The Patient Specific Functional Scale - Brazil as an instrument for the functional assessment of patients with chronic non-specific low back pain: Construct validity (hypothesis testing and structural validity) and test-retest reliability

The objective was to assess the validity and reliability of the Patient-Specific Functional Scale-Brazil (PSFS-B) in patients with non-specific chronic low back pain. A methodological study was conducted, and 101 volunteers with chronic non-specific low back pain were interviewed and asked to complete the PSFS-B questionnaire and the Oswestry Disability Index-Brazil 2.0 reference questionnaire. The Oswestry Disability Index-Brazil 2.0 is a standardized tool used to assess functional disability of the lumbar spine. A new assessment (follow-up) was conducted one week later using the same instruments. The COSMIN checklist was utilized as a guide. Two questionnaires were employed to assess patients: the Patient-Specific Functional Scale-Brazil (PSFS-Br) and the Oswestry Disability Index-Brazil 2.0 (ODI-Br). Data were analyzed to assess construct validity (hypothesis testing and structural validity), internal consistency, and test-retest reliability. The statistical methods employed included Pearson's correlation coefficient, confirmatory factorial analysis, Cronbach's alpha, and intraclass correlation coefficient. The results of the Patient-Specific Functional Scale-Brazil demonstrated a moderate negative correlation with the ODI-Br in hypothesis testing (r = -0.691 and r = -0.754) and in structural validity (Comparative Fit Index (0.986), Tucker-Lewis Index (0.958), Root Mean Square Error of Approximation (0.194), and Standardized Root Mean Square Residual (0.134). Furthermore, the instrument demonstrated excellent internal consistency (α = 0.951) and test-retest reliability (intraclass correlation coefficient = 0.978), and was additionally validated by the Bland-Altman plot (0.125). In conclusion, the Patient-Specific Functional Scale-Brazil is a valid and reliable tool for the evaluation and follow-up of patients with non-specific chronic low back pain.

Preoperative spinal education for lumbar spinal stenosis: A feasibility study

INTRODUCTION

Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positive surgical outcomes and promote patient self-efficacy, while attempting to mitigate postoperative complications. No efforts have investigated the prehabilitation strategies specifically for patients undergoing LSS surgery.

OBJECTIVE

To determine the feasibility of delivery and acceptability by participants of a novel prehabilitation intervention for patients undergoing LSS surgery.

DESIGN

Feasibility study.

SETTING

Outpatient orthopedic clinic at an academic medical center.

PARTICIPANTS

Patients at least 50 years of age, who were scheduled for LSS surgery between October 2020 and October 2021.

INTERVENTION

PreOperative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS), is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) Educational booklet and video; (2) In-person physical therapy (PT) session; and (3) Telemedicine visit with a physiatrist.

MAIN OUTCOME MEASURE(S)

The primary outcomes of interest were feasibility and acceptability of intervention by participants. Key potential surgical outcomes were length of stay and discharge disposition.

RESULTS

POSE-LSS was completed by all eligible participants enrolled (n = 15) indicating feasibility and acceptability. Potential effectiveness measures including length of stay and discharge disposition were positively associated with the POSE-LSS intervention.

CONCLUSIONS

This study demonstrates that a novel prehabilitation intervention is feasible, acceptable, and appears positively associated with important short-term measures of postoperative recovery that may impact the trajectory of patient care following LSS surgery.

A systematic review of the psychometric properties of physical performance tests for sarcopenia in community-dwelling older adults

BACKGROUND

This review provides an overview of the psychometric properties of the short physical performance battery (SPPB), timed up and go test (TUG), 4 m gait speed test (4 m GST) and the 400 m walk test (400 m WT) in community-dwelling older adults.

METHODS

A systematic search was conducted in MEDLINE, CINAHL and EMBASE, resulting in the inclusion of 50 studies with data from in total 19,266 participants (mean age 63.2-84.3). Data were extracted and properties were given a sufficient or insufficient overall rating following the COSMIN guideline for systematic reviews of patient-reported outcome measures. Quality of evidence (QoE) was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

The SPPB was evaluated in 12 studies, TUG in 30, 4 m GST in 12 and 400 m WT in 2. Reliability of the SPPB, TUG and 4 m GST was rated sufficient (moderate to good QoE). The measurement error of the SPPB was rated insufficient (low QoE). Criterion validity for the SPPB was insufficient in indicating sarcopenia (moderate QoE), while the TUG was sufficient and insufficient for determining mobility limitations (low QoE) and activities of daily living disability (low QoE), respectively. Construct validity of the SPPB, TUG, 4 m GST and 400 m WT was rated insufficient in many constructs (moderate to high QoE). Responsiveness was rated as insufficient for SPPB (high QoE) and TUG (very low QoE), while 4 m GST was rated as sufficient (high QoE).

CONCLUSION

Overall, the psychometric quality of commonly used physical performance tests in community-dwelling older adults was generally rated insufficient, except for reliability. These tests are widely used in daily practice and recommended in guidelines; however, users should be cautious when drawing conclusions such as sarcopenia severity and change in physical performance due to limited psychometric quality of the recommended measurement instruments. There is a need for a disease-specific physical performance test for people with sarcopenia.This research received no specific grant from any funding agency and was registered a priori using the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42022359725).

