Application of Rasch analysis to the parent adherence report questionnaire in juvenile idiopathic arthritis

BACKGROUND

Adherence to treatment in children with juvenile idiopathic arthritis (JIA) is associated with better outcomes. Assessing patient adherence in JIA, as well as attitudes and beliefs about prescribed treatments, is important for the clinician in order to optimize patient management. The objective of the current study was to evaluate the psychometric properties of the Parent (proxy-report) Adherence Report Questionnaires (PARQ), which assesses beliefs and behaviors related to adherence to treatments prescribed for JIA.

METHODS

A Rasch analysis was conducted on data collected with parents of children with JIA from two studies in which the PARQ was used as a measure of adherence.

RESULTS

The PARQ showed preliminary evidence of multidimensionality with two factors, accounting for 38 % and 27 % of the variance respectively. The PARQ in its original version does not adhere to expectations of the Rasch model. A transformed version of the PARQ obtained by deletion of the general adherence scale and modification of visual analog scales into 5-point likert scales improved fit to the model and showed preliminary evidence of unidimensionality.

CONCLUSIONS

The PARQ was transformed based on the results of the Rasch analysis. The transformed version of the PARQ shows preliminary evidence of unidimensionality and may allow computation of a total score, although further testing is needed to verify these findings.

The effect of a task-oriented intervention on arm function in people with stroke: a randomized controlled trial

Objective: To evaluate the efficacy of a task-oriented intervention in enhancing arm function in people with stroke.

Design: Two-centre, observer-blinded, stratified, block-randomized controlled trial.

Setting: General community.

Patients: Ninety-one individuals within one year of a first or recurrent stroke consented to participate between May 2000 and February 2003.

Interventions: The experimental intervention involved practice of functional, unilateral and bilateral tasks that were designed to improve gross and fine manual dexterity whereas the control intervention was composed of walking tasks. Members in both groups participated in three sessions a week for six weeks.

Main outcome measure(s): The primary test of arm function was the Box and Block Test. Secondary tests included the Nine-Hole Peg Test, maximal grip strength, the Test d'Evaluation des Membres supé rieurs des Personnes Agées (TEMPA) and the Stroke Rehabilitation Assessment of Movement.

Results: Results are for the more affected arm. Baseline performance on the Box and Block Test was an average of 26 blocks (standard deviation (SD=16) in the experimental group (n=47) and 26 blocks (Sd=18) in the control group (n=44). These values represent approximately 40% of age-predicted values. Values for the postintervention evaluation were an average of 28 (SD=17) and 28 (SD=19) blocks for the experimental and control group respectively. No meaningful change on other measures of arm function was observed.

Conclusions: A task-oriented intervention did not improve voluntary movement or manual dexterity of the affected arm in people with chronic stroke.

[Patient advisors for victims of traumatic amputation: a critical intervention]

Patient advisors for victims of traumatic amputation: a critical intervention. Since 2014, the Centre of Expertise in Reimplantation and Microsurgical Revascularization at the University of Montreal (CEVARMU) has been recruiting on an ad hoc basis former patients, who have completed the rehabilitation process, to accompany and support new patients at the Centre during their care process. Considered full-fledged partners of the care team, these patient advisors are invited to meet with patients who are hospitalized or in the rehabilitation process to not only share their experience but also ensure that the treatment plans proposed to the patients are well understood and meet their needs. Around forty interventions have been conducted by five patient advisors, helping to strengthen the credibility of professional interventions, break down patients' isolation, and give new meaning to the work of health professionals.

Repeatability and Minimal Detectable Change in Longitudinal Median Nerve Excursion Measures During Upper Limb Neurodynamic Techniques in a Mixed Population: A Pilot Study Using Musculoskeletal Ultrasound Imaging

This study determined test-retest reliability and minimum detectable change in longitudinal median nerve excursion during upper limb neurodynamic tests (ULNTs). Seven participants with unilateral or bilateral carpal tunnel syndrome and 11 healthy participants were randomly tested with two ULNTs (i.e., tensioner and slider). Each ULNT was performed three times each at 45° and 90° of shoulder abduction on two separate visits. Video sequences of median nerve excursion, recorded by a physical therapist using ultrasound imaging, were quantified using computer software. The generalizability theory, encompassing a G-Study and a D-study, measured the dependability coefficient (Φ) along with standard error of measurement (SEM) accuracy and allowed various testing protocols to be proposed. The highest reliability (Φ = 0.84) and lowest minimal measurement error (SEM = 0.58 mm) of the longitudinal median nerve excursion were reached during the ULNT-slider performed with 45° of shoulder abduction and when measures obtained from three different image sequences recorded during a single visit were averaged. It is recommended that longitudinal median nerve excursion measures computed from three separate image sequences recorded during a single visit be averaged in clinical practice. Ideally, adding a second visit (six image sequences) is also suggested in research protocols.

