1
|
Cacchio A, Calvisi V, Di Carlo G, Petralia G, Angelozzi M. Efficacy and Safety of the Phytochemical Product Linfadren in the Management of Patients With Persistent Ankle Edema Following Trauma or Surgery: A Randomized Controlled Trial. Foot Ankle Int 2023; 44:972-982. [PMID: 37724868 DOI: 10.1177/10711007231189679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND Persistent posttraumatic/postsurgery ankle edema (PPAE) is edema that persists from 2 weeks to 3 months after injury or surgery. PPAE has negative effects on the healing process and quality of life. This study aimed to evaluate the efficacy of a phytochemical product containing diosmin, coumarin, and arbutin (Linfadren) in addition to the conventional treatment, in patients with PPAE. METHODS Between October 2018 and February 2020, 60 outpatients with PPAE (42 with ankle fractures and 18 with ankle sprains) were enrolled and randomized (1:1 ratio) to receive either 6-week conventional treatment plus Linfadren (study group) or conventional treatment alone (control group). Primary outcome was ankle edema as measured by the "figure-of-8-20" method. Secondary outcomes were ankle function measured by the Lower Extremity Functional Scale (LEFS), and patient's overall perceived treatment efficacy. Tolerability of Linfadren was also evaluated. Assessments were performed at baseline, at end of treatment (6 weeks after baseline), and 3 months after the end of treatment (follow-up). A subgroup analysis was also conducted for the injury type (fracture/sprain) to identify if this factor affected the results of the primary outcome measure. RESULTS At the end of treatment, the study group had a significantly greater improvement in ankle edema, improved ankle function, and more patients who considered this treatment effective compared with the control group. The measured difference in circumference by the figure-of-8-20 method averaged 4% at 6 weeks and 5% at 3 months. No difference between groups was seen in rescue medication. No adverse events were recorded. Subgroup analysis revealed no significant influence of the injury type on the primary outcome measure. CONCLUSION Linfadren in addition to conventional treatment was more effective than conventional treatment alone in patients with PPAE. LEVEL OF EVIDENCE Level I, randomized controlled trial.
Collapse
Affiliation(s)
- Angelo Cacchio
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Vittorio Calvisi
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giancarlo Di Carlo
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Giuseppe Petralia
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| | - Massimo Angelozzi
- Department of Life, Health & Environmental Sciences, School of Medicine, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
2
|
Rodham P, Panteli M, Vun JSH, Harwood P, Giannoudis PV. Lower limb post-traumatic osteomyelitis: a systematic review of clinical outcomes. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:1863-1873. [PMID: 35986815 PMCID: PMC10276112 DOI: 10.1007/s00590-022-03364-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE The aim of this study was to examine the patient-reported outcomes of patients presenting with post-traumatic osteomyelitis (PTOM) of the lower limb over the past 15 years. This period was chosen to reflect modern treatment principles and increased centralisation of care. METHODS An electronic literature search of the relevant databases (PubMed, Ovid Medline, Embase, and the Cochrane library) was conducted to identify studies published between January 2006 and July 2021 reporting series of greater than 10 patients with PTOM of the tibia or femur at the site of a previous fracture. Studies reporting septic non-union were excluded. RESULTS Sixteen eligible studies were identified and included in the final report. Remission of infection was achieved in 93.2% of cases (range 70-100%), whilst amputation was reported in 1-7% of cases. A variety of patient-reported outcome measures were utilised including the lower extremity functional scale, short musculoskeletal functional assessment, Enneking score, and EQ-5D-3L. Limb-specific functional outcomes returned to levels similar to that of the general population although poorer outcomes were noted in specific cohorts including those with complex anatomic disease and active medical comorbidities. CONCLUSION Infection following fracture fixation remains a difficult problem to treat. Regardless, using modern treatments and techniques patients can have comparable functional outcomes to that of the general population. High-quality studies are required to advance our knowledge into which types of treatments offer a benefit and how to further improve outcomes.
Collapse
Affiliation(s)
- Paul Rodham
- NIHR Academic Clinical Fellow, Academic Department of Trauma & Orthopaedics, School of Medicine, Leeds General Infirmary, University of Leeds, Clarendon Wing, Level D, Great George Street, Leeds, LS1 3EX, UK.
| | - Michalis Panteli
- Lecturer in Trauma & Orthopaedic Surgery, Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - James S H Vun
- Higher Surgical Trainee in Trauma and Orthopaedics, Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Harwood
- Consultant Trauma and Orthopaedic Surgeon, Academic Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter V Giannoudis
- Professor of Trauma and Orthopaedics, Academic Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| |
Collapse
|
3
|
Farrell K, Comis LE, Casimir MM, Hodsdon B, Jiménez-Silva R, Dunigan T, Bhattacharyya T, Jha S. Occupational engagement, fatigue, and upper and lower extremity abilities in persons with melorheostosis. PM R 2023; 15:587-595. [PMID: 35403375 PMCID: PMC9548523 DOI: 10.1002/pmrj.12817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/14/2022] [Accepted: 03/30/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Melorheostosis is a rare bone disorder with limited literature that describes the effect of this disease on functional and motor abilities. As part of a natural history study, four outcome measures were administered to better understand the burden this disease has on a person's ability to engage in basic and instrumental activities of daily living. OBJECTIVE To investigate the relationship between functional engagement, fatigue, and motor ability in patients with melorheostosis. DESIGN Cross-sectional data gathered from a longitudinal natural history observational study. SETTING Rehabilitation department within a single institution. PARTICIPANTS Forty-seven adult volunteers with melorheostosis were enrolled. Two participants were removed for failure to meet diagnosis eligibility. Thirty patients had lower extremity (LE) osteosclerotic bone lesions, 14 had upper extremity (UE) lesions, and one had lesions in both UEs and LEs. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Activity Card Sort, Second Edition (ACS); Multi-Dimensional Fatigue Inventory; Lower Extremity Functional Scale; Upper Extremity Functional Index. RESULTS On the ACS, high-demand leisure (HDL) activities were the least retained (p < .001). Of the activities rated most important, HDL activities were the most likely to have been given up (27%). General fatigue (μ = 11.8) and physical fatigue (μ = 11.0) were the two most limiting fatigue constructs. There were moderate negative correlations with HDL activities compared to physical fatigue (r = -0.524, p < .001) and reduced activity fatigue (r = -0.58, p = .001). LE lesions had a large effect on completing LE tasks (d = 0.95) and UE lesions had a medium effect on completing tasks involving the UE (d = 0.69). CONCLUSIONS Patients with melorheostosis experience fatigue and low engagement in HDL activities. The results of this study underscore the importance of acknowledging activity domain, fatigue constructs, and lesion location to support and provide targeted evidence-based rehabilitative therapy. CLINICAL TRIAL REGISTRATION NUMBER NCT02504879.
Collapse
Affiliation(s)
- Kathleen Farrell
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Leora E. Comis
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Morgan M. Casimir
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Bonnie Hodsdon
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Rafael Jiménez-Silva
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Tiara Dunigan
- Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - Timothy Bhattacharyya
- Clinical and Investigative Orthopedics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Smita Jha
- Clinical and Investigative Orthopedics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
- Section on Congenital Disorders, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| |
Collapse
|
4
|
Nguyen MQ, Dalen I, Iversen MM, Harboe K, Paulsen A. Ankle fractures: a systematic review of patient-reported outcome measures and their measurement properties. Qual Life Res 2023; 32:27-45. [PMID: 35716224 PMCID: PMC9829578 DOI: 10.1007/s11136-022-03166-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE Ankle fractures are commonly occurring fractures, especially in the aging population, where they often present as fragility fractures. The disease burden and economic costs to the patient and society are considerable. Choosing accurate outcome measures for the evaluation of the management of ankle fractures in clinical trials facilitates better decision-making. This systematic review assesses the evidence for the measurement properties of patient-reported outcome measures (PROMs) used in the evaluation of adult patients with ankle fractures. METHODS Searches were performed in CINAHL, EMBASE, Medline and Google Scholar from the date of inception to July 2021. Studies that assessed the measurement properties of a PROM in an adult ankle fracture population were included. The included studies were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology for systematic reviews of PROMs. RESULTS In total, 13 different PROMs were identified in the 23 included articles. Only the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM) presented some evidence on content validity. The Olerud-Molander Ankle Score (OMAS) and Self-reported Foot and Ankle Score (SEFAS) displayed good evidence of construct validity and internal consistency. The measurement properties of the OMAS, LEFS and SEFAS were most studied. CONCLUSION The absence of validation studies covering all measurement properties of PROMs used in the adult ankle fracture population precludes the recommendation of a specific PROM to be used in the evaluation of this population. Further research should focus on validation of the content validity of the instruments used in patients with ankle fractures.
Collapse
Affiliation(s)
- Michael Quan Nguyen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway.
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Ingvild Dalen
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Research, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
| | - Marjolein Memelink Iversen
- Centre on Patient-Reported Outcomes, Department of Research and Development, Haukeland University Hospital, Helse Bergen HF, Bergen, Norway
- Department of Health and Caring Sciences, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Knut Harboe
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Aksel Paulsen
- Department of Orthopedic Surgery, Stavanger University Hospital, Helse Stavanger HF, Stavanger, Norway
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
5
|
Rodham P, Panteli M, Qin C, Harwood P, Giannoudis PV. Long-term outcomes of lower limb post-traumatic osteomyelitis. Eur J Trauma Emerg Surg 2023; 49:539-549. [PMID: 36115908 PMCID: PMC9925588 DOI: 10.1007/s00068-022-02104-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/31/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Whilst recurrence and amputation rates in post-traumatic osteomyelitis (PTOM) are described, limb specific functional outcomes are not, leading to a knowledge gap when counselling patients prior to management. We aim to investigate the patient reported outcomes (PROMS) of this patient group to provide reference for discussions with patients prior to embarking on treatment. METHODS Single institution cross-sectional retrospective study of all patients presenting with PTOM of the tibia/femur over a 7-year period. Alongside recurrence and amputation rates, patient reported outcomes were recorded including the lower extremity functional scale (LEFS), EQ-5D-3L and EQ-VAS. RESULTS Seventy-two patients (59 male; median age 46 years) were identified. Treatment was principle-based and included debridement (with Reamer-Irrigator-Aspirator (RIA) in 31/72), local antibiotics (52/72), soft tissue reconstruction (21/72) and systemic antibiotic therapy in all cases. PROMS were collected in 84% of all eligible patients at a median of 112-month post-treatment. Twelve patients experienced recurrence, whilst nine underwent amputation. The median LEFS was 60, the EQ-5D-3L index score was 0.760, and the EQ-VAS was 80. These scores are substantially lower than those seen in the general population (77, 0.856 and 82.2, respectively). LEFS was significantly higher, where RIA was utilised (69.6 vs 52.8; p = 0.02), and in those classified as BACH uncomplicated (74.4 vs 58.4; p = 0.02). EQ-5D-3L was also higher when RIA was utilised (0.883 vs 0.604; p = 0.04), with no difference in EQ-VAS scores. CONCLUSIONS Patients with PTOM report functional outcomes below that of the general population, even when in remission. Improved outcomes were associated with uncomplicated disease and the use of RIA.