The SaVe project - Sarcopenia and Vertigo in aging patients with colorectal cancer: A study protocol for three randomized controlled trials

INTRODUCTION

Older patients with cancer range from fit to frail with various comorbidities and resilience to chemotherapy. Besides nausea and fatigue, a significant number of patients experience dizziness and impaired walking balance after chemotherapy, which can have great impact on their functional ability and health related quality of life. Symptoms are easily overlooked and therefore often underreported and managed, which is why symptoms could end up as long-lasting side effects. The aim of this study is to investigate the development of dizziness, decline in walking balance, and sarcopenia and the effect of a comprehensive geriatric assessment and 12 weeks of group-based exercise on these symptoms. The exercise intervention includes vestibular and balance exercises, and progressive resistance training, to counteract the symptoms in older patients with colorectal cancer treated with chemotherapy.

MATERIALS AND METHODS

This is a randomized controlled trial including patients ≥65 years initiating (neo)adjuvant or first-line palliative chemotherapy for colorectal cancer. Patients will undergo a comprehensive assessment program including measures of vestibular function, balance, muscle strength, mass, and endurance, peripheral and autonomic nerve function, and subjective measures of dizziness, concern of falling, and health related quality of life. Tests will be performed at baseline, 12, and 24 weeks. Patients will be placed in three different randomized controlled trials depending on chemotherapy regimen and randomized 1:1 to comprehensive geriatric assessment and exercise three times/week or control. Participants in both groups will continue with usual care, including standardized oncological treatment. In total, 150 patients are needed to assess the two primary outcomes of (1) maintenance of walking balance assessed with Dynamic Gait Index and (2) lower limb strength and endurance assessed with 30 Second Sit-to-Stand Test at 12 weeks. The primary outcomes will be analyzed using a mixed linear regression model investigating the between-group differences.

DISCUSSION

Trial enrollment began in April 2023 and is the first trial to evaluate reasons for dizziness, decline in walking balance, and sarcopenia in older patients receiving chemotherapy. The trial will provide new and valuable knowledge in how to assess, manage, and prevent dizziness, decline in walking balance, and sarcopenia in older patients with colorectal cancer.

TRIAL REGISTRATION

The Regional Ethics Committee (j.nr. H-22064206). Danish Data Protection Agency (P-2023-86) and ClinicalTrials.gov (NCT05710809).

Reliability and minimal detectable change of the Short Physical Performance Battery in older adults with mild cognitive impairment

OBJECTIVES

Reliability of the Short Physical Performance Battery (SPPB) are rarely examined among older adults with mild cognitive impairment (MCI). This study aimed to investigate the test-retest reliability and minimal detectable change (MDC) of the SPPB in older adults with MCI.

METHODS

Participants included 100 older adults with MCI. The SPPB was assessed with the first 2 assessments separated by a 20-min interval and the third separated by a 1-week interval. The intraclass correlation coefficient (ICC) and MDC values were estimated.

RESULTS

The intraday ICC was 0.73 for the SPPB score, 0.90 for the 4-m walk time (4mwt), and 0.95 for the 5-times chair stand time (5cst); the corresponding interday ICC values were 0.76, 0.89, and 0.91, respectively. The MDC values ranged from 1.1 to 1.2 for the SPPB score, from 0.77 to 0.80 s for the 4mwt, and from 1.32 to 1.77 for the 5cst.

CONCLUSIONS

The SPPB had satisfactory reliability among older adults with MCI. The test-retest reliability of the SPPB is sufficient (>0.7) for group comparisons. Moreover, the test-retest reliability for the 4mwt and 5cst subscale performances is acceptable (> 0.9) for individual-level measurements over time.

Perspectives of patients with osteoarthritis for using digital technology in rehabilitation at a public community centre in the Cape Metropole area: A qualitative study

Objectives

To explore the perspectives of people with osteoarthritis (OA) on the use of digital technology into their rehabilitation program, including their awareness, views on accessibility, affordability and willingness to accept digital modalities for rehabilitation delivery.

Methods

A qualitative, descriptive design was conducted. Patients with OA who receive care at a public community rehabilitation centre in the Western Cape, South Africa were eligible to participants. Semi-structured interviewed were conducted and Atlas.ti 23 software was used for thematic analysis.

Results

The findings showed that the participants had limited awareness and exposure to telerehabilitation (TR), along with minimal digital literacy and skills. They were sceptical about the effectiveness of TR and concerned about the inherent lack of physical interactions with health professionals. However, some acknowledged TR's potential benefits for accessibility, convenience, family involvement and long-term community health improvement. Participants were willing to learn more about TR.

Conclusion

Considering the benefits of TR in lower resource settings such as South Africa, investment to increase awareness and patient education and training in TR may assist in enhancing access and quality of care. Resources dedicated to TR and management buy-in in low-and-middle income countries (LMICs) is necessary to facilitate the fit-for-context roll-out of TR.

The Psychometric Properties of the Short Physical Performance Battery to Assess Physical Performance in Older Adults: A Systematic Review

BACKGROUND

Maintaining physical performance in older age is critical. The Short Physical Performance Battery (SPPB) is one of many tools available to measure physical performance in older people.

PURPOSE

Describe the psychometric properties of the SPPB.

METHODS

Using a systematic review methodology, quantitative studies addressing the validity, reliability, and sensitivity of the SPPB in populations 60 years or older were included. We searched 8 databases: MEDLINE, CINAHL, Cochrane, Ageline, Amed, Embase, Scopus, and Emcare, as well as gray literature. Two researchers independently screened, appraised, and extracted data from the literature, following which a descriptive synthesis was undertaken.

