Mapping Patient-Specific Functional Scale (PSFS) items to the International Classification of Functioning, Disability and Health (ICF)

The Validity and Responsiveness of the Patient-Specific Functional Scale in Patients With First Carpometacarpal Osteoarthritis

PURPOSE

The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis.

METHODS

Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients.

RESULTS

We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46-0.68) and 0.47 (0.35-0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up.

CONCLUSIONS

The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire.

CLINICAL RELEVANCE

The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis.

Development of a Conversion Table Linking Functional Independence Measure Scores to International Classification of Functioning, Disability, and Health Qualifiers: Insights from a Survey of Healthcare Professionals

In clinical practice, patient assessments rely on established scales. Integrating data from these scales into the International Classification of Functioning, Disability, and Health (ICF) framework has been suggested; however, a standardized approach is lacking. Herein, we tested a new approach to develop a conversion table translating clinical scale scores into ICF qualifiers based on a clinician survey. The survey queried rehabilitation professionals about which functional independence measure (FIM) item scores (1-7) corresponded to the ICF qualifiers (0-4). A total of 458 rehabilitation professionals participated. The survey findings indicated a general consensus on the equivalence of FIM scores with ICF qualifiers. The median value for each item remained consistent across all item groups. Specifically, FIM 1 had a median value of 4; FIM 2 and 3 both had median values of 3; FIM 4 and 5 both had median values of 2; FIM 6 had a median value of 1; and FIM 7 had a median value of 0. Despite limitations due to the irreconcilable differences between the frameworks of existing scales and the ICF, these results underline the ICF's potential to serve as a central hub for integrating clinical data from various scales.

Content analysis of the Measure of the Quality of the Environment by linkage with the International Classification of Functioning, Disability and Health

BACKGROUND

This study explores the linkage between the Measurement of Environmental Quality (MQE) and the International Classification of Functioning, Disability, and Health (ICF). Stemming from the Human Development Model-Disability Creation Process (HDM-DCP), MQE enhances understanding of how environmental quality impacts disability development across diverse socio-cultural contexts. Integrating MQE with ICF expands the perspective on disability formation beyond HDM-DCP, encompassing ICF's functioning approach.

OBJECTIVE

To link the MQE with the concepts and categories of the ICF.

METHODS

Two health professionals with adequate taxonomic knowledge of the ICF performed the initial linkage, which was based on updated standardized rules considering all hierarchical levels of the ICF. Linkage agreement between the first two assessors was measured using the Kappa (k) coefficient and respective 95% confidence intervals. In the absence of a consensus between the two assessors (k > 0.60), a third assessor was consulted to make the arbitrary decision of the final categories linked to the MQE.

RESULTS

Insufficient agreement between the two assessors was found for the linkage process (k = 0.52; p < 0.001), requiring the final decision from the third assessor. At the end of the process, 26 ICF categories were linked to the main concepts (MC) measured by the 26 items of the short version of the MQE. Ten ICF categories were linked to the additional concepts (AC) measured by the MQE. Moreover, the MQE addresses the five domains of the ICF component "environmental factors," with a predominance of the "services, systems and policies" domain (MC = 45.8% and AC = 40%).

CONCLUSION

The linkage of the concepts measured by the MQE to ICF categories enabled mapping the content of the MQE, identifying it as a promising tool for measuring environmental factors in accordance with ICF percepts.

Validity and reliability of the Turkish version of the patient-specific functional scale in patients with low back pain

BACKGROUND

The Patient-Specific Functional Scale (PSFS) is among the most used measures to evaluate physical function. The PSFS has not been translated into Turkish for patients with low back pain to date. The purpose of the present study was to translate and cross-culturally adapt the PSFS into Turkish (PSFS-T) and to assess its reliability and validity in patients with low back pain.

METHODS

A total of 105 participants completed the PSFS-T, Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Visual Analogue Scale (VAS) for pain. Sixty-nine participants completed the PSFS-T questionnaire twice in 7 days. The internal consistency of the PSFS-T was assessed using Cronbach's alpha while the Intraclass Correlation Coefficient (ICC) was used to evaluate test-retest reliability. The convergent validity of PSFS-T was determined with ODI, RMDQ, and VAS questionnaires by using Pearson's correlation coefficient analysis.

RESULTS

The PSFS-T demonstrated acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC2,1 = 0.75) with no floor or ceiling issues. The PSFS-T showed a moderate correlation with ODI (Rp =0 .49, p<0.001) and RMDQ (Rp =0 .46, p<0.001). A poor correlation was found between PSFS-T and VAS (Rp = 0.36, p< 0.001). Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) for the PSFS-T scores were 0.69 and 1.91 respectively.

CONCLUSION

The Turkish version of PSFS is a valid and reliable instrument for the assessment of low back patients. It may be considered a preferable scale for clinical assessment of Turkish-speaking patients with low back pain.

Measurement Properties' Evaluation of the Arabic Version of the Patient-Specific Functional Scale in Patients with Multiple Sclerosis

Purpose: The aim of this study was to assess the reliability and validity of the Arabic version of the patient-specific functional scale (PSFS-Ar) in patients with multiple sclerosis (MS) disorder. Materials and Methods: Reliability and validity were examined in patients with multiple sclerosis using a longitudinal cohort study design. One hundred (N = 100) patients with MS were recruited to examine the PSFS-Ar, test-retest reliability (using the interclass correlation coefficient model 2,1 (ICC_2,1)), construct validity (using the hypothesis testing method), and floor-ceiling effect. Results: A total of 100 participants completed the PSFS-Ar (34% male, 66% female). The PSFS-Ar showed an excellent test-retest reliability score (ICC_2,1 = 0.87; 95% confidence interval, 0.75-0.93). The SEM of the PSFS-Ar was 0.80, while the MDC₉₅ was 1.87, indicating an acceptable measurement error. The construct validity of the PSFS-Ar was 100% correlated with the predefined hypotheses. As hypothesized, the correlation analysis revealed positive correlations between the PSFS-Ar and the RAND-36 domains of physical functioning (0.5), role limitations due to physical health problems (0.37), energy/fatigue (0.35), and emotional well-being (0.19). There was no floor or ceiling effect in this study. Conclusions: The study results showed that the PSFS-Ar is a self-reported outcome measure that is useful for detecting specific functional difficulties in patients with multiple sclerosis. Patients are able to express and report a variety of functional limitations easily and effectively, as well as to measure their response to physical therapy. The PSFS-Ar is, therefore, recommended for use in Arabic-speaking countries for clinical practice and research for patients with multiple sclerosis.

