Tetraplegia Hand Activity Questionnaire (THAQ): the development, assessment of arm-hand function-related activities in tetraplegic patients with a spinal cord injury

Development, Content Validity and Reliability of Upper Extremity Functional Skill Measure in C5-C7 Spinal Cord Injury

STUDY DESIGN

A methodological research design.

OBJECTIVE

To create an objective measure for assessing hand functions in C5-C7 spinal cord injury (SCI) and estimation of its content validity and internal consistency reliability.

METHOD

This study was executed in three phases. Phase 1 included a thorough review of the literature, semi-structured in-depth interviews of participants with tetraplegia and interviews of caregivers of SCI individuals and healthcare workers dealing with SCI to understand the hand functions of individuals with C5-C7 SCI. Phase 2 consisted of the development of the tool. The content validity ratio (CVR) method and the opinion of the expert validated the content of the upper extremity functional skill measure (UEFSM). Phase 3 included a quantitative evaluation of the tool which was done on a targeted group of 30 subjects with C5-C7 SCI.

RESULTS

Through the review of the literature and in-depth interview of the participants, 11 items were developed under four content areas: grasp, grip, pinch and gross movement. Items with a minimum CVR of 0.56 were retained at a significance level of p = 0.05 resulting in a 10-item tool for assessing the hand function of individuals with C5-C7 SCI categorized under four subscales. Pilot testing on 10 subjects reveals an average time of 2 minutes and 25 seconds to complete the task. The Cronbach's alpha was found to be 0.878.

CONCLUSION

UEFSM is a 10-item tool with good content validity and internal consistency reliability for the assessment of hand functions in individuals with C5-C7 SCI.

Internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia

STUDY DESIGN

Psychometric study.

OBJECTIVES

This study aimed to evaluate the internal consistency and validity of the Italian version of the Jebsen-Taylor hand function test (JTHFT-IT) in people with tetraplegia.

SETTING

Italian spinal units.

METHODS

Psychometric properties of the JTHFT-IT were assessed following international guidelines. The internal consistency was examined using Cronbach's alpha coefficient. Pearson's correlation coefficient was calculated for the concurrent validity of JTHFT-IT with a dynamometer, while the construct validity was calculated in comparison to that of the Van Lieshout test short version in Italian (VLT-SV-IT).

RESULTS

The test was administered to 48 right-hand dominant people with tetraplegia. Cronbach's alpha calculation resulted in a value of 0.96 for the right hand and 0.94 for the left hand. In terms of the validity of the scale, the Pearson's correlation, as measured in relation to the VLT-SV-IT and dynamometer, showed statistically significant results (range for the correlation coefficient of between -0.96 and -0.12, p < 0.05).

CONCLUSIONS

The findings of this study support the internal consistency and validity of the JTHFT-IT and its use among a population with cervical SCI as a measure of hand functionality.

Predicting upper limb compensation during prehension tasks in tetraplegic spinal cord injured patients using a single wearable sensor

Upper limb (UL) compensation is a common strategy of patients with a high spinal cord injury (SCI), i.e., tetraplegic patients, to perform activities of daily living (ADLs) despite their sensorimotor deficits. Currently, an objective and sensitive tool to assess UL compensation, which is applicable in the clinical routine and in the daily life of patients, is missing. In this work, we propose a metric to quantify this compensation using a single inertial measurement unit (IMU). The spread of forearm pitch angles of an IMU attached to the wrist of 17 SCI patients and 18 healthy controls performing six prehension tasks of the graded redefined assessment of strength, sensibility and prehension (GRASSP) was extracted. Using the spread of the forearm pitch angles, a classification of UL compensation was possible with very good to excellent accuracies in all six different prehension tasks. Furthermore, the spread of forearm pitch angles correlated moderately to very strongly with qualitative and quantitative GRASSP prehension scores and the task duration. Therefore, we conclude that our proposed method has a high potential to classify compensation accurately and objectively and might be used to quantify the degree of UL compensation in ADLs. Thus, this method could be implemented in clinical trials investigating the effectiveness of interventions targeting UL functions.

Validation and cross-cultural adaptation of the Van Lieshout test in an Italian population with cervical spinal cord injury: a psychometric study

STUDY DESIGN

Psychometric study.