Is neuroplasticity in the central nervous system the missing link to our understanding of chronic musculoskeletal disorders?

Background

Musculoskeletal rehabilitative care and research have traditionally been guided by a structural pathology paradigm and directed their resources towards the structural, functional, and biological abnormalities located locally within the musculoskeletal system to understand and treat Musculoskeletal Disorders (MSD). However the structural pathology model does not adequately explain many of the clinical and experimental findings in subjects with chronic MSD and, more importantly, treatment guided by this paradigm fails to effectively treat many of these conditions.

Discussion

Increasing evidence reveals structural and functional changes within the Central Nervous System (CNS) of people with chronic MSD that appear to play a prominent role in the pathophysiology of these disorders. These neuroplastic changes are reflective of adaptive neurophysiological processes occurring as the result of altered afferent stimuli including nociceptive and neuropathic transmission to spinal, subcortical and cortical areas with MSD that are initially beneficial but may persist in a chronic state, may be part and parcel in the pathophysiology of the condition and the development and maintenance of chronic signs and symptoms. Neuroplastic changes within different areas of the CNS may help to explain the transition from acute to chronic conditions, sensory-motor findings, perceptual disturbances, why some individuals continue to experience pain when no structural cause can be discerned, and why some fail to respond to conservative interventions in subjects with chronic MSD. We argue that a change in paradigm is necessary that integrates CNS changes associated with chronic MSD and that these findings are highly relevant for the design and implementation of rehabilitative interventions for this population.

Summary

Recent findings suggest that a change in model and approach is required in the rehabilitation of chronic MSD that integrate the findings of neuroplastic changes across the CNS and are targeted by rehabilitative interventions. Effects of current interventions may be mediated through peripheral and central changes but may not specifically address all underlying neuroplastic changes in the CNS potentially associated with chronic MSD. Novel approaches to address these neuroplastic changes show promise and require further investigation to improve efficacy of currents approaches.

Psychometric evaluation of the Disabilities of the Arm, Shoulder and Hand (DASH) with Dupuytren's contracture: validity evidence using Rasch modeling

Background

Dupuytren’s contracture is a progressive, fibroproliferative disorder that causes fixed finger contractures and can lead to disability. With the advances of new therapeutic interventions, the necessity to assess the functional repercussions of this condition using valid, reliable and sensitive outcome measures is of growing interest. The Disabilities of the Arm, Shoulder and Hand (DASH) is one frequently used patient-reported outcome measure but its reliability and validity have never been demonstrated specifically for a population affected with Dupuytren’s contracture. The objective of this study was to evaluate the psychometric properties of the DASH, with focus on validity evidence using the Rasch measurement model.

Methods

Secondary analysis was performed on data collected as part of a randomised clinical trial. One hundred fifty-three participants diagnosed with Dupuytren’s contracture completed the DASH at four time points (pre-op, 3, 6 and 12 months post-op). Baseline data were analysed using traditional analysis and to test whether they adhered to the expectations of the Rasch model. Post-intervention data were subsequently included and analyzed to determine the effect of the intervention on the items.

Results

DASH scores demonstrated large ceiling effects at all time points. Initial fit to the Rasch model revealed that the DASH did not adhere to the expectations of the Rasch partial credit model (χ² = 119.92; p < 0.05). Multiple items displayed inadequate response categories and two items displayed differential item functioning by gender. Items were transformed and one item deleted leading to an adequate fit. Remaining items fit the Rasch model but still do not target well the population under study.

Conclusions

The original version of the 30-item DASH did not display adequate validity evidence for use in a population with Dupuytren’s contracture. Further development is required to improve the DASH for this population.

Electronic supplementary material

The online version of this article (doi:10.1186/1471-2474-15-361) contains supplementary material, which is available to authorized users.

Umbilical and fetal middle cerebral artery Doppler reference ranges in a twin population followed longitudinally from 24 to 38 weeks' gestation

OBJECTIVE

To construct monochorionic diamniotic (MCDA) and dichorionic diamniotic (DCDA) twin reference ranges for umbilical artery (UA) pulsatility index (PI), UA resistance index (RI), fetal middle cerebral artery (MCA) PI and peak systolic velocity (PSV) and cerebroplacental ratio (CPR) from 24 weeks' to 38 weeks' gestation and compare these with published normal values for singleton pregnancies.