Utility of a Pediatric Adaptive Sports Clinic: A Case Series Review

BACKGROUND

Limited funding is available for athletes with disabilities in the United Kingdom. This compounds the barriers to participation and development that already exist.

METHOD

To combat this growing problem, a Multi-Disciplinary Pediatric Adaptive Sports Clinic was formed.

RESULT

Fifteen athletes with disabilities attended the Clinic from November 2017 to November 2019. In our cohort, there were 10 males and 5 females (age range: 13-18 years). Most athletes participated at a grassroots level (n = 9). The range of diagnoses included cerebral palsy, Ehlers Danlos syndrome and congenital hand differences. Forty-four appointments were made after the initial meeting with a 95% attendance rate. Improvements beyond the minimal clinically important differences (MCID) for the Patient Specific Functional Scale, Numerical Pain Rating Scale, and Medical Research Council Manual Muscle Testing Scale were noted in over half of cases.

CONCLUSION

With a focus on injury prevention and strength and conditioning techniques, this clinic supported athletes to successfully compete from a recreational to an elite level across all types of sports and adolescent ages by providing patient-specific regimens. Our case series provides preliminary evidence to suggest the formation of similar clinics that can support athletes with disabilities across a range of sports.

Comparing the Primary Concerns of Injured Collegiate Athletes With the Content of Patient-Reported Outcome Measures

CONTEXT

Patient-reported outcome measures (PROMs) have been endorsed for providing patient-centered care. However, PROMs must represent their target populations.

OBJECTIVE

To identify the primary concerns of collegiate athletes experiencing injury and compare those with the content of established PROMs.

DESIGN

Cross-sectional study.

SETTING

Collegiate athletic training facilities.

PATIENTS OR OTHER PARTICIPANTS

Collegiate athletes experiencing injury (N = 149).

MAIN OUTCOME MEASURE(S)

Open-ended responses to the Measure Yourself Medical Outcome Profile were used to identify primary concerns, which were linked to International Classification of Functioning, Disability and Health taxonomy codes. Items of the Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; Lower Extremity Functional Scale; Knee injury and Osteoarthritis Outcome Score (KOOS); International Knee Documentation Committee Subjective Knee Form (IKDC); Foot and Ankle Ability Measure; Disabilities of the Arm, Shoulder, and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire were linked to International Classification of Functioning, Disability and Health codes. We calculated χ2 single-sample goodness-of-fit tests to determine if 70% of the content was shared between PROMs and participant-generated codes.

RESULTS

Participant-generated concerns were primarily related to sport participation (16%) and pain (23%). Chi-square tests showed that the Lower Extremity Functional Scale and Foot and Ankle Ability Measure presented significant content differences, with common participant-generated lower extremity responses at all levels. The Patient-Reported Outcomes Measurement Information System; modified Disablement of the Physically Active Scale; KOOS; IKDC; Disabilities of the Arm, Shoulder and Hand; Functional Arm Scale for Throwers; and Kerlan-Jobe Orthopaedic Clinic questionnaire did not have significant content differences for level 2 codes; still, significant differences were present for level 3 analyses except for the KOOS and IKDC (P < .001). All measures except the IKDC contained significant superfluous content (P < .05).

CONCLUSIONS

The presence of significant content differences supports clinician-perceived barriers regarding the relevance of established PROMs. However, the IKDC was a relevant and efficient PROM for evaluating the primary concerns of collegiate athletes experiencing lower extremity injury. Clinicians should consider using patient-generated measures to support coverage of patient-specific concerns in care.

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

BACKGROUND AND PURPOSE

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

METHODS

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

RESULTS

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

DISCUSSION AND CONCLUSIONS

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

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

OBJECTIVE

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

DESIGN

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

LITERATURE SEARCH

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

STUDY SELECTION CRITERIA

Published primary articles without language restrictions.

DATA SYNTHESIS

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

RESULTS

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

CONCLUSION

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

World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease

Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94-100% for the three additional PROMs. Thirty-four new 'Personal Factors' emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. 'pf_embarrassed by cough' or 'pf_panic/afraid when can't get a breath'. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11.

Content validity and responsiveness of the Patient-Specific Functional Scale in patients with Dupuytren's disease

INTRODUCTION

Patient-reported outcome measures have become the standard tool for reflecting the patient's perspective on their treatment outcome for a wide variety of hand conditions. The Patient-Specific Functional Scale (PSFS), is an individualized questionnaire that enables patients to specify those activities with which they have difficulty in daily life.

PURPOSE OF THE STUDY

This study aims to determine the content validity and responsiveness of the PSFS compared with the Michigan Hand Questionnaire (MHQ) in patients with Dupuytren's disease.

STUDY DESIGN

Multicentre inception cohort.

METHODS

Patients with Dupuytren's disease being treated with percutaneous needle aponeurotomy, limited fasciectomy, or skin graft were selected from a database with routine outcome measurements in usual care. To assess content validity of the PSFS, the activities specified by patients were classified into the International Classification of Function core set for hand conditions. The standardized response mean is calculated for the pre- and post-change scores of the PSFS to evaluate responsiveness.

RESULTS

Three hundred and eight patients were analyzed before and three months after treatment. Content validity of the PSFS was appropriate because 95% of all items could be classified into the International Classification of Function activities and participation domain. The standardized response mean of the PSFS was 1.0 (95% confidence interval, 0.86-1.2), which was substantially larger than the standardized response mean of the MHQ score 0.58 (95% confidence interval, 0.42-0.74).

DISCUSSION

The PSFS is a content-valid questionnaire which may be more responsive to change than a fixed-item instrument such as the MHQ in patients with Dupuytren's disease.