Collapse
Affiliation(s)
- Paul Rodham
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, Leeds, LS1 3EX UK
| | - Michalis Panteli
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, Leeds, LS1 3EX UK
| | - Catherine Qin
- North East Thames Foundation School, Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, UK
| | - Paul Harwood
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter V. Giannoudis
- LIMM Section Musculoskeletal Disease, Academic Department of Trauma and Orthopaedics, School of Medicine, University of Leeds, Leeds General Infirmary, Clarendon Wing, Level A, Great George Street, Leeds, LS1 3EX UK
| |
Collapse
|
6
|
Castillo-Domínguez A, García-Romero JC, Alvero-Cruz JR, Ponce-García T, Benítez-Porres J, Páez-Moguer J. Systematic Review of Patient-Reported Outcome Measures for Patients with Exercise-Induced Leg Pain. Medicina (B Aires) 2022; 58:medicina58070841. [PMID: 35888560 PMCID: PMC9318164 DOI: 10.3390/medicina58070841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Background and Objectives: To determine the most commonly used patient-reported outcome measures (PROMs) in exercise-induced leg pain (EILP) and to identify specific PROMs for EILP in order to evaluate their psychometric properties and methodological quality. Materials and Methods: A strategic search was performed in different databases to identify and extract the characteristics of studies based on the use of PROMs in patients with EILP. Specific PROMs were evaluated according to the Terwee et al. and COSMIN criteria. Results: Fifty-six studies were included in the review. The Medial Tibial Stress Syndrome Score (MTSSS), Lower Extremity Functional Scale (LEFS) and Exercise-Induced Leg Pain Questionnaire (EILP-Q) were identified as specific PROMs for EILP. The Visual Analog Scale (VAS) was the most widely used instrument in the assessment of EILP. The methodological quality assessment showed six positive values for the LEFS, four for the MTSSS and three for the EILP-Q for the eight psychometric properties analyzed according to the COSMIN criteria. The evaluation of the nine psychometric properties according to Terwee showed five positive values for the LEFS and MTSSS, and three for the EILP-Q. Conclusions: The overall methodological quality of the PROMs used was low. The VAS was the most widely used instrument in the assessment of EILP, and the LEFS was the highest quality PROM available for EILP, followed by the MTSSS and EILP-Q, respectively.
Collapse
Affiliation(s)
| | - Jerónimo C. García-Romero
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - José Ramón Alvero-Cruz
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Tomás Ponce-García
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Javier Benítez-Porres
- Department of Human Physiology, Histology, Pathological Anatomy and Sports Physical Education, University of Malaga, 29071 Malaga, Spain; (J.C.G.-R.); (J.R.A.-C.); (T.P.-G.); (J.B.-P.)
| | - Joaquín Páez-Moguer
- Department of Nursing and Podiatry, University of Malaga, 29071 Malaga, Spain;
| |
Collapse
|
7
|
Russell Esposito E, Farrokhi S, Shuman BR, Sessoms PH, Szymanek E, Hoppes CW, Bechard L, King D, Fraser JJ. Uneven treadmill training for rehabilitation of lateral ankle sprains and chronic ankle instability: a pragmatic randomized controlled trial (Preprint). JMIR Res Protoc 2022; 11:e38442. [PMID: 35731551 PMCID: PMC9260521 DOI: 10.2196/38442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 12/26/2022] Open
Abstract
Background Lateral ankle sprains (LASs) are common injuries among military service members. Approximately 40% of individuals with an LAS progress to develop chronic ankle instability (CAI), a condition that results in substantial mechanical and neurophysiological impairment and activity limitation. Since proprioceptive and balance training improve functional outcomes and prevent secondary injury following LAS, they are recommended in clinical practice. Uneven treadmills are an innovative modality that challenge the sensorimotor system while performing an ecologically valid task simulating environments frequently encountered by service members with LAS and CAI. Objective The aim of this study is to evaluate whether the inclusion of uneven treadmill training in standard rehabilitation can improve clinical, functional, biomechanical, and patient-reported outcomes compared with the standard of care alone in service members with LAS and CAI. The prophylactic effects of treatment on secondary injury and identification of any contributing or mediating factors that influence outcomes following treatment will also be evaluated. We hypothesize that service members receiving uneven treadmill training will demonstrate greater improvements in clinical and instrumented measures of impairment, patient-reported function, and lower risk of injury recurrence than the control group immediately post and 18 months following treatment. Methods A multisite, parallel randomized clinical trial will be performed among service members aged 18-49 years being treated for LAS and CAI in military treatment facilities in the United States. Participants randomly assigned and allocated to receive the experimental intervention will be provided up to 12 sessions of training on an uneven terrain treadmill over a 6-week treatment course to supplement standard rehabilitation care. Treatment intensity of the rehabilitation exercises and treadmill training will be progressed on the basis of patient-perceived intensity and treatment responses. Outcome measures will include patient-reported outcomes, functional assessments, performance measures, and biomechanical measures. Investigators collecting outcome measures will be blinded to treatment allocation. Reinjury rates and patient-reported outcomes of function will be tracked over 18 months following treatment. Results The project was funded in September 2020. Patient recruitment began in November 2021, with 3 participants enrolled as of February 2022. Dissemination of the main study findings is anticipated in 2024. Conclusions This study will assess the impact of an innovative uneven-terrain treadmill on treatment outcomes in the rehabilitation of service members with LAS and CAI. The results of this study will be used to inform rehabilitation practices and to potentially improve functional outcomes and secondary prevention in this patient population. Trial Registration ClinicalTrials.gov NCT04999904; https://clinicaltrials.gov/ct2/show/NCT04999904?term=NCT04999904 International Registered Report Identifier (IRRID) DERR1-10.2196/38442
Collapse
Affiliation(s)
- Elizabeth Russell Esposito
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
| | - Shawn Farrokhi
- Department of Defense -Veterans Affairs Extremity Trauma and Amputation Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- Department of Physical Medicine and Rehabilitation, Uniformed Services University, Bethesda, MD, United States
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
| | - Benjamin R Shuman
- Center for Limb Loss and Mobility, Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - Pinata H Sessoms
- Warfighter Performance Department, Naval Health Research Center, San Diego, CA, United States
| | - Eliza Szymanek
- Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
| | - Carrie W Hoppes
- Doctoral Program in Physical Therapy, Army-Baylor University, U.S. Army Medical Center of Excellence, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX, United States
- San Antonio Military Medical Center, Fort Sam Houston, San Antonio, TX, United States
| | - Laura Bechard
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - David King
- Henry M Jackson Foundation, Bethesda, MD, United States
| | - John J Fraser
- Department of Physical and Occupational Therapy, Naval Medical Center San Diego, San Diego, CA, United States
- Operational Readiness and Health Directorate, Naval Health Research Center, San Diego, CA, United States
- Primary Care Sports Medicine Fellowship, Naval Hospital Camp Pendleton, Oceanside, CA, United States
| |
Collapse
|
8
|
Ratter J, Pellekooren S, Wiertsema S, van Dongen JM, Geleijn E, de Groot V, Bloemers FW, Jansma E, Ostelo RWJG. Content validity and measurement properties of the Lower Extremity Functional Scale in patients with fractures of the lower extremities: a systematic review. J Patient Rep Outcomes 2022; 6:11. [PMID: 35092528 PMCID: PMC8800956 DOI: 10.1186/s41687-022-00417-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Fractures of lower extremities are common trauma-related injuries, and have major impact on patients' functional status. A frequently used Patient-Reported Outcome Measure (PROM) to evaluate patients’ functional status with lower extremity fractures is the Lower Extremity Functional Scale (LEFS). However, there is no systematic review regarding content validity and other measurement properties of the LEFS in patients with lower extremity fractures. Methods A search was performed in PubMed, Embase, Scopus, and Cochrane Library from inception until November 2020. Studies on development of the LEFS and/or the evaluation of one or more measurement properties of the LEFS in patients with lower extremity fractures were included, and independently assessed by two reviewers using COSMIN guidelines. Results Seven studies were included. Content validity of the LEFS was rated 'inconsistent', supported by very low quality of evidence. Structural validity was rated ‘insufficient’ supported by doubtful methodological quality. Internal consistency, measurement error, and responsiveness were rated 'indeterminate' supported by inadequate to adequate methodological quality. The methodological quality of the construct validity (hypotheses testing) assessment was rated as 'inadequate'. Conclusion The LEFS has several shortcomings, the lack of sufficient content validity being the most important one as content validity is considered the most crucial measurement property of a PROM according to the COSMIN guidelines. In interpreting the outcomes, one should therefore be aware that not all relevant aspects of physical functioning may be accounted for in the LEFS. Further validation in a well-designed content validity study is needed, including a clearly defined construct and patient involvement during the assessment of different aspects of content validity. Plain English summary Bone fractures of the lower extremities are a common injury. During rehabilitation it is essential to evaluate how patients experience their physical functioning, in order to monitor the progress and to optimize treatment. To measure physical functioning often questionnaires (also known as Patient Reported Outcome Measures) are used, such as the Lower Extremity Functional Scale (LEFS). However, it is not clear if the LEFS actually measures physical function, and if its other measurement properties are sufficient for using this questionnaire among patients with fractures in the lower extremities. Therefore, we systematically searched and assessed scientific papers on the development of the LEFS (i.e., its ability to measure physical functioning), and papers on the performance of the LEFS with regard to several measurement properties to identify possible factors that may cause measurement errors. Hereby we have assessed the quality of the studies included. Our main finding was that the LEFS may not measure all aspects of physical function. Given the low quality of the papers included in our study, these findings come with considerable uncertainty. As the LEFS was developed more than 20 years ago, it may not represent physical functioning as we currently conceptualize this. Therefore, we recommend to perform a study in which the content of the LEFS will be evaluated by experts in the field as well as patients, and modify the questionnaire as needed.
Collapse
Affiliation(s)
- Julia Ratter
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands.
| | - Sylvia Pellekooren
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Suzanne Wiertsema
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Johanna M van Dongen
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Edwin Geleijn
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Vincent de Groot
- Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HZ, Amsterdam, The Netherlands
| | - Frank W Bloemers
- Department of Trauma Surgery, Amsterdam Movement Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Elise Jansma
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Raymond W J G Ostelo
- Department of Health Sciences, Faculty of Science, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Epidemiology and Data Science, Location VUmc, Amsterdam Movement Sciences, Amsterdam UMC, De Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Saarinen AJ, Bondfolk AS, Repo JP, Sandelin H, Uimonen MM. Longitudinal Validity and Minimal Important Change for the Modified Lower Extremity Functional Scale (LEFS) in Orthopedic Foot and Ankle Patients. J Foot Ankle Surg 2022; 61:127-131. [PMID: 34384700 DOI: 10.1053/j.jfas.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
The lower extremity functional scale (LEFS) is a patient-reported outcome measure for lower extremity disorders. Aim of this study was to assess the longitudinal validity including responsiveness and test-retest reliability of the revised 15-item version, and to define the minimal important change (MIC) of the modified LEFS in a generic sample of orthopedic foot and ankle patients who underwent surgery. Responsiveness, effect size, and standardized response mean were measured by determining the score change between the baseline and 6 months administration of the LEFS from 156 patients. There was no significant difference between preoperative (median 78, interquartile range [IQR] 64.2-90.3) and postoperative (median 75.0, IQR 61.7-95.0) scores. Both effect size and standardized response mean were low (0.06 and 0.06, respectively). Test-retest reliability of the LEFS was satisfactory. Intraclass correlation coefficient was 0.85 (95% confidence interval 0.81-0.88). MIC value could not be estimated due to the lack of significant score change. The modified LEFS presented with relatively low longitudinal validity in a cohort of generic orthopedic foot and ankle patients. The findings of this study indicate that the modified LEFS might not be the optimal instrument in assessing the clinical change over time for these patients.
