Reliability and validity of the Chinese version of the Short Musculoskeletal Function Assessment questionnaire in patients with skeletal muscle injury of the upper or lower extremities

Improved responsiveness for JKOOS+ compared to KOOS in Japanese patients undergoing total knee arthroplasty

BACKGROUND

Existing knee related patient reported outcome measurements (PROMs) have overwhelmingly been developed and validated in western chair-based societies, suggesting a potential for a western bias in PROMs evaluation of patients with knee conditions. We, therefore, endeavor to evaluate the responsiveness of the previously developed culturally relevant Japanese version of the knee injury and osteoarthritis outcome score (JKOOS+).

METHODS

We enrolled 114 patients scheduled for total knee arthroplasty (TKA) across 8 knee clinics in Japan. Patients completed the Oxford Knee Score (OKS) and JKOOS + both at the time of enrollment and again 1-year post-TKA. Responsiveness was evaluated using effect size and standardized response mean (SRM). An effect size or SRM >0.8 is considered adequately responsive. We further tested the difference in responsiveness between the original Japanese language KOOS activities of daily living (ADL) domain and the novel Japanese ADL (JADL) domain using the modified Jacknife test.

RESULTS

All domains were adequately responsive with the exception of the KOOS sports and recreation domain, which has previously been ignored by TKA researchers due to its lack of applicability to elderly patients undergoing TKA. The JADL domain outperformed the ADL domain in both effect size (1.51 v. 1.45) and SRM (1.67 v. 1.57) (p < 0.001). The novel Knee Flexion (KF) domain was adequately responsive, though less responsive than other domains except sports and recreation (p < 0.01 v. all other PROMs domains).

CONCLUSIONS

The JKOOS+ JADL domain is significantly more responsive than the Europe-developed ADL domain to TKA in Japanese knee patients suffering from knee osteoarthritis (OA). The KF domain, unique to the JKOOS+ and intended to assess difficulty with knee flexion, is adequately responsive to TKA in Japanese patients suffering from OA.

Cross-cultural adaptation and validation of the Short Musculoskeletal Function Assessment (SMFA) into Spanish (Chile)

The purpose of this protocol was to adapt and validate the English version of the Short Musculoskeletal Function Assessment (SMFA) into Chilean Spanish according to the World Health Organisation guidelines. This is a cross-sectional study of 897 surveys of patients with non-traumatic surgical orthopaedic pathologies. We analysed internal consistency, validity, and acceptability, including correlation with the short form 36 (SF-36) medical score. The validation included 900 participants with a response rate of 99,66%, with excellent internal consistency (Cronbach's α = 0.962). The Dysfunction and Bother Index items showed a value of 0.952 and 0.884 respectively, eliminating one item in the Dysfunction sub-scale. The principal component analysis was forced to four factors explaining 55.5% of the variance. SMFA-CL sub-scales are significantly correlated with SF-36 components and subcomponents. The first version of the SMFA-CL version (Spanish-Chilean) scale is reported. This culturally adapted score demonstrated a high rate of reliability, validity, and ability to objectively evaluate foot and ankle pathologies.

Validity of the short musculoskeletal function assessment questionnaire in patients with a spine fracture

PURPOSE

The aim of this study was to validate the use of the Short Musculoskeletal Function Assessment (SMFA) questionnaire in patients with a spine fracture.

METHODS

Cross-sectional cohort of individuals that had sustained a spine fracture (C1-L5) one year earlier. Patients were asked to fill out SMFA, Oswestry Disability Index (ODI), EQ-5D-3L and EQ-VAS. Spearman's rank correlation coefficient (rho) was used to assess convergent validity for each patient-reported outcome measure (PROM). Bland-Altman plots were used to assess PROM agreement.

RESULTS

82 patients completed all questionnaires. The correlations between SMFA Dysfunction and Bother indices and ODI were 0.89 and 0.86, with EQ-5D-3L index 0.89 and 0.80, and with EQ-VAS 0.80 and 0.73, respectively. The correlation for separate categories of the SMFA dysfunction index (daily activities, emotional status, arm and hand function, mobility) ranged between 0.71-0.87 for ODI, 0.72-0.84 for EQ-5D-3L index, and 0.67-0.77 for EQ-VAS. A selection of the ten items of SMFA that had the highest correlations with ODI resulted in a correlation of 0.91. The agreements between SMFA indices and ODI in Bland-Altman plots were good with small differential biases and minimal proportional biases, but worse for SMFA and EQ-5D-3L index and EQ-VAS.

