Validity and reliability of the Persian version of the trunk impairment scale in people with multiple sclerosis.

BACKGROUND: In order to provide an important measuring tool for the assessment, prognosis of recovery, and treatment of people with multiple sclerosis (PWMS), the aim of this research is to examine the validity and reliability of the Trunk Impairment Scale (TIS) in Persian. METHODS: The research included 105 PWMS. The TIS questionnaire was translated and culturally equivalent according to the IQOLA approach. The Intra Class Correlations (ICC) and Cronbach's alpha were used to assess the internal consistency of the questionnaire. Barthel Index (BI), Time Up and Go (TUG), Multiple Sclerosis Walking Scale-12 (MSWS-12), and Trunk Control Test (TCT) scores were correlated with the TIS score in order to assess validity. RESULTS: 86 of 105 participants in this study were female. For several subscales, the ICC correlation coefficient ranged from 0.89 to 0.98. The Cronbach's alpha value of the TIS total score indicates that the TIS questionnaire has quite good internal consistency. (Cronbach's alpha=0.97). The TIS and the MSWS-12, BI, TUG, and TCT questionnaires have correlation coefficients of 0.78, 0.72, 0.60, and 0.71, respectively, indicating strong construct and concurrent validity. CONCLUSION: The results of the research showed that the TIS in Persian is a relevant and reliable tool for assessing trunk abnormalities in Persian-speaking PWMS.

Romberg Neck Torsion :A New Specific Test for Cervicogenic Dizziness.

AIMS: Previous studies have shown that Cervical myofascial pain syndrome with dizziness (CMPS-D ) is one of the most common causes of cervicogenic dizziness and is associated with challenge in diagnosis and treatment. this study aimed to investigate the Romberg neck torsion test in patients with CMPS-D and healthy controls. MATERIALS AND METHODS: Cross-sectional, observational study. twenty patients with CMPS-D were compared with twenty healthy controls. the Romberg (neutral position and neck torsion) and smooth pursuit neck torsion tests were performed in patients with CMPS-D and healthy controls. RESULTS: The results confirmed that there are significant differences in the Romberg neck torsion test between subjects with CMPS-D and healthy controls (p < 0.05). in addition, There was a significant correlation between Romberg neck torsion and smooth pursuit neck torsion results (p < 0.05). CONCLUSION: The results of Romberg neck torsion test in CMPS-D subjects were different from those in healthy controls, which was attributed to neck pain and changes in cervical proprioception input. Romberg neck torsion is a new method for assessing cervicogenic dizziness.

Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders.

PURPOSE: To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). METHOD: A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. RESULTS: Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. CONCLUSIONS: The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis. The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings. The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.

Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome.

PURPOSE: To investigate the responsiveness and determine the minimally important differences (MID) of Persian versions of the Kujala patellofemoral scale (KPS), lower extremity functional scale (LEFS), and functional index questionnaire (FIQ) in patients with patellofemoral pain syndrome (PFPS). METHOD: Outcome measures including the Persian KPS, LEFS, and FIQ were administered to 233 patients at baseline and then again 4 weeks after physiotherapy. Moreover, the 7-point global rating scale was completed by the patients at 4 weeks. Responsiveness was evaluated using the correlation analysis and the receiver operating characteristics (ROC) method. RESULTS: Correlation analysis showed that the relationship of all outcome measures with the global rating scale falls within the fair range of relationship (Gamma = 0.26-0.40). Moreover, the results of ROC analysis showed that the all outcome measures have acceptable high responsiveness index. Furthermore, the MIDs of 9.5, 4.5, and 1.5 points were obtained for the Persian KPS, LEFS, and FIQ, respectively. CONCLUSIONS: The Persian-versions of all outcome measures are responsive for evaluating change following physiotherapy intervention. The MID values obtained in this study will help the clinicians and researchers to determine if a patient with PFPS has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Persian-versions of the KPS, LEFS, and FIQ can be used as three "responsive" outcome measures in clinical studies of patients with patellofemoral pain syndrome (PFPS). These assessment tools have clinical relevance for rehabilitation specialists working on patients with PFPS. The minimally important differences provide valuable information for the clinicians and researchers to make decision about the identification of a clinical change in health status of patients with PFPS.

Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders.