CONCLUSIONS

The PSFS is a valuable tool to set therapy goals and evaluate the progress over time in patients with Dupuytren's disease.

The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons-Elbow form capture aspects of functioning that are important to patients with elbow injuries

STUDY DESIGN

This is a cross-sectional study.

INTRODUCTION

The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons-elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice.

PURPOSE OF THE STUDY

To use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e.

METHODS

One hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement.

RESULTS

A total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475-driving (35%) and D440-fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%.

DISCUSSION

This study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section ('d' categories) of the ICF, this validated that these PROMs measure this conceptual domain.

CONCLUSION

The PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.

Contextualizing the Impact of Snakebite Envenoming on Patients: A Qualitative Content Analysis of Patient-Specific Functional Scale Activities Using the International Classification of Functioning, Disability and Health

To categorize the Patient-specific Functional Scale (PSFS) activities in snakebite envenoming (SBE) using the International Classification of Function (ICF) model in order to describe the impact of SBE on patients’ activities and daily lives and to develop a theoretical SBE model of functioning, we performed a post-hoc analysis of two multi-center, prospective studies, conducted at 14 clinical sites in the United States with consecutive SBE patients presenting to the emergency department. Qualitative content analysis and natural language processing were used to categorize activities reported in the PSFS using the ICF model. Our sample included 93 patients. The mean age was 43.0 (SD 17.9) years, most had lower extremity injuries (59%). A total of 99 unique activities representing eight domains came within the Activity and Participation component of the ICF model, with the majority in the Mobility and General Tasks and Demands domains. The main concerns of SBE patients are the ability to perform daily activities and to engage within their social environment. Applying the ICF model to SBE can facilitate the creation of a patient-centered treatment approach, moving beyond body-structural impairments towards a function-based treatment approach and facilitate early integration of rehabilitation services.

What Are the Most Important Problems in Functioning Among Patients With Shoulder Pain? An Analysis of the Patient-Specific Functional Scale

OBJECTIVE

The purpose of this study was to identify important functional problems among individuals with shoulder pain using the Patient-Specific Functional Scale (PSFS) and to investigate differences between individuals receiving primary care and individuals receiving secondary care.

METHODS

In this cross-sectional study located in a primary and secondary care outpatient clinic, a total of 177 individuals seeking care for shoulder pain (84 from primary care and 93 from secondary care) were recruited. Background variables, pain, physical activity, and PSFS responses were collected using a questionnaire software package. Meaningful concepts were linked from the PSFS responses to the International Classification of Functioning, Disability and Health (ICF) according to established rules. Frequencies for the ICF categories were estimated separately for primary care and secondary care. Differences between primary care and secondary care were investigated by calculating CIs for the sample proportions at ICF chapter level.

RESULTS

The primary care sample reported functional problems linked to 226 ICF categories, whereas the secondary care sample reported functional problems linked to 337 ICF categories. Of the linked ICF categories, 87.7% belonged to the Activities and Participation component of the ICF. Seventeen categories were identified in >3% of the individuals; of those, the most frequent categories were recreation and leisure, lifting and carrying objects, doing housework, hand and arm use, and remunerative employment. Categories included in the ICF chapters of self-care and domestic life were significantly more frequent in the secondary care sample, whereas there was a trend that neuromusculoskeletal and movement-related functions were more frequent in primary care.

CONCLUSION

The present findings indicate that individuals with shoulder pain report a wide range of functional problems, from basic functions related to mobility to activities related to work and leisure. This study also discovered differences between patients in primary care and secondary care. The large variation in the experiences between people supports the use of an individualized measure in assessments.

IMPACT

This study adds new knowledge about problems in functioning among people with shoulder pain and how the individual experience varies between primary care and secondary care settings. Moreover, the content analyses used in this study showed the full potential of the ICF classification and should have potential for further application.

Content validity of the Brief and Comprehensive ICF Core Sets for common disabling conditions in a developing country

The International Classification of Functioning, Disability and Health (ICF) features associated tools, the Brief and Comprehensive ICF Core Sets. These are designed to be universally applicable, but have limited evidence of content validity (i.e. comprehensiveness and relevance) in low income, non-Western countries. In this cross-sectional study, we aimed to assess the content validity of the ICF Core Sets in Nepal. We interviewed 161 participants with stroke, spinal cord injury (SCI), chronic obstructive pulmonary disease (COPD), and musculoskeletal conditions and asked them to identify activities they had difficulty performing due to their health condition. We mapped 544 participant responses to the ICF and assessed if these ICF categories were represented in the respective ICF core sets. The Comprehensive Core Sets for stroke, COPD, SCI, and musculoskeletal conditions contained more items identified by participants than the respective Brief Core Sets (e.g., 89% vs. 26% in stroke). Among ICF categories that represented at least 5% of participants' responses, the Brief Core Sets covered 40%-71% of participants' responses whereas the Comprehensive Core Sets covered 67%-100% of responses. This is the first study to evaluate the content validity of the ICF Brief and Comprehensive core sets in Nepali individuals with stroke, SCI, MSK conditions, and COPD. The Comprehensive Core Sets for stroke, COPD, and SCI have adequate content validity for use in clinical practice and research in Nepal; the Brief Core Sets may not adequately meet local and individual needs unless supplemented with additional ICF categories.

Cross-cultural adaptation, reliability and validity of the Turkish version of Patient-Specific Functional Scale in patients with chronic neck pain

Background/aim

Current clinical guidelines recommend to use both clinical and self-reported measurements for evaluation of chronic neck pain. Among the self-reported outcomes, Neck disability index and patient-specific functional scale are the most widely used and recommended instruments. The purpose of our study was to determine the test-retest reliability and validity of patient-specific functional scale which was not validated in Turkish language previously.

Materials and methods

Translation and adaptation process had conducted according to the Beaton et al. Sociodemographic data, Turkish version of patient-specific functional scale and neck disability index were recorded at the initial assessment. Retest assessment was produced for reliability analyses and intraclass correlation coefficient (ICC3,2) was determined. The correlations between patient-specific functional scale and neck disability index and hypothesis testing were examined for the convergent and construct validity analysis.