CONCLUSION

The SMFA indices are highly correlated with ODI in patients with a spine fracture. The Dysfunction index and Bother index, or selected SMFA items, may be used to assess outcome in patients with spine fractures as an alternative to ODI.

Reliability and validity of culturally adapted Turkish Short Musculoskeletal Function Assessment questionnaire (SMFA-TR)

AIM

This study aimed to culturally adapt and validate the Turkish version of the Short Musculoskeletal Function Assessment Questionnaire (SMFA-TR) which primarily assesses the functional status of patients.

METHODS

The translation and cross-cultural adaptation of SMFA to Turkish was made by the standardized procedure and tested for clinimetric quality. The following analyses were made to evaluate clinimetric quality of the SMFA-TR: reliability with factor analysis and Chronbach's α (construct validity), correlations between SMFA-TR and Short Form (SF)-36 (concurrent validity), test-retest reliability (intraclass correlation analyses), floor and ceiling effects. The questionnaire was applied to 166 patients with musculoskeletal problems. All patients filled in the SMFA-TR and the validated Turkish SF-36 questionnaire. Forty-two patients returned to complete the same questionnaires at 10 days.

RESULTS

Factor analysis revealed a 4-factor structure of the SMFA-TR. Cronbach's α values were over 0.88 for both original subscales (dysfunction and bother) of the SMFA. Internal consistency (0.88-0.94) and test-retest reliability coefficients (0.90-0.98) were high for both subscales. Turkish SF-36 questionnaire conventional subscales showed significant correlations with SMFA-TR subscales. No floor or ceiling effects were found.

CONCLUSION

The Turkish version of the SMFA was found to be reliable and valid for Turkish-speaking patients with musculoskeletal injuries or disorders.

Is PROMIS the new standard for patient-reported outcomes measures in orthopaedic trauma research?

This review describes some of the benefits of the Patient-Reported Outcomes Measurement Information System (PROMIS) architecture, determined how frequently PROMIS measures were used in the current orthopaedic trauma literature, and compared the features of PROMIS instruments with other frequently used patient-reported outcomes measures (PROMs). PROMIS instruments have several unique elements to their architecture, such as item response theory, computerized adaptive testing options, and scaling using T-scores, that differentiate the instruments from many other PROMs. Over the past five years, 108 different PROMs were reported in 319 studies published in high-impact orthopaedic journals. PROMIS measures, including PROMIS Physical Function, Pain Interference, and Upper Extremity Function, were only used in seven studies (2%). PROMIS measures were found to be comparable to other more common PROMs with respect to respondent burden, administration options, and psychometric assessments specific to fracture patients. Likely, the limited familiarity and interpretability of PROMIS measures in the fracture population remain the most substantial barriers to broader adoption in orthopaedic trauma research.

Validation of Chichewa Short Musculoskeletal Function Assessment (SMFA) questionnaire: A cross-sectional study

Background

The Short Musculoskeletal Function Assessment (SMFA) tool measures function and quality of life in patients with musculoskeletal conditions.

Objective

This study aimed to translate and adapt culturally the SMFA into Chichewa, and assess its clinimetric properties.

Methods

The translated Chichewa version was administered to 53 patients with musculoskeletal disorders. To assess repeatability, an additional 20 patients answered the questionnaire twice over a time interval of two weeks. Internal consistency, floor and ceiling effects, and repeatability were tested; construct validity was assessed with the World Health Organization Quality of Life Assessment tool (WHOQOL-BREF).

Results

There was good internal consistency for both Dysfunction and Bothersome indices (Cronbach's alpha 0.90) and good construct validity between both indices with the WHOQOL-BREF. Pearson's correlation coefficient and intraclass correlation coefficient (ICC) for repeatability for the Dysfunction Index were 0.941 and 0.922 (95% CI: 0.772, 0.971) respectively, and 0.877 and 0.851 (95% CI: 0.629, 0.941) for the Bothersome Index respectively.

Conclusion

The translated Chichewa SMFA is a valid tool for populations that speak the Chichewa language.

The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma

OBJECTIVE

To assess test-retest reliability, construct validity and responsiveness of the Dutch Short Musculoskeletal Function Assessment (SMFA-NL) in patients who sustained acute physical trauma.

DESIGN

A longitudinal cohort study.

SETTING

A level 1 trauma center in The Netherlands.

SUBJECTS

Patients who required hospital admission after sustaining an acute physical trauma.

INTERVENTION

Patients completed the SMFA-NL at six weeks, eight weeks and six months post-injury.

MAIN MEASURE

The measures used were The Dutch Short Musculoskeletal Function Assessment. Test-retest reliability (between six and eight weeks post-injury) using intraclass correlation coefficients, the smallest detectable change and Bland and Altman plots. Construct validity (six weeks post-injury) and responsiveness (between six weeks and six months post-injury) were evaluated using the hypothesis testing method.