OBJECTIVE

To assess the reliability and validity of the Italian-translated and adapted version of the Van Lieshout test (VLT) in a population of people with cervical spinal cord injury (C-SCI).

SETTING

Multicenter study in multiple hospitals in Italy.

METHODS

The original scale was translated from English to Italian according to international guidelines. The internal consistency, test-retest reliability, and responsiveness of the Italian version of the VLT (IT-VLT) were examined. The IT-VLT was administered to 50 individuals with C-SCI, and its construct and convergent validity were evaluated using Pearson correlation coefficients with the Italian version of the Spinal Cord Injury Measure version III (SCIM III).

RESULTS

All psychometric properties of the IT-VLT showed significant values, including the Cronbach's α, which was 0.95 (left hand) and 0.94 (right hand). Furthermore, the test-retest reliability showed an intraclass correlation coefficient of 0.89, 0.81, and 0.87 for the right hand, left hand, and total value, respectively. The Pearson correlation coefficient of the IT-VLT and the Italian version of the SCIM III showed all significant results r = 0.559 (p < 0.01). The IT-VLT score improved significantly during in-patient rehabilitation In fact the mean (95% CI) change between T0 and T1 was - 13.2 ± 28.6 (- 21.38; - 5.10).

CONCLUSIONS

The IT-VLT was a reliable and a valid outcome measure for assessing hand function in the Italian population with C-SCI. The present study lays the grounds to investigate the psychometric properties of the short version of the IT-VLT.

A systematic review and comparison of questionnaires in the management of spinal cord injury, multiple sclerosis and the neurogenic bladder

AIMS

Validated questionnaires are increasingly the preferred method used to obtain historical information. Specialized questionnaires exist validated for patients with neurogenic disease including neurogenic bladder. Those currently available are systematically reviewed and their potential for clinical and research use are described.

METHODS

A systematic search via Medline and PubMed using the key terms questionnaire(s) crossed with Multiple Sclerosis (MS) and Spinal Cord Injury (SCI) for the years 1946 to January 22, 2014 inclusive. Additional articles were selected from review of references in the publications identified. Only peer reviewed articles published in English were included.

RESULTS

18 questionnaires exist validated for patients with neurogenic bladder; 14 related to MS, 3 for SCI, and 1 for neurogenic bladder in general; with 4 cross-validated in both MS and SCI. All 18 are validated for both male and female patients; 59% are available only in English. The domains of psychological impact and physical function are represented in 71% and 76% of questionnaires, respectively. None for the female population included elements to measure symptoms of prolapse.

CONCLUSION

The last decade has seen an expansion of validated questionnaires to document bladder symptoms in neurogenic disease. Disease specific instruments are available for incorporation into the clinical setting for MS and SCI patients with neurogenic bladder. The availability of caregiver and interview options enhances suitability in clinical practice as they can be adapted to various extents of disability. Future developments should include expanded language validation to the top 10 global languages reported by the World Health Organization.

Clinimetric Properties of the Duruoz Hand Index in Patients With Stroke

OBJECTIVE

To investigate the reliability, validity, and responsiveness of the Duruoz Hand Index (DHI) in assessing activity limitation related to hand function in patients with stroke.

DESIGN

Prospective validation study. A consecutive sample of stroke patients was evaluated on 3 occasions: 2 baseline measurements with a 24-hour interval in between, and again 1 month later immediately after a 4-week inpatient rehabilitation program.

SETTING

Three different inpatient rehabilitation centers.

PARTICIPANTS

A consecutive sample of 56 patients with stroke (33 men, 23 women) with a mean age 62 years and a mean time since stroke 84 days.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Brunnstrom stages, Modified Ashworth Scale, sensory status, FIM instrument, and DHI. Test-retest reliability was tested using the intraclass correlation coefficient (ICC) and internal consistency was tested using the Cronbach alpha coefficient. Indexes of measurement error were calculated by standard error of measurement and minimal detectable change (MDC). Construct validity was assessed by association with the FIM instrument (Spearman rho correlation coefficient). Responsiveness was assessed by calculation of the effect size and paired t test.

RESULTS

The test-retest reliability and internal consistency of the DHI were excellent, with an ICC of .99 (95% confidence interval, .93-.99) and alpha of .97. The MDC was 1.4 DHI points. The correlation between the DHI and the FIM self-care items was high (rho=-.73). The DHI significantly discriminated the patients with dominant side paresis versus nondominant side paresis (P<.01). The DHI score improved significantly after a 4-week inpatient rehabilitation program (P<.05).