RESULTS

Twenty-eight studies with varying methodological quality were included. Floor and ceiling effects were reported in 4 studies, generally related to very high or very low functioning adults. Nineteen studies investigated validity with varying correlations between the SPPB and other physical performance assessment tools. Ten studies reported good to excellent reliability (intraclass correlation coefficient ranging 0.82-0.92). Minimum detectable change indicates low sensitivity (ranging 0.7-3.42).

DISCUSSION

Evidence from the literature indicates that the SPPB is a reliable and valid measure of physical performance in adults older than 60 years. However, the SPPB has a narrow scope and is most appropriate for frail older adults who can ambulate and are cognitively able to follow instructions. It has limited applicability for specific populations such as people with dementia who have difficulty following instructions. Targeted training for users may improve its usability and success in clinical practice.

CONCLUSIONS

Clinicians should be mindful that while the SPPB has good validity and reliability, it has limited applicability for people with dementia and is not particularly sensitive to change. In practice, this means that it provides a good snapshot of a client's physical performance compared with the rest of the older population; it is less useful for tracking changes to physical performance over time.

Impact of walk advice alone or in combination with supervised or home-based structured exercise on patient-reported physical function and generic and disease-specific health related quality of life in patients with intermittent claudication, a secondary analysis in a randomized clinical trial

BACKGROUND

Supervised exercise is an integral part of the recommended first-line treatment for patients with intermittent claudication (IC). By reflecting the patients' perspectives, patient-reported outcome measurements provide additional knowledge to the biomedical endpoints and are important outcomes to include when evaluating exercise interventions in patients with IC. We aimed to evaluate the one-year impact of three strategies: unsupervised Nordic pole walk advice (WA), WA + six months of home-based structured exercise (HSEP) or WA + six months of hospital-based supervised exercise (SEP) on health-related quality of life and patient-reported physical function in patients with IC.

METHODS

This secondary exploratory analysis of a multi-center, randomized clinical trial compared three exercise strategies. The primary outcome of the secondary analysis was the one-year change in the 36-Item Short-Form (SF-36). Secondary outcomes were three- and six-months SF-36 changes alongside three, six- and 12-months changes in the disease-specific Vascular Quality of Life instrument (VascuQoL) and the Patient-Specific Functional Scale (PSFS). The Kruskal-Wallis test with Bonferroni-adjusted post-hoc tests were used for between-group comparisons. Effect size calculations were used to describe the size of observed treatment effects, and the clinical meaningfulness of observed changes in the VascuQoL summary score at one year was studied using established minimally important difference (MID) thresholds.

RESULTS

A total of 166 patients with IC, mean age: 72.1 (SD 7.4) years, 41% women, were randomized. No significant between-group differences were observed over time for the SF-36 or the PSFS scores whereas some significant between-group differences were observed in the VascuQoL domain and summary scores over time, favoring SEP and/or HSEP over WA. The observed SF-36 and VascuQoL domain and summary score effect sizes were small to moderate, and many domain score effect sizes also remained unchanged over time. A significantly higher proportion of the patients in the SEP group reached the VascuQoL summary score MID of improvement in one year.

CONCLUSION

Clinically important improvements were observed in SEP using the VascuQoL, while we did not observe any significant between-group differences using the SF-36. Whereas effect sizes for the observed changes over time were generally small, a significantly higher proportion of patients in SEP reached the VascuQoL MID of improvement.

TRIAL REGISTRATION

NCT02341716, January 19, 2015 (retrospectively registered).

Rehabilitation Prognostic Factors following Hip Fractures Associated with Patient's Pre-Fracture Mobility and Functional Ability: A Prospective Observation Study

Low physical function is associated with poor outcomes in the elderly population suffering from hip fractures. The present study aims to evaluate the prognostic tools for predicting patient recovery after hip fractures and investigate the correlation between the pre-fracture motor and functional statuses. A prospective study was performed, including 80 patients suffering from hip fractures. Patient history, previous falls, the type of fracture and overall survival were evaluated. Patient-reported outcome measures (SF-36, EQ-5D/VAS, Charlson Comorbidity Index (CCI), Short Physical Performance Battery (SPPB), Timed Up and Go (TUG) and Harris Hip Score (HHS)) were monitored before hospital discharge at 6 weeks, and 3, 6 and 12 months postoperatively. Overall, 55% of patients experienced at least one fall, and 46% of them used crutches before the fracture. The average CCI score was 6.9. The SPPB score improved from 1.4 ± 1.3 (1 week) to 4.4 ± 2.1 (48 weeks). A one-year age increase, female sex, and prior history of falls lead to 0.1-, 0.92-, 0.56-fold lower SPPB scores, respectively, at 12 months. The HHS recorded the greatest improvement between 6 and 12 weeks (52.1 ± 14.6), whereas the TUG score continued to improve significantly from 139.1 ± 52.6 s (6 weeks) to 66.4 ± 54 s (48 weeks). The SPPB and performance test can be routinely used as a prognostic tool.

Implementation of neurological group-based telerehabilitation within existing healthcare during the COVID-19 pandemic: a mixed methods evaluation

BACKGROUND

There is a need to evaluate if and how telerehabilitation approaches might co-exist within healthcare in the long-term. Our aim was to implement and evaluate a multidisciplinary group-based telerehabilitation approach for people engaging in neurological rehabilitation.

METHODS

NeuroRehabilitation OnLine (NROL) was adapted and implemented within an existing healthcare system as a programme of repeating six-week blocks. A robust evaluation was undertaken simultaneously using a convergent parallel design underpinned by implementation frameworks. This included service data, and patient and staff interviews. Implementation success was conceptualised using the outcomes of appropriateness, acceptability and sustainability.