Results

The final form was completed by 110 chronic neck pain patients (Male: 33; mean ages: 43.13 ± 13.75 years, Female: 77; mean ages: 44.45 ± 14.38). Test-retest reliability of patient-specific functional scale was found good level (ICC: 0.85). The relationship between patient-specific functional scale and neck disability index was found moderate level (P < 0.05, rho: –0.578). The median score of PSFS-T in the low disability group was significantly higher than the high disability group in the hypothesis testing of construct validity (P < 0.001).

Conclusion

The Turkish version of the patient-specific functional scale is a valid and reliable scale for evaluating functional status in patients with chronic neck pain.

Responsiveness and minimal important change of the QuickDASH and PSFS when used among patients with shoulder pain

Background

The Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) and the Patient-Specific Functional Scale (PSFS) are commonly used outcome instruments for measuring self-reported disability in patients with shoulder pain. To date, few studies have evaluated the responsiveness and estimated their minimal important change (MIC). Further assessment will expand the current knowledge and improve the interpretability of these instruments in clinical and research practice. The purpose of this prospective cohort study with 3 months follow-up was to evaluate the responsiveness of the QuickDASH and PSFS in patients with shoulder pain, and to estimate their MICs by using two different anchor-based methods.

Methods

Patients with shoulder pain recruited at a multidisciplinary hospital outpatient clinic completed the QuickDASH and PSFS at baseline and at 3 months follow-up. The responsiveness was evaluated by using a criterion approach with the area under the receiver operating characteristic curve (AUC) and a construct approach by testing 9 a-priori hypotheses. The MIC was assessed using two anchor-based MIC methods.

Results

134 patients participated at baseline and 117 (87.3%) at 3 months follow-up. The AUC was acceptable for both QuickDASH (0.75) and PSFS (0.75). QuickDASH met 7 (77.8%) and PSFS 8 (88.9%) of the hypotheses. None of the instruments showed signs of floor and ceiling effects. The MIC estimates ranged from 10.8 to 13.6 for QuickDASH and from 1.9 to 2.0 for PSFS, depending on the method used.

Conclusion

This study demonstrates that both the QuickDASH and PSFS are responsive measures of disability in patients with shoulder pain. The estimated MIC values were presented.

Patient's satisfaction beyond hand function in Dupuytren's disease: analysis of 1106 patients

This study investigates the outcomes of 1106 patients with Dupuytren's disease treated with limited fasciectomy or percutaneous needle fasciotomy over 16 years according to the different domains of patient-reported hand function. These patients completed the Michigan Hand Outcomes Questionnaire before and 3 months after surgery. Scores for the various outcome parameters were calculated and linear regression analyses were used to examine associations between the changes in digital extension deficit and change in Michigan Hand Outcomes Questionnaire (sub)scores. We found the largest effects of surgical treatment in the decreases in extension deficit, the appearance of the hand, and the satisfaction with the hand function. However, associations between different domains of evaluation were weak. We conclude that improvement of digital extension deficits is not parallel to varying aspects of patient satisfaction. The findings underline the importance of assessing domains relating to patient satisfaction other than objective hand function measures in Dupuytren's disease. Level of evidence: IV.

Activity and Exercise Intolerance After Concussion: Identification and Management of Postural Orthostatic Tachycardia Syndrome

Supplemental Digital Content is Available in the Text.

Background and Purpose:

Postural orthostatic tachycardia syndrome (POTS) is increasingly recognized as a complication affecting recovery from concussion. Individuals with POTS demonstrate refractory dizziness, lightheadedness, cognitive dysfunction, fatigue, headache, chronic pain, nausea and gastrointestinal dysmotility, activity and exercise intolerance, syncope, and tachycardia. Subtypes of POTS may include hypovolemia, hyperadrenergic states, autonomic neuropathy, and underlying autoimmunity, which may variably impact response to rehabilitation in varying ways. The subtle presentation of POTS postconcussion is often mistaken for underlying anxiety, conversion disorder, or lack of motivation for recovery. This article will present clinical features of POTS that may arise after concussion, and propose a role for physical therapists in the diagnosis and management of POTS during concussion recovery.

Summary of Key Points:

Data recorded and entered into a database during clinic visits from a large pediatric institution indicate that 11.4% of individuals diagnosed with POTS report onset of symptoms within 3 months of sustaining a concussion. Activation of the sympathetic nervous system can result in lightheadedness, shortness of breath, chest pain, tachycardia, palpitations on standing or with exertion, and activity and exercise intolerance. Identified comorbidities in people with POTS such as joint hypermobility and autoimmune disorders can further influence recovery.

Recommendations for Clinical Practice:

Physical therapists may identify signs and symptoms of POTS in a subset of individuals who remain refractory to typical interventions and who exhibit symptom exacerbation with orthostatic activity. Incorporation of an individualized POTS exercise program into current established concussion interventions may be useful, with emphasis on initial recumbent exercises and ongoing physical therapy assessment of exercise tolerance for dosing of activity intensity and duration.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A211).

Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial

BACKGROUND

Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes.

METHODS

In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice.

RESULTS

80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes.

CONCLUSION

This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.

The content and construct validity of the modified patient specific functional scale (PSFS 2.0) in individuals with neck pain

Study design: Clinical measurement study.Background: The Patient Specific Functional Scale (PSFS) is a commonly used outcome measure, however answering options differ and content validity has yet to be assessed.Objective: To assess the content validity of the PSFS in patients with neck pain presenting to a physical therapist. And secondly, to assess the construct validity of the PSFS using the preferred version identified in the content validity study.Methods: The target population consisted of patients with neck pain presenting to physical therapy. First, content validity was assessed through semi structured interviews and content thematic analysis. Second, construct validity was assessed on the PSFS 2.0 by examining its correlation with the Neck Disability Index (NDI).Results: Eleven patients were interviewed. Patients indicated the concept of 'activity limitations' is very important to them. The PSFS is considered to be relevant and easy to understand. Patients had an explicit preference for the PSFS 2.0 version (using a different answering option and example list) and indicated they preferred to answer the PSFS 2.0 together with a clinician. One hundred patients participated in the construct validity study on the PSFS 2.0. The median PSFS 2.0 score was 4.5 and the correlation with the NDI was substantial (0.54).Conclusion: The results of this study indicate that in individuals with neck pain, the PSFS is appropriate however; PSFS 2.0 is the preferred version. The PSFS 2.0 is considered to be valid in terms of content validity and construct validity for patients with neck pain.