RESULTS

A total of 248 patients (mean age: 46.5, SD: 13.4) participated, 145 patients completed the retest questionnaires (eight weeks) and 160 patients completed the responsiveness questionnaires (six months). The intraclass correlation coefficients indicated good to excellent reliability on all subscales (0.80 to 0.98). The smallest detectable change was 17.4 for the Upper Extremity Dysfunction subscale, 11.0 for the Lower Extremity Dysfunction subscales, 13.9 for the Problems with Daily Activities subscale and 16.5 for the Mental and Emotional Problems subscale. At group level, the smallest detectable change ranged from 1.48 to 1.96. A total of 86% of the construct validity hypotheses and 79% of the responsiveness hypotheses were confirmed.

CONCLUSION

This study showed that the SMFA-NL has good to excellent reliability, sufficient construct validity and is able to detect change in physical function over time.

Measuring outcomes following tibial fracture

AIM

The aim of this study was to determine how outcome is measured following adult tibial fracture in the modern era of functional outcome measurement and patient reported outcomes.

METHODS

A systematic review of publications since 2009 was performed, looking specifically at acute, adult tibial shaft fractures. Ovid Medline, Embase, PubMed and PsycINFO databases were searched for relevant titles which were then screened by two authors with adjudication where necessary by a third. Relevant articles were reviewed in full and data was extracted concerning the study participants, study design and any measures that were used to quantify the results following fracture. The results were collated and patient reported outcome measures were assessed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) standards.

RESULTS

A total of 943 titles and articles were reviewed, with 117 included for full analysis. A wide range of clinical and radiological "outcomes" were described, along with named clinician- and patient-reported outcome measures. There was considerable heterogeneity and lack of detail in the description of the simplest outcomes, such as union, infection or reoperation. Reported clinician and patient reported outcome measures are variably used. None of the identified patient reported outcome measures have been validated for use following tibial fracture.

CONCLUSION

We recommend definition of a core outcome set for use following tibial fracture. This will standardise outcome reporting following these injuries. Furthermore, there is need for a validated patient reported outcome measure to better assess patient important outcomes in this patient group.

Structural Validity of the Short Musculoskeletal Function Assessment in Patients With Injuries

BACKGROUND

The Short Musculoskeletal Function Assessment (SMFA) is a widely used patient-reported outcome measure, originally having 2 elements of outcome: the function index and the bother index. In multiple studies, it has been argued that the SMFA should be scored using 3, 4, or 6 subscales instead. Therefore, there is inconsistency with the number of underlying dimensions of the SMFA.

OBJECTIVE

The aim of this study was to evaluate the structural validity of the various proposed subscale configurations of the SMFA in a broad range of Dutch patients with injuries.

DESIGN

This study used a prospective cohort design.

METHODS

Participants with injuries were asked to complete the Dutch SMFA (SMFA-NL) at 5 to 8 weeks postinjury. The structural validity of the 6 different factor structures that have been proposed in other studies was evaluated using confirmatory factor analyses. Internal consistency was analyzed using Cronbach alpha.

RESULTS

A total of 491 patients participated (response rate = 74%). A 4-factor structure showed an acceptable fit (root-mean-square error of approximation [RMSEA] = 0.070, comparative fit index = 0.973, Tucker-Lewis index = 0.971). Other models, including the original 2-index structure, showed insufficient structural validity in Dutch patients with injuries. The 4-factor structure showed sufficient discriminant validity and good internal consistency (Cronbach alpha ≥ 0.83).

LIMITATIONS

It is unclear whether conclusions are generalizable across different countries, people who are elderly, and people without injuries.

CONCLUSION

In a broad range of patients with injuries, the SMFA-NL may be best scored and interpreted using a 4-factor structure. Other factor structures showed insufficient structural validity.

The moderating effect of social support on the relationship between physical health and suicidal thoughts among Chinese rural elderly: A nursing home sample

Suicide rate is relatively high among Chinese rural elderly. While there has been some exciting work on reporting and preventing suicide among community-dwelling elderly, only a few published studies have addressed the issues of rural nursing homes in China. This study aimed to investigate the relationship among perceived social support, physical health, and suicidal thoughts of the elderly living in Chinese rural nursing homes. It also examined the moderating effects of social support on the path from physical health to suicidal thoughts of the rural institutional elderly in China. This study investigated 205 participants aged 60 years and above in Chinese rural nursing homes. Participants' suicidal thoughts, perceived social support, and physical health were assessed. This study conducted descriptive analysis, Student's t-test, and Pearson's chi-square test to test how physical health and social support predicted suicidal thoughts, as well as the moderating effects of family's, friends', and others' social support on physical health and suicidal thoughts. Both physical health and perceived social support were significantly related to suicidal thoughts. Perceived social support from family, friends, and significant others moderated the relationship between physical health and suicidal thoughts. Findings of this study suggested that increasing social support and improving physical health would be effective in both suicide prevention and intervention for the residents in Chinese rural nursing homes.