RESULTS

Eight NROL blocks delivered 265 sessions with 1347 patient contacts, and NROL continues as part of standard practice. The approach was appropriate for varied demographics and had positive patient opinions and outcomes for many. Staff perceived NROL provided a compatible means to increase therapy and help meet targets, despite needing to mitigate some challenges when fitting the approach within the existing system. NROL was considered acceptable due to good attendance (68%), low drop-out (12%), and a good safety record (one non-injury fall). It was accepted as a new way of working across rehabilitation disciplines as an 'extra layer of therapy'. NROL had perceived advantages in terms of patient and staff resource (e.g. saving time, energy and travel). NROL provided staffing efficiencies (ratio 0.6) compared to one-to-one delivery. Technology difficulties and reluctance were surmountable with dedicated technology assistance. Leadership commitment was considered key to enable the efforts needed for implementation and sustained use.

CONCLUSION

Pragmatic implementation of group-based telerehabilitation was possible as an adjunct to neurological rehabilitation within an existing healthcare system. The compelling advantages reported of having NROL as part of rehabilitation supports the continued use of this telerehabilitation approach. This project provides an exemplar of how evaluation can be run concurrently with implementation, applying a data driven rather than anecdotal approach to implementation.

Measurement Properties of the Patient-Specific Functional Scale in Rehabilitation for Patients With Stroke: A Prospective Observational Study

OBJECTIVE

This study investigated the validity, reliability, responsiveness, and interpretability of the Patient-Specific Functional Scale (PSFS) in subacute stroke rehabilitation to determine its suitability to measure patient-identified rehabilitation goals.

METHODS

A prospective observational study was designed according to the checklist from Consensus-Based Standards for Selecting Health Measurement Instruments. Seventy-one patients diagnosed with stroke were recruited in the subacute phase from a rehabilitation unit in Norway. The International Classification of Functioning, Disability and Health was used to assess the content validity. Assessment of construct validity was based on hypotheses for correlation of the PSFS and comparator measurements. We assessed reliability by calculating the Intraclass Correlation Coefficient (ICC) (3.1) and the standard error of measurement. The assessment of responsiveness was based on hypotheses for the correlation of change scores between the PSFS and the comparator measurements. A receiver operating characteristic analysis was conducted to assess responsiveness. The smallest detectable change and minimal important change were calculated.

RESULTS

Eighty percent of the PSFS items were classified as activities and participation in the International Classification of Functioning, Disability and Health, indicating satisfactory content validity. The reliability was satisfactory with an ICC of 0.81 (95% CI = 0.69-0.89). The standard error of measurement was 0.70 point, and the smallest detectable change was 1.94 points. Five of 7 hypotheses were confirmed for construct validity, and 5 of 6 were confirmed for responsiveness, indicating moderate construct validity and high responsiveness. Assessing responsiveness with a criterion approach resulted in an area under the curve of 0.74. A ceiling effect was identified for 25% of the participants 3 months after discharge. The minimal important change was estimated to be 1.58 points.

CONCLUSION

This study demonstrates satisfactory measurement properties for the PSFS in individuals undergoing inpatient stroke rehabilitation.

IMPACT

This study supports the use of the PSFS to document and monitor patient-identified rehabilitation goals in patients receiving subacute stroke rehabilitation when applied using a shared decision approach.

Clinical Findings in a Pati ent with Large B-Cell Lymphoma andNeuroniti s: A Case Study

BACKGROUND

 Given the multifaceted nature of the balance system, an interdisciplinary approach to patient care is imperative. For surgical patients with complex medical histories, comprehensive vestibular evaluations provide information on baseline vestibular function and identify possible surgical risks and outcomes. This case study follows a patient diagnosed with probable right vestibular neuronitis immediately preceding surgical resection of a left brainstem lesion, later diagnosed as a B cell lymphoma (BCL) and provides details regarding pre- and postsurgical outcomes.

PURPOSE

 This case study expands on the importance of the inclusion of vestibular audiologists on the interdisciplinary team for related surgical procedures to provide insight into possible surgical risks and subsequent effects on patients' postsurgical quality of life.

RESEARCH DESIGN

 Case report.

STUDY SAMPLE

 A 68-year-old female patient evaluated within the Henry Ford Health System for management of diffuse large BCL.

DATA COLLECTION

 Standard neuro-otology, neuro-surgical, audiological, and vestibular evaluations were conducted to evaluate the patient's complex symptomology.

RESULTS

 This case report outlines a patient hospitalized for a left brainstem mass, later diagnosed as an aggressive form of lymphoma, with a concurrent episode of vestibular neuronitis on the contralesional side. Functional outcomes are discussed following surgical intervention to remove the mass. Postsurgical vestibular testing revealed a bilateral vestibular hypofunction.

CONCLUSIONS

 Vestibular audiology plays an essential role in the multidisciplinary team for complex dizzy patients with related surgical procedures, as this subset of the field can offer critical insight into postsurgical recommendations and patient expectations.