PURPOSE: The aim was to culturally translate and validate the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower extremity musculoskeletal disorders (n = 304). METHOD: This is a prospective methodological study. After a standard forward-backward translation, psychometric properties were assessed in terms of test-retest reliability, internal consistency, construct validity, dimensionality, and ceiling or floor effects. RESULTS: The acceptable level of intraclass correlation coefficient >0.70 and Cronbach's alpha coefficient >0.70 was obtained for the Persian LEFS. Correlations between Persian LEFS and Short-Form 36 Health Survey (SF-36) subscales of Physical Health component (rs range = 0.38-0.78) were higher than correlations between Persian LEFS and SF-36 subscales of Mental Health component (rs range = 0.15-0.39). A corrected item--total correlation of >0.40 (Spearman's rho) was obtained for all items of the Persian LEFS. Horn's parallel analysis detected a total of two factors. No ceiling or floor effects were detected for the Persian LEFS. CONCLUSIONS: The Persian version of the LEFS is a reliable and valid instrument that can be used to measure functional status in Persian-speaking patients with different musculoskeletal disorders of the lower extremity. Implications for Rehabilitation The Persian lower extremity functional scale (LEFS) is a reliable, internally consistent and valid instrument, with no ceiling or floor effects, to determine functional status of heterogeneous patients with musculoskeletal disorders of the lower extremity. The Persian version of the LEFS can be used in clinical and research settings to measure function in Iranian patients with different musculoskeletal disorders of the lower extremity.

Validation of the Persian version of Functional Index Questionnaire (FIQ) and Modified FIQ in patients with patellofemoral pain syndrome.

The aim of this investigation was to culturally translate and validate the Functional Index Questionnaire (FIQ) and Modified FIQ (MFIQ) in patients with patellofemoral pain syndrome (PFPS). A sample of 100 patients with PFPS completed the FIQ and MFIQ, and Short-Form 36 (SF-36) Health Survey in the first session. The FIQ and MFIQ were re-administered to a sample of 47 patients to evaluate test-retest reliability. Test-retest reliability and internal consistency were evaluated by the intraclass correlation coefficient (ICC) and Cronbach's alpha coefficient, respectively. Corrected item-total correlations and construct validity were assessed by Spearman's rank correlation. Factor analysis was performed on all items of the Persian FIQ and MFIQ to determine the number of underlying factors and the items which load on each factor. An acceptable level of test-retest reliability (ICC = 0.84, 0.85) and internal consistency (Cronbach's alpha = 0.79, 0.82) was obtained for both the Persian FIQ and MFIQ, respectively. Item-total correlations were greater than 0.40 for all but two questions of the Persian FIQ and all but four questions of the Persian MFIQ. A total of two factors were detected for each questionnaire. There were moderate to low correlations between the Persian FIQ/MFIQ and SF-36. Persian FIQ and MFIQ are two reliable and valid outcome measures of functional limitation and it seems that they are suitable for use in clinical practice of patients with chronic PFPS.

Persian translation and validation of the Kujala Patellofemoral Scale in patients with patellofemoral pain syndrome.

PURPOSE: To culturally translate and validate the Persian version of Kujala Patellofemoral Scale (KPS) and evaluate the test-retest reliability, internal consistency, construct validity and ceiling or floor effects of this instrument in patients with patellofemoral pain syndrome (PFPS). METHOD: After standard forward and backward translations, 100 patients with PFPS completed the Persian versions of the KPS and Short-Form 36 Health Survey (SF-36) in the first visit. With time interval of 2-3 days after the first visit, 47 patients filled out the KPS in the second visit. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC(2,1)) with 95% confidence interval (95% CI) and Cronbach's α coefficient, respectively. The Spearman's rank correlation (r(s)) was used to assess the correlations between the Persian KPS and SF-36 subscales. RESULTS: The acceptable level of ICC >0.70 (ICC = 0.96, 95% CI = 0.93-0.98) and Cronbach's α coefficient >0.70 (α = 0.81) was obtained for the Persian KPS. There were low to moderate correlations (r(s) = 0.25-0.60, p < .01) between the Persian KPS and Persian SF-36 subscales of mental and physical health components. However, correlations between the Persian KPS and SF-36 physical components were higher than correlations between the Persian KPS and SF-36 mental components. No ceiling and floor effects were seen for the Persian KPS. CONCLUSIONS: The Persian version of KPS is a reliable and valid outcome measure of disability and seems to be a suitable instrument for use in clinical practice of Iranian patients with chronic PFPS.

Reliability and validity of the Tegner and Marx activity rating scales in Iranian patients with anterior cruciate ligament injury.