Collapse
Affiliation(s)
- Antti J Saarinen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland; Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Anton S Bondfolk
- Faculty of Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jussi P Repo
- Department of Orthopedics and Traumatology, Unit of musculoskeletal Surgery, Tampere University Hospital and University of Tampere, Finland.
| | - Henrik Sandelin
- Department of Orthopedics and Traumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mehiläinen Sports Hospital, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Hospital, Jyväskylä, Finland
| |
Collapse
|
10
|
Leliveld MS, Verhofstad MHJ, Van Lieshout EMM. Measurement properties of Patient-Reported Outcome Measures in patients with a tibial shaft fracture; validation study alongside the multicenter TRAVEL study. Injury 2021; 52:1002-1010. [PMID: 33451691 DOI: 10.1016/j.injury.2020.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/12/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
The aim of this study was to evaluate the measurement properties of the Short Musculoskeletal Function Assessment (SMFA) and Lower Extremity Functional Scale (LEFS) in patients who sustained a tibial shaft fracture, by comparing them with the scores of a general health-related quality of life instrument scale (i.e., EuroQoL-5D). Data of 136 patients participating in a multicenter randomized controlled trial comparing incisions for intramedullary nail entry in adults with a tibial shaft fracture were used. Patients completed the SMFA, LEFS, EQ-5D and an anchor question at 2 and 6 weeks, and at 3, 6 and 12 months. Reliability (internal consistency), construct validity, responsiveness (longitudinal validity), floor and ceiling effects, minimal important change (MIC), and smallest detectable change (SDC) were determined. The SMFA and LEFS (sub)scales showed adequate internal consistency (0.84<α<0.94). Construct and longitudinal validity were also adequate (correctly predicted hypotheses between 83%-100%). Floor effects were not present. Ceiling effects were present at 12 months for the SMFA lower extremity dysfunction and bother subscales (22% and 19%, respectively) and the LEFS (19%). MICs could not be determined with the available data. The SDC was 13.84 points for the SMFA and 38.74 points for the LEFS. This study confirms that the SMFA and LEFS are reliable, valid, and responsive instruments for monitoring functional limitation in patients after sustaining a tibia shaft fracture during at least the first six months post-injury. An anchor-based MIC for the SMFA remains to be determined.
Collapse
Affiliation(s)
- Mandala S Leliveld
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, the Netherlands.
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, the Netherlands.
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, the Netherlands.
| | -
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 Rotterdam, the Netherlands
| |
Collapse
|
11
|
McKeown R, Parsons H, Ellard DR, Kearney RS. An evaluation of the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture. Physiotherapy 2021; 112:1-8. [PMID: 34000602 DOI: 10.1016/j.physio.2021.03.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the measurement properties of the Olerud Molander Ankle Score in adults with an ankle fracture. METHODS Patients completed outcome measure questionnaires at baseline, six, 10- and 16-weeks postinjury as part of an ongoing clinical trial on ankle fracture rehabilitation. The internal consistency, convergent validity, structural validity and interpretability of the Olerud Molander Ankle Score was assessed. This was achieved through using the respective analysis methods of Cronbach's alpha, correlation coefficients, principal component analysis, evaluation of floor and ceiling scores and estimation of the minimally important change using anchor-based methods. RESULTS The Olerud Molander Ankle Score showed adequate convergent validity against hypotheses set in relation to scores of comparator instruments. Principal component analysis demonstrated that the measure has two subscales: ankle function and ankle symptoms. The internal consistency of the measure and the ankle function subscale was sufficient, but inconclusive for the ankle symptoms subscale. There were no floor and ceiling effects present within the scores and the estimated minimally important change was 9.7 points. CONCLUSION The Olerud Molander Ankle Score demonstrates sufficient measurement properties and is likely to be primarily measuring the construct of patient reported function following ankle fracture. Further research should evaluate the relevance of other domains to individuals recovering from and ankle fracture, such as social participation and psychological wellbeing. The development of a core outcome set would be advantageous to standardise outcome measurement collection in this area.
Collapse
Affiliation(s)
- Rebecca McKeown
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | - Helen Parsons
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick and University Hospitals Coventry and Warwickshire, United Kingdom.
| | - Rebecca S Kearney
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick and University Hospitals Coventry and Warwickshire, United Kingdom.
| |
Collapse
|
12
|
Cross-cultural adaption and validation of simplified Chinese version of the lower extremity function scale in patients with knee osteoarthritis. Clin Rheumatol 2020; 39:3041-3048. [PMID: 32318972 DOI: 10.1007/s10067-020-05077-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The lower extremity function scale (LEFS) is widely used to investigate patients' functional status due to musculoskeletal dysfunction of the lower extremity. The aims of this study were to translate and cross-culturally adapt the LEFS into simplified Chinese (SC-LEFS) and evaluate the psychometric properties in patients with knee osteoarthritis (OA). METHODS The SC-LEFS was translated and cross-culturally adapted on the basis of guideline. Patients scheduled for knee arthroplasty (108) were invited in this study. The Cronbach's alpha coefficient was employed to assess the internal consistency. The test-retest reliability was determined by intra-class correlation coefficient (ICC). Pearson's correlation coefficient was detected to evaluate the criterion validity between the SC-LEFS and WOMAC/SF-36/range of motion (ROM). Construct validity was assessed by exploratory factorial analysis. Additionally, responsiveness analysis was conducted with effect size (ES) and standardized response mean (SRM). RESULTS The results revealed good internal consistency (Cronbach's alpha = 0.975) and good test-retest reliability (ICC = 0.937). Strong correlations were observed between the SC-LEFS and WOMAC pain/function/total, physical component summary of SF-36, and ROM. We confirmed the SC-LEFS as a two-factor structure with factor 1 and factor 2 explaining 73.781% and 5.546% of the variance, respectively. The ES (1.74) and SRM (1.95) indicated a good responsiveness. CONCLUSIONS The SC-LEFS has been nicely adapted into simplified Chinese. It was proved to be reliable and valid for knee OA patients from China mainland who are undergoing arthroplasty. Furthermore, additional research should be conducted to assess these findings in other dysfunctions of lower extremity in a larger sample size. Key Points • The present study firstly cross-culturally adapted the lower extremity function scale (LEFS) into simplified Chinese and applied for patients with knee osteoarthritis in China mainland. • The psychometric properties including reliability, validity, and responsiveness were evaluated in SC-LEFS. • The SC-LEFS turned out to be a reliable and valid tool for clinical physicians and researchers assessing patients with knee osteoarthritis.
Collapse
|
13
|
Ponkilainen VT, Tukiainen EJ, Uimonen MM, Häkkinen AH, Repo JP. Assessment of the structural validity of three foot and ankle specific patient-reported outcome measures. Foot Ankle Surg 2020; 26:169-174. [PMID: 30797700 DOI: 10.1016/j.fas.2019.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 01/21/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The structural validity of the Lower extremity functional scale (LEFS), the Visual analogue scale foot and ankle (VAS-FA), and the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) has not been compared earlier in patients after foot and ankle surgery. METHODS Altogether 165 previously operated patients completed the foot and ankle specific instruments, the 15D health-related quality of life (HRQoL) instrument, and general health (VAS). RESULTS The LEFS, the VAS-FA and the WOMAC had slight differences in their measurement properties. The VAS-FA had the best targeting and coverage. All three foot and ankle measures accounted for mobility and usual activities when compared to the different aspects of generic HRQoL. CONCLUSIONS The LEFS, the VAS-FA and the WOMAC have relatively similar psychometric properties among foot and ankle patients, yet the VAS-FA provides the best targeting and coverage.
Collapse
Affiliation(s)
- Ville T Ponkilainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland.
| | - Erkki J Tukiainen
- Department of Plastic Surgery, Central Hospital of Helsinki University, HUS, Helsinki, Finland
| | - Mikko M Uimonen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Arja H Häkkinen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| |
Collapse
|
14
|
Ikeda AJ, Fergason JR, Wilken JM. Clinical Outcomes with the Intrepid Dynamic Exoskeletal Orthosis: A Retrospective Analysis. Mil Med 2019; 184:601-605. [PMID: 30796439 DOI: 10.1093/milmed/usz004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/10/2018] [Accepted: 01/07/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries. Clinical outcomes were routinely collected on patients fit with IDEOs at the Center for the Intrepid, Brooke Army Medical Center. The purpose of this retrospective study was to analyze the clinical outcomes collection process and the patient outcomes collected as part of routine clinical care. METHODS The Brooke Army Medical Center IRB approved this study and granted waivers of informed consent and HIPAA authorization. Electronic medical records were reviewed over an 18-month period from July 2014 to January 2016. Records were examined to obtain the date of IDEO delivery, date of outcomes form completion, responses on the forms, and to verify diagnosis or injury. Data gathered included wear time, IDEO comfort, pain with and without the IDEO, Lower Extremity Functional Scale scores with and without the IDEO, and global rating of change questions for everyday activities and high impact activities. Wilcoxon signed-ranked tests were used to compare pain and function with vs. without the IDEO. RESULTS During the 18-month period, new IDEOs were delivered to 156 unique patients. Outcomes forms were collected as part of routine clinical care from 90 of these 156 patients (58%). An additional nine forms were collected from patients who received their IDEOs prior to July 2014. In all, 99 outcomes forms were collected. Mean follow-up time from IDEO delivery to outcomes form completion was 35 ± 31 days for the original 90 patients. The most common patient diagnoses were fracture, nerve injury, arthritis, and fusion. Responses on the forms indicated that patients were generally comfortable wearing their IDEOs (8.3 ± 1.3 on a 0-10 scale) and wore them most of the day (10.7 ± 3.4 hours per day). Improvement in pain (from 5.2 ± 2.9 to 1.7 ± 1.6 points on a 0-10 scale) and Lower Extremity Functional Scale scores (from 29.7 ± 16.6 to 59.5 ± 13.6 points) with the IDEO were both more than the minimal clinically important difference and were statistically significant (p < 0.001). CONCLUSION This descriptive retrospective study demonstrated that it was feasible to collect clinical outcomes data which were relevant for characterizing the effects of IDEO use and enabled quantification of improvements in self-reported function and walking pain with the IDEO. Due to the retrospective nature of this study, limitations include missing data and the lack of any performance measures to complement the self-reported data. Clinical outcomes collection continues as a routine part of clinical care and there remains an ongoing aim to collect information on all patients to obtain an accurate assessment of devices and services and ultimately better serve our patients.