Physical functioning and health-related quality of life after COVID-19: a long-term perspective case series

The purpose of our study was to monitor the long-term changes in physical functioning and health-related quality of life in individuals who received outpatient rehabilitation after COVID-19. Individuals referred to outpatient rehabilitation for post-COVID-19 physical therapy were assessed before the treatment, at the end of the treatment, and 2 and 6 months after the end of the treatment. The physical functioning was assessed by Barthel Index, Timed Up and Go test, Short Physical Performance Battery test (SPPB), Patient-Specific Functioning Scale (PSFS), and EuroQOL 5D-3L. Friedman's test was utilized to assess changes in the assessments. The proportions of individuals showing variation in performance equal to or greater than the absolute minimal detectable change (MDC) value of the SPPB and PSFS were calculated. Forty-four cases were monitored for 7.3-15.6 months. At baseline, they showed substantial independence in activities of daily living, moderate mobility limitations, and below-average health-related quality of life. Their status significantly improved over time (Friedman's test P = 0.002 to <0.001); post hoc analysis confirmed the improvement of mobility and health-related quality of life at 6-month follow-up relative to the baseline. After accounting for MDC values, 55% meaningfully improved on SPPB and 45% on PSFS, although some worsened (11 and 5%, respectively) and the remaining showed no meaningful change. Despite good independence in activities of daily living and perceived health, individuals surviving the COVID-19 may not have fully recovered their premorbid functioning status seven to 15 months after the infection.

The Effectiveness of Exercise Physiology Services During the COVID-19 Pandemic: A Pragmatic Cohort Study

BACKGROUND

The COVID-19 pandemic markedly changed how healthcare services are delivered and telehealth delivery has increased worldwide. Whether changes in healthcare delivery borne from the COVID-19 pandemic impact effectiveness is unknown. Therefore, we examined the effectiveness of exercise physiology services provided during the COVID-19 pandemic.

METHODS

This prospective cohort study included 138 clients who received exercise physiology services during the initial COVID-19 pandemic. Outcome measures of interest were EQ-5D-5L, EQ-VAS, patient-specific functional scale, numeric pain rating scale and goal attainment scaling.

RESULTS

Most (59%, n = 82) clients received in-person delivery only, whereas 8% (n = 11) received telehealth delivery only and 33% (n = 45) received a combination of delivery modes. Mean (SD) treatment duration was 11 (7) weeks and included 12 (6) sessions lasting 48 (9) minutes. The majority (73%, n = 101) of clients completed > 80% of exercise sessions. Exercise physiology improved mobility by 14% (β = 0.23, P = 0.003), capacity to complete usual activities by 18% (β = 0.29, P < 0.001), capacity to complete important activities that the client was unable to do or having difficulty performing by 54% (β = 2.46, P < 0.001), current pain intensity by 16% (β = - 0.55, P = 0.038) and goal attainment scaling t-scores by 50% (β = 18.37, P < 0.001). Effectiveness did not differ between delivery modes (all: P > 0.087).

CONCLUSIONS

Exercise physiology services provided during the COVID-19 pandemic improved a range of client-reported outcomes regardless of delivery mode. Further exploration of cost-effectiveness is warranted.

Validation of the patients-specific functional scale in patients with haemophilia

INTRODUCTION

A complete functional assessment is essential to measure health status and treatment effects in patients with haemophilia. The Patient-Specific Functional Scale (PSFS) is a reliable, valid, simple and quick scale that measures physical function in patients with musculoskeletal disorders. However, the reliability and validity of the PSFS have not been evaluated in patients with haemophilia.

AIM

The aim of this study was to validate the Patient-Specific Functional Scale in patients with haemophilia.

METHODS

Twenty-eight patients with haemophilia participated in the study. They completed the PSFS and the Haemophilia Activity List (HAL) scales by telephone during an initial session, and then repeated the assessment in a follow-up session 1 week apart. Reliability was analysed by the internal correlation coefficient (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). The concurrent validity of the PSFS was determined by correlating the initial score of the PSFS scale to the initial score of the HAL scale. Correlations were calculated by means of scatter plots and Pearson product-moment r correlation coefficient.

RESULTS

ICC and SEM values showed excellent reliability for the PSFS scale, with a SDC of 1. A significant moderate correlation was found between the results of the PSFS and the HAL (r = .57, P < .001).

CONCLUSION

The PSFS is a reliable and valid scale to measure the functionality of people with haemophilia.

Feasibility of a 4-Week Manual Therapy and Exercise Intervention on Posture and Function in Community-Dwelling Older Adults: A Pilot Study

BACKGROUND AND PURPOSE

Thoracic hyperkyphosis is a common condition that progresses with aging and has been associated with impaired functional performance, increased risk of falls, and even mortality. Previous studies to improve posture primarily used exercise for durations of 3 months or longer. The purpose of this pilot study was to examine the feasibility of a manual therapy intervention in community-dwelling older adults over a 4-week time frame that is comparable to the typical clinical setting, to test the appropriateness and procedures for the measurement of posture and function in the older population with hyperkyphosis, and to collect preliminary data to describe change in posture and function measures.

METHODS

Twenty-four participants with hyperkyphosis or forward head posture were recruited, and 22 participants completed this pilot study. Feasibility was measured based on attendance, tolerance, safety, and retention. Issues with measurement procedures were recorded. The intervention included manual therapy and exercise 3 times a week for 4 weeks to target spinal and peripheral joint stiffness, muscle lengthening, and muscle activation. Outcomes included height, kyphotic index (KI), Block Test, Acromion to Table (ATT), Timed Up and Go (TUG), 5 times sit-to-stand (5XSTS), Functional Reach (FR), 2-minute walk test (2MWT), and Patient-Specific Functional Scale (PSFS). Data collected at visits 1, 6, and 12 were analyzed using 1-way repeated-measures multivariate analysis of variance.

