Development and assessment of a verbal response scale for the Patient-Specific Functional Scale (PSFS) in a low-literacy, non-western population

"Otherwise … he will be a beggar": a focus group study to understand the Perspectives of physiotherapists about measuring rehabilitation outcomes and impact in low-resource and conflict-affected settings

PURPOSE

Rehabilitation outcomes are important for patients, professionals and policy makers. Most outcome measures (OMs) were developed for "Western" contexts and may be inadequate for low-resource and conflict settings, where the ability to demonstrate impact would be critical to strengthening the sector. This study aims to understand perspectives of physiotherapists from challenging environments regarding current practices, value, barriers, and facilitators of measuring rehabilitation outcomes.

MATERIALS & METHODS

Focus group discussions were held in English with 35 physiotherapists from 18 countries. Audio recordings were transcribed verbatim, anonymised, and analysed using reflexive thematic analysis.

RESULTS

Four themes emerged illustrating the levels at which outcomes and measures were discussed: User (patients, families), provider (physiotherapists, rehabilitation workers), application (OMs), and structure (management, health system). Participants discussed diversity in current practices and patient populations, utility of OMs and a neglected rehabilitation sector lacking investment. Barriers to progressing outcome measurement included lacking patient health literacy, rehabilitation provider training, valid OMs, and leadership. Participants suggested improved patient involvement, routine outcome measurement by using, developing, or adapting simple, context- and stakeholder-relevant OMs, and support from management.

CONCLUSIONS

These insights illustrate the need of and provide robust recommendations for context-adapted development of rehabilitation outcome measurement in various challenging contexts.

Assessing independence in mobility activities in trauma care: Validity and reliability of the Activity Independence Measure-Trauma (AIM-T) in humanitarian settings

The importance of measuring outcomes after injury beyond mortality and morbidity is increasingly recognized, though underreported in humanitarian settings. To address shortcomings of existing outcome measures in humanitarian settings, the Activity Independence Measure-Trauma (AIM-T) was developed, and is structured in three subscales (i.e., core, lower limb, and upper limb). This study aimed to assess the AIM-T construct validity (structural validity and hypothesis testing) and reliability (internal consistency, inter-rater reliability and measurement error) in four humanitarian settings (Burundi, Iraq, Cameroon and Central African Republic). Patients with acute injury (n = 195) were assessed using the AIM-T, the Barthel Index (BI), and two pain scores. Structural validity was assessed through confirmatory factor analysis. Hypotheses were tested regarding correlations with BI and pain scores using Pearson correlation coefficient (PCC) and differences in AIM-T scores between patients' subgroups, using standardized effect size Cohen's d (d). Internal consistency was assessed with Cronbach's alpha (α). AIM-T was reassessed by a second rater in 77 participants to test inter-rater reliability using intraclass correlation coefficient (ICC). The results showed that the AIM-T structure in three subscales had an acceptable fit. The AIM-T showed an inverse weak to moderate correlation with both pain scores (PCC<0.7, p≤0.05), positive strong correlation with BI (PCC≥0.7, p≤0.05), and differed between all subgroups (d≥0.5, p≤0.05). The inter-rater reliability in the (sub)scales was good to excellent (ICC 0.86-0.91) and the three subscales' internal consistency was adequate (α≥0.7). In conclusion, this study supports the AIM-T validity in measuring independence in mobility activities and its reliability in humanitarian settings, as well as it informs on its interpretability. Thus, the AIM-T could be a valuable measure to assess outcomes after injury in humanitarian settings.

A comparison between measurement properties of four shoulder-related outcome measures in Nepalese patients with shoulder pain

Purpose

The Patient-Specific Functional Scale (PSFS), Disability of the Arm, Shoulder and Hand (DASH), Quick-DASH, and Shoulder Pain and Disability Index (SPADI) are frequently used instruments in shoulder functional assessment. They are available in Nepali and all but the PSFS has been validated for shoulder assessment. Therefore, the aim of this study was to validate the Nepali PSFS in shoulder pain patients and to compare validity, reliability, and responsiveness of all four instruments to provide a recommendation for their use.

