Absolute and relative intrarater reliability of the modified motor assessment scale according to Uppsala academic hospital -99

BACKGROUND

For some of the most commonly used motor measures, psychometric properties, and minimal detectable change (MDC95) remain largely unknown, limiting the interpretability of tests.

OBJECTIVE

The aim was to establish intrarater reliability, MDC95 and floor- and ceiling effects for a modified version of the Motor Assessment Scale (M-MAS UAS-99).

METHODS

Data was derived from an intervention study that enrolled 41 individuals with chronic stroke. Test scores from two subsequent assessments with 3 weeks apart were used for establishing the floor and ceiling effect, the intraclass correlation coefficient (ICC[2,1]), standard error mean (SEM) and the MDC95 for the total score, and subdomains of the M-MAS UAS-99.

RESULTS

The intrarater reliability was excellent with an ICC[2,1] between 0.970 and 0.995 for both total score and subdomains. The MDC95 for the M-MAS UAS-99 total score was 1.22 which means ≥ 2.0 points on an individual basis. For bed mobility subdomain, a ceiling effect was seen, but not for the total score of the test. No floor effect was seen for the test.

CONCLUSION

M-MAS UAS-99 has excellent intrarater reliability. Any individual increase in test scores must reach 2.0 to be considered a true change.

Effects of enriched task-specific training on sit-to-stand tasks in individuals with chronic stroke

BACKGROUND

Approximately 80% of stroke survivors experience motor impairment of the contralateral limb that severely affects their activities of daily living (ADL).

OBJECTIVE

To evaluate whether an enriched task-specific training (ETT) program affected the performance and kinetics of sit-to-stand (STS) tasks.

METHODS

The study was part of an exploratory study with a within-subject, repeated-measure-design, with assessments before and after a three-week-long baseline period, and six months after the intervention. Forty-one participants underwent assessments of strength and endurance measured by the 30-second-chair-stand test (30sCST). The STS-kinetics, including the vertical ground reaction force (GRF) during STS, were analysed in an in-depth-subgroup of three participants, using a single-subject-experimental-design (SSED). For kinetic data, statistical significance was determined with the two-standard deviation band method (TSDB).

RESULTS

After the baseline period, a small increase was seen in the 30sCST (from 5.6±4.5 to 6.1±4.9, p = 0.042). A noticeable significant change in the 30sCST was shown after the intervention (from 6.1±4.9 to 8.2±5.4, p < 0.001), maintained at six months. The in-depth kinetic analyses showed that one of three subjects had a significant increase in loading of the affected limb post-intervention.

CONCLUSION

ETT can produce long-term gains in STS performance. Weight-bearing strategies could be one of several factors that contribute to improvements in STS performance in the chronic phase after stroke.

The impact of upper limb spasticity-correcting surgery on the everyday life of patients with disabling spasticity: a qualitative analysis

PURPOSE

The aim of this study was to explore the patient perspective of their experiences of daily life after spasticity-correcting surgery for disabling upper limb (UL) spasticity after spinal cord injury (SCI) and stroke.

MATERIALS AND METHODS

Eight patients with UL spasticity resulting from SCI (n= 6) or stroke (n= 2) were interviewed 6-9 months after spasticity-correcting surgery. A phenomenographic approach was used to analyze the interviews.

RESULTS

Five themes emerged from the interviews: (1) bodily changes, such as increased muscle strength, range of motion, and reduced muscle-hypertonicity; (2) improved occupational performance, facilitating tasks, mobility, and self-care; (3) regained control, explicating the perception of regaining bodily control and a more adaptable body; (4) enhanced interpersonal interactions, entailing the sense of being more comfortable undertaking social activities and personal interactions; and (5) enhanced psychological well-being, including having more energy, increased self-esteem, and greater happiness after surgery.

CONCLUSIONS

The participants experienced improvements in their everyday lives, including body functions, activities, social life, and psychological well-being. The benefits derived from surgery made activities easier, increased occupational performance, allowed patients regain their roles and interpersonal interactions, and enhanced their psychological well-being.Implications for rehabilitationSpasticity-correcting surgery benefits patients by improving bodily functions, which in turn, enable gains in activities, social life, and psychological well-being.Patients' experiences of increased body functions, such as enhanced mobility and reduced muscle hypertonicity, appear to increase the sense of bodily control.The surgery can increase participation and psychological well-being, even for patients whose functional or activity level did not improve after the treatment.The benefits expressed by the individuals in this study can be used to inform, planning, and in discussion with patients and other healthcare professionals about interventions targeting spasticity.