RESULTS AND DISCUSSION

Measurement and intervention protocols were found to be feasible. A significant effect for the aggregate dependent variables change over time was found. Univariate analysis of each dependent variable showed significance except for FR. All postural measures (height, KI, Block Test, and ATT) significantly improved statistically. The KI and ATT exceed the minimal detectable change for clinical significance. Function showed statistical improvements in the TUG, 5XSTS, 2MWT, and PSFS. Clinical significance was reached with the PSFS. Seven of 9 measures showed a statistically significant change in just 2 weeks.

CONCLUSIONS

This pilot study suggests that manual therapy and exercise applied to older adults shows promise for improvement in measures of posture and functional performance in a clinically feasible 4-week time frame.

Evaluating the Impact of a Regional Student-Led Physiotherapy Clinic Model to Improve Self-Reported Function in Community-Dwelling Adults With Neurological Diagnoses

BACKGROUND AND PURPOSE

Neurological conditions are a major cause of health morbidity that negatively impacts function and quality of life (QoL). Despite this burden, community services are disproportionally scarce. Student-led physiotherapy services (SLSs) are a model that can increase community access to health care while providing authentic clinical experiences for students. SLSs consistently demonstrate high client satisfaction; however, limited evaluation of the impact of this model on the client's clinical outcomes exists. Therefore the aim of this project was to evaluate the impact of a physiotherapy student-led community-based rehabilitation service.

METHODS

The SLS operated 4 days a week over a 15-week period. Forty-two community-dwelling clients (mean age 74 years) with a neurological diagnosis were included. During initial consultation, participants completed basic demographics, up to 3 Patient-Specific Functional Scales (PSFSs) and a QoL questionnaire (World Health Organization Quality of Life-Brief Questionnaire [WHOQOL-BREF]). At discharge, participants completed the WHOQOL-BREF, PSFS, and a patient experience survey. Risk event data were also collected.

RESULTS

Over half of the PSFS items targeted mobility (55%). There was a significant improvement (P < 0.05) in median change (quartiles) for pre-/post-PSFS scores for clients whose primary condition was balance 1.0 (0.0-3.0), cerebrovascular accident 1.0 (2.0-3.0) or multiple Sclerosis 1.0 (1.0-2.0), and mean (SD) WHOQOL-BREF scores for Physical Health (12.2 ± 1.5 to 13.1 ± 1.3) and Social Relationships (12.7 ± 2.7 to 16.6 ± 3.3). Patient experience survey results indicated that clients had confidence and trust in students. No adverse events were reported.

DISCUSSION AND CONCLUSIONS

The SLS model provides a strategy to increase access to health care and clinical placement capacity. Findings demonstrated improved self-rated function, QoL, and positive patient experience for community-dwelling clients with nonacute neurological diagnoses.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A380).

Measurement Properties of the Patient-Specific Functional Scale and Its Current Uses: An Updated Systematic Review of 57 Studies Using COSMIN Guidelines

OBJECTIVE

To systematically review measurement properties, including acceptability, feasibility, and interpretability, and current uses of the Patient-Specific Functional Scale (PSFS).

DESIGN

Systematic review of a patient-reported outcome measure using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) guidelines.

LITERATURE SEARCH

We searched 11 databases from January 2010 to July 2020 for articles on measurement properties or use of PSFS.

STUDY SELECTION CRITERIA

Published primary articles without language restrictions.

DATA SYNTHESIS

Two independent reviewers screened all records, extracted data, and performed risk of bias assessments using COSMIN guidelines. We qualitatively synthesized findings for each measurement property in musculoskeletal and nonmusculoskeletal conditions, and 2 reviewers independently performed Grading of Recommendations Assessment, Development and Evaluation assessments. This study was preregistered with the Open Science Framework (https://doi.org/10.17605/OSF.IO/42UZT).

RESULTS

Of the 985 articles screened, we included 57 articles on measurement properties and 255 articles on the use of PSFS. The PSFS had sufficient test-retest reliability in musculoskeletal (22 studies, 845 participants, low-to-moderate certainty) and nonmusculoskeletal conditions (6 studies, 197 participants, very low certainty), insufficient construct validity as a measure of physical function (21 studies, 2 945 participants, low-to-moderate certainty), and sufficient responsiveness (32 studies, 13 770 participants, moderate-to-high certainty). The standard error of measurement ranged from 0.35 to 1.5. The PSFS was used in 87 unique health conditions, some without prior evidence of validity.

CONCLUSION

The PSFS is an easy-to-use, reliable, and responsive scale in numerous musculoskeletal conditions, but the construct validity of PSFS remains uncertain. Further study of the measurement properties of the PSFS in nonmusculoskeletal conditions is necessary before clinical use. J Orthop Sports Phys Ther 2022;52(5):262-275. Epub: 05 Feb 2022. doi:10.2519/jospt.2022.10727.

Structured guideline-based physiotherapy reduces difficulties in activities of daily living in Parkinson's disease

BACKGROUND

In the long term, Parkinson's disease (PD) leads to the development of difficulties in daily functional tasks. There remains a paucity of evidence on the effectiveness of physiotherapy on patient-perceived difficulties regarding basic activities of daily living (ADL).

OBJECTIVES

To assess an effect of a versatile physiotherapy intervention on patient-perceived difficulties in basic ADL.