Collapse
Affiliation(s)
- Andrea J Ikeda
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX.,Extremity Trauma and Amputation Center of Excellence, 2748 Worth Road, Suite 29, JBSA Fort Sam Houston, TX
| | - John R Fergason
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX
| | - Jason M Wilken
- Center for the Intrepid, Department of Rehabilitation Medicine, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX.,Extremity Trauma and Amputation Center of Excellence, 2748 Worth Road, Suite 29, JBSA Fort Sam Houston, TX.,Department of Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA
| |
Collapse
|
15
|
Lourduraj DB, Barnawal SP, Pattabi K, Gnanasekaran V, Sadhasivam A, Vinod KS, Sharma D, Jayaram Y. Application of the Lower Extremity Functional Scale and Its Correlation with Lymphedema Health-Related Quality of Life on Lower Limb Filarial Lymphedema Patients. Lymphat Res Biol 2019; 18:254-260. [PMID: 31532703 PMCID: PMC7310210 DOI: 10.1089/lrb.2019.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study carried out as a part of the lymphedema (LE)—osteoarthritis project to know the feasibility and applicability of lower extremity functional scale (LEFS) and LE health-related quality of life (LEHRQoL) among filarial LE patients of the lower extremity. Materials and Methods: Following inclusion and exclusion criteria 30 LE patients and 30 controls were recruited in the study. After obtaining informed written consent, Tamil version of the two “self-reporting assessment tools” LEFS and LEHRQoL were applied to all the participants by two examiners independently. Feasibility was assessed by the time schedule. Internal consistency and the correlation between two examiners was assessed by calculating Cronbach's alpha and Karl Pearson correlation coefficient and Spearman rank correlation respectively. Results: The mean time taken for completing the LEFS and LEHRQoL questionnaire was 5 minutes and 2 seconds and 12 minutes and 8 seconds respectively. Internal consistency reliability assessment showed good internal consistency for both the examiners (Cronbach's alpha 0.816 and 0.812). There was a strong positive correlation for the cases (r = 0.956, p < 0.001; r = 0.908, p < 0.001) and controls (r = 0.992, p < 0.001; r = 0.985, p < 0.001) between the two examiners. Conclusions: LEFS and LEHRQoL were well accepted among filarial LE patients and the patients with low literacy were able to respond without any difficulty to both assessment tools. LEFS was found suitable for the assessment of lower extremity functions of the LE patients as in other diseases affecting the lower limb and it also indirectly brought out the impact on the QoL.
Collapse
Affiliation(s)
- De Britto Lourduraj
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | | | - Kamaraj Pattabi
- Division of Epidemiology & Biostatistics, National Institute of Epidemiology-ICMR, Chennai, India
| | - Vijayalakshmi Gnanasekaran
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | - Anbusivam Sadhasivam
- Unit of Clinical Epidemiology and Chemotherapy, Vector Control Research Centre, Indian Council of Medical Research (ICMR), Pondicherry, India
| | - K Supriya Vinod
- College of Physiotherapy, Mother Theresa Post Graduate and Research Institute of Health Sciences, Pondicherry, India
| | - Deep Sharma
- Department of Orthopaedics, JIPMER, Pondicherry, India
| | - Yuvaraj Jayaram
- Division of Epidemiology & Biostatistics, National Institute of Epidemiology-ICMR, Chennai, India
| |
Collapse
|
16
|
Korakakis V, Saretsky M, Whiteley R, Azzopardi MC, Klauznicer J, Itani A, Al Sayrafi O, Giakas G, Malliaropoulos N. Translation into modern standard Arabic, cross-cultural adaptation and psychometric properties' evaluation of the Lower Extremity Functional Scale (LEFS) in Arabic-speaking athletes with Anterior Cruciate Ligament (ACL) injury. PLoS One 2019; 14:e0217791. [PMID: 31181087 PMCID: PMC6557503 DOI: 10.1371/journal.pone.0217791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 05/18/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The Lower Extremity Functional Scale evaluates the functional status of patients that have lower extremity conditions of musculoskeletal origin. Regional Arabic dialects often create barriers to clear communication and comparative research. We aimed to cross-culturally adapt the Lower Extremity Functional Scale in modern standard Arabic that is widely used and understood in the Middle East and North Africa region, and assess its psychometric properties. METHODS Cross-cultural adaptation followed a combination of recommended guidelines. For psychometric evaluation 150 patients with anterior cruciate ligament injury and 65 asymptomatic individuals were recruited. All measurement properties as indicated by the Consensus-based Standards for the selection of health status Measurement Instruments recommendations were evaluated, including content-relevance analysis, structural validity, longitudinal reproducibility, anchor- and distribution-based methods of responsiveness, as well as the longitudinal pattern of change of Lower Extremity Functional Scale in anterior cruciate ligament injured patients' functional status. RESULTS The questionnaire presented excellent internal consistency (α = 0.96), reliability (0.80-0.98), and good convergent validity (ρ = 0.85). For reproducibility testing: minimal detectable change was 9.26 points; for responsiveness assessment: minimal clinically important difference was 9 points and presented moderate effect sizes (Glass'Δ = 0.71, Cohen's d = 0.81). Its unidimensionality was not confirmed and an exploratory factor analysis indicated a 2-factor solution explaining 78.1% of the variance. CONCLUSION The Arabic Lower Extremity Functional Scale presented acceptable psychometric properties comparable to the original version. The Arabic version of Lower Extremity Functional Scale can be used in research and clinical practice to assess the functional status of Arabic-patients suffering an anterior cruciate ligament injury.
Collapse
Affiliation(s)
- Vasileios Korakakis
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
- Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece
- * E-mail:
| | | | - Rodney Whiteley
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | - Abdallah Itani
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Omar Al Sayrafi
- Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Giannis Giakas
- Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, Greece
| | - Nikolaos Malliaropoulos
- Sports and Exercise Medicine Clinic, Thessaloniki, Greece
- National Track & Field Centre, Sports Medicine Clinic, Thessaloniki, Greece
- European Sports Care, London, United Kingdom
| |
Collapse
|
17
|
de Graaf MW, Reininga IH, Wendt KW, Heineman E, El Moumni M. The Short Musculoskeletal Function Assessment: a study of the reliability, construct validity and responsiveness in patients sustaining trauma. Clin Rehabil 2019; 33:923-935. [PMID: 30722686 PMCID: PMC6482597 DOI: 10.1177/0269215519828152] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
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.
Collapse
Affiliation(s)
- Max W de Graaf
- 1 Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Inge Hf Reininga
- 1 Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Klaus W Wendt
- 1 Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Erik Heineman
- 2 Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mostafa El Moumni
- 1 Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
18
|
Repo JP, Tukiainen EJ, Roine RP, Kautiainen H, Lindahl J, Ilves O, Järvenpää S, Häkkinen A. Reliability and validity of the Finnish version of the Visual Analogue Scale Foot and Ankle (VAS-FA). Foot Ankle Surg 2018; 24:474-480. [PMID: 29409192 DOI: 10.1016/j.fas.2017.05.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/06/2017] [Accepted: 05/26/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND There have previously been no validated foot and ankle-specific patient-reported outcome measures in Finnish. METHODS The Visual Analogue Scale Foot and Ankle (VAS-FA) was translated and adapted into Finnish. Thereafter, 165 patients who had undergone foot and ankle surgery completed a questionnaire set on two separate occasions. Analyses included testing of floor-ceiling effect, internal consistency, reproducibility, and validity. RESULTS Minor linguistic differences emerged during the translation. Some structural adjustments were made. The mean (SD) total VAS-FA score was 74 (23). In the three subscales, maximum scores were noted in 2-5% of the responses, and internal consistency ranged from 0.81 to 0.94. Reproducibility was excellent (ICC, 0.97). The total VAS-FA score correlated significantly with the Lower Extremity Functional Scale (r=0.84) and the 15D Mobility dimension (r=0.79). The VAS-FA loaded on two factors (pain/movement and problems/limitations). CONCLUSIONS The Finnish version of the VAS-FA has high reliability and strong validity.
Collapse
Affiliation(s)
- Jussi P Repo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Finland.
| | - Erkki J Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Risto P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, HUS, Finland; Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Hannu Kautiainen
- Department of General Practice, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Jan Lindahl
- Department of Orthopedics and Traumatology, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Outi Ilves
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Salme Järvenpää
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Häkkinen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland; Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| |
Collapse
|
19
|
Mostafaee N, Negahban H, Shaterzadeh Yazdi MJ, Goharpey S, Mehravar M, Pirayeh N. Responsiveness of a Persian version of Knee Injury and Osteoarthritis Outcome Score and Tegner activity scale in athletes with anterior cruciate ligament reconstruction following physiotherapy treatment. Physiother Theory Pract 2018; 36:1019-1026. [PMID: 30468412 DOI: 10.1080/09593985.2018.1548672] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate the responsiveness and determine the minimal clinically important changes (MCICs), anchored by the patient response to a 7-point global rating scale, for Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity scale in athletes undergoing physiotherapy treatment after anterior cruciate ligament reconstruction (ACL-R). Methods: Fifty-four patients undergoing physiotherapy completed the Persian versions of KOOS and Tegner scales at weeks 6 and 10 post ACL-R. The 7-point global rating of change was also completed at week 10. Responsiveness was calculated via receiver operating characteristic curve and correlation analysis. Results: Acceptable responsiveness was reached by the KOOS sports and recreation subscale (Sport/Rec) (area under the curve (AUC) = 0.72; Gamma = 0.37) and Tegner scale (AUC = 0.75; Gamma = 0.59). The MCIC scores of KOOS subscales and Tegner scale were reported. Conclusion: Our findings demonstrated that the KOOS Sport/Rec subscale and Tegner scale have adequate responsiveness between weeks 6 and 10 of physiotherapy. Therefore, these scales should be used to evaluate the effects of physiotherapy treatment and the changes in activity levels in this population. The MCIC scores of the KOOS and Tegner scale can be used to detect changes significant to the patient while avoiding limitations of other methods.
Collapse
Affiliation(s)
- Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran
| | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences , Mashhad, Iran.,Orthopedic Research Center, Mashhad University of Medical Sciences , Mashhad, Iran
| | | | - Shahin Goharpey
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
| | - Nahid Pirayeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz, Iran
| |
Collapse
|
20
|
Repo JP, Tukiainen EJ, Roine RP, Sampo M, Sandelin H, Häkkinen AH. Rasch analysis of the Lower Extremity Functional Scale for foot and ankle patients. Disabil Rehabil 2018; 41:2965-2971. [DOI: 10.1080/09638288.2018.1483435] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jussi P. Repo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Erkki J. Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, HUS, Finland
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Mika Sampo
- Comprehensive Cancer Center, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, HUS, Finland
| | - Arja H. Häkkinen
- Department of Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| |
Collapse
|
21
|
Garratt AM, Naumann MG, Sigurdsen U, Utvåg SE, Stavem K. Evaluation of three patient reported outcome measures following operative fixation of closed ankle fractures. BMC Musculoskelet Disord 2018; 19:134. [PMID: 29720142 PMCID: PMC5930432 DOI: 10.1186/s12891-018-2051-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 04/19/2018] [Indexed: 11/25/2022] Open
Abstract
Background Several patient reported outcome measures (PROMs) are available for assessing the outcomes of ankle fracture but few have been compared for recommended measurement properties. This study compares the measurement properties of the Lower Extremity Function Scale (LEFS), Olerud Molander Ankle Score (OMAS) and Self-Reported Foot and Ankle Score (SEFAS) following ankle surgery. Methods The retrospective cohort study included 959 patients aged 18 years and over who underwent surgical treatment (ORIF) for unstable and closed ankle fractures in SE Norway. The PROMs were included in a postal questionnaire sent to patients’ homes in 2015, three years after surgery. Missing data, structural validity, internal consistency, test-retest reliability and validity were assessed. Results Confirmatory factor analysis results showed model fit for the SEFAS and a bi-dimensional LEFS with scales of easy and difficult items. The OMAS performed less satisfactorily. Cronbach’s alpha and test-retest correlations ranged from 0.82 to 0.96 and 0.91 to 0.93 respectively. The smallest detectable differences for group and individual comparisons were 14.1 to 20.6 and 0.93 to 1.55; SEFAS performed best. As hypothesised, instrument scores were highly correlated and with those for the EQ-5D and SF-36 physical functioning. Mean imputation where half or more items are completed increased usable scores by 1.4–15.7% without affecting measurement properties. Conclusions The three instruments largely performed satisfactorily in relation to important measurement properties but the LEFS had evidence for two dimensions relating to easier and more difficult aspects of function. Mean imputation where half or more items are completed increased the number of usable responses for all three instruments. The three instruments represent different approaches to measuring outcomes and their content should be considered carefully when choosing between them. The SEFAS is designed for a range of foot disorders including ankle fractures and has the best measurement properties in this population.