Comfortable and Maximum Gait Speed in Individuals with Chronic Stroke and Community-Dwelling Controls

BACKGROUND

The relationship between maximum and comfortable gait speed in individuals with mild to moderate disability in the chronic phase of stroke is unknown.

OBJECTIVE

This study examines the relationship between comfortable and maximum gait speed in individuals with chronic stroke and whether the relationship differ from that seen in a community-dwelling elderly population. Further, we investigate the influence of age, gender, time post-stroke and degree of disability on gait speed.

MATERIALS AND METHODS

Gait speed was measured using the 10-meter walk test (10MWT) and the 30-meter walk test (30MWT) in 104 older individuals with chronic stroke and 154 community-dwelling controls, respectively.

RESULTS

We found that the maximum gait speed in individuals with stroke could be estimated by multiplying the comfortable speed by 1.41. This relationship differed significantly from that of the control group, for which the corresponding factor was 1.20. In the stroke group, age, gender and time post-stroke did not affect the relationship, whereas the degree of disability was negatively correlated with maximum speed - but not when included in the multiple analysis. In the community-dwelling population, higher age and female gender had a negative relationship with maximum gait speed. When correcting for those parameters, the coefficient was 1.07.

CONCLUSIONS

The maximum gait speed in the chronic phase of stroke can be estimated by multiplying the individual's comfortable gait speed by 1.41. This estimation is not impacted by age, gender, degree of disability and time since stroke. A similar but weaker relationship can be seen in the community-dwelling controls.

Arm activity measure (ArmA): psychometric evaluation of the Swedish version

Background

Patient Reported Outcomes Measure (PROM) are commonly used in research and essential to understand the patient experience when receiving treatment. Arm Activity Measure (ArmA) is a valid and reliable self-report questionnaire for assessing passive (section A) and active (section B) real-life arm function in patients with disabling spasticity. The original English version of ArmA has been psychometrically tested and translated into Thai.

Aims

Translate and cross-culturally adapt ArmA to Swedish language and context. Further, to evaluate the reliability, validity and sensitivity of the Swedish version of the questionnaire (ArmA-S) in patients with disabling upper limb spasticity caused by injuries to the central nervous system (CNS).

Materials and methods

ArmA was translated and cross-culturally adapted according to established guidelines. Validity and reliability were evaluated in 61 patients with disabling spasticity. Face and content validity was evaluated by expert opinions from clinicians and feedback from patients with upper limb spasticity. Internal consistency reliability was assessed with Cronbach’s alpha and test-retest reliability was assessed using the quadratic weighted kappa.

Results

ArmA-S was shown to be clinically feasible, with good face and content validity and no floor or ceiling effects. Internal consistency of ArmA-S was high and equivalent to ArmA; with Chronbach´s alpha coefficients values of 0.94 and 0.93 for section A and B, respectively. Test-retest reliability was good, with kappa values of 0.86 and 0.83 for section A and B, respectively. Some layout modifications of ArmA-S were made to further increase the user-friendliness, test-retest reliability, and responsiveness.

Conclusion

ArmA-S was shown to be a reliable and valid self-report questionnaire for use in clinical practice and research to assess improvements in passive and active upper limb function in patients with disabling spasticity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41687-021-00310-4.

The effects of ageing on functional capacity and stretch-shortening cycle muscle power

[Purpose] To examine the effects of age and gender in an ageing population with respect to functional decline and the relationship between muscle power and functional capacity. [Participants and Methods] The cohort (N=154) was subdivided into youngest-old (65–70 years.; n=62), middle-old (71–75 years.; n=46), and oldest-old (76–81 years.; n=46). Measures of mechanical muscle function included countermovement jump height, muscle power, leg strength and grip strength. Functional performance-based measures included heel-rise, postural balance, Timed Up and Go, and gait speed. [Results] The oldest-old performed significantly worse than the middle-old, whereas the youngest-old did not outperform the middle-old to the same extent. Increased contribution of muscle power was observed with increasing age. Males had consistently higher scores in measures of mechanical muscle function, whereas no gender differences were observed for functional capacity. [Conclusion] The age-related decline in functional capacity appears to accelerate when approaching 80 years of age and lower limb muscle power seems to contribute to a greater extent to the preservation of functional balance and gait capacity at that stage. Males outperform females in measures of mechanical muscle function independent of age, while the findings give no support for the existence of gender differences in functional capacity.