METHODS

The study sample included 24 patients (10 men and 14 women) with PD. Participants were randomly assigned into intervention (IG) and control groups (CG). Two assessments were performed with a gap of 10 weeks. Following first assessment, during an 8-week period, IG participants attended sixteen physiotherapy 60-minutes sessions in groups that were divided into five parts to address the core areas recommended by the European Physiotherapy Guideline for PD (EPGPD): gait, transfers, balance, physical capacity, and manual activities. The main assessment tool was the Modified Patients Specific Functional Scale (ModPSFS), which represents a self-assessment rating on difficulties perceived in 17 different commonly occurring activities.

RESULTS

IG members reported a significant reduction in self-perceived difficulties as assessed by ModPSFS (effect size 1.39; 95%CI 5.1, 26.6 points, p = 0.005).

CONCLUSIONS

2-months conventional physiotherapy with incorporated core areas recommended in EPGPD for PD reduced patient-perceived difficulties in basic ADL.

Patient characteristics and outcome in three different working models of home-based rehabilitation: a longitudinal observational study in primary health care in Norway

Background

The organisation of health care services for older adults varies within and between countries. In Norway, primary care physiotherapy services offer home-based rehabilitation to older adults. The aim of this study was to compare patients’ characteristics and treatment outcomes in three working models of home-based rehabilitation.

Methods

Patients referred to home-based rehabilitation in a large municipality in Norway were invited to participate in this prospective observational study. The three working models, early intervention, reablement and regular physiotherapy, were organised according to the patients’ function and degree of independence. The older adults (≥ 65 years) were allocated to the different models by either a multidisciplinary group of health care personnel or by direct referral. Patients’ demographic and clinical characteristics, including physical function (Patient-specific functional scale, PSFS), physical performance (Short Physical Performance Battery, SPPB) and health-related quality of life (EQ-5D) were registered at baseline and follow-up (maximum 6 months after baseline). One-way ANOVA was used to analyse group differences in clinical characteristics and paired t-tests to analyse changes from baseline to follow-up.

Results

In total, 603 and 402 patients (median (interquartile range) age: 84 (77–88) years) completed baseline and follow-up assessments, respectively. Patients in all three working models had an increased risk for functional decline. Patients receiving early intervention (n = 62) had significantly (p < 0.001) better physical performance and health-related quality of life (SPPB mean 7.9, SD 2.7; EQ-5D:mean 0.59, SD 0.19), than patients receiving reablement (n = 132) (SPPB: mean 5.5, SD 2.6; EQ-5D: mean 0.50, SD 0.15) and regular physiotherapy (n = 409) (SPPB: mean 5.6, SD 2.8; EQ-5D: mean 0.41, SD 0.22). At follow-up, the three working models showed significantly improvements in physical function (PSFS: mean change (95 % CI): 2.5 (1.9 to 3.2); 1.8 (0.5 to 3.1); 1.7 (0.8 to 2.6), for regular physiotherapy, reablement, and early intervention, respectively). Patients receiving regular physiotherapy and reablement also significantly improved physical performance and health-related quality of life.

Conclusions

While older adults receiving reablement and regular physiotherapy showed similar patient characteristics and treatment outcomes, early intervention identified older patients at risk of functional decline at an earlier stage. These results are relevant for policy makers when designing and improving prevention and rehabilitation strategies in primary health care.

Construct Validity, Test-Retest Reliability, Sensitivity to Change, and Feasibility of the Patient-Specific Functional Scale in Acutely Hospitalized Older Patients With and Without Cognitive Impairment

BACKGROUND AND PURPOSE

The Patient-Specific Functional Scale (PSFS) as an individualized patient-reported outcome measure may allow to assess limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI).

METHODS

The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients-83.0 (6.4) years-with (Mini-Mental State Examination [MMSE] 18-23, n = 52) and without CI (MMSE ≥24, n = 68) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (rs) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects.

RESULTS

The PSFS showed fair to moderate correlations with all construct variables in patients with CI (rs = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (rs = |0.27 to 0.36|), but low for the SPPB and DEMMI (rs = -0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in both subgroups.

CONCLUSIONS

The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment.

Gait Parameters of Older Adults according to Their Fall History and Functional Capacity While Walking at Different Speeds

INTRODUCTION

It is believed that functional capacity and fall history are factors capable of influencing the gait parameters of older adults. Thus, the objective of this study was to verify whether gait parameters of community-dwelling older adults differ according to their functional capacity and fall history when walking at self-selected walking speed (SSWS) and fast walking speed (FWS) using principal component analysis (PCA).

METHODS

Two hundred ninety-five participants (82.3% women and 17.7% men) were allocated in four groups according to their fall history and functional capacity: non-fallers with higher functional capacity (NFHFC, n = 94; 69.3 ± 5.5 years), non-fallers with lower functional capacity (NFLFC, n = 114; 72.0 ± 8.1 years), fallers with higher functional capacity (FHFC, n = 29; 70.0 ± 6.0 years), and fallers with lower functional capacity (FLFC, n = 58; 72.5 ± 8.2 years). Fall history, anthropometric data, functional capacity by short physical performance battery and mobility by Timed Up and Go (TUG), and spatiotemporal gait parameters were evaluated.

RESULTS

Data analysis indicated that FLFC presented the lowest scores, especially in the Five Times Sit-to-Stand Test and TUG. The PCA showed that the first principal component (PC1) explained the most substantial amount of the data variability in both walking speeds (SSWS and FWS), predominantly including temporal parameters. PC2 composed by spatial outcomes (stride and step length and walking speed) showed the highest effect size. PC1 and PC2 were able to differentiate functional status, regardless of fall history.