Collapse
Affiliation(s)
- Andrew M Garratt
- Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
| | | | - Ulf Sigurdsen
- Department of Orthopaedics, Akershus University Hospital, Lørenskog, Norway
| | - Stein Erik Utvåg
- Department of Orthopaedics, Akershus University Hospital, Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pulmonary Medicine, Medical Division, Akershus University Hospital, Lørenskog, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
22
|
Functional outcomes following surgical-site infections after operative fixation of closed ankle fractures. Foot Ankle Surg 2017; 23:311-316. [PMID: 29202994 DOI: 10.1016/j.fas.2016.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 10/05/2016] [Accepted: 10/16/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND To compare the functional outcomes between patients with and without postoperative surgical-site infection (SSI) after surgical treatment in closed ankle fractures. METHODS Retrospective cohort study with prospective follow-up. Of 1011 treated patients, 959 were eligible for inclusion in a postal survey. Functional outcomes were assessed using three self-reported questionnaires. RESULTS In total 567 patients responded a median of 4.3 years (range 3.1-6.2 years) after surgery. In total 29/567 had an SSI. The mean Olerud and Molander Ankle Score was 19.8 points lower for patients with a deep SSI (p=0.02), the Lower Extremity Functional Scale score was 10.2 points lower (p<0.01) and the Self-Reported Foot & Ankle Questionnaire score was 5.0 points higher (p=0.10) than for those without an SSI, after adjusting for age, sex, smoking status, diabetes, physical status, fracture classification and duration of surgery. CONCLUSIONS Patients with a deep SSI had worse long-term functional outcomes than those without an SSI.
Collapse
|
23
|
Galleher M, Crowe B, Selhorst M. The effectiveness of manual physical therapy interventions in pediatric patients with anterior hip pain: a retrospective study. J Man Manip Ther 2017; 25:288-293. [PMID: 29449771 PMCID: PMC5810783 DOI: 10.1080/10669817.2017.1314583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES The purposes of this study were to: (1) assess the benefit of adding manual therapy (MT) to physical therapy care in pediatric patients with anterior hip pain; (2) assess the relative risk of adverse reactions when MT is used; and (3) report the types of MT used. METHODS This study was a retrospective chart review of patients treated in a hospital-based sports medicine clinic. The charts of 201 patients (mean age = 14.23 ± 2.15 years) met the inclusion criteria and were reviewed. Patients were grouped into those who received MT during their episode of care, and those who did not. Pain efficiency (change in pain/number of visits), number and type of adverse reactions, as well as frequency and type of manual therapy interventions used, were the outcomes of interest. RESULTS The mean pain efficiency was significantly less if manual therapy was performed (MT = 0.60 [95% CI 0.47-0.72], no MT = 0.80 [95% CI 0.71-0.90] p = 0.01). There was no significant difference between groups in risk of adverse reactions (MT = 5, no MT = 5). The number of visits was significantly different between groups (MT = 9.43 ± 3.9 sessions, and no MT = 7.6 ± 5.2 sessions). DISCUSSION MT did not increase the risk of an adverse reaction in pediatric patients with anterior hip pain. While it appears to be a safe intervention, it did not improve pain efficiency or patient adherence. Future research should be performed to assess the effectiveness of MT, when performed by skilled therapists, in pediatric patients with hip pain in a controlled manner.Level of Evidence: 3b.
Collapse
Affiliation(s)
| | | | - Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children’s Hospital, Columbus, OH, USA
| |
Collapse
|
24
|
Cox T, Sneed T, Hamann H. Neurodynamic mobilization in a collegiate long jumper with exercise-induced lateral leg and ankle pain: A case report. Physiother Theory Pract 2017; 34:241-249. [PMID: 28937849 DOI: 10.1080/09593985.2017.1377793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
STUDY DESIGN Case Report. BACKGROUND The purpose of this case report is to describe nerve mobilization in the treatment of lower extremity neuropathic pain in a female collegiate long jumper. CASE DESCRIPTION A 21 year-old long jumper presented 7 months after onset of ankle and leg pain. She complained of "aching" pain over the lateral ankle, radiating proximally to just superior to the lateral knee. Neurodynamic testing of the sural and superficial branch of the fibular nerves was positive. Interventions/Outcomes: Persistent neuropathic pain which impeded sport participation in a collegiate athlete did not improve using traditional rehabilitation intervention, but did ameliorate as a result of an intervention which included self-administered, supervised nerve mobilization of the sural and superficial branch of fibular nerve. The patient improved in all outcome measures including the Lower Extremity Functional Scale (LEFS), Numerical Pain Rating Scale (NPRS), and the Global Rating of Change (GROC). DISCUSSION In a female collegiate athlete with persistent neuropathic pain, initial improvements were achieved with traditional rehabilitation, but her pain continued. Considerable additional improvements were achieved following the addition of self-administered, supervised nerve mobilization. Neurodynamic testing should be performed on patients with possible peripheral nerve involvement and treatment commenced if positive.
Collapse
Affiliation(s)
- Terry Cox
- a Department of Physical Therapy , Southwest Baptist University , Bolivar , MO , USA
| | - Tom Sneed
- a Department of Physical Therapy , Southwest Baptist University , Bolivar , MO , USA
| | - Herb Hamann
- a Department of Physical Therapy , Southwest Baptist University , Bolivar , MO , USA
| |
Collapse
|
25
|
Bos I, Wynia K, Drost G, Almansa J, Kuks JBM. The extremity function index (EFI), a disability severity measure for neuromuscular diseases: psychometric evaluation. Disabil Rehabil 2017; 40:1561-1568. [PMID: 28291950 DOI: 10.1080/09638288.2017.1300690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To adapt and to combine the self-report Upper Extremity Functional Index and Lower Extremity Function Scale, for the assessment of disability severity in patients with a neuromuscular disease and to examine its psychometric properties in order to make it suitable for indicating disease severity in neuromuscular diseases. DESIGN A cross-sectional postal survey study was performed among patients diagnosed with a neuromuscular disease. METHODS Patients completed both adapted extremity function scales, questionnaires for psychometric evaluation, and disease-specific questions. Confirmatory factor analysis was performed, and reliability and validity were examined. RESULTS Response rate was 70% (n = 702). The Extremity Function Index model with a two-factor structure - for upper and lower extremities - showed an acceptable fit. The Extremity Function Index scales showed good internal consistency (alphas: 0.97-0.98). The known-groups validity test confirmed that Extremity Function Index scales discriminate between categories of "Extent of limitations" and "Quality of Life." Convergent and divergent validity tests confirmed that Extremity Function Index scales measure the physical impact of neuromuscular diseases. Relative validity tests showed that the Extremity Function Index scales performed well in discriminating between subgroups of patients with increasing "Extent of limitations" compared to concurrent measurement instruments. CONCLUSION The Extremity Function Index proved to be a sound and easy to apply self-report disability severity measurement instrument in neuromuscular diseases. Implications for rehabilitation The Extremity Function Index reflects the functioning of all muscles in the upper and lower extremities involved in activities of daily living. The Extremity Function Index is an easy to administer and patient-friendly disability severity measurement instrument that has the ability to evaluate differences in disability severity between relevant neuromuscular disease subgroups. The Extremity Function Index is a valid and reliable disability severity measurement instrument for neuromuscular diseases.
Collapse
Affiliation(s)
- Isaäc Bos
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Klaske Wynia
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands.,b Department of Community and Occupational Health , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Gea Drost
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Josué Almansa
- b Department of Community and Occupational Health , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| | - Jan B M Kuks
- a Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , the Netherlands
| |
Collapse
|
26
|
Alnahdi AH. Rasch validation of the Arabic version of the lower extremity functional scale. Disabil Rehabil 2016; 40:353-359. [DOI: 10.1080/09638288.2016.1254285] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ali H. Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
27
|
Bravini E, Giordano A, Sartorio F, Ferriero G, Vercelli S. Rasch analysis of the Italian Lower Extremity Functional Scale: insights on dimensionality and suggestions for an improved 15-item version. Clin Rehabil 2016; 31:532-543. [DOI: 10.1177/0269215516647180] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Elisabetta Bravini
- School in Advanced Sciences and Technology in Rehabilitation Medicine and Sport, Tor Vergata University, Rome, Italy
| | - Andrea Giordano
- Bioengineering, Salvatore Maugeri Foundation – IRCCS, Veruno (NO), Italy
| | - Francesco Sartorio
- Unit of Occupational Rehabilitation and Ergonomics, Salvatore Maugeri Foundation – IRCCS, Veruno (NO), Italy
| | - Giorgio Ferriero
- Unit of Occupational Rehabilitation and Ergonomics, Salvatore Maugeri Foundation – IRCCS, Veruno (NO), Italy
| | - Stefano Vercelli
- Unit of Occupational Rehabilitation and Ergonomics, Salvatore Maugeri Foundation – IRCCS, Veruno (NO), Italy
| |
Collapse
|
28
|
Repo JP, Tukiainen EJ, Roine RP, Ilves O, Järvenpää S, Häkkinen A. Reliability and validity of the Finnish version of the Lower Extremity Functional Scale (LEFS). Disabil Rehabil 2016; 39:1228-1234. [DOI: 10.1080/09638288.2016.1193230] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jussi P. Repo
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Erkki J. Tukiainen
- Department of Plastic Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Risto P. Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland
| | - Outi Ilves
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Salme Järvenpää
- Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Arja Häkkinen
- Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
- Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| |
Collapse
|
29
|
Crowell MS, Deyle GD, Owens J, Gill NW. Manual physical therapy combined with high-intensity functional rehabilitation for severe lower extremity musculoskeletal injuries: a case series. J Man Manip Ther 2016; 24:34-44. [PMID: 27252581 DOI: 10.1179/2042618614y.0000000076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Severe lower extremity trauma accounts for large healthcare costs and often results in elective amputation and poor long-term outcomes. The purpose of this case series is to describe an orthopedic manual physical therapy (OMPT) approach combined with a return to run (RTR) clinical pathway consisting of high-intensity functional rehabilitation with a custom energy-storing orthosis. METHODS Three consecutive male patients, aged 21-23 years, with severe lower extremity musculoskeletal injuries were treated with a combined intervention that included a mean (SD) of 12 (2·1) OMPT sessions and 24 (8·7) functional rehabilitation sessions over a mean of 6 weeks (1·0). Additional training with a custom energy-storing orthosis consisted of a mean of 15 (1·2) additional sessions over 4 weeks. Patient self-report outcome measures and a variety of physical performance tests captured change in function. RESULTS Baseline lower extremity functional scale (LEFS) and foot and ankle ability measure activities of daily living subscale (FAAM-ADL) scores indicated severe disability. All patients exceeded the minimal clinically important difference (MCID) in at least one self-report outcome or physical performance test without a brace. Two of three patients exceeded the MCID for at least two physical performance tests after training with and utilizing a custom energy-storing orthosis. DISCUSSION Clinically meaningful changes in self-reported function or physical performance were observed in all patients. A multi-modal approach, including manual therapy and functional exercise, may address the entire spectrum of impairments in patients with severe lower extremity trauma, resulting in improvements in both braced and un-braced function.