Cross-cultural Adaptation and Validation of the Nepali Translation of the Patient-Specific Functional Scale

Background The Patient-Specific Functional Scale (PSFS) is among the most commonly used measures to assess physical function. Objectives We aimed to translate and cross-culturally validate the PSFS to Nepali and further assess its psychometric properties. Methods This longitudinal, single-arm cohort study translated and cross-culturally adapted the PSFS to Nepali (PSFS-NP) following recommended guidelines. A sample of 104 Nepalese with musculoskeletal pain was recruited to evaluate the psychometric properties of the PSFS-NP. We assessed the internal consistency (Cronbach alpha), 2-week test-retest reliability (intraclass correlation coefficient [ICC_3,2]), the smallest detectable change at the 90% confidence interval (CI), and construct validity. Concurrent validity was assessed against the Nepali versions of the Oswestry Disability Index, global rating of change, and numeric pain-rating scale. Receiver operating characteristic curves were plotted to measure responsiveness and area under the curve, and the minimum important change (MIC) was estimated. Results The PSFS-NP showed good reliability, with a Cronbach alpha of .75, an ICC of 0.89 (95% CI: 0.78, 0.94), and a smallest detectable change at the 90% CI of 1.46. It demonstrated significant correlations with the Nepali versions of the Oswestry Disability Index (r = -0.47, P = .001), global rating of change (r = 0.71, P<.001), and numeric pain-rating scale (r = -0.32 and -0.55, P<.001). Areas under the curve ranged from 0.72 to 0.99. The MIC was 2.00 in the main analysis. Secondary analyses revealed MICs of 0.50, 0.66, and 2.00 for small, medium, and large improvement, respectively. Conclusion The PSFS-NP is a reliable, valid, and responsive measure. It can be used in clinical practice and research in Nepalese with musculoskeletal pain. J Orthop Sports Phys Ther 2018;48(8):659-664. Epub 6 Apr 2018. doi:10.2519/jospt.2018.7925.

Relationship of the Patient-Specific Functional Scale to commonly used clinical measures in hand osteoarthritis

STUDY DESIGN

Prospective cohort correlation study.

INTRODUCTION

There is no known published research on correlations between the Patient-Specific Functional Scale (PSFS), hand grip strength, and the Disability of the Arm, Shoulder and Hand (DASH) in a population with hand osteoarthritis (OA).

PURPOSE

The purpose of this study is to establish reliability of the PSFS and to evaluate the relationship between the PSFS, hand grip strength, and the DASH for a population with hand OA.

METHODS

Thirty-five participants in 4 hand clinics completed the PSFS, hand grip strength testing, and the DASH at the onset of therapy and at discharge. Eighteen participants enrolled at the primary investigator's site completed a baseline PSFS one week before the pretreatment collection with data used to establish relative and absolute reliability. Data were analyzed separately at pretreatment and posttreatment with Spearman's rho correlation (P < .05). Intraclass correlation (2, 1), standard error of the measurement, and minimum detectable change (MDC90 and MDC95) were calculated from the repeated baseline and pretreatment PSFS.

RESULTS

Intraclass correlation for PSFS was (r = 0.80) with the standard error of the measurement = 0.56, MDC90 = 1.30, and MDC95 = 1.56. Small correlation between the PSFS and DASH scores was found pretreatment (ρ = -0.10) and change scores (ρ = 0.13).

CONCLUSION

Excellent reliability with small measurement error has established clinical utility of the PSFS for the population with hand OA. These outcome measures were shown to measure different constructs and therefore should not be used interchangeably.

LEVEL OF EVIDENCE

3.

Arthroscopic Surgical Procedures Versus Sham Surgery for Patients With Femoroacetabular Impingement and/or Labral Tears: Study Protocol for a Randomized Controlled Trial (HIPARTI) and a Prospective Cohort Study (HARP)

Study Design Study protocol for a randomized controlled trial and a prospective cohort. Background The number of arthroscopic surgical procedures for patients with femoroacetabular impingement syndrome (FAIS) has significantly increased worldwide, but high-quality evidence of the effect of such interventions is lacking. Objectives The primary objective will be to determine the efficacy of hip arthroscopic procedures compared to sham surgery on patient-reported outcomes for patients with FAIS (HIP ARThroscopy International [HIPARTI] Study). The secondary objective will be to evaluate prognostic factors for long-term outcome after arthroscopic surgical interventions in patients with FAIS (Hip ARthroscopy Prospective [HARP] Study). Methods The HIPARTI Study will include 140 patients and the HARP Study will include 100 patients. The international Hip Outcome Tool-33 will be the primary outcome measure at 1 year. Secondary outcome measures will be the Hip disability and Osteoarthritis Outcome Score, Arthritis Self-Efficacy Scale, fear of movement (Tampa Scale of Kinesiophobia), Patient-Specific Functional Scale, global rating of change score, and expectations. Other outcomes will include active hip range of motion, hip muscle strength tests, functional performance tests, as well as radiological assessments using radiographs and magnetic resonance imaging. Conclusion To determine the true effect of surgery, beyond that of placebo, double-blinded placebo-controlled trials including sham surgery are needed. The HIPARTI Study will direct future evidence-based treatment of FAIS. Predictors for long-term development and progression of degenerative changes in the hip are also needed for this young patient group with FAIS; hence, responders and nonresponders to treatment could be determined. J Orthop Sports Phys Ther 2018;48(4):325-335. doi:10.2519/jospt.2018.7931.

Neck Pain: Revision 2017

The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to neck pain. J Orthop Sports Phys Ther. 2017;47(7):A1-A83. doi:10.2519/jospt.2017.0302.