Motor Function in the Late Phase After Stroke: Stroke Survivors' Perspective

Objective

To examine the association between observer-assessed functional status and perceived recovery in the late phase after stroke. The study also aimed to determine whether observer-assessed functional improvements as a result of horse-riding therapy (H-RT) are related to enhanced perception of stroke recovery.

Methods

This is a descriptive correlational study using data derived from a three-armed randomized controlled trial in which 123 individuals were enrolled, among whom 43 received H-RT for 12 weeks. The measures included the Modified Motor Assessment Scale, Berg Balance Scale, Timed Up and Go, timed 10-m walk, and perceived recovery from stroke indicated by item #9 in the Stroke Impact Scale (version 2.0). Spearman rank order correlation (rs) was used in the analyses.

Results

There were moderate to strong positive or negative correlations between all four observer-assessed motor variables and participants’ ratings of perceived late-phase stroke recovery at trial entrance, ranging from r_s=-0.49 to r_s=0.54 (p<0.001). The results of the correlational analyses of variable changes showed that, after the end of the H-RT intervention, both self-selected and fast gait speed improvement were significantly correlated with increments in self-rated stroke recovery (r_s=-0.41, p=0.01 and r_s=-0.38, p=0.02, respectively).

Conclusion

This study provided data supporting the association between individual ratings of self-perceived recovery after stroke and observer-assessed individual motor function. The results further demonstrate that enhancement in perceived stroke recovery after completing the intervention was associated with objectively measured gains in both self-selected and fast gait speed.

Experience of enriched rehabilitation in the chronic phase of stroke

Purpose: In this study, we explored the experiences of patients who participated in an enriched task-specific therapy (ETT) program in the chronic phase after stroke.Method: Focus group interviews were conducted with twenty participants with a mean time since stroke of 30 months and mean age 61 years, who completed the ETT program including task-specific training and environmental enrichment. ETT was delivered 3.5-6 h per day, 5½ days per week for 3 weeks in a climate suitable for both indoor and outdoor activities. The training consisted of repetitive mass practice of gradually increasing difficulty. Directly after the intervention, qualitative interviews were conducted in six focus groups. The interviews were analysed with qualitative content analysis.Results: Three main categories describing the informants' experiences of the ETT program were identified. These categories were; 1. The program-different and hard - highlighting the participants view of the ETT as strenuous and different in nature; 2. My body and mind learn to know better - describing positive changes in participants' body function and functional ability as well as behavioural changes experienced throughout the ETT; and 3. The need and trust from others - emphasizing the perceived importance of trust in rehabilitation clinicians and the support of family and other participants. From these categories, a main theme emerged: It's hard but possible-but not alone!Conclusion: A therapy program including task-specific training and environmental enrichment may provide late-phase stroke survivors with perceived improvements in functional ability, knowledge insights, perceptions of rehabilitation needs and enriching emotional impacts.Implications for rehabilitationETT is feasible and may lead to perceived improvements in function and a change of mindset, even in the chronic phase after stroke.Trust in the competence of the rehabilitation staff is an important factor in compliance with the high-intensity training in the ETT program.Given the lack of stimulation and socialization among many individuals with chronic stroke, the social and physical environment are important components of the ETT program.

Effects of horse-riding therapy and rhythm and music-based therapy on functional mobility in late phase after stroke

BACKGROUND

Persons with stroke commonly have residual neurological deficits that seriously hamper mobility.

OBJECTIVE

To investigate whether horse-riding therapy (H-RT) and rhythm and music-based therapy (R-MT) affect functional mobility in late phase after stroke.