Collapse
Affiliation(s)
- Michael S Crowell
- Keller Army Community Hospital, West Point, NY, USA; Army-Baylor University Sports Physical Therapy Doctoral Residency, West Point, NY, USA
| | - Gail D Deyle
- Army-Baylor University Doctoral Fellowship in Orthopedic Manual Physical Therapy, San Antonio Military Medical Center, Fort Sam Houston, TX, USA
| | - Johnny Owens
- The Center for the Intrepid, San Antonio Military Medical Center, Fort Sam Houston, TX, USAA
| | - Norman W Gill
- U.S. Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX, USA
| |
Collapse
|
30
|
Borda J, Selhorst M. The use of compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy in an adolescent athlete: a case report. J Man Manip Ther 2016; 25:57-61. [PMID: 28855793 DOI: 10.1080/10669817.2016.1159403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Achilles tendinopathy is an overuse injury that often affects individuals engaged in recreational or competitive level activity. Although most patients experience satisfactory results with therapy, a substantial portion fail to respond to traditional treatment. The purpose of this case study is to describe the successful use of compression tack and flossing (CTF) with lacrosse ball massage (LBM) in the treatment of an adolescent athlete with Achilles tendinopathy who had failed to respond to traditional treatment. CASE DESCRIPTION The patient was a 14-year old female diagnosed with chronic Achilles tendinopathy. She presented with 8/10 left posterior ankle pain during activity and scored 66/80 on the Lower Extremity Functional Scale (LEFS). After six weeks of PT consisting of eccentric exercise, proprioceptive training, and iontophoresis, the patient continued to report pain during sport and no significant improvements on the LEFS. With traditional PT failing to resolve symptoms, the patient was treated with CTF and LBM. OUTCOMES The outcomes of interest were the LEFS and the ability to participate in sport without pain. After only two sessions focusing on CTF and LBM, she had 0/10 pain during sport and scored a 79/80 on the LEFS. Patient was discharged to continue with a home exercise program consisting of CTF and LBM, and eccentric exercise. DISCUSSION The patient's outcomes significantly improved after CTF and LBM was added to eccentric exercise. These results suggest that this intervention may be a viable adjunct treatment for Achilles tendinopathy; however further research, including controlled clinical trials and long-term outcome data, are warranted.
Collapse
Affiliation(s)
- Jennifer Borda
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, USA
| | - Mitchell Selhorst
- Sports and Orthopedic Physical Therapy, Nationwide Children's Hospital, Columbus, OH, USA
| |
Collapse
|
31
|
Abstract
STUDY DESIGN Systematic review of measurement properties. BACKGROUND Many primary studies have examined the measurement properties, such as reliability, validity, and sensitivity to change, of the Lower Extremity Functional Scale (LEFS) in different clinical populations. A systematic review summarizing these properties for the LEFS may provide an important resource. OBJECTIVE To locate and synthesize evidence on the measurement properties of the LEFS and to discuss the clinical implications of the evidence. METHODS A literature search was conducted in 4 databases (PubMed, MEDLINE, Embase, and CINAHL), using predefined search terms. Two reviewers performed a critical appraisal of the included studies using a standardized assessment form. RESULTS A total of 27 studies were included in the review, of which 18 achieved a very good to excellent methodological quality level. The LEFS scores demonstrated excellent test-retest reliability (intraclass correlation coefficients ranging between 0.85 and 0.99) and demonstrated the expected relationships with measures assessing similar constructs (Pearson correlation coefficient values of greater than 0.7). The responsiveness of the LEFS scores was excellent, as suggested by consistently high effect sizes (greater than 0.8) in patients with different lower extremity conditions. Minimal detectable change at the 90% confidence level (MDC90) for the LEFS scores varied between 8.1 and 15.3 across different reassessment intervals in a wide range of patient populations. The pooled estimate of the MDC90 was 6 points and the minimal clinically important difference was 9 points in patients with lower extremity musculoskeletal conditions, which are indicative of true change and clinically meaningful change, respectively. CONCLUSION The results of this review support the reliability, validity, and responsiveness of the LEFS scores for assessing functional impairment in a wide array of patient groups with lower extremity musculoskeletal conditions.
Collapse
|
32
|
The Immediate Effects of Different Types of Ankle Support Introduced 6 Weeks After Surgical Internal Fixation for Ankle Fracture on Gait and Pain: A Randomized Crossover Trial. J Orthop Sports Phys Ther 2016; 46:157-67. [PMID: 26813753 DOI: 10.2519/jospt.2016.6212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized 3-treatment, 3-period crossover trial. BACKGROUND There is variation in clinical practice regarding the type of ankle support used to aid recovery after ankle fracture internal fixation surgery. OBJECTIVE To determine the immediate effects of different ankle supports commonly issued to patients 6 weeks after surgery. METHODS Participants were 18 adults, 6 weeks after internal fixation for transsyndesmotic/infrasyndesmotic fracture, in a major trauma center in the UK. Interventions were a stirrup brace and walker boot compared with Tubigrip. Outcomes were (1) step-length and single-limb support time asymmetry (percentage comparing injured and uninjured limbs), (2) step width, (3) gait velocity, and (4) pain during walking (visual analog scale, 0-100). RESULTS Participants (mean ± SD age, 47 ± 14 years) included 8 women and 10 men, 6 weeks after surgical internal fixation for ankle fracture. Single-limb support time asymmetry reduced by 3% (95% confidence interval [CI]: 0%, 6%; P = .02) in the stirrup brace and by 5% (95% CI: 2%, 7%; P = .001) in the walker boot compared with Tubigrip. Step width was 1.2 cm (95% CI: 0.6, 1.7; P<.001) wider in the walker boot than in Tubigrip. Self-reported pain was lower in the walker boot (5/100) and in the stirrup brace (13/100) compared to the Tubigrip (18/100, P = .03). No significant differences were found in the effects of the supports on step-length asymmetry between the walker boot or stirrup brace and Tubigrip. CONCLUSION At 6 weeks after surgical internal fixation for ankle fracture, pain and single-limb support time asymmetry over a short distance and for a short-term walk were immediately reduced with the use of a walker boot use and, to a lesser extent, a stirrup-brace compared to Tubigrip. Step width also widened in a walker boot, which may confer some additional gait stability. These results apply to immediate effects, so studies with longer-term follow-up are now indicated. The trial was registered at http://www.isrctn.com/ (ISRCTN84536917). Level of Evidence Therapy, level 2b.
Collapse
|
33
|
Confirmatory factor analysis of the Arabic version of the Lower Extremity Functional Scale. Int J Rehabil Res 2016; 39:36-41. [DOI: 10.1097/mrr.0000000000000141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Alnahdi AH, Alderaa AA, Aldali AZ, Alsobayel H. Reference values for the Y Balance Test and the lower extremity functional scale in young healthy adults. J Phys Ther Sci 2015; 27:3917-21. [PMID: 26834380 PMCID: PMC4713819 DOI: 10.1589/jpts.27.3917] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 09/25/2015] [Indexed: 12/26/2022] Open
Abstract
[Purpose] This study aimed to establish gender-specific reference values for the Y Balance Test (YBT) and the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in healthy young adults in Saudi Arabia, and to examine gender differences in the YBT and LEFS-Ar values. [Subjects and Methods] Healthy young adults (31 females, 30 males) completed the YBT and LEFS-Ar in 1 test session. Descriptive statistical analysis (mean, standard deviation, 95% confidence interval) was used to compute the YBT and LEFS-Ar reference values. Independent t-tests were used to examine gender differences in the YBT and LEFS-Ar values. [Results] Gender-specific reference values were obtained for the right, left, dominant, and non-dominant leg as well as for the average performance of both the legs. males showed greater YBT normalized reach distances than females did in the anterior, posteromedial, and posterolateral directions; furthermore, males showed higher YBT composite scores than females did. However, the LEFS-Ar values did not differ between males and females. [Conclusion] Gender-specific reference values were obtained for the YBT and LEFS-Ar in healthy young adults in Saudi Arabia. males performed better than females did in the YBT. However, no gender differences were noted in LEFS-Ar.
Collapse
Affiliation(s)
- Ali H Alnahdi
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Asma A Alderaa
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Ali Z Aldali
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| | - Hana Alsobayel
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Saudi Arabia
| |
Collapse
|
35
|
Abstract
STUDY DESIGN Case series. BACKGROUND Ankle fractures commonly result in persistent pain, stiffness, and functional impairments. There is insufficient evidence to favor any particular rehabilitation approach after ankle fracture. The purpose of this case series was to describe an impairment-based manual physical therapy approach to treating patients with conservatively managed ankle fractures. CASE DESCRIPTION Patients with stable ankle fractures postimmobilization were treated with manual physical therapy and exercise targeted at associated impairments in the lower limb. The primary outcome measure was the Lower Extremity Functional Scale. Secondary outcome measures included the ankle lunge test, numeric pain-rating scale, and global rating of change. Outcome measures were collected at baseline (performed within 7 days of immobilization removal) and at 4 and 12 weeks postbaseline. OUTCOMES Eleven patients (mean age, 39.6 years; range, 18-64 years; 2 male), after ankle fracture-related immobilization (mean duration, 48 days; range, 21-75 days), were treated for an average of 6.6 sessions (range, 3-10 sessions) over a mean of 46.1 days (range, 13-81 days). Compared to baseline, statistically significant and clinically meaningful improvements were observed in Lower Extremity Functional Scale score (P = .001; mean change, 21.9 points; 95% confidence interval: 10.4, 33.4) and in the ankle lunge test (P = .001; mean change, 7.8 cm; 95% confidence interval: 3.9, 11.7) at 4 weeks. These changes persisted at 12 weeks. DISCUSSION Statistically significant and clinically meaningful improvements in self-reported function and ankle range of motion were observed at 4 and 12 weeks following treatment with impairment-based manual physical therapy. All patients tolerated treatment well. Results suggest that this approach may have efficacy in this population. LEVEL OF EVIDENCE Therapy, level 4.
Collapse
|
36
|
Alnahdi AH, Alrashid GI, Alkhaldi HA, Aldali AZ. Cross-cultural adaptation, validity and reliability of the Arabic version of the Lower Extremity Functional Scale. Disabil Rehabil 2015; 38:897-904. [PMID: 26186622 DOI: 10.3109/09638288.2015.1066452] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The aim was to translate and cross-culturally adapt the Lower Extremity Functional Scale (LEFS) into Arabic language and to examine its measurement properties in patients with musculoskeletal disorders of the lower extremity. METHODS Standard forward and backward translation followed by expert committee review, then preliminary testing was carried out to produce the final Arabic version of LEFS (LEFS-Ar). The test-retest reliability, measurement error, internal consistency and construct validity of the LEFS-Ar were examined in patients with musculoskeletal disorders of the lower extremity (N = 116). RESULTS The LEFS-Ar had excellent test-retest reliability (ICC2,1 = 0.96). LEFS-Ar standard error of measurement was 3.5 points while the minimal detectable change MDC95 was 9.8 points. LEFS-Ar showed excellent internal consistency with Cronbach's alpha of 0.95. Parallel analysis and factor analysis showed that LEFS-Ar measures one underlying factor with all items loading heavily on this single factor. LEFS-Ar showed significant positive correlation with patient's global assessment of function (r = 0.59) and that patients recovering from surgery reported lower LEFS-Ar score compared to patients with no surgery further supporting the construct validity of the LEFS-Ar. CONCLUSION LEFS-Ar has excellent internal consistency, test-retest reliability with relatively small measurement error and is a valid measure of activity limitation due to lower extremity musculoskeletal disorders. All these measurement properties of the LEFS-Ar suggest the clinical usefulness of this measure. IMPLICATIONS FOR REHABILITATION The Arabic Lower Extremity Functional Scale (LEFS-Ar) is a reliable and valid measure of activity limitation due to lower extremity musculoskeletal disorders with relatively small measurement error. LEFS-Ar can be used in daily clinical practice and for research purposes to quantify activity limitation in Arabic-speaking individuals with lower extremity musculoskeletal disorders.