CONCLUSIONS

Functional capacity showed great importance when analyzing gait parameters at different walking speeds (SSWS and FWS), regardless of fall history. Older adults with high functional capacity demonstrate better performance during gait. Besides, spatiotemporal parameters are the main factors explaining gait variability, both in SSWS and FWS.

Utilization of Safe Fall Landing Strategies in Physical Therapist Management of Geriatric Populations: A Case Report

OBJECTIVE

Safe fall landing strategies (SFLS) have shown promise to decrease injury during falls but have been examined primarily in young, healthy populations. There is emerging evidence to suggest SFLS can be safe and effective for a geriatric population; however, this intervention has not been examined in a clinical physical therapist practice setting. This case study seeks to determine how SFLS can be incorporated into a physical therapy program with a geriatric population.

METHODS (CASE DESCRIPTION)

A 77-year-old woman reported imbalance and inability to return to her previous active lifestyle. Multiple SFLS were implemented during the course of physical therapist management. Controlled fall heights were gradually progressed over the course of therapy.

RESULTS

Gains in Patient Specific Functional Scale score (initial score = 2.5, discharge score = 8), static balance, and ability to perform floor-to-waist lifting were seen following physical therapist intervention that included SFLS. The patient was able to perform a back fall and a front fall from a standing position and reported no adverse side effects throughout the course of physical therapist care.

CONCLUSION

This case report demonstrates how SFLS were safely and pragmatically progressed for 1 patient in a clinical physical therapy setting. SFLS may have the potential to improve patient outcomes and even decrease the risks associated with falls, though further evaluation is needed.

IMPACT

This case report introduces SFLS as an emerging intervention in the clinical physical therapist practice setting. This case report should encourage future research needed to assess the effectiveness and safety of this treatment strategy in physical therapy.

Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders

PURPOSE

To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders.

MATERIALS AND METHODS

The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton's guidelines. Patients with lower extremity musculoskeletal disorders (N = 116) were recruited to examine the test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses.

RESULTS

Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test-retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS.

CONCLUSIONS

The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test-retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders.Implications for rehabilitationRehabilitation specialist can confidently interpret patient's score in the Arabic PSFS to represent the extent of activity limitation.Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time.The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders.The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Weak Data: The Social Biography of a Measurement Instrument and How It Failed to Ensure Accountability in Home Care

Contemporary health and social care is saturated by processes of datafication. In many cases, these processes are nested within an ostensibly simple logic of accountability: Define a politically and morally desirable goal, then measure the level of achievement. This logic has come to permeate public health initiatives globally and today it operates in most health care systems in various ways. We explore here a particular instantiation of the logic associated with the introduction of a measurement instrument used in Danish home care. Building on ethnographic fieldwork, interviews, and analysis of policy documents, we show how the instigated processes of datafication-despite hopeful political claims-erode care levels and disempower older people. We believe that these findings can be of relevance for other settings that subscribe to the same accountability logic and to similar forms of measurement instruments.

Predicting outcomes within an innovative post-acute rehabilitation model for older adults

BACKGROUND

Understanding the provision of health services to community-dwelling older adults is of great importance due to regulatory changes within post-acute care. The aim of this study was to illustrate pathways by which older adults, within an innovative post-acute care delivery model, move to either independence or re-admission back into higher levels of care to maximize the value of rehabilitation delivery.

METHODS

Clinical data specific to an episode of care (n = 30,001) provided to Medicare beneficiaries treated via a rehabilitation house-calls model of care in their homes and senior living communites were separated into training and test sets. Classification trees were fit on the training set's administrative and clinical variables. Descriptive statistics were calculated for the overall sample, patient characteristics, clinical characteristics, and clinical outcomes.

RESULTS

Subjects were 83.3 years on average, 69.4% were female, and 62.2% were seen in their own homes while 37.8% were in senior living. The key variables predictive of progressing to independence were total number of visits, the presence of the Patient Specific Functional Scale (PSFS), PSFS score at discharge and change in PSFS. Prediction accuracy of the classification tree on the test set was 82.4%.

CONCLUSIONS

Older adults progress to a higher degree of independence, instead of higher levels of care, via several distinct pathways within a rehabilitation house-calls model of care. A mix of service utilization and outcome variables are key predictors of each pathway and may be used to maximize the value of service delivery. Further examination of the predictors of outcome using administrative datasets drawn from different sub-sets of older adults across the post-acute care continuum is warranted.

Feasibility and informativeness of the Patient-Specific Functional Scale with patients with Parkinson's disease

Introduction: The primary purpose of this study was to examine the feasibility and informativeness of the Patient-Specific Functional Scale (PSFS) for identifying activities that persons with Parkinson disease (PD) self-identified as difficult.Method: Informativeness was investigated by cross-referencing the identified activities with the International Classification of Functioning, Disability, and Health (ICF), the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS), and Parkinson's Disease Questionnaire (PDQ-39). Twenty-eight individuals with PD (Hoehn & Yahr stage 1-4) completed the PSFS. Activities identified by the participants were classified according to the ICF and then cross-referenced across the MDS-UPDRS and PDQ-39.Results: Participants identified 98 specific (60 different) activities that they were unable to do or were having difficulty with as a result of PD. Activities most frequently listed as difficult included some aspect of fine hand use, dressing, eating, or changing position (e.g. transferring). All activities could be classified using the ICF, but many were not addressed specifically by the MDS-UPDRS or PDQ-39.Conclusion: We conclude that the PSFS can be used for identifying activities that persons with PD personally find difficult and may be useful as a compliment to the MDS-UPDRS and PDQ-39.