1
|
de Lima A, Pereira ND, Foschi CVS, Ilha J. Identifying the content of the Lower Extremity Motor Activity Log based on the International Classification of Functioning, Disability and Health. Disabil Rehabil 2024:1-7. [PMID: 39300787 DOI: 10.1080/09638288.2024.2404547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 09/09/2024] [Accepted: 09/11/2024] [Indexed: 09/22/2024]
Abstract
PURPOSE To identify the content and the constructs measured in the Lower Extremity Motor Activity Log (LE-MAL) based on the International Classification of Functioning, Disability and Health (ICF) framework and to determine whether the instrument items fit within the ICF mobility domain. METHODS Concepts and constructs measured within each scale were linked to the best-matched ICF categories and classified using established linking rules. Two independent researchers determined the initial linkages. A final consensus was reached with the other researchers. The agreement was analysed through the agreement percentage and the kappa coefficient. RESULTS The subscales assess performance through information about need or dependency, personal and environmental factors, and appraisal of the items. Thirteen concepts were identified in LE-MAL: two concepts for the Assistance Scale are covered in the environmental factors component; 10 concepts for the Functional Performance Scale where all items are covered in the mobility domain; one concept for the confidence scale is covered in the body functions component. CONCLUSIONS The general construct of LE-MAL assessed is performance in the ICF mobility domain and provides additional information about the mental function, environmental factors, independence, appraisal, and personal factors. The study highlighted the conceptual connection between the LE-MAL and the ICF framework.
Collapse
Affiliation(s)
- Aline de Lima
- Department of Physiotherapy, College of Health and Sport Science, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Natalia Duarte Pereira
- Department of Physiotherapy, Functionality and Technological Innovation in Neuro Rehabilitation Group (GFIT), Universidade Federal de São Carlos (UFSCar), São Carlos, Brazil
| | - Clarissa Volpato Sombrio Foschi
- Department of Physiotherapy, College of Health and Sport Science, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| | - Jocemar Ilha
- Department of Physiotherapy, College of Health and Sport Science, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Brazil
| |
Collapse
|
2
|
Sprizon GS, Pereira ND, Almeida LO, Dos Anjos SM, Morris DM, Ilha J. A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL). Spinal Cord 2024; 62:468-478. [PMID: 38907085 DOI: 10.1038/s41393-024-01011-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/23/2024]
Abstract
STUDY DESIGN Mixed-method approach. OBJECTIVES To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL). SETTING SCIR-Group (UDESC)/Brazil. METHODS Developing the WC-MAL comprised five steps: (1) defining the construct-based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items - activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated. RESULTS From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of "Mobility (d4)" and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96. CONCLUSION The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.
Collapse
Affiliation(s)
- Giovana S Sprizon
- Department of Physiotherapy, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Natália D Pereira
- Department of Physical Therapy, Universidade Federal de São Carlos (UFSCar), São Carlos, São Paulo, Brazil
| | - Lorena O Almeida
- Department of Physiotherapy, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil
| | - Sarah M Dos Anjos
- Department of Occupational Therapy, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
- Department of Physical Therapy, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - David M Morris
- Department of Physical Therapy, The University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Jocemar Ilha
- Department of Physiotherapy, Spinal Cord Injury Rehabilitation Research Group (SCIR-Group), Physiotherapy Graduate Program, Universidade do Estado de Santa Catarina (UDESC), Florianópolis, Santa Catarina, Brazil.
| |
Collapse
|
3
|
Brito SAFD, Scianni AA, Peniche PDC, Faria CDCDM. Measurement properties of outcome measures used in neurological telerehabilitation: A systematic review using COSMIN checklist. Clin Rehabil 2023; 37:415-435. [PMID: 36448251 DOI: 10.1177/02692155221129834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
OBJECTIVE To summarize the measurement properties (reliability, validity, and responsiveness) and the clinical utility of measurement tools used in telerehabilitation in individuals with neurological conditions. DESIGN Systematic review. SUBJECTS Individuals with neurological conditions. INTERVENTION Not applicable. MAIN MEASURES The methodological quality of the studies using the COSMIN Risk of Bias Checklist, the quality of the measurement properties using the criteria for good measurement properties, and the clinical utility of the measurements using the Tyson & Connell scale. RESULTS From the 22,188 identified studies, 47 were included. Forty-three measurement tools were identified. The main modes of administration were telephone and videoconference. Studies involved mostly individuals with stroke, multiple sclerosis, and Alzheimer's disease. Criterion validity and reliability were the most investigated measurement properties. None of the tools had their responsiveness investigated. Twenty-two measurement tools have at least one measurement property evaluated as "sufficient" in a study with appropriate methodological quality ("very good" or "adequate"). Nineteen measurement tools showed adequate clinical utility. Eight measurement tools, investigated in individuals with stroke, spinal cord injury or Alzheimer's disease, all administered by telephone, were recommended. CONCLUSION The present results can be used to assist in choosing appropriate measurement tools, both in research and clinical practice, during telerehabilitation in individuals with neurological conditions. Measurement error, content validity, structural validity, and responsiveness need to be further investigated. In addition, the measurement properties of tools used in telerehabilitation in other neurological conditions, such as Huntington's disease, should also be investigated. REGISTRATION NUMBER CRD42021257662.