METHODS

This study is part of a randomized controlled trial in which H-RT and R-MT was provided twice weekly for 12 weeks. Assessment included the timed 10-meter walk test (10 mWT), the six-minute walk test (6 MWT) and Modified Motor Assessment Scale (M-MAS).

RESULTS

123 participants were assigned to H-RT (n = 41), R-MT (n = 41), or control (n = 41). Post-intervention, the H-RT group completed the 10 mWT faster at both self-selected (-2.22 seconds [95% CI, -3.55 to -0.88]; p = 0.001) and fast speed (-1.19 seconds [95% CI, -2.18 to -0.18]; p = 0.003), with fewer steps (-2.17 [95% CI, -3.30 to -1.04]; p = 0.002 and -1.40 [95% CI, -2.36 to -0.44]; p = 0.020, respectively), as compared to controls. The H-RT group also showed improvements in functional task performance as measured by M-MAS UAS (1.13 [95% CI, 0.74 to 1.52]; p = 0.001). The gains were partly maintained at 6 months among H-RT participants. The R-MT did not produce any immediate gains. However, 6 months post-intervention, the R-MT group performed better with respect to time; -0.75 seconds [95% CI, -1.36 to -0.14]; p = 0.035) and number of steps -0.76 [95% CI, -1.46 to -0.05]; p = 0.015) in the 10 mWT at self-selected speed.

CONCLUSIONS

The present study supports the efficacy of H-RT in producing immediate gains in gait and functional task performance in the late phase after stroke, whereas the effectiveness of R-MT is less clear.

Structural brain changes in hyperthyroid Graves' disease: protocol for an ongoing longitudinal, case-controlled study in Göteborg, Sweden-the CogThy project

INTRODUCTION

Cognitive impairment and reduced well-being are common manifestations of Graves' disease (GD). These symptoms are not only prevalent during the active phase of the disease but also often prevail for a long time after hyperthyroidism is considered cured. The pathogenic mechanisms involved in these brain-derived symptoms are currently unknown. The overall aim of the CogThy study is to identify the mechanism behind cognitive impairment to be able to recognise GD patients at risk.

METHODS AND ANALYSIS

The study is a longitudinal, single-centre, case-controlled study conducted in Göteborg, Sweden on premenopausal women with newly diagnosed GD. The subjects are examined: at referral, at inclusion and then every 3.25 months until 15 months. Examinations include: laboratory measurements; eye evaluation; neuropsychiatric and neuropsychological testing; structural MRI of the whole brain, orbits and medial temporal lobe structures; functional near-infrared spectroscopy of the cerebral prefrontal cortex and self-assessed quality of life questionnaires. The primary outcome measure is the change in medial temporal lobe structure volume. Secondary outcome measures include neuropsychological, neuropsychiatric, hormonal and autoantibody variables. The study opened for inclusion in September 2012 and close for inclusion in October 2019. It will provide novel information on the effect of GD on medial temporal lobe structures and cerebral cortex functionality as well as whether these changes are associated with cognitive and affective impairment, hormonal levels and/or autoantibody levels. It should lead to a broader understanding of the underlying pathogenesis and future treatment perspectives.

ETHICS AND DISSEMINATION

The study has been reviewed and approved by the Regional Ethical Review Board in Göteborg, Sweden. The results will be actively disseminated through peer-reviewed journals, national and international conference presentations and among patient organisations after an appropriate embargo time.

TRIAL REGISTRATION NUMBER

44321 at the public project database for research and development in Västra Götaland County, Sweden (https://www.researchweb.org/is/vgr/project/44321).

Mental Fatigue and Functional Near-Infrared Spectroscopy (fNIRS) - Based Assessment of Cognitive Performance After Mild Traumatic Brain Injury