Validity and reliability of the Disabilities of Arm, Shoulder, and Hand scale in dental students: A transnational study

This study aimed to evaluate the validity and reliability of the Disabilities of Arm, Shoulder, and Hand (DASH) scale in Brazilian and American dental students and assess the influence of demographic variables on disability in them. A cross-sectional observational study was conducted with a nonprobabilistic sample. The sample was composed of students of both genders from the School of Dentistry of Araraquara, State University of São Paulo (UNESP) (n = 288), and students from Stony Brook University, New York, NY, USA (n = 149). The disabilities of the upper limbs were estimated using the DASH scale. The samples were characterized by collecting information on gender, academic year, and sports and work activities. The refined bifactorial model presented goodness-of-fit indices for both countries. There was a significant effect of the variables gender and academic year for the Brazilian sample and the variable sports practices for the American sample. The refined bifactorial model was valid and reliable for the Brazilian and American populations. In this model, the removal of item 17 for the Brazilian sample and items 3, 13, and 23 for the American sample was necessary. Demographic variables such as gender, academic year, and sports practice contributed significantly to the level of disability in the study populations.

Selected life quality variables of women treated surgically due to intertrochanteric femur fractures in the aspect of nursing and rehabilitation standards

Introduction: The aim of presented study was to evaluate selected quality of life indicators for women treated surgically due to intertrochanteric femur fractures in terms of implementation of physiotherapeutic and nursing standards. Clinical Hospital in Krakow (5WSK) within the period from January 2015 to December 2016. At that time, 145 women with intertrochanteric femur fracture were admitted to the hospital. The age of the patients ranged between 58 and 92 years, with an average of 83.6 years. The following questionnaires and score scales were used to assess the quality of life: Short Pfeiffer Mental Status Questionnaire (SPMSQ), Instrumental Activities of Daily Living (IADL) scale, SF-36 Quality of Life Questionnaire, Barthel scale, HOOS scale, Geriatric Depression Scale (GDS) by Yesavage, the author’s questionnaire on rehabilitation care problems related to urinary tract infections, bed sores, pneumonia, gastrointestinal disorders, gastrointestinal infections and thromboembolic complications as well as survival rate. Results and conclusions: 1. The quality of life of women operated because of intertrochanteric femoral fractures using an intramedullary Gamma nail had deteriorated in both short and long-term observation. 2. Maintenance and individualization of nursing standards and rehabilitation in women treated surgically due to intertrochanteric femoral fractures had a positive effect on the overall process of their treatment. 3.The level of physical activity declared by women operated due to intertrochanteric femur fracture prior to the occurrence of these fractures, has a signifi cant effect on their functional results in short and long-term observation. The higher the level of physical activity of these patients before the fracture, the more favourable was the functional outcome. 4. The level of mood and self-acceptance of the disease in women treated surgically for this fracture had signifi cant impact on the process of their nursing as well as rehabilitation, and on functional status in short and long-term follow-up. The higher the level of mood and self-acceptance of the disease in these women, the better the process of their nursing, rehabilitation and the functional outcome.

Reliability and validity of the Korean version of the Short Musculoskeletal Function Assessment questionnaire for patients with musculoskeletal disorder

[Purpose] The purpose of this study was to establish the reliability and validity of the Short Musculoskeletal Function Assessment questionnaire, which was translated into Korean, for patients with musculoskeletal disorder. [Subjects and Methods] Fifty-five subjects (26 males and 29 females) with musculoskeletal diseases participated in the study. The Short Musculoskeletal Function Assessment questionnaire focuses on a limited range of physical functions and includes a dysfunction index and a bother index. Reliability was determined using the intraclass correlation coefficient, and validity was examined by correlating short musculoskeletal function assessment scores with the 36-item Short-Form Health Survey (SF-36) score. [Results] The reliability was 0.97 for the dysfunction index and 0.94 for the bother index. Validity was established by comparison with Korean version of the SF-36. [Conclusion] This study demonstrated that the Korean version of the Short Musculoskeletal Function Assessment questionnaire is a reliable and valid instrument for the assessment of musculoskeletal disorders.