Patient-centered evaluation of home-based rehabilitation developed using community-based participatory research approach for people with disabilities: a case series

PURPOSE

The purpose of this study was to evaluate the effectiveness of the locally tailored and individualized home-based rehabilitation (HBR) program developed using the community-based participatory research (CBPR) approach, in terms of perceived health in patients with different levels of social engagement, and to explore the perceived facilitators and barriers to rehabilitation.

METHOD

A concurrent mixed-method design was employed. Four patients participated in the combined therapist- and self-delivered HBR program for 5 months. The perceived health outcomes were quantitatively assessed at baseline, after the therapist-delivered intervention period, and at 1 and 3 months after the self-delivered intervention period. Then, in-depth individual interviews were conducted to explore the facilitators and barriers to rehabilitation.

RESULTS

The perceived health of patients who were fully or partially engaged in society was increased during the therapist-delivered intervention period, and maintained the increased level during the self-delivered intervention period, whereas that of patients who were rarely or not engaged dropped again to lower than the baseline. These results were caused by differentiated facilitators and barriers to rehabilitation depending on the level of social engagement.

CONCLUSIONS

Applying tailored strategies to patients with differing levels of social engagement is recommended to further optimize the local relevance of the HBR program. Implications for rehabilitation A community-based participatory research approach can provide an opportunity to enhance local relevance through community-academic partnerships, in developing a home-based rehabilitation (HBR) program for the people with disabilities. For community therapists, enhancing the local relevance of the HBR program, applying tailored strategies to patients with differing levels of social engagement is recommended because the perceived health of the HBR program can be different owing to differing perceived facilitators and barriers to rehabilitation, depending on the level of social engagement. For patients with rare or no engagement in society, satisfying their need for interaction with the therapists and helping them cope with their wrong belief about the possibility of their recovery is important to encourage behavioral change and perceived physical improvements.

Which assessment tools address the categories of the Brief ICF Core Set for Hand Conditions?

Introduction

The purpose of this study was to explore whether assessment tools address aspects that are relevant according to the Brief ICF Core Set for Hand Conditions (BICF-CS).

Methods

Assessment tools meant to assess functioning and/or environmental factors in adults with hand conditions were reviewed. MEDLINE and CINAHL databases, previously published reviews, the book Clinical Assessment Recommendations of the ASHT, and websites of assessment tools were used for the content comparison and linking to the 23 categories of the BICF-CS. The updated version of the linking rules was applied by two reviewers.

Results

Forty-six assessment tools, known within the areas of hand therapy and hand surgery, were linked to the 23 categories of the BICF-CS. Regarding Body functions and body structures, the categories that were most frequently addressed were b730 “Muscle power functions,” b280 “Sensation of pain,” b710 “Mobility of joint functions, ” and s730 “Structure of upper extremity. ” Regarding Activities and Participation, d440 “Fine hand use” was addressed mostly and 25 assessment tools (with a total of 146 items) were linked to this category. Regarding Environmental Factors, only one assessment tool was identified that could be linked to two categories. Fifteen points of discussion were encountered in the linking process.

Conclusions

Content comparison of 46 assessment tools revealed that 19 of the 23 categories of the BICF-CS were addressed. The environmental factors were hardly addressed.

Validity and sensitivity to change of the Patient Specific Functional Scale used during rehabilitation following proximal humeral fracture

PURPOSE

To describe content validity, concurrent validity, sensitivity to change, internal consistency and the outcome distribution of the Patient Specific Functional Scale (PSFS) in patients with proximal humeral fracture.

METHOD

Fifty-three patients with proximal humeral fracture treated conservatively or surgically with plate and screw or intramedullary nail were recruited 6 weeks (±1 week) post-trauma or post-surgery. The following assessments were used: the PSFS, patient global score, shoulder function assessment, grip strength and Western Ontario Osteoarthritis of the shoulder Index (WOOS), before start of (n = 53) and after (n = 22) 2-3 months of group rehabilitation.

RESULTS

In total, 96% of the activities stated in the PSFS was classified in the International Classification of Functioning, Disability and Health activity component and 62% were found in the WOOS. Correlations between measures were low. The PSFS was highly sensitive to change to a period of group rehabilitation. All questions of the PSFS contributed to the total score. Both floor and ceiling effects could be noted.

CONCLUSION

The PSFS shows satisfying measurement properties and may be a useful complement in the evaluation of individual changes during a period of rehabilitation after proximal humeral fracture.

IMPLICATIONS FOR REHABILITATION

The PSFS assesses on activity level in patients with proximal humeral fracture. The PSFS is sensitive to change for group rehabilitation after humeral fracture. The PSFS can be useful for goal-setting, motivating and individually tailoring rehabilitation activities. The PSFS should be used in addition to specific measures of body functions and general health.

Individualized low-load motor control exercises and education versus a high-load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial

STUDY DESIGN

Randomized controlled trial.

BACKGROUND

Low back pain is a common disorder. Patients with low back pain frequently have aberrant and pain-provocative movement patterns that often are addressed with motor control exercises.

OBJECTIVE

To compare the effects of low-load motor control (LMC) exercise and those of a high-load lifting (HLL) exercise.

METHODS

Seventy participants with recurrent low back pain, who were diagnosed with nociceptive mechanical pain as their dominating pain pattern, were randomized to either LMC or HLL exercise treatments. Participants were offered 12 treatment sessions over an 8-week period. All participants were also provided with education regarding pain mechanisms.

METHODS

Participants were assessed prior to and following treatment. The primary outcome measures were activity (the Patient-Specific Functional Scale) and average pain intensity over the last 7 days (visual analog scale). The secondary outcome measure was a physical performance test battery that included 1 strength, 3 endurance, and 7 movement control tests for the lumbopelvic region.

RESULTS

Both interventions resulted in significant within-group improvements in pain intensity, strength, and endurance. The LMC group showed significantly greater improvement on the Patient-Specific Functional Scale (4.2 points) compared with the HLL group (2.5 points) (P<.001). There were no significant between-group differences in pain intensity (P=.505), strength, and 1 of the 3 endurance tests. However, the LMC group showed an increase (from 2.9 to 5.9) on the movement control test subscale, whereas the HLL group showed no change (from 3.9 to 3.1) (P<.001).