Collapse
Affiliation(s)
| | - Aline Alvim Scianni
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paula da Cruz Peniche
- Department of Physical Therapy, 28114Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | |
Collapse
|
4
|
Cristine de Faria L, Barbosa Marques D, Hellen Dos Santos Cerqueira Gomes L, Dos Anjos S, Pereira ND. Self-reported use of the paretic lower extremity of people with stroke: A reliability and validity study of the Lower-Extremity Motor Activity Log (LE-MAL) - Brazil. Physiother Theory Pract 2022:1-9. [PMID: 35320022 DOI: 10.1080/09593985.2022.2043966] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Most measures to assess the lower extremity (LE) after a neurological injury assess the lower limb motor capacity in the laboratory or clinical settings as the lower-extremity motor subscale of Fugl Meyer Assessment (FMA-LE). The LE Motor Activity Log (LE-MAL) measures the use of paretic LE in real-life conditions, which for many researchers and stakeholders is considered an important goal of rehabilitation. OBJECTIVE Investigate the reliability, validity, floor, and ceiling effects of the Brazilian version of the LE-MAL. METHODS Cross-sectional study to examine the reliability and validity of LE-MAL in patients with chronic stroke. The translation and adaptation of LE-MAL was carried out for the Brazilian version. After this stage, to ensure the inter-rater reliability two raters (LCF, DBM) applied the translated version of LE-MAL in the 21 selected participants. Subsequently, the concurrent validity was calculated by the correlation with the FMA-LE. RESULTS The translation and retro-translation of the LE-MAL was approved to the Brazilian context. A floor effect was not observed, and there was no ceiling effect for the LE-MAL total scores. The Inter-rater reliability ranged between 0.80 and 0.86. The Bland-Altman analysis showed difference of LE-MAL scores ranged from 0.8 to 1.6. The Cronbach's alpha coefficients for LE-MAL and subscales were high ranging between 0.86 and 0.80. There was a significant moderate correlation between the LE-MAL and FMA-LE (Pearson correlation 0.55 (p = .009)). CONCLUSION The Brazilian version LE-MAL is valid and reliable to assess real-world use of the paretic LE of individuals with chronic stroke.
Collapse
Affiliation(s)
| | | | | | - Sarah Dos Anjos
- Department of Occupational Therapy, University of Alabama at Birmingham, School of Health Professions Building, Birmingham, AL, USA
| | | |
Collapse
|
5
|
Mark VW. Functional neurological disorder: Extending the diagnosis to other disorders, and proposing an alternate disease term—Attentionally-modifiable disorder. NeuroRehabilitation 2022; 50:179-207. [DOI: 10.3233/nre-228003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: The term “functional neurological disorder,” or “FND,” applies to disorders whose occurrence of neurological symptoms fluctuate with the patient’s attention to them. However, many other disorders that are not called “FND” nonetheless can also follow this pattern. Consequently, guidelines are unclear for diagnosing “FND.” OBJECTIVE: To review the neurological conditions that follow this pattern, but which have not so far been termed “FND,” to understand their overlap with conditions that have been termed “FND,” and to discuss the rationale for why FND has not been diagnosed for them. METHOD: A systematic review of the PubMed literature registry using the terms “fluctuation,” “inconsistency,” or “attention” did not yield much in the way of these candidate disorders. Consequently, this review instead relied on the author’s personal library of peer-reviewed studies of disorders that have resembled FND but which were not termed this way, due to his longstanding interest in this problem. Consequently, this approach was not systematic and was subjective regarding disease inclusion. RESULTS: This review identified numerous, diverse conditions that generally involve fluctuating neurological symptoms that can vary with the person’s attention to them, but which have not been called “FND.” The literature was unclear for reasons for not referring to “FND” in these instances. CONCLUSION: Most likely because of historical biases, the use of the term “FND” has been unnecessarily restricted. Because at its core FND is an attentionally-influenced disorder that can respond well to behavioral treatments, the field of neurological rehabilitation could benefit by extending the range of conditions that could be considered as “FND” and referred for similar behavioral treatments. Because the term “FND” has been viewed unfavorably by some patients and clinical practitioners and whose treatment is not implied, the alternative term attentionally-modifiable disorder is proposed.
