Construct Validity and Test-Retest Reliability of the Questionnaire Rising and Sitting Down in Lower-Limb Amputees

Measures of perceived mobility ability in community-dwelling older adults: a systematic review of psychometric properties

OBJECTIVES

The objective of this systematic review was to synthesise the psychometric properties of measures of perceived mobility ability and related frameworks used to define and operationalise mobility in community-dwelling older adults.

METHODS

We registered the review protocol with PROSPERO (CRD42022306689) and included studies that examined the psychometric properties of perceived mobility measures in community-dwelling older adults. Five databases were searched to identify potentially relevant primary studies. We qualitatively summarised psychometric property estimates and related operational frameworks. We conducted risk of bias and overall quality assessments, and meta-analyses when at least three studies were included for a particular outcome. The synthesised results were compared against the Consensus-based Standards for the Selection of Health Measurement Instruments criteria for good measurement properties.

RESULTS

A total of 36 studies and 17 measures were included in the review. The Late-Life Function and Disability Index: function component (LLFDI-FC), lower extremity functional scale (LEFS), Mobility Assessment Tool (MAT)-short form (MAT-SF) or MAT-Walking, and Perceived Driving Abilities (PDA) Scale were identified with three or more eligible studies. Most measures showed sufficient test-retest reliability (moderate or high), while the PDA scale showed insufficient reliability (low). Most measures had sufficient or inconsistent convergent validity (low or moderate) or known-groups validity (low or very low), but their predictive validity and responsiveness were insufficient or inconsistent (low or very low). Few studies used a conceptual model.

CONCLUSION

The LLFDI-FC, LEFS, PDA and MAT-SF/Walking can be used in community-dwelling older adults by considering the summarised psychometric properties. No available comprehensive mobility measure was identified that covered all mobility domains.

Recommendations from the ISPO lower-limb COMPASS: Patient-reported and performance-based outcome measures

BACKGROUND

Outcome measures (patient-reported and performance-based) are used widely but not uniformly within the clinical setting for individuals with lower-limb absence (LLA). The need for more detailed information by funding bodies, service planners and providers, and researchers requires the systematic and routine use of outcome measures. Currently, there is no consensus on which outcome measure(s) should be used for individuals with LLA. The aim of the International Society of Prosthetics and Orthotics (ISPO) lower-limb Consensus Outcome Measures for Prosthetic and Amputation Services (COMPASS) was to produce a recommended list of outcome measures to be actively promoted for routine use within clinical practice before and after an episode of care.

METHODS

Between May and June 2021, 46 users, clinicians, researchers, managers, and policymakers working in the field of LLA and prosthetic users met virtually. Consensus participants were first asked to complete an online survey with questions based on the results from a systematic review and the outcomes from an expert panel. A modified Delphi technique was used to determine outcome measures for use in routine clinical practice. This paper discusses the ISPO lower-limb COMPASS process from which recommendations were made.

RESULTS

The ISPO lower-limb COMPASS resulted in the following 6 recommendations: (1) Amputee Mobility Predictor, Timed Up and Go, Two-Minute Walk Test, Prosthetic Evaluation Questionnaire-Residual Limb Health, Prosthetic Evaluation Questionnaire-Utility, and Trinity Amputation and Prosthesis Experience Scales-Revised, which make up the ISPO lower-limb COMPASS ; (2) Comprehensive High-Level Activity Mobility Predictor and Six-Minute Walk Test are 2 additional outcome measures recommended for higher-activity-level individuals with LLA, which make up the COMPASS+ ; (3) Patient-Specific Function Scale makes up the COMPASS Adjunct ; (4) a generic health-related quality of life outcome measure such as the European Quality of Life-5D-5L or Patient-Reported Outcomes Measurement Information System-29 item can be used to supplement the COMPASS; (5) outcome measures suited to low- and middle-income countries need to be developed with a focus on activities such as sitting cross-legged, kneeling, squatting, and other culturally important mobility-related activities; and (6) translation, validation, and open sharing of translated outcome measures included in the COMPASS, COMPASS+, and COMPASS Adjunct occurs.

CONCLUSION

The above recommendations represent the current status of knowledge on outcome measures for LLA based on research and international consensus and hence, will change over time. This work has been developed for clinicians and researchers to improve knowledge on outcome measures to guide clinical decision-making and future research initiatives.