CONCLUSION

An LMC intervention may result in superior outcomes in activity, movement control, and muscle endurance compared to an HLL intervention, but not in pain intensity, strength, or endurance. Registered at ClinicalTrials.gov (NCT01061632).

LEVEL OF EVIDENCE

Therapy, level 2b-.

Conceptualizing disability in US national surveys: application of the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) framework

PURPOSE

Disability data inform resource allocation and utilization, characterize functioning and changes over time, and provide a mechanism to monitor progress toward promoting and protecting the rights of individuals with disability. Data collection efforts, however, define and measure disability in varied ways. Our objective was to see how the content of disability measures differed in five US national surveys and over time.

METHODS

Using the WHO ICF as a conceptual framework for measuring disability, we assessed the National Health Interview Survey (NHIS), Current Population Survey (CPS), Survey of Income and Program Participation (SIPP), National Survey of SSI Children and Families (NSCF), and American Community Survey (ACS) for their content coverage of disability relative to each of the four ICF components (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify question content into categories within each ICF component and computed the proportion of categories within each ICF component that was represented in the questions selected from these five surveys.

RESULTS

The disability measures varied across surveys and years. The NHIS captured a greater proportion of the ICF body functions and body structures components than did other surveys. The SIPP captured the most content of the ICF activities and participation component, and the NSCF contained the most content of the ICF environmental factors component.

CONCLUSIONS

This research successfully illustrated demonstrated the utility of the ICF in examining the content of disability measures in five national surveys and over time.

Effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes: a randomized clinical trial

BACKGROUND

Exercise training is effective for improving physical fitness and physical function in people with type 2 diabetes. However, limited research has been conducted on the optimal exercise training intensity for this population.

OBJECTIVE

The primary study objective was to investigate the effects of moderate- versus high-intensity exercise training on physical fitness and physical function in people with type 2 diabetes.

DESIGN

This was a randomized clinical trial.

SETTING

The setting was a university campus.

PARTICIPANTS

Twenty-one people with type 2 diabetes were randomly allocated to receive either moderate-intensity training (MOD group) or high-intensity training (HIGH group).

INTERVENTION

The MOD group performed resistance training at an intensity of 75% of the 8-repetition maximum (8-RM) and aerobic training at an intensity of 30% to 45% of the heart rate reserve (HRR). The HIGH group performed resistance training at an intensity of 100% of the 8-RM and aerobic training at an intensity of 50% to 65% of the HRR.

MEASUREMENTS

Muscle strength (peak torque [newton-meters]), exercise capacity (graded exercise test duration [minutes]), and physical function (Patient-Specific Functional Scale questionnaire) were measured at baseline and 3 months later. Acute exercise-induced changes in glucose levels were assessed immediately before exercise, immediately after exercise, and 1 hour after exercise during the first exercise training session.

RESULTS

Although both groups showed improvements in physical fitness and physical function, the between-group effect sizes were not statistically significant (exercise capacity estimated marginal mean [EMM] difference=2.1, 95% confidence interval [95% CI]=-0.2, 4.5; muscle strength EMM difference=20.8, 95% CI=-23.3, 65.0; and physical function EMM difference=0.1, 95% CI=-0.6, 0.9). Mean percent changes in glucose levels measured immediately before exercise and immediately after exercise, immediately after exercise and 1 hour after exercise, and immediately before exercise and 1 hour after exercise for the MOD group were -11.4%, -5.0%, and -15.8%, respectively; those for the HIGH group were -21.5%, 7.9%, and -15.3%, respectively.

LIMITATIONS

Sample size, lack of outcome assessor masking, and physical function measurement subjectivity were limitations.

CONCLUSIONS

Moderate- and high-intensity exercise training, as defined in this study, may lead to similar improvements in physical fitness and physical function in people with type 2 diabetes.

The effect of work-based mentoring on patient outcome in musculoskeletal physiotherapy: study protocol for a randomised controlled trial

BACKGROUND

Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of postgraduate clinical mentoring on physiotherapist performance have been assessed, but the impact of this mentoring on patient outcomes remains unknown. The objective of this trial is to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes in musculoskeletal physiotherapy.

METHODS/DESIGN

A stepped wedge cluster randomised controlled trial (CRCT) has been designed to recruit a minimum of 12 senior physiotherapists who work in musculoskeletal outpatient departments of a large National Health Service (NHS) organization. Participating physiotherapists will be randomised by cluster to receive the intervention at three time periods. Patients will be blinded to whether their physiotherapist has received the intervention. The primary outcome measure will be the Patient-Specific Functional Scale; secondary outcome measures will include the EQ-5D, patient activation, patient satisfaction and physiotherapist performance. Sample size considerations used published methods describing stepped wedge designs, conventional values of 0.80 for statistical power and 0.05 for statistical significance, and pragmatic groupings of 12 participating physiotherapists in three clusters. Based on an intergroup difference of 1.0 on the PSFS with a standard deviation of 2.0, 10 patients are required to complete outcome measures per physiotherapist, at time period 1 (prior to intervention roll-out) and at each of time periods 2, 3 and 4, giving a sample size of 480 patients. To account for the potential loss to follow-up of 33%, 720 sets of patient outcomes will be collected.All physiotherapist participants will receive 150 hours of mentored clinical practice as the intervention and usual in-service training as control. Consecutive, consenting patients attending treatment by the participating physiotherapists during data collection periods will complete outcome measures at baseline, discharge and 12 months post-baseline. The lead researcher will be blinded to the allocation of the physiotherapist when analyzing outcome data; statistical analysis will involve classical linear models incorporating both an intervention effect and a random intercept term to reflect systematic differences among clusters.

TRIAL REGISTRATION

Assigned 31 July 2012: ISRCTN79599220.

Introduction to Special Issue: A Review of the International Classification of Functioning, Disability and Health and Physical Therapy over the Years

BACKGROUND AND PURPOSE

The International Classification of Functioning, Disability and Health (ICF) of the World Health Organization was developed as a common framework to understand health and to describe the impact of health condition on functioning. The purpose of this paper is to summarize the literature on the use of the ICF in physical therapy practice and research.