Pathological mental fatigue after mild traumatic brain injury (TBI-MF) is characterized by pronounced mental fatigue after cognitive activity. The neurological origin is unknown, and we aimed in the present study to investigate how prolonged mental activity affects cognitive performance and its neural correlates in individuals with TBI-MF. We recruited individuals with TBI-MF (n = 20) at least 5 months after injury, and age-matched healthy controls (n = 20). We used functional near-infrared spectroscopy (fNIRS) to assess hemodynamic changes in the frontal cortex. The self-assessed mental energy level was measured with a visual analog scale (VAS) before and after the experimental procedure. A battery of six neuropsychological tests including Stroop–Simon, Symbol Search, Digit Span, Parallel Serial Mental Operation (PaSMO), Sustained Attention and Working Memory test, and Digit Symbol Coding (DSC) were used. The sequence was repeated once after an 8 min sustained-attention test. The test procedure lasted 2½ h. The experimental procedure resulted in a decrease in mental energy in the TBI-MF group, compared to controls (interaction, p < 0.001, η_p² = 0.331). The TBI-MF group performed at a similar level on both DSC tests, whereas the controls improved their performance in the second session (interaction, p < 0.01, η_p² = 0.268). During the Stroop–Simon test, the fNIRS event-related response showed no time effect. However, the TBI-MF group exhibited lower oxygenated hemoglobin (oxy-Hb) concentrations in the frontal polar area (FPA), ventrolateral motor cortex, and dorsolateral prefrontal cortex (DLPFC) from the beginning of the test session. A Stroop and Group interaction was found in the left ventrolateral prefrontal cortex showing that the TBI-MF group did have the same oxy-Hb concentration for both congruent and incongruent trials, whereas the controls had more oxy-Hb in the incongruent trial compared to the congruent trial (interaction, p < 0.01, η_p² = 0.227). In sum these results indicate that individuals with TBI-MF have a reduced ability to recruit the frontal cortex, which is correlated with self-reported mental fatigue. This may result both in deterioration of cognitive function and the experience of a mental fatigue after extended mental activity.

Phantom motor execution as a treatment for phantom limb pain: protocol of an international, double-blind, randomised controlled clinical trial

INTRODUCTION

Phantom limb pain (PLP) is a chronic condition that can greatly diminish quality of life. Control over the phantom limb and exercise of such control have been hypothesised to reverse maladaptive brain changes correlated to PLP. Preliminary investigations have shown that decoding motor volition using myoelectric pattern recognition, while providing real-time feedback via virtual and augmented reality (VR-AR), facilitates phantom motor execution (PME) and reduces PLP. Here we present the study protocol for an international (seven countries), multicentre (nine clinics), double-blind, randomised controlled clinical trial to assess the effectiveness of PME in alleviating PLP.

METHODS AND ANALYSIS

Sixty-seven subjects suffering from PLP in upper or lower limbs are randomly assigned to PME or phantom motor imagery (PMI) interventions. Subjects allocated to either treatment receive 15 interventions and are exposed to the same VR-AR environments using the same device. The only difference between interventions is whether phantom movements are actually performed (PME) or just imagined (PMI). Complete evaluations are conducted at baseline and at intervention completion, as well as 1, 3 and 6 months later using an intention-to-treat (ITT) approach. Changes in PLP measured using the Pain Rating Index between the first and last session are the primary measure of efficacy. Secondary outcomes include: frequency, duration, quality of pain, intrusion of pain in activities of daily living and sleep, disability associated to pain, pain self-efficacy, frequency of depressed mood, presence of catastrophising thinking, health-related quality of life and clinically significant change as patient's own impression. Follow-up interviews are conducted up to 6 months after the treatment.

ETHICS AND DISSEMINATION

The study is performed in agreement with the Declaration of Helsinki and under approval by the governing ethical committees of each participating clinic. The results will be published according to the Consolidated Standards of Reporting Trials guidelines in a peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT03112928; Pre-results.

Multimodal rehabilitation in the late phase after stroke enhances the life situation of informal caregivers

Purpose The burden of caregiving for stroke survivors is well known, but the effect of late stroke rehabilitation on the life situation of informal caregivers is unknown. Here, we assessed changes in the life situation of informal caregivers of stroke survivors enrolled in a multimodal intervention trial. Methods This controlled study was a questionnaire-based survey accompanying a three-armed randomized controlled trial of 123 stroke survivors. The care recipients of 106 caregivers who chose to participate were assigned to rhythm-and-music-based therapy (R-MT; n = 37), horse-riding therapy (H-RT; n = 37), or delayed intervention (control group, n = 32). Perceived changes in the life situation of the caregivers were evaluated with the Life Situation among Spouses after the Stroke Event (LISS) questionnaire before randomization, after the 12-week intervention, and 3 and 6 months later. Results After the intervention, the change in the median LISS score was significantly higher among intervention caregivers (1.5 [interquartile range (IQR) 8.8]) than controls (1.5 [IQR 8.8] vs. 0.0 [IQR 12.0], p = 0.036). The improvement was maintained at 3 months (1.5 [IQR 9.0] vs. 0.0 [IQR 10.5], p = 0.039) but not at 6 months (p = 0.284). Conclusion Engaging stroke survivors in multimodal interventions late after stroke appears to have potential to produce gains also in the general life situation of informal caregivers.

