Early motor predictors of recovery in patients with severe traumatic brain injury.

RESEARCH DESIGN: Retrospective observational study. OBJECTIVE: To compare motor variables between patients with severe traumatic brain injury who emerge and patients who do not emerge from vegetative state, in an attempt to identify early motor manifestations associated with consistent patient improvement. METHODS AND PROCEDURES: Patients were divided into two groups: group 1, patients who emerged from vegetative state attaining at least a state of functional interactive communication and/or functional use of two different objects (n = 8); and group 2, patients who did not emerge (n = 7). Twenty-one motor variables were compared weekly between groups until the end of the treatment programme. RESULTS: Significant differences were observed in head control (p = 0.051) and head turning (p = 0.002) variables, as well as in visual fixation and pursuit (p = 0.051) after a median of 41 days of therapy; and in head control and head turning; visual fixation and pursuit; phonation; pain localization, reach and grasp, and trunk movement (p ≤ 0.051) after a median of 212 days of programme duration. CONCLUSIONS: Head turning, together with or immediately followed by visual pursuit and fixation, proved to be clinically significant variables associated with recovery from vegetative state to higher states of consciousness beyond minimally conscious state.

Cross-cultural adaptation and validation of the Argentinean version of the Roland-Morris Disability Questionnaire.

STUDY DESIGN: Psychometric testing of a translated, culturally adapted questionnaire. OBJECTIVE: Argentinean Roland-Morris Disability Questionnaire (RMDQ) validation and cross-cultural adaptation for its use in Argentinean population with lumbar pain. SUMMARY OF BACKGROUND DATA: The RMDQ is one of the most widely used and validated instruments for measuring disability in low back pain. However, no validated Argentine version of the Test was available at the time our study was initiated. MATERIALS AND METHODS: The RMDQ Argentinean cross-cultural adaptation was tested among 132 chronic lumbar pain patients, of which, 50 completed the pre-final RMDQ questionnaire and did a retest 24 hours later. The data gathered, as well as the absent response rate and the conflictive sentences for the patient were reviewed. There were no sentences marked as conflictive, therefore, the RMDQ (final) was handed out to another 82 patients. The interclass correlation coefficient was used to assess reliability and internal consistency by means of the Cronbach's alpha. The convergent validity was assessed calculating Pearson's correlation coefficient comparing the RMDQ's results with: the amount of pain (EVA), the range of movement of the spine, and the tightening of the hamstrings by means of the Active Knee Extension Test (through digital inclinometry). RESULTS: Reliability Test-retest (24 hours): interclass correlation coefficient: 0.940 (P < 0.01). Internal consistency reached 0.904 Cronbach's alpha. The RMDQ's convergent validity calculating Pearson's correlation coefficient was r: 0.544 (P < 0.01) for EVA and r: -0.378 (P < 0.01) for range of movement from T1, which is in agreement with previous results published in similar studies. Concurrent validity was assessed correlating the RMDQ results with the Argentinean Oswestry Disability Index calculating Pearson's Coefficient and it proved very good, r: 0.811 (P < 0.01). CONCLUSION: The results of the study show that the Argentinean version of the RMDQ is reliable and valid as a lumbar disability measurement tool. The authors recommend this tool for future clinical studies.