Validity of the Canadian occupational performance measure

Psychometric qualities of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV)

This study evaluated the psychometric qualities (internal consistency, test-retest reliability, and concurrent validity) of the Dutch language version of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH-DLV) in patients (n = 50) with a variety of unilateral disorders of the upper limb. All patients completed the Canadian Occupational Performance Measure (COPM) and the DASH-DLV before receiving occupational therapy. After therapy, patients again filled in the DASH-DLV. The internal consistency of the DASH-DLV was excellent (Cronbach's alpha = 0.95), and the test-retest reliability was satisfactory (Pearson's r = 0.98, p < 0.0001 kappa coefficient = 0.67, p < 0.0001). A small but statistically significant difference (effect size = 0.09) was found between the initial and reassessment DASH-DLV scores (paired t-test p < 0.01). The concurrent validity of the DASH-DLV was assessed by comparison with the COPM outcomes: 81% of the problematic activities mentioned during COPM administration were included in the questionnaire (kappa coefficient = 0.79, p < 0.0001). The DASH-DLV is a reliable and valid instrument for assessing disability and symptoms in a selected sampling of 50 Dutch patients with a variety of unilateral upper limb disorders. Further psychometric testing is recommended in a larger random population of Dutch-speaking subjects with unilateral upper limb disorders.

Splinting and radial nerve palsy: a single-subject experiment

This study examines which of three splint designs most effectively improved hand function in a patient with radial nerve palsy, and demonstrates the application of a single-subject experimental design. The static volar wrist cock-up splint (splint 1), dynamic tenodesis suspension splint (splint 2), and dorsal wrist cock-up with dynamic finger extension splint (splint 3) were evaluated. Each splint was worn for 3 weeks, and hand function was assessed by means of standardized measures of function and disability. Statistical significance was calculated using the minimal level of detectable change (MDC) at the 95% confidence level. Only with splints 2 and 3 did a true change in function occur, compared with baseline scores (no splint). In addition, the patient completed all tasks while using splints 2 and 3 but did not complete three tasks while using splint 1. The hand therapists' goal is to fabricate a splint that improves function and that the patient will wear. Only splint 3 met these criteria. This experiment highlights the need to evaluate both the statistical and the clinical significance of treatment interventions.

The utility of the Dutch Arthritis Impact Measurement Scales 2 for assessing health status in individuals with haemophilia: a pilot study

The aim of this pilot study was to examine the usefulness of the Dutch version of the Arthritis Impact Measurement Scales 2 (D-AIMS2)in assessing the health status of Dutch individuals with haemophilia. Sixty-eight individuals with mild, moderate, and severe haemophilia attending our clinic for their annual check-up participated. They first completed the Canadian Occupational Performance Measure (COPM). The D-AIMS2 was filled in afterwards at home. With the COPM, individuals rated their specific problematic activities of daily life (ADL), as well as the severity and importance of each problem. The D-AIMS2 is a comprehensive, self-administered questionnaire that evaluates functional health status. Fifty-seven individuals completed and returned the D-AIMS2. Reliability analysis demonstrated good internal consistency for the scales (Cronbach's alpha=0.76-1.00), as well as for the components (alpha=0.80-0.88), except for the component 'social interaction' (alpha=0.44). Criterion validity of the D-AIMS2 was assessed by comparison with COPM outcomes; 80% of the problematic ADLs were included in the questionnaire, 20% were missing. Correlations between the D-AIMS2 components 'physical health' and 'symptoms' with predicted scores of those individuals by a highly experienced physiotherapist (r=0.63 and 0.53, respectively) substantiated its concurrent validity. Based on these results we concluded that the D-AIMS2, with minor adjustments, can be an appropriate tool for assessing the health status of Dutch haemophilia patients.