Validation of Modified Dental Anxiety Scale for Dental Extraction Procedure (MDAS-DEP)

Background:

Dental anxiety remains a common problem encountered amongst those who are going to have a dental extraction procedure.

Objective:

The objective of the current study was to test the validity and reliability of the modified dental anxiety scale for dental extraction procedure (MDAS-DEP).

Methods:

The current study was conducted by using a cross-sectional survey method on one hundred and thirty-two (69 female; 63 male) participants who were about to go through the dental extraction procedure. A modified version of the MDAS was used in the current study. The questions of the original MDAS were replaced by specific questions about the dental extraction procedure, accompanied by five Likert-type answers. Reliability was measured by referring to the Cronbach’s alpha value whilst construct validity was measured by using Pearson’s correlation.

Results:

The analysis of the current study showed a Cronbach’s alpha value of 0.822 Whilst the Pearson’s correlation analysis revealed that all questions were proven to be valid, with the highest r value gained by question number 5 (r = 0.817, p < 0.01).

Conclusion:

The current scale was proven to be valid and reliable to be used as a specific scale to measure dental anxiety due to dental extraction.

Psychometric Properties of Functional, Ambulatory, and Quality of Life Instruments in Lower Limb Amputees: A Systematic Review

OBJECTIVE

Summarize the psychometric properties of functional, ambulatory, and quality of life instruments among adult lower limb amputees, highlighting evidence deemed generalizable to the United States Medicare population.

DATA SOURCES

Six databases and existing systematic reviews through October 30, 2017. Searches included terms for lower limb amputation or prostheses and outcome measures in humans, without language restriction.

STUDY SELECTION

We included peer-reviewed studies of at least 20 adults (≥18 years) with lower limb amputation. Eligible studies reported on psychometric properties of functional, ambulatory, or quality of life instruments. Fifty-three of 425 retrieved articles (12%) met criteria.

DATA EXTRACTION

Study characteristics and psychometric property data (validity, reliability, responsiveness, minimum detectable change, minimal important difference, or floor or ceiling effect) were extracted into a customized form based on standardized criteria. All extracted data were confirmed by 2 experts in systematic review and rehabilitation outcome measurement. Instruments were categorized regarding having been validated and found reliable. Other reported psychometric properties were recorded. Studies were also assessed for applicability to the Medicare population based on age and amputation etiology (dysvascular).

DATA SYNTHESIS

Fifty-six studies (in 53 articles) reported psychometric properties of 50 instruments. There is evidence for both validity and reliability for 30 instruments, 17 of which have evidence that was deemed generalizable to the Medicare population. Most of the remaining instruments have evidence of either validity or reliability, but not both. Twelve instruments have been assessed specifically among lower limb amputees prior to prosthesis prescription. Thirteen instruments have been assessed regarding their predictive properties for future outcomes.

CONCLUSIONS

Numerous instruments assessing ambulation, function, quality of life, and other patient-centered outcomes have evidence of validity and reliability for adults with lower limb amputations. Researchers and clinicians should use validated, reliable instruments when feasible. Many existing and new instruments require validation for use with lower limb amputees.

The State of Nutrigenomic Education in Poland

BACKGROUND

In Poland, 45 higher education institutions offer degrees in dietetics. However, only 20 of these offer nutrigenomics or nutrigenetics courses.

OBJECTIVES

The purpose of this study was to assess the current state of nutri-genomic education in Poland and to evaluate the level of nutrigenomic knowledge held by dieticians.

METHODS

A cross-sectional survey was performed to examine the self-reported attitudes of 193 dietetics students and dietetics professionals who graduated from 33 Polish higher-level institutions.

RESULTS

The great majority of respondents were familiar with nutrigenomics and had a positive attitude to it, and this attitude was independent of whether they participated in nutrigenomics courses. Sixty-six percent of the respondents had received training in nutrigenomics, but nutrigenomic education did not meet the expectations of 57% of dieticians. Dieticians possess low levels of self-reported knowledge of nutrigenomics, and only about 15% of respondents know how to effectively communicate information on genetic risk to patients and understand the effect of nutrients on molecular mechanisms. Despite this lack of knowledge, 59% of respondents had a positive attitude to nutri-genomics, and 63% of them had a great interest in broadening their knowledge. Subjects who had participated in nutrigenomics courses exhibited a better understanding of several areas of nutrigenomics. They were especially interested in practical aspects of nutrigenomics, such as the essence of personalized diets and the practical application of nutrigenomics.

