MSISQ-15 scale, assessed by Cronbach's alpha, was 0.75. Test-retest reliability interclass correlations was, for example, 0.86. The construct validity was calculated and showed statistically significant results in relation to the mental health status investigated with the SF-12. CONCLUSIONS: The MSISQ-15 is a valid, reliable, and useful questionnaire for investigating how often the symptoms of an SCI interfere with a person's satisfaction or sexual activity.

Quality of life, concern of falling and satisfaction of the sit-ski aid in sit-skiers with spinal cord injury: observational study.

STUDY DESIGN: Observational study. OBJECTIVE: To describe (1) user satisfaction, (2) the Quality of Life (QoL) and (3) fear of falling in individuals with tetraplegia or paraplegia who used a mono-ski for sit-skiing. SETTING: Spinal units and Sport associations. METHODS: An observational study of people with spinal cord injury (SCI) who used a sit-ski. Participants were recruited in various SCI rehabilitation centers and sport associations. Participants completed three assessment tools: the Quebec User Evaluation of Satisfaction with assistive Technology (QUEST 2.0); the World Health Organization Quality of Life (WHOQoL-BREF); the Spinal Cord Injury Fall Concern Scale (SCI-FCS). Results were evaluated with chi-squared test and Kolmogorov-Smirnov's test and the significance was set for p values < 0.05. RESULTS: Fifteen participants were included. Results showed positive and statistically significant values for all the items of the SCI-FCS related to fear of falling, and for most of the items of the WHOQoL-BREF related to QoL and the QUEST 2.0 related to satisfaction with the device. CONCLUSIONS: This study highlights that sit skiing is correlated with high levels of satisfaction with the mono-ski, increases in QoL, and low levels of fear of falling. In adding these findings to the existent literature, it can be stated with more certainty that sit-skiing is a sport that can be recommended in rehabilitation and sports therapy programs.

Construct validity, test-retest reliability, and the ability to detect change of the Canadian Occupational Performance Measure in a spinal cord injury population.

Study design: Cross-sectional study. Objectives: To examine the construct validity and the ability to detect change, of the Italian version of the Canadian Occupational Performance Measure (COPM) in a spinal cord injury (SCI) population. Settings: Rehabilitation service of the Paraplegic Center of Ostia, Italy. Methods: Thirty-nine spinal cord injury participants were recruited. The clinimetric properties of the measure were assessed following international guidelines. Cronbach's alpha and the intraclass correlation coefficient were assessed for internal consistency and test-retest reliability, respectively. Construct validity was evaluated, by calculating correlation between COPM and the Spinal Cord Independence Measure (SCIM) through Pearson's correlation coefficient and Spearman's Rho. The ability to detect change was evaluated on the overall sample. Results: The COPM was shown to be reliable in a spinal cord injury sample with positive and statistically significant results for Cronbach's alpha (0.89) and ICC (0.99 for the performance subtest and 0.98 for the satisfaction subtest). Correlation coefficients did not show a correlation between the COPM total score and the SCIM. The COPM scores improved significantly during in-patient rehabilitation, moreover the mean change between the start of treatment and the end of the therapy as evaluated with the Wilcoxon signed-rank test was -4.25 points for the performance score and -2.96 points for the satisfaction score. Conclusions: This study showed that the COPM is a reliable tool for assessing SCI clients' perceived performance of daily activities and their satisfaction with their performance.

The outcome measures for loss of functionality in the activities of daily living of adults after stroke: a systematic review.

OBJECTIVE: To provide clinicians and researchers information regarding (1) the existing outcome measures to assess the loss of functionality in the activities of daily living (ADLs) of patients with stroke and (2) the presence of these assessment tools in the Italian context. STUDY DESIGN AND SETTING: For this Systematic Review Medline, CINAHL, and PsycINFO were searched for articles published up to 4 July 2017. Two authors independently identified eligible studies on the basis of predefined inclusion criteria and extracted data. Study quality and risk of bias were assessed using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. RESULTS: Of 370 publications identified and screened, 46 studies fell within the inclusion criteria and were critically reviewed. The most commonly used tools were: the Frenchay Activities Index and the Functional Independence Measure. CONCLUSION: This review has emphasized the need for agreement among researchers as to which tool must be studied in depth or adapted to other national contexts in order to develop universal norms and standards.

Validation of the short version of the Van Lieshout Test in an Italian population with cervical spinal cord injuries: a cross-sectional study.

STUDY DESIGN: Psychometric study. OBJECTIVE: To validate the Italian version of the Van Lieshout Test Short Version (VLT-SV) with a spinal cord injury population. SETTING: Three Italian spinal units. METHODS: The Italian version of the VLT-SV (VLT-SV-IT) was administered to a sample of people with cervical spinal cord injuries (C-SCI) and the test-retest was performed. Reliability was assessed using Cronbach's alpha for internal consistency and the intraclass correlation coefficient for repeatability assessment (test-retest). Pearson's correlation coefficient was calculated for concurrent validity with the Italian version of the Jebsen-Taylor Hand Function Test (JTHFT) and for construct validity with the Italian version of the Spinal Cord Injury Independence Measure (SCIM III). RESULTS: The VLT-SV-IT was administered to 61 individuals and all psychometric properties were significant: Cronbach's alpha was 0.95 (left hand and right hand) and the intraclass correlation coefficient for test-retest reliability was 0.90 for the right hand, the left hand, and the total score. Pearson's correlation coefficient of the VLT-SV-IT with the JTHFT was significant, while the correlation with SCIM III was not. The obtained values are considered acceptable and consistent with international guidelines. CONCLUSIONS: The VLT-SV-IT was shown to be a reliable and valid assessment tool for measuring hand function in the Italian population with C-SCI. This result suggests that it could be used as a starting point for hand therapy and to assist in clinical decision-making regarding treatment policy.