METHODS

This prospective multicenter cohort study included 1028 unselected twin pairs recruited over a 2-year period. Participants with dichorionic twins underwent fortnightly ultrasound surveillance from 24 weeks' gestation, with monochorionic twins being followed every 2 weeks from 16 weeks until delivery. A total of 7536 fetal Doppler examinations in 618 twin pregnancies were included in the analysis, with reference ranges for MCDA and DCDA pregnancies constructed for each of the Doppler indices using multilevel modeling.

RESULTS

UA-PI and UA-RI appear to be higher in twins than in singletons, and MCA-PI and MCA-PSV appear to be lower. The CPR also appears to be lower in twins than in singletons. Similar MCA indices were observed in MCDA and DCDA twins.

CONCLUSION

We have established longitudinal reference ranges for UA-PI and UA-RI, MCA-PI and MCA-PSV and CPR in twin pregnancies, which appear to differ from those in singleton pregnancies. The derived twin-specific reference ranges may be more appropriate in the surveillance of these high-risk pregnancies. Applying the singleton CPR cut-off of ≤ 1.0 may lead to a large number of false-positive diagnoses of cerebral redistribution in twin fetuses.

Protected areas and freshwater conservation: a survey of protected area managers in the Tennessee and Cumberland River Basins, USA

As the scientific community has highlighted the plight of freshwater species, there have been increasing calls for protected area (PA) designation and management specific to the conservation of aquatic species and ecosystems. In this study we examined PA management in one relatively well-resourced (high levels of financial and technical resources) part of the world: the Tennessee and Cumberland River Basins, USA. We asked managers their perceptions about the current status of freshwater ecosystems within PAs, the sources of stress that are degrading freshwater ecosystem integrity, the degree to which PAs address these stressors, and the availability of technical, human, and financial resources for management activities that benefit freshwater ecosystems and the species they support. Managers generally perceive that freshwater ecosystems within PAs are under low levels of stress, with less than half reporting any alteration to ecosystem integrity, and very few reporting alterations at medium or high levels. Most PAs have fewer resources dedicated to freshwater conservation and management than to other activities, and some PAs completely lack resources for freshwater management. We recommend a review of every PA's goals and objectives and any needed updates to include the conservation of freshwater ecosystems. We also recommend an analysis to determine the most pressing stressors to aquatic life within each PA, stemming from sources both from within and outside of a PA's boundaries, and that this information be used to guide future management. Finally, we suggest that management resources be prioritized for PAs that include large portions of the catchments of their freshwater systems; that can address the dominant sources of stress within the PA; or that contain representative ecosystems, species assemblages or populations of rare, endemic, and threatened species.

Poster - Thur Eve - 20: Serial FDG 4DPET imaging during radiotherapy in advanced lung cancer patients

The availability of respiratory synchronized PET (4DPET) imaging has enabled more accurate analysis of metabolic response since motion blur is minimized. We present our preliminary analysis of serial FDG 4DPET images acquired at weeks 0, 2, 4, and 7 during radiotherapy of seven stage II-III NSCLC patients. The tumor and nodal PTV of the week 0 images restrained a 4DPET image thresholding algorithm to automatically contour SUV levels ranging from 20 to 80% of the maximum SUV, creating an intensity volume histogram (IVH) for each week. These contours allowed analysis of PET volumes and standard PET metrics such as SUV_max and SUV_mean . We found a trend for decreasing SUV_max and SUV_mean over a treatment course in both the tumor and nodal regions. On average, the SUV_max within the tumor decreased by 17±13% (1 SD) after 2 weeks, 30±13% after 4 weeks, and 39±19% after 7 weeks of radiotherapy. Decreasing volume trends were also observed in the 20 to 80% max SUV autocontours, ranging from 26±29% to 50±40% respectively, over 7 weeks of treatment. Only one patient demonstrated an increase in FDG uptake within the tumor volume between week 0 and week 2 of treatment, and was also the only patient to recur locally at 3 months following treatment. Changes in tumor metabolism over the course of advanced NSCLC radiotherapy are quantifiable with serial FDG 4DPET imaging. Preliminary analysis suggests that variations in these trends could be useful in identifying non-responding patients that may require an alternative radiotherapeutic approach.