PURPOSE: The aims of this study were to culturally translate and validate the Persian version of Tegner and Marx activity rating scales and to investigate their psychometric properties in a sample of patients (n = 100) with anterior cruciate ligament (ACL) injury. METHOD: Four questionnaires were completed by the respondents: Tegner and Marx activity scales, Knee injury and Osteoarthritis Outcome Score (KOOS) and Short-Form 12 Health Survey (SF-12). The Tegner and Marx were re-administered to 45 patients in the retest session, with time interval of 2-6 days between the two sessions. Test-retest reliability and internal consistency were assessed using intra-class correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate construct validity of Tegner and Marx compared to similar and dissimilar concepts of KOOS and SF-12, the Spearman's rank correlation was used. RESULTS: Both Tegner and Marx activity scales have a high ICC level. The minimum Cronbach's alpha level of 0.70 was exceeded by Marx scale. In terms of construct validity, most of a priori hypotheses were confirmed. CONCLUSIONS: The Persian version of Tegner and Marx seems to be suitable for Iranian patients with ACL injury. Future studies are needed to investigate the psychometric properties of these questionnaires for Iranian patients with different knee problems.

Reliability and validity of the foot and ankle outcome score: a validation study from Iran.

The aims of this study were to culturally adapt and validate the Persian version of Foot and Ankle Outcome Score (FAOS) and present data on its psychometric properties for patients with different foot and ankle problems. The Persian version of FAOS was developed after a standard forward-backward translation and cultural adaptation process. The sample included 93 patients with foot and ankle disorders who were asked to complete two questionnaires: FAOS and Short-Form 36 Health Survey (SF-36). To determine test-retest reliability, 60 randomly chosen patients completed the FAOS again 2 to 6 days after the first administration. Test-retest reliability and internal consistency were assessed using intraclass correlation coefficient (ICC) and Cronbach's alpha, respectively. To evaluate convergent and divergent validity of FAOS compared to similar and dissimilar concepts of SF-36, the Spearman's rank correlation was used. Dimensionality was determined by assessing item-subscale correlation corrected for overlap. The results of test-retest reliability show that all the FAOS subscales have a very high ICC, ranging from 0.92 to 0.96. The minimum Cronbach's alpha level of 0.70 was exceeded by most subscales. The Spearman's correlation coefficient for convergent construct validity fell within 0.32 to 0.58 for the main hypotheses presented a priori between FAOS and SF-36 subscales. For dimensionality, the minimum Spearman's correlation coefficient of 0.40 was exceeded by most items. In conclusion, the results of our study show that the Persian version of FAOS seems to be suitable for Iranian patients with various foot and ankle problems especially lateral ankle sprain. Future studies are needed to establish stronger psychometric properties for patients with different foot and ankle problems.

Test-retest reliability [corrected] of center of pressure measures of postural stability during quiet standing in a group with musculoskeletal disorders consisting of low back pain, anterior cruciate ligament injury and functional ankle instability.

Reliability is a population-specific property, but to the authors' knowledge there has been no study to determine the test-retest reliability of the postural stability measures such as center of pressure (COP) measures in the population of patients with musculoskeletal disorders (MSDs), while their clinical applications have been presented in literature. So, 33 patients with low back pain (LBP), anterior cruciate ligament (ACL) injury and functional ankle instability (FAI) randomly completed postural measurements with three levels of difficulty (rigid surface-eyes open, rigid surface-eyes closed, and foam surface-eyes closed) in two sessions. COP data were used to calculate standard deviation of amplitude, standard deviation of velocity, phase plane portrait, mean total velocity and area (95% confidence ellipse). Relative reliability of these measures was assessed using intraclass correlation coefficient (ICC) and absolute reliability using standard error of measurement (SEM) and coefficient of variation (CV). Also, minimal metrically detectable change (MMDC) was calculated to quantify intervention effects. Among different COP parameters, mean total velocity in all conditions of postural difficulty showed high to very high reliability, with ICC range of 0.74-0.91, SEM range of 0.09-0.40cm/s, CV range of 5.31-8.29% and MMDC range of 0.19-0.79cm/s. Phase plane portrait in anteroposterior-mediolateral (AP-ML) and ML direction were other best parameters with respect to the level of reliability. Mean total velocity and phase plane portrait parameters are suggested as good candidates to use for quantification and assessment of balance performance and identifying those with MSDs.