Collapse
Affiliation(s)
- Victor W. Mark
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
6
|
Perspectives From Persons With Multiple Sclerosis for a Comprehensive Real-World Change Therapy for Mobility. Arch Rehabil Res Clin Transl 2021; 4:100166. [PMID: 35282147 PMCID: PMC8904863 DOI: 10.1016/j.arrct.2021.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective To assess the personal perspectives of persons with multiple sclerosis (MS) on the acceptability of a novel physical therapy program that is designed to transfer gains from the clinic to their real-world lower extremity (LE) use, termed LE constraint-induced therapy (CIT). The program includes several behavior change techniques (prescribed home exercises, daily structured therapist interviews and problem solving for LE activities, keeping an activity diary) and a concentrated physical treatment schedule. Design Anonymous internet survey. Setting Participants accessed the survey from computers in the community. Participants Five hundred adults (N=500) were recruited from an MS support organization's registry for having indicated from mild to total limb spasticity because they were anticipated to have markedly impaired LE use in the community. Interventions Not applicable. Main Outcome Measures Participants were offered the options on a nonnumerical Likert scale of “Very likely,” “Likely,” “Neutral,” “Unlikely,” or “Very unlikely” to indicate their personal acceptability for each of 5 different key treatment procedures after these were explained. Totals for each option within each key procedure were analyzed for their acceptability. Results Of the 281 persons who responded, 90% expressed interest in participating in LE CIT. A large majority of persons who completed the survey selected either “Very likely” or “Likely” for each key procedure (median=88%, range=65%-90%, P<.01). This indicated strong acceptance for the procedures of LE CIT. In addition, more respondents who already had had previous physical therapy accepted LE CIT than did respondents who had not had physical therapy (P<.01). Conclusions The results suggest there is strong acceptance of CIT for mobility with preliminary evidence of benefiting community LE use for persons with MS. The results support further clinical trials of LE CIT for persons with MS.
Collapse
|
7
|
Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB, de Freitas SF, Kawamura CM, Lopes JAF, Arida RM. Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial. Trials 2021; 22:463. [PMID: 34281611 PMCID: PMC8287769 DOI: 10.1186/s13063-021-05424-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/06/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Protocols involving intensive practice have shown positive outcomes. Constraint induced movement therapy (CIT) appears to be one of the best options for better outcomes in upper limb rehabilitation, but we still have little data about lower extremity constraint-induced movement therapy (LE-CIT) and its effects on gait and balance. OBJECTIVE To evaluate the effects of an LE-CIT protocol on gait functionality and balance in chronic hemiparetic patients following a stroke. METHODS The study adopts a randomized, controlled, single-blinded study design. Forty-two patients, who suffered a stroke, who were in the chronic phase of recovery (>6 months), with gait disability (no community gait), and who were able to walk at least 10 m with or without the advice or support of 1 person, will be randomly allocated to 2 groups: the LE-CIT group or the control group (intensive conventional therapy). People will be excluded if they have speech deficits that render them unable to understand and/or answer properly to evaluation scales and exercises selected for the protocol and/or if they have suffered any clinical event between the screening and the beginning of the protocol. Outcome will be assessed at baseline (T0), immediately after the intervention (T1), and after 6 months (T2). The outcome measures chosen for this trial are as follows: 6-min walk test (6minWT), 10-m walk test (10mWT), timed up and go (TUG), 3-D gait analysis (3DGA), Mini Balance Evaluation Systems Test (Mini-BESTest), and as a secondary measure, Lower Extremity Motor Activity Log will be evaluated (LE-MAL). The participants in both groups will receive 15 consecutive days of daily exercise. The participants in the LE-CIT group will be submitted to this protocol 2.5 h/day for 15 consecutive days. It will include (1) intensive supervised training, (2) use of shaping as strategy for motor training, and (3) application of a transfer package (plus 30 min). The control group will receive conventional physiotherapy for 2.5 h/day over 15 consecutive days (the same period as the CIT intervention). Repeated measures analyses will be made to compare differences and define clinically relevant changes between groups. RESULTS Data collection is currently on-going and results are expected in 2021. DISCUSSION LE-CIT seems to be a good protocol for inclusion into stroke survivors' rehabilitation as it has all the components needed for positive results, as well as intensity and transference of gains to daily life activities. TRIAL REGISTRATION www.ensaiosclinicos.gov.br RBR-467cv6 . Registered on 10 October 2017. "Effects of Lower Extremities - Constraint Induced Therapy on gait and balance function in chronic hemipretic post-stroke patients".
Collapse
Affiliation(s)
- Elaine Menezes-Oliveira
- Neurology/Neuroscience program, Federal University of São Paulo – UNIFESP, Botucatu street, 862 - 5° floor Edifico Ciências Biomédicas, São Paulo, Brazil
- Adults Physiotherapy Department, Associação de Assistência à Criança Deficiente, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - Gabriela da Silva Matuti
- Adults Physiotherapy Department, Associação de Assistência à Criança Deficiente, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - Clarissa Barros de Oliveira
- Adults Physiotherapy Department, Associação de Assistência à Criança Deficiente, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - Simone Ferreira de Freitas
- Adults Physiotherapy Department, Associação de Assistência à Criança Deficiente, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - Catia Miyuki Kawamura
- Laboratory of Gait Analysis, Associação de Assistência à Criança com Deficiência – São Paulo, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - José Augusto Fernandes Lopes
- Laboratory of Gait Analysis, Associação de Assistência à Criança com Deficiência – São Paulo, Professor Ascendino Reis avenue, 724 – Ibirapuera, São Paulo, Brazil
| | - Ricardo Mario Arida
- Neurology/Neuroscience program, Federal University of São Paulo – UNIFESP, Botucatu street, 862 - 5° floor Edifico Ciências Biomédicas, São Paulo, Brazil
| |
Collapse
|