CONCLUSIONS

The DHI is a time and labor efficient, practical instrument that can be used to assess the hand-related activity level for clinical and research purposes in patients with stroke.

How do C6/C7 tetraplegic patients grasp balls of different sizes and weights? Impact of surgical musculo-tendinous transfers

STUDY DESIGN

Prospective control cohort study.

OBJECTIVES

To develop a new test to analyse qualitatively grasping strategies in C6/C7 tetraplegic patients, and to quantify the effect of musculo-tendinous transfers.

SETTING

France.

METHODS

Twelve C6/C7 tetraplegic adults (17 arms; 31.3+/-7.9 years) and 17 healthy subjects (30.9+/-9.4 years) completed the study. We assessed participants' ability to grasp, move and release standardized balls of variable sizes and weights.

OUTCOME MEASURES

Failures, movement duration (MD), grip patterns, forearm orientation during transport.

RESULTS

In patients as well as in controls, the number of digits involved in prehension increased proportionally to the size and weight of the ball. C6 non-operated tetraplegic patients failed 38.2% of the tasks. They frequently used supine transport (51.4% of successful tasks). MD was longer, with a large distribution of values. The presence of active elbow extension poorly influenced the amount of failure nor grip configuration, but significantly reduced MD and supine transport (34%). Patients who were evaluated after hand surgery showed a trend towards improved MD and more frequent completion (failure 30%), especially for middle-sized and middle-weighted balls. Grip patterns were deeply modified, and all transports were made in pronation.

CONCLUSION

The 'Tetra Ball Test' evidences the characteristics of grasping in tetraplegic patients and those influenced by surgery. It may be useful in understanding effects of surgical procedures. This preliminary study must be completed to evaluate the quantitative responsiveness and reproducibility of this test and to develop instrumented electronic balls to optimise it.

Measurement properties of the short version of the Van Lieshout test for arm/hand function of persons with tetraplegia after spinal cord injury

STUDY DESIGN

Two validation studies.

OBJECTIVES

To assess the measurement properties of the short version of the Van Lieshout test (VLT-SV), a new test for arm/hand function of persons with tetraplegia after spinal cord injury (SCI).

SETTING

Two specialized rehabilitation centres in The Netherlands.

METHODS

Study 1 (N=12)--assessment of inter-rater reliability (intraclass correlations (ICC); weighted kappa; Bland-Altman plots). Study 2 (N=55)--assessment of convergent validity by computing Spearman's correlations with the Grasp-Release test (GRT; criterion standard) and with motor level of injury, ASIA impairment scale, international classification for surgery of the hand, and the self-care and transfer scales of the functional independence measure. All statistics were computed separately for the right- and the left-hand scores.

RESULTS

Inter-rater reliability was excellent (ICC 0.98 and 0.99). Agreement was independent of the height of the scores and the limits of agreement were +/-0.5 points on a 0-5 scale. Convergent validity was very good with a Spearman correlation of 0.87 and 0.90 between the VLT-SV and the GRT and correlations between 0.35 and 0.85 with the other indicators of arm/hand function.

CONCLUSION

The VLT-SV seems a reliable and valid test to assess arm/hand function of persons with tetraplegia after SCI.

[Assessment of functional abilities, handicap and quality of life in patients with spinal cord injuries]

OBJECTIVES

A literature review of the methods of evaluating function, handicap and quality of life in patients with spinal cord injuries.

METHODS

The literature review was based on the available French and English articles published since 1990 in 3 databases: MEDLINE, Pascal and Embase.

RESULTS

The literature is dominated by descriptions of tools for evaluating functional limitations in motor deficiencies. Such descriptions involve the validation of generic tools for patients with spinal cord injuries or of specific tools during the evaluation of a particular intervention such as surgery of the tetraplegic hand or adaptation of technical help.

CONCLUSION

The tools to assess patients with spinal-cord injuries are sufficiently numerous and varied to allow us to evaluate physical, functional and psychosocial dimensions. Rigorous methodological validation is continuously at the base of those proposed tools and thus reinforces our choice to use them. Unfortunately, few evaluation tools for patients with spinal cord injuries have been published, translated into French and validated.