Validation and cross-cultural adaptation of the Van Lieshout test in an Italian population with cervical spinal cord injury: a psychometric study.

STUDY DESIGN: Psychometric study. OBJECTIVE: To assess the reliability and validity of the Italian-translated and adapted version of the Van Lieshout test (VLT) in a population of people with cervical spinal cord injury (C-SCI). SETTING: Multicenter study in multiple hospitals in Italy. METHODS: The original scale was translated from English to Italian according to international guidelines. The internal consistency, test-retest reliability, and responsiveness of the Italian version of the VLT (IT-VLT) were examined. The IT-VLT was administered to 50 individuals with C-SCI, and its construct and convergent validity were evaluated using Pearson correlation coefficients with the Italian version of the Spinal Cord Injury Measure version III (SCIM III). RESULTS: All psychometric properties of the IT-VLT showed significant values, including the Cronbach's α, which was 0.95 (left hand) and 0.94 (right hand). Furthermore, the test-retest reliability showed an intraclass correlation coefficient of 0.89, 0.81, and 0.87 for the right hand, left hand, and total value, respectively. The Pearson correlation coefficient of the IT-VLT and the Italian version of the SCIM III showed all significant results r = 0.559 (p < 0.01). The IT-VLT score improved significantly during in-patient rehabilitation In fact the mean (95% CI) change between T0 and T1 was - 13.2 ± 28.6 (- 21.38; - 5.10). CONCLUSIONS: The IT-VLT was a reliable and a valid outcome measure for assessing hand function in the Italian population with C-SCI. The present study lays the grounds to investigate the psychometric properties of the short version of the IT-VLT.

Cross-cultural adaptation and validation of the "Spinal Cord Injury-Falls Concern Scale" in the Italian population.

STUDY DESIGN: Psychometrics study. OBJECTIVE: The objective of this study was to develop an Italian version of the Spinal Cord Injury-Falls Concern Scale (SCI-FCS) and examine its reliability and validity. SETTING: Multicenter study in spinal units in Northern and Southern Italy. The scale also was administered to non-hospitalized outpatient clinic patients. METHODS: The original scale was translated from English to Italian using the "Translation and Cultural Adaptation of Patient-Reported Outcomes Measures" guidelines. The reliability and validity of the culturally adapted scale were assessed following the "Consensus-Based Standards for the Selection of Health Status Measurement Instruments" checklist. The SCI-FCS-I internal consistency, inter-rater, and intra-rater reliability were examined using Cronbach's alpha coefficient and the intraclass correlation coefficient, respectively. Concurrent validity was evaluated using Pearson's correlation coefficient with the Italian version of the short form of the Wheelchair Use Confidence Scale for Manual Wheelchair Users (WheelCon-M-I-short form). RESULTS: The Italian version of the SCI-FCS-I was administered to 124 participants from 1 June to 30 September 2017. The mean ± SD of the SCI-FCS-I score was 16.73 ± 5.88. All SCI-FCS items were either identical or similar in meaning to the original version's items. Cronbach's α was 0.827 (p < 0.01), the inter-rater reliability was 0.972 (p < 0.01), and the intra-rater reliability was 0.973 (p < 0.01). Pearson's correlation coefficient of the SCI-FCS-I scores with the WheelCon-M-I-short form was 0.56 (p < 0.01). CONCLUSIONS: The SCI-FCS-I was found to be reliable and a valid outcome measure for assessing manual wheelchair concerns about falling in the Italian population.

The Wheelchair Use Confidence Scale: Italian translation, adaptation, and validation of the short form.

OBJECTIVE: We developed an Italian version of the Wheelchair Use Confidence Scale for Manual Users-Short Form (WheelCon-M-I-short form) and examined its reliability and validity. METHODS: The original scale was translated from English to Italian using the "Translation and Cultural Adaptation of Patient Reported Outcomes Measures-Principles of Good Practice" guidelines. The WheelCon-M-I-short form was administered to experienced manual wheelchair users who had a variety of diagnoses. Its internal consistency and test-retest reliability were examined. Its concurrent validity was evaluated using Pearson correlation coefficients with the Italian version of the Wheelchair Outcome Measure (WhOM-I) and the Italian version of the Barthel index (BI). RESULTS: The WheelCon-M-I-short form was administered to 31 subjects. The mean ± SD of the WheelCon-M-I-short form score was 7.5 ± 1.9. All WheelCon-M-I-short form items were either identical or similar in meaning to the WheelCon-M-short form items. Cronbach's α for the WheelCon-M-I-short form was 0.95 (p < 0.01), and the test-retest reliability (ICC) was 0.978 (p < 0.01). The Pearson correlation coefficient of the WheelCon-M-I-short form scores with the WhOM-I scores was 0.7618 (p < 0.01). The Pearson correlation coefficient of the WheelCon-M-I-short form scores with the Italian BI scores was 0.638 (p < 0.01). CONCLUSIONS: The WheelCon-M-I-short form was found to be reliable and a valid outcome measure for assessing manual wheelchair confidence in the Italian population. Implication for Rehabilitation The WheelCon-M-I-short form is a valid outcome measure available for assessing wheelchair confidence, according to Bandura's social cognitive theory, self-efficacy is a better predictor of future behavior than skill itself. Translation of the WheelCon-M-short form into the WheelCon-M-I-short form provides a new tool for Italian professionals. Clinicians now have a method to measure this invisible barrier to wheelchair use, and they will be able to make informed decisions when prescribing the use of manual wheelchairs and when training clients in their use. The WheelCon-M-I-short form also provides researchers with a tool in an important and relevant area of study for future research.