Method

Patients attending physiotherapy completed the Nepali PSFS at baseline and follow-up (1–3 weeks). It was tested for reliability using internal consistency (Cronbach’s α), intraclass correlation coefficient (ICC), construct validity by hypothesis testing and responsiveness by anchor-based method using Area Under the Curve (AUC). The instruments were compared based on reported measurement properties and patients’ preference.

Results

156 patients enrolled at baseline and 121 at follow-up. The PSFS showed sufficient reliability (α = 0.70, ICC = 0.82), construct validity (all three hypotheses met) and responsiveness (AUC = 0.83). Measurement property comparison demonstrated adequate reliability and validity, while PSFS was the most responsive instrument. Patients favoured the verbal rating scale of the DASH/Quick-DASH. The DASH had a lower completion rate for ‘culturally sensitive’ and ‘uncommon’ activities.

Conclusion

The Nepali PSFS is a reliable, valid, and responsive instrument in shoulder functional assessment. The combined use of the Quick-DASH or SPADI with the PSFS is recommended for a comprehensive assessment of Nepali shoulder pain patients in clinical and research settings. They are shorter, more appropriate to the Nepali context and provide balanced self-evaluation.

The inflammatory bowel disease disk application: A platform to assess patients' priorities and expectations from treatment

OBJECTIVE

Inflammatory bowel disease (IBD) significantly impacts on patients' well-being. Patients' preferences for treatment outcomes do not necessarily fit physicians' goals. We aimed to investigate patients' priorities and expectations from treatment.

METHODS

A questionnaire based on the IBD Disk application was distributed to patients through social media. Patient's preferences were assessed by grading the 10 IBD Disk items on a Likert-type scale from 1 to 10. A cluster analysis was used to classify patients into homogeneous subgroups according to their preferred items, using the K-means method.

RESULTS

Among the 224 patients, 69.2% had Crohn's disease (CD). Their mean age was (38.9 ± 14.9) years and 62.9% were female. More CD patients compared with those with ulcerative colitis were treated with biologics compared with those with ulcerative colitis (71.0% vs 39.1%, P < 0.001). Most IBD Disk items ranked high in patients' preferences for treatment outcomes. Their leading preference was reducing abdominal pain, which was more prominent in CD patients, followed by regulating defecation and energy. Least important were interpersonal interactions, sexual functions, and body image. Patients were categorized into three clusters. Cluster 3 patients gave lower scores to most items and were characterized by tertiary education (P = 0.001), higher income (P < 0.001), less active disease (P = 0.02), and higher prevalence of successful treatment (P = 0.04).

CONCLUSIONS

Patients' preferences for treatment outcomes are influenced by higher education, higher income, rural-dwelling, and disease activity. Better understanding of individual patient's preferences and the factors that affect them might bridge the gap between patients' and physicians' priorities to achieve better teamwork in controlling disease outcomes.

Content validity of the Brief and Comprehensive ICF Core Sets for common disabling conditions in a developing country

The International Classification of Functioning, Disability and Health (ICF) features associated tools, the Brief and Comprehensive ICF Core Sets. These are designed to be universally applicable, but have limited evidence of content validity (i.e. comprehensiveness and relevance) in low income, non-Western countries. In this cross-sectional study, we aimed to assess the content validity of the ICF Core Sets in Nepal. We interviewed 161 participants with stroke, spinal cord injury (SCI), chronic obstructive pulmonary disease (COPD), and musculoskeletal conditions and asked them to identify activities they had difficulty performing due to their health condition. We mapped 544 participant responses to the ICF and assessed if these ICF categories were represented in the respective ICF core sets. The Comprehensive Core Sets for stroke, COPD, SCI, and musculoskeletal conditions contained more items identified by participants than the respective Brief Core Sets (e.g., 89% vs. 26% in stroke). Among ICF categories that represented at least 5% of participants' responses, the Brief Core Sets covered 40%-71% of participants' responses whereas the Comprehensive Core Sets covered 67%-100% of responses. This is the first study to evaluate the content validity of the ICF Brief and Comprehensive core sets in Nepali individuals with stroke, SCI, MSK conditions, and COPD. The Comprehensive Core Sets for stroke, COPD, and SCI have adequate content validity for use in clinical practice and research in Nepal; the Brief Core Sets may not adequately meet local and individual needs unless supplemented with additional ICF categories.