Collapse
Affiliation(s)
- Ali H Alnahdi
- a Department of Rehabilitation Sciences , College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia and
| | - Ghada I Alrashid
- b Department of Rehabilitation , King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia
| | - Hatem A Alkhaldi
- b Department of Rehabilitation , King Khalid University Hospital, King Saud University , Riyadh , Saudi Arabia
| | - Ali Z Aldali
- a Department of Rehabilitation Sciences , College of Applied Medical Sciences, King Saud University , Riyadh , Saudi Arabia and
| |
Collapse
|
37
|
Abstract
The International Classification of Functioning Disability and Health (ICF) represents a general framework for concepts of health and disability. The number of patients undergoing Total knee arthroplasty (TKA) is increasing worldwide. Capturing the different health-related ICF domains in this increasing number of patients with TKA requires clinicians and researchers to be familiar with the tools that can be used in daily clinical practice to capture these health-related domains. This paper aimed to review the outcome measures related to the different ICF domains in patients with TKA and to review the psychometric properties of these outcome measures. An electronic search for relevant articles using MEDLINE and CINHAL databases up to March 2014 was performed. In addition to the electronic search, the articles retrieved were searched manually for relevant studies. Impairment-based outcome measures important to patients with TKA included measures of knee pain intensity, knee joint mobility, and muscle performance. Outcome measures capturing activity limitation in patients with TKA included both self-reported and performance-based measures as each capture a different aspect of the activity limitation construct. The disability component of the late life function and disability instrument can be used to quantify participation restriction patients with TKA. Clinicians and researchers are encouraged to measure the different health-related domains in patients with TKA using the outcome measures presented in this review.
Collapse
|
38
|
Negahban H, Behtash Z, Sohani SM, Salehi R. Responsiveness of two Persian-versions of shoulder outcome measures following physiotherapy intervention in patients with shoulder disorders. Disabil Rehabil 2015; 37:2300-4. [PMID: 25640004 DOI: 10.3109/09638288.2015.1005760] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To identify the ability of the Persian-version of the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) to detect changes in shoulder function following physiotherapy intervention (i.e. responsiveness) and to determine the change score that indicates a meaningful change in functional ability of the patient (i.e. Minimally Clinically Important Difference (MCID)). METHOD A convenient sample of 200 Persian-speaking patients with shoulder disorders completed the SPADI and the DASH at baseline and then again 4 weeks after physiotherapy intervention. Furthermore, patients were asked to rate their global rating of shoulder function at follow-up. The responsiveness was evaluated using two methods: the receiver operating characteristics (ROC) method and the correlation analysis. Two useful statistics extracted from the ROC method are the area under curve (AUC) and the optimal cutoff point called as MCID. RESULTS Both the SPADI and the DASH showed the AUC of greater than 0.70 (AUC ranges = 0.77-0.82). The best cutoff points (or change scores) for the SPADI-total, SPADI-pain, SPADI-disability and the DASH were 14.88, 26.36, 23.86, and 25.41, respectively. Additionally, moderate to good correlations (Gamma = -0.51 to -0.58) were found between the changes in SPADI/DASH and changes in global rating scale. CONCLUSIONS The Persian SPADI and DASH have adequate responsiveness to clinical changes in patients with shoulder disorders. Moreover, the MCIDs obtained in this study will help the clinicians and researchers to determine if a Persian-speaking patient with shoulder disorder has experienced a true change following a physiotherapy intervention. Implications for Rehabilitation Responsiveness was evaluated using two methods; the receiver operating characteristics (ROC) method and the correlation analysis. The Persian SPADI and DASH can be used as two responsive instruments in both clinical practice and research settings. The MCIDs of 14.88 and 25.41 points obtained for the SPADI-total and DASH indicated that the change scores of at least 14.88 points on the SPADI-total and 25.41 points on the DASH is necessary to certain that a true change has occurred following a physiotherapy intervention.
Collapse
Affiliation(s)
- Hossein Negahban
- a Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran and
| | - Zeinab Behtash
- a Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran and
| | - Soheil Mansour Sohani
- b Department of Physical Therapy , School of Rehabilitation Sciences, Iran University of Medical Sciences , Tehran , Iran
| | - Reza Salehi
- a Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences , Ahvaz , Iran and
| |
Collapse
|
39
|
Pan SL, Liang HW, Hou WH, Yeh TS. Responsiveness of SF-36 and Lower Extremity Functional Scale for assessing outcomes in traumatic injuries of lower extremities. Injury 2014; 45:1759-63. [PMID: 24938677 DOI: 10.1016/j.injury.2014.05.022] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 05/02/2014] [Accepted: 05/18/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the responsiveness of one generic questionnaire, Medical Outcomes Study Short Form-36 (SF-36), and one region-specific outcome measure, Lower Extremity Functional Scale (LEFS), in patients with traumatic injuries of lower extremities. DESIGN A prospective and observational study of patients after traumatic injuries of lower extremities. Assessments were performed at baseline and 3 months later. SETTING In-patients and out-patients in two university hospitals in Taiwan. PARTICIPANTS A convenience sample of 109 subjects were evaluated and 94 (86%) were followed. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Assessments of responsiveness with distribution-based approach (effect size, standardized response mean [SRM], minimal detectable change) and anchor-based approach (receiver's operating curve analysis, ROC analysis). RESULTS LEFS and physical component score (PCS) of SF-36 were all responsive to global improvement, with fair-to-good accuracy in discriminating between participants with and without improvement. The area under curve gained by ROC analysis for LEFS and SF-36 PCS was similar (0.65 vs. 0.70, p=0.26). CONCLUSIONS Our findings revealed comparable responsiveness of LEFS and PCS of SF-36 in a sample of subjects with traumatic injuries of lower limbs. Either type of functional measure would be suitable for use in clinical trials where improvement in function was an endpoint of interest.
Collapse
Affiliation(s)
- Shin-Liang Pan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC
| | - Huey-Wen Liang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
| | - Wen-Hsuan Hou
- Department of Physical Medicine and Rehabilitation, Taipei Medical University Hospital, Taipei, Taiwan, ROC; School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC
| | - Tian-Shin Yeh
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan, ROC; Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan, ROC
| |
Collapse
|
40
|
Negahban H, Mostafaee N, Sohani SM, Hessam M, Tabesh H, Montazeri A. Responsiveness and minimally important differences for selected Persian-version of outcome measures used in patients with patellofemoral pain syndrome. Disabil Rehabil 2014; 37:1285-90. [DOI: 10.3109/09638288.2014.962107] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
41
|
Development and validation of the ankle fracture outcome of rehabilitation measure (A-FORM). J Orthop Sports Phys Ther 2014; 44:488-99, B1-2. [PMID: 24853921 DOI: 10.2519/jospt.2014.4980] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Delphi panel and cohort study. OBJECTIVE To develop and refine a condition-specific, patient-reported outcome measure, the Ankle Fracture Outcome of Rehabilitation Measure (A-FORM), and to examine its psychometric properties, including factor structure, reliability, and validity, by assessing item fit with the Rasch model. BACKGROUND To our knowledge, there is no patient-reported outcome measure specific to ankle fracture with a robust content foundation. METHODS A 2-stage research design was implemented. First, a Delphi panel that included patients and health professionals developed the items and refined the item wording. Second, a cohort study (n = 45) with 2 assessment points was conducted to permit preliminary maximum-likelihood exploratory factor analysis and Rasch analysis. RESULTS The Delphi panel reached consensus on 53 potential items that were carried forward to the cohort phase. From the 2 time points, 81 questionnaires were completed and analyzed; 38 potential items were eliminated on account of greater than 10% missing data, factor loadings, and uniqueness. The 15 unidimensional items retained in the scale demonstrated appropriate person and item reliability after (and before) removal of 1 item (anxious about footwear) that had a higher-than-ideal outfit statistic (1.75). The "anxious about footwear" item was retained in the instrument, but only the 14 items with acceptable infit and outfit statistics (range, 0.5-1.5) were included in the summary score. CONCLUSION This investigation developed and refined the A-FORM (Version 1.0). The A-FORM items demonstrated favorable psychometric properties and are suitable for conversion to a single summary score. Further studies utilizing the A-FORM instrument are warranted. J Orthop Sports Phys Ther 2014;44(7):488-499. Epub 22 May 2014. doi:10.2519/jospt.2014.4980.
Collapse
|
42
|
Reliability and validity of the Taiwan Chinese version of the Lower Extremity Functional Scale. J Formos Med Assoc 2014; 113:313-20. [DOI: 10.1016/j.jfma.2012.07.032] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 07/17/2012] [Accepted: 07/23/2012] [Indexed: 01/20/2023] Open
|
43
|
Skaara HE, Moksnes H, Frihagen F, Stuge B. Self-reported and performance-based functional outcomes after surgical repair of proximal hamstring avulsions. Am J Sports Med 2013; 41:2577-84. [PMID: 23989349 DOI: 10.1177/0363546513499518] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Because a proximal hamstring avulsion results in residual loss of function, surgical repair is recommended. Few studies have investigated postoperative function with validated outcomes. PURPOSE To examine lower extremity function after surgical repair of proximal hamstring avulsions using validated self-reported and performance-based functional outcomes. STUDY DESIGN Case series; Level of evidence, 4. METHODS Operative records from 2006 to 2010 were retrospectively reviewed in 3 hospitals. A total of 39 patients who had undergone surgical repair of a proximal hamstring avulsion were identified, and 36 met the inclusion criteria. Thirty-one patients completed questionnaires with demographic background data and quality of life-related questions: the Lower Extremity Functional Scale (LEFS) and the Proximal Hamstring Injury Questionnaire (PHIQ). Thirty patients were evaluated using a Biodex dynamometer for isokinetic quadriceps and hamstring strength measurements at a velocity of 60 deg/s, and 27 patients performed 4 single-legged hop tests. RESULTS Twenty-eight repairs were acute (<4 weeks), and 3 were chronic. There were complete ruptures of all 3 tendons in 17 (55%) cases. The mean follow-up was 30 months. Most patients experienced little or no pain or limitations during activities of daily living. The mean LEFS score was 89%, and 29 (94%) of the 31 patients were satisfied with the result after surgery. Eighteen (58%) of the 31 patients had returned to their preinjury activity level. Significant differences in the mean hamstring strength (peak torque) (P < .001) and single-legged hop test (P = .01) between the uninvolved and involved leg were found. Twenty-two (71%) of the 31 patients did not fully trust their operated leg during physical activities and feared sustaining a hamstring injury. Return to activity significantly correlated with the single-legged hop test, the LEFS score, and the questions regarding trust and fear. CONCLUSION In this study, using both validated self-reported and performance-based outcome measures after surgical repair of proximal hamstring avulsions, minor pain and limitations to activities of daily living were seen. Isokinetic hamstring strength in the operated leg was significantly lower compared with the nonoperated leg, and a majority of the patients did not trust the operated leg completely during physical activity.