CONCLUSIONS

In conclusion, Polish dieticians have a positive attitude to nutrigenomics but do not perceive themselves as well educated in this field, which is partly due to systemic problems. The study shows the need for improvements in nutrigenomic education in Poland.

Establishing the Turkish version of the SIGAM mobility scale, and determining its validity and reliability in lower extremity amputees

PURPOSE

The aim of this study is to adapt the Special Interest Group in Amputee Medicine (SIGAM) mobility scale to Turkish, and to test its validity and reliability in lower extremity amputees.

MATERIAL AND METHODS

Adaptation of the scale into Turkish was performed by following the steps in American Association of Orthopedic Surgeons (AAOS) guideline. Turkish version of the scale was tested twice on 109 patients who had lower extremity amputations, at hours 0 and 72. The reliability of the Turkish version was tested for internal consistency and test-retest reliability. Structural validity was tested using the "scale validity" method. For this purpose, the scores of the Short Form-36 (SF-36), Functional Ambulation Scale (FAS), Get Up and Go Test, and Satisfaction with the Prosthesis Questionnaire (SATPRO) were calculated, and analyzed using Spearman's correlation test.

RESULTS

Cronbach's alpha coefficient was 0.67 for the Turkish version of the SIGAM mobility scale. Cohen's kappa coefficients were between 0.224 and 0.999. Repeatability according to the results of the SIGAM mobility scale (grades A-F) was 0.822. We found significant and strong positive correlations of the SIGAM mobility scale results with the FAS, Get Up and Go Test, SATPRO, and all of the SF-36 subscales.

CONCLUSION

In our study, the Turkish version of the SIGAM mobility scale was found as a reliable, valid, and easy to use scale in everyday practice for measuring mobility in lower extremity amputees. Implications for Rehabilitation Amputation is the surgical removal of a severely injured and nonfunctional extremity, at a level of one or more bones proximal to the body. Loss of a lower extremity is one of the most important conditions that cause functional disability. The Special Interest Group in Amputee Medicine (SIGAM) mobility scale contains 21 questions that evaluate the mobility of lower extremity amputees. Lack of a specific Turkish scale that evaluates rehabilitation results and mobility of lower extremity amputees, and determines their needs, directed us to perform a study on this topic when we took the number of amputations performed in our country into consideration. SIGAM mobility scale is directed at rehabilitation specialists who are working in amputee medicine. Turkish version of this scale was found both reliable and valid in our study and hence it can be used in clinical practice and studies.

Psychometric evaluation of self-report outcome measures for prosthetic applications

Documentation of clinical outcomes is increasingly expected in delivery of prosthetic services and devices. However, many outcome measures suitable for use in clinical care and research have not been psychometrically tested with prosthesis users. The aim of this study was to determine test-retest reliability, mode-of-administration (MoA) equivalence, standard error of measurement (SEM), and minimal detectable change (MDC) of standardized, self-report instruments that assess constructs of importance to people with lower limb loss. Prosthesis users (n = 201) were randomly assigned to groups based on MoA (i.e., paper, electronic, or mixed-mode). Participants completed two surveys 2 to 3 d apart. Instruments included the Prosthetic Limb Users Survey of Mobility, Prosthesis Evaluation Questionnaire-Mobility Subscale, Activities-Specific Balance Confidence Scale, Quality of Life in Neurological Conditions-Applied Cognition/General Concerns, Patient-Reported Outcomes Measurement Information System Profile, and Socket Comfort Score. Intraclass correlation coefficients indicated all instruments are appropriate for group-level comparisons and select instruments are suitable for individual-level applications. Several instruments showed evidence of possible floor and ceiling effects. All were equivalent across MoAs. SEM and MDC were quantified to facilitate interpretation of outcomes and change scores. These results can enhance clinicians' and researchers' ability to select, apply, and interpret scores from instruments administered to prosthesis users.