METHODS

We performed a scoping-narrative review and searched for relevant English language articles from 2001 to 2012 in multiple databases that included MEDLINE, PsycINFO, PubMed and Physiotherapy Evidence Database. Our keywords for the search consisted of ['physical therapy' OR 'physiotherapy'] AND ['ICF']. All types of articles were considered.

RESULTS

We found 268 articles; out of which, 79 were reviewed. The years with most publications were 2011 (n = 16), 2008 (n = 15) and 2010 and 2012 (both with n = 13). Publications mostly came from the United States with 27% of the articles. The journal Physical Therapy leads with almost a third of ICF-related physical therapy publications. The ICF has been mostly used in studies of musculoskeletal and neuromuscular conditions. We found a wide array of application of the ICF in research, clinical practice and teaching (classroom and clinical education). Emerging topics included using the ICF in resource allocation and prevention and wellness.

CONCLUSION

The use of the ICF in physical therapy practice and research is promising and continues to evolve. With recent developments in ICF-based measurement and integration in assessment tools for use in the clinics, research and teaching, the need to show the added value of using the ICF in practice and research remains.

Functional improvements desired by patients before and in the first year after total hip arthroplasty

BACKGROUND

In the field of rehabilitation, patients are supposed to be experts on their own lives, but the patient's own desires in this respect are often not reported. Our objectives were to describe the patients' desires regarding functional improvements before and after total hip arthroplasty (THA).

METHODS

Sixty-four patients, 34 women and 30 men, with a mean age of 65 years, were asked to describe in free text which physical functions they desired to improve. They were asked before surgery and at three and 12 months after surgery. Each response signified one desired improvement. The responses were coded according to the International Classification of Functioning, Disability and Health (ICF) to the 1st, 2nd and 3rd category levels. The frequency of the codes was calculated as a percentage of the total number of responses of all assessments times and in percentage of each time of assessment.

RESULTS

A total of 333 responses were classified under Part 1 of the ICF, Functioning and Disability, and 88% of the responses fell into the Activities and Participation component. The numbers of responses classified into the Activities and Participation component were decreasing over time (p < 0.001). The categories of Walking (d450), Moving around (d455), and Recreation and leisure (d920) included more than half of the responses at all the assessment times. At three months after surgery, there was a trend that fewer responses were classified into the Recreation and leisure category, while more responses were classified into the category of Dressing (d540).

CONCLUSIONS

The number of functional improvements desired by the patients decreased during the first postoperative year, while the content of the desires before and one year after THA were rather consistent over time and mainly concerned with the ability to walk and participate in recreation and leisure activities. At three months, however, there was a tendency that the patients were more concerned about the immediate problems with putting on socks and shoes.

Validity and reliability of the Swedish version of the Patient Specific Functional Scale in patients treated surgically for carpometacarpal joint osteoarthritis

DESIGN

Cross-sectional clinical measurements.

INTRODUCTION

Activity limitation is often persistent after surgically treated carpometacarpal (CMC) joint osteoarthritis (OA).

PURPOSE

To describe content and concurrent validity, test-retest reliability and internal consistency of the Swedish version of the Patient Specific Functional Scale (PSFS) in patients with surgically treated CMC joint OA.

METHODS

Fifty-eight patients were assessed ten weeks after surgical treatment of CMC joint OA. PSFS, the shorter version of Disabilities of the Arm, Shoulder and Hand (Quick DASH), EuroQol-5Dimensions (EQ-5D), pain intensity, joint movement of CMC joint, grip and pinch strength were assessed. Classification of activities was done according to the International Classification of Functioning, Disability and Health (ICF). Spearman correlation, intra-class correlation coefficient (ICC) and Kappa were calculated to assess validity, test-retest reliability and internal consistency. The PSFS was administered twice, 2-3 days apart.

RESULTS

All of the activity limitations stated in the PSFS could be classified according to the activity component in the ICF. Significant correlations for the PSFS were obtained with pain at rest (r(s) = -0.36) and the Quick DASH (r(s) = -0.28). Test-retest reliability was good, ICC (0.79) and the three items of the PSFS correlated 0.69-0.83 with the total score of PSFS.

CONCLUSION

Content validity was excellent, concurrent validity was low-moderate, as in earlier studies. The PSFS could be a valuable supplement to existing measures in measuring activity limitations in individuals with surgically treated CMC joint OA.

LEVEL OF EVIDENCE

Not applicable.

Linking self-determined functional problems of patients with neck pain to the International Classification of Functioning, Disability, and Health (ICF)

OBJECTIVE

To describe commonly reported self-determined functional problems in patients with neck pain and to evaluate their fit to the components of the International Classification of Functioning, Disability, and Health (ICF).

METHODS

Overall, 249 patients were included in this cross-sectional study that comprised patients with neck pain referred to the outpatient clinic at Oslo University Hospital (2007-2009). Patients were asked to report their three most significant functional problems on the Patient-Specific Functional Scale, a self-determined measure of function. The ICF was used as a tool for analysis. Meaningful concepts within the functional problems were identified, coded, and linked to second-level categories within the components of "body functions," and "activities and participation." Two researchers performed coding and linking independently. The ICF categories were presented by percentage of the total number of functional problems linked to the ICF.

RESULTS

Of 628 reported functional problems, 13 meaningful ICF domains were identified: four domains belonging to the body functions component (b) and nine domains belonging to activities and participation components (d). Within the 88 second-level ICF classification categories of body functions, the most frequently reported items were sleep function (b134; 27%) and mobility of joint functions (b710; 26%). Within the 538 second-level categories of activities and participation, remunerative employment was reported as the most frequent item (d850; 15%), closely followed by doing housework (d640; 14%), and recreation and leisure activities (d920; 13%). Only two meaningful concepts, described as "be active" and "to function after activities," were not assigned to a specific ICF category.

CONCLUSION

The majority of the specific functional problems presented by patients in this study showed a good fit with the ICF model. The substantial number of links to the activities and participation categories, such as mobility, domestic life, employment, and social and civic life, suggests that a comprehensive approach, as well as the involvement of a multidisciplinary team, should be present in the rehabilitation of neck pain-related disability.