Collapse
Affiliation(s)
- Heléne Engberg Skaara
- Heléne Engberg Skaara,Oslo University Hospital, Ullevål Hospital, Division of Surgery and Clinical Neuroscience, Building 72, 2nd Floor, PO Box 4950, Nydalen, Oslo, Norway, N-0424.
| | | | | | | |
Collapse
|
44
|
Stasi S, Papathanasiou G, Korres N, Marinakis G, Chronopoulos E, Baltopoulos P, Papaioannou N. Validation of the Lower Extremity Functional Scale in community-dwelling elderly people (LEFS-Greek); determination of functional status cut-off points using TUG test. Eur Geriatr Med 2013. [DOI: 10.1016/j.eurger.2013.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Negahban H, Hessam M, Tabatabaei S, Salehi R, Sohani SM, Mehravar M. Reliability and validity of the Persian lower extremity functional scale (LEFS) in a heterogeneous sample of outpatients with lower limb musculoskeletal disorders. Disabil Rehabil 2013; 36:10-5. [DOI: 10.3109/09638288.2013.775361] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
46
|
McPhail SM, Dunstan J, Canning J, Haines TP. Life impact of ankle fractures: qualitative analysis of patient and clinician experiences. BMC Musculoskelet Disord 2012; 13:224. [PMID: 23171034 PMCID: PMC3517753 DOI: 10.1186/1471-2474-13-224] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 11/11/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ankle fractures are one of the more commonly occurring forms of trauma managed by orthopaedic teams worldwide. The impacts of these injuries are not restricted to pain and disability caused at the time of the incident, but may also result in long term physical, psychological, and social consequences. There are currently no ankle fracture specific patient-reported outcome measures with a robust content foundation. This investigation aimed to develop a thematic conceptual framework of life impacts following ankle fracture from the experiences of people who have suffered ankle fractures as well as the health professionals who treat them. METHODS A qualitative investigation was undertaken using in-depth semi-structured interviews with people (n=12) who had previously sustained an ankle fracture (patients) and health professionals (n=6) that treat people with ankle fractures. Interviews were audio-recorded and transcribed. Each phrase was individually coded and grouped in categories and aligned under emerging themes by two independent researchers. RESULTS Saturation occurred after 10 in-depth patient interviews. Time since injury for patients ranged from 6 weeks to more than 2 years. Experience of health professionals ranged from 1 year to 16 years working with people with ankle fractures. Health professionals included an Orthopaedic surgeon (1), physiotherapists (3), a podiatrist (1) and an occupational therapist (1). The emerging framework derived from patient data included eight themes (Physical, Psychological, Daily Living, Social, Occupational and Domestic, Financial, Aesthetic and Medication Taking). Health professional responses did not reveal any additional themes, but tended to focus on physical and occupational themes. CONCLUSIONS The nature of life impact following ankle fractures can extend beyond short term pain and discomfort into many areas of life. The findings from this research have provided an empirically derived framework from which a condition-specific patient-reported outcome measure can be developed.
Collapse
Affiliation(s)
- Steven M McPhail
- Centre for Functioning and Health Research, Metro South Health, Buranda Plaza, Corner Ipswich Road and Cornwall Street Buranda, Brisbane, Australia.
| | | | | | | |
Collapse
|
47
|
Translation and cross-cultural adaptation of the lower extremity functional scale into a Brazilian Portuguese version and validation on patients with knee injuries. J Orthop Sports Phys Ther 2012; 42:932-9. [PMID: 23047028 DOI: 10.2519/jospt.2012.4101] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Clinical measurement. OBJECTIVE To translate and culturally adapt the Lower Extremity Functional Scale (LEFS) into a Brazilian Portuguese version, and to test the construct and content validity and reliability of this version in patients with knee injuries. BACKGROUND There is no Brazilian Portuguese version of an instrument to assess the function of the lower extremity after orthopaedic injury. METHODS The translation of the original English version of the LEFS into a Brazilian Portuguese version was accomplished using standard guidelines and tested in 31 patients with knee injuries. Subsequently, 87 patients with a variety of knee disorders completed the Brazilian Portuguese LEFS, the Medical Outcomes Study 36-Item Short-Form Health Survey, the Western Ontario and McMaster Universities Osteoarthritis Index, and the International Knee Documentation Committee Subjective Knee Evaluation Form and a visual analog scale for pain. All patients were retested within 2 days to determine reliability of these measures. Validation was assessed by determining the level of association between the Brazilian Portuguese LEFS and the other outcome measures. Reliability was documented by calculating internal consistency, test-retest reliability, and standard error of measurement. RESULTS The Brazilian Portuguese LEFS had a high level of association with the physical component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.82), the Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.87), the International Knee Documentation Committee Subjective Knee Evaluation Form (r = 0.82), and the pain visual analog scale (r = -0.60) (all, P<.05). The Brazilian Portuguese LEFS had a low level of association with the mental component of the Medical Outcomes Study 36-Item Short-Form Health Survey (r = 0.38, P<.05). The internal consistency (Cronbach α = .952) and test-retest reliability (intraclass correlation coefficient = 0.957) of the Brazilian Portuguese version of the LEFS were high. The standard error of measurement was low (3.6) and the agreement was considered high, demonstrated by the small differences between test and retest and the narrow limit of agreement, as observed in Bland-Altman and survival-agreement plots. CONCLUSION The translation of the LEFS into a Brazilian Portuguese version was successful in preserving the semantic and measurement properties of the original version and was shown to be valid and reliable in a Brazilian population with knee injuries.
Collapse
|
48
|
Slaven EJ, Mathers J. Management of chronic ankle pain using joint mobilization and ASTYM® treatment: a case report. J Man Manip Ther 2012; 19:108-12. [PMID: 22547921 DOI: 10.1179/2042618611y.0000000004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Treatment of ankle sprains predominately focuses on the acute management of this condition; less emphasis is placed on the treatment of ankle sprains in the chronic phase of recovery. Manual therapy, in the form of joint mobilization and manipulation, has been shown to be effective in the management of this condition, but the combination of joint mobilization and manipulation in tandem with ASTYM® treatment has not been explored. The purpose of this case report is to chronicle the management of a patient with chronic ankle pain who was treated with manual therapy including manipulation and ASTYM treatment. As a result of a fall down stairs 6 months previously, the patient sustained a severe ankle sprain. The soft tissue damage was accompanied by bony disruptions which warranted the patient spending 3 weeks in a walking boot. At the initial evaluation, the patient reported difficulty with descending stairs reciprocally and not being able to run more than 4 minutes on the treadmill before the pain escalated to the level that she had to stop running. After five sessions of therapy consisting of joint mobilization, manipulation and ASTYM, the patient was able to descend stairs and run 40 minutes without pain.
Collapse
Affiliation(s)
- Emily J Slaven
- Krannert School of Physical Therapy, University of Indianapolis, IN, USA
| | | |
Collapse
|
49
|
Takasaki H, Chien CW, Johnston V, Treleaven J, Jull G. Validity and reliability of the perceived deficit questionnaire to assess cognitive symptoms in people with chronic whiplash-associated disorders. Arch Phys Med Rehabil 2012; 93:1774-81. [PMID: 22634231 DOI: 10.1016/j.apmr.2012.05.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/07/2012] [Accepted: 05/15/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To investigate the validity and reliability of the Perceived Deficit Questionnaire (PDQ) for use in people with chronic whiplash-associated disorders. DESIGN Cross-sectional. SETTING Tertiary institution. PARTICIPANTS Patients (N=105) with chronic whiplash-associated disorders and asymptomatic controls (n=50). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The 20-item PDQ inclusive of 4 sections (attention/concentration, retrospective memory, prospective memory, and organization/planning) rated on a 5-point scale. RESULTS Internal construct validity of the PDQ was examined by Rasch analysis, confirming the appropriateness of its 5-point scale and the unidimensionality of each section after modification by eliminating 1 item each from the attention/concentration and retrospective memory sections. Preliminary evidence was also gained for external construct validity (convergent validity) of the modified PDQ by demonstrating significant (P<.05) correlations of all sections with a global measure of disability due to neck pain (the Neck Disability Index). The whiplash group demonstrated significantly (P<.05) higher scores in each section of the modified PDQ than did the control group, indicating evidence for discriminant validity. In addition, the modified PDQ demonstrated good internal consistency (Rasch-generated reliability >.8) and acceptable test-retest reliability with 1-month interval (intraclass correlation coefficients >.8). CONCLUSIONS The modified PDQ appears to be a valid and reliable questionnaire and could be used quickly in clinical practice to gain a basic understanding of perceived cognitive symptoms in people with chronic whiplash-associated disorders.
Collapse
Affiliation(s)
- Hiroshi Takasaki
- National Health and Medical Research Council Centre of Clinical Research Excellence - Spinal Pain, Injury and Health, Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, Brisbane, Queensland, Australia.
| | | | | | | | | |
Collapse
|
50
|
Abstract
BACKGROUND Existing lower-limb, region-specific, patient-reported outcome measures have clinimetric limitations, including limitations in psychometric characteristics (eg, lack of internal consistency, lack of responsiveness, measurement error) and the lack of reported practical and general characteristics. A new patient-reported outcome measure, the Lower Limb Functional Index (LLFI), was developed to address these limitations. OBJECTIVE The purpose of this study was to overcome recognized deficiencies in existing lower-limb, region-specific, patient-reported outcome measures through: (1) development of a new lower-extremity outcome scale (ie, the LLFI) and (2) evaluation of the clinimetric properties of the LLFI using the Lower Extremity Functional Scale (LEFS) as a criterion measure. DESIGN This was a prospective observational study. METHODS The LLFI was developed in a 3-stage process of: (1) item generation, (2) item reduction with an expert panel, and (3) pilot field testing (n=18) for reliability, responsiveness, and sample size requirements for a larger study. The main study used a convenience sample (n=127) from 10 physical therapy clinics. Participants completed the LLFI and LEFS every 2 weeks for 6 weeks and then every 4 weeks until discharge. Data were used to assess the psychometric, practical, and general characteristics of the LLFI and the LEFS. The characteristics also were evaluated for overall performance using the Measurement of Outcome Measures and Bot clinimetric assessment scales. RESULTS The LLFI and LEFS demonstrated a single-factor structure, comparable reliability (intraclass correlation coefficient [2,1]=.97), scale width, and high criterion validity (Pearson r=.88, with 95% confidence interval [CI]). Clinimetric performance was higher for the LLFI compared with the LEFS on the Measurement of Outcome Measures scale (96% and 95%, respectively) and the Bot scale (100% and 83%, respectively). The LLFI, compared with the LEFS, had improved responsiveness (standardized response mean=1.75 and 1.64, respectively), minimal detectable change with 90% CI (6.6% and 8.1%, respectively), and internal consistency (α=.91 and .95, respectively), as well as readability with reduced user error and completion and scoring times. LIMITATIONS Limitations of the study were that only participants recruited from outpatient physical therapy clinics were included and that no specific conditions or diagnostic subgroups were investigated. CONCLUSION The LLFI demonstrated sound clinimetric properties. There was lower response error, efficient completion and scoring, and improved responsiveness and overall performance compared with the LEFS. The LLFI is suitable for assessment of lower-limb function.
Collapse
|