Long-Term Improvements After Multimodal Rehabilitation in Late Phase After Stroke: A Randomized Controlled Trial

BACKGROUND AND PURPOSE

Treatments that improve function in late phase after stroke are urgently needed. We assessed whether multimodal interventions based on rhythm-and-music therapy or horse-riding therapy could lead to increased perceived recovery and functional improvement in a mixed population of individuals in late phase after stroke.

METHODS

Participants were assigned to rhythm-and-music therapy, horse-riding therapy, or control using concealed randomization, stratified with respect to sex and stroke laterality. Therapy was given twice a week for 12 weeks. The primary outcome was change in participants' perception of stroke recovery as assessed by the Stroke Impact Scale with an intention-to-treat analysis. Secondary objective outcome measures were changes in balance, gait, grip strength, and cognition. Blinded assessments were performed at baseline, postintervention, and at 3- and 6-month follow-up.

RESULTS

One hundred twenty-three participants were assigned to rhythm-and-music therapy (n=41), horse-riding therapy (n=41), or control (n=41). Post-intervention, the perception of stroke recovery (mean change from baseline on a scale ranging from 1 to 100) was higher among rhythm-and-music therapy (5.2 [95% confidence interval, 0.79-9.61]) and horse-riding therapy participants (9.8 [95% confidence interval, 6.00-13.66]), compared with controls (-0.5 [-3.20 to 2.28]); P=0.001 (1-way ANOVA). The improvements were sustained in both intervention groups 6 months later, and corresponding gains were observed for the secondary outcomes.

CONCLUSIONS

Multimodal interventions can improve long-term perception of recovery, as well as balance, gait, grip strength, and working memory in a mixed population of individuals in late phase after stroke.

CLINICAL TRIAL REGISTRATION

URL: http//www.ClinicalTrials.gov. Unique identifier: NCT01372059.

Essential gains and health after upper-limb tetraplegia surgery identified by the International classification of functioning, disability and health (ICF)

STUDY DESIGN

A questionnaire-based survey.

OBJECTIVES

To describe functional gains and health following upper-limb tetraplegia surgery using the International Classification of Functioning, Disability and Health (ICF) as a reference and to explore interconnections across different dimensions of functioning and health.

SETTING

A specialized center for advanced reconstruction of extremities at Sahlgrenska University Hospital, Gothenburg, Sweden.

METHODS

Fifty-seven individuals who participated in a satisfaction survey were included in the present study. Besides questions concerned with the respondents' satisfaction with different aspects of surgery, the measures included perceived overall health status (EQ-VAS) and achieved grip strength. Univariate analyses were used to explore interconnections between measures.

RESULTS

The gains could be subcategorized and linked to the ICF domains 'mobility', 'self-care', 'communication', 'domestic life', and 'community, social and civic life', with 'handling objects' and 'maneuvering a wheelchair' as the most frequently reported gains. The mean EQ-VAS score was 67±22. No significant correlation was shown between grip strength and activity gains, nor between grip strength and perceived overall health. The degree of satisfaction was, however, associated with self-reported overall health among participants.

CONCLUSION

The functional gains achieved after tetraplegia surgery could be applied to the ICF constructs' body functions/structures and activity with possible implications on participation. The overall health perception was relatively high and could be linked to the degree of satisfaction among participants. Muscle strength is not necessarily transferable to activity performance. This emphasizes the importance of addressing factors other than strength in the post-surgical rehabilitation and assessments.

Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire

Study design:

A questionnaire-based survey.

Objectives:

To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire.

Setting:

A center for advanced reconstruction of extremities, Gothenburg, Sweden.

Methods:

Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling.

Results:

Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test–retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities.

Conclusion:

Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.