Elisabetta Bravini

Minimal Clinically Important Difference of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and Its Shortened Version (QuickDASH)

STUDY DESIGN Prospective, single-group observational design. OBJECTIVES To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches. BACKGROUND Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process. METHODS The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale. RESULTS The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH. CONCLUSION The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.

Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review.

The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales.

How much is Kinesio taping a psychological crutch

We read with interest the paper by Lins et al. (2012) regarding the immediate effects of the application of Kinesio Taping (KT) on the neuromuscular performance of quadriceps. The authors stated that KT was not capable of altering lower limb muscle strength or function in healthy women, confirming the results of another recent study (Wong et al., 2012). Shortly before the acceptance of these papers we published a placebo-controlled trial (Vercelli et al., 2012) comparing the effects of two KT conditions (applied with the aim of enhancing or inhibiting muscle strength, respectively) and a placebo KT application on the quadriceps of 36 healthy subjects. The main outcome measures were concentric peak knee extensor torque at 60 and 180 /sec, and single-leg triple hop for distance. No significant differences between baseline and KT application were observed, regardless of the type or direction of tape application. Such findings are perfectly in line with those more recently reported by Lins et al. (2012) and Wong et al. (2012), and confirm the lack of evidence on this topic. It should also be stressed that, to date, the mechanisms by which KT application might conceivably increase muscular strength have not been fully elucidated or confirmed (Lins et al., 2012). In the absence of an observed change in physiological or performance variables, however, our secondary exploratory analysis revealed that participants’ subjective perception of strength increased, irrespective of the KT condition. In a post-experiment interview in which we asked our subjects if they felt stronger, unchanged, or weaker after tape application, about 45% declared that they felt stronger after experimental KT (regardless of whether the technique was facilitating or inhibiting), while this percentage was about 30% after placebo application. Placebos could have specific effects on both objective (e.g. muscle power or strength, heart rate, running speed, jump height or length) and subjective (e.g. perceived exertion, internal states, feelings of wellbeing and safety) variables (Berdi et al., 2011). In a recent meta-analysis of the evidence for KT effectiveness in treatment and prevention of sports injuries, the placebo effects on objective variables showed conflicting results, but the types of tape used as placebo and their application in the different papers were not standardized (Williams et al., 2012). To our knowledge, our study is the first analyzing the placebo effects of KT on a subjective variable (perceived strength), similar results having been previously reported for non-elastic taping in ankle instability (Sawkins et al.,

A systematic review of questionnaires to assess patient satisfaction with limb orthoses

Background: Assessment of patient satisfaction with orthosis is a key point for clinical practice and research, requiring questionnaires with robust psychometric properties. Objectives: To identify which validated questionnaires are used to investigate patient satisfaction with orthosis in limb orthotics and to analyse (1) their main fields of clinical application, (2) the orthosis-related features analysed by the questionnaires and (3) the strength of their psychometric properties. Study design: Systematic review. Methods: A literature search using MEDLINE (PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus databases for original articles published within the last 20 years was performed. Results: A total of 106 papers pertaining to various clinical fields were selected. The main features of patient satisfaction with orthosis analysed were as follows: aesthetic, ease in donning and doffing the device, time of orthotic use and comfort. Conclusion: Of the questionnaires used to investigate patient satisfaction with orthosis, only four are adequately validated for this purpose: two for generic orthotic use (Quebec User Evaluation of Satisfaction with assistive Technology 2.0 and Client Satisfaction with Device of Orthotics and Prosthetic Users’ Survey) and two for specific application with orthopaedic shoes (Questionnaire for the Usability Evaluation of orthopaedic shoes and Monitor Orthopaedic Shoes). Further development, refinement and validation of outcome measures in this field are warranted. Clinical relevance Given the importance of analysing patient satisfaction with orthosis (PSwO), appropriate instruments to assess outcome are needed. This article reviews the currently available instruments and reflects on how future studies could be focused on the development, refinement and validation of outcome measures in this field.

The Mini-BESTest: a review of psychometric properties.

The Mini-Balance Evaluation Systems Test (Mini-BESTest) has been identified as the most comprehensive balance measure for community-dwelling adults and elderly individuals. It can be used to assess balance impairments in several other conditions, mainly Parkinson’s disease and stroke. Despite increasing use of the Mini-BESTest since it was first published 5 years ago, no systematic review synthesizing its psychometric properties is available. The aim of this study was to provide a comprehensive review of the psychometric properties of the Mini-BESTest when administered to patients with balance deficits because of different diseases. A literature search was performed on articles published before July 2015 in journals indexed by MEDLINE and Scopus databases. The search produced 98 papers, 24 of which fulfilled the inclusion criteria for this review. Most papers (n=19) focused on patients affected by neurological diseases, mainly Parkinson’s disease. In 21 papers, the psychometric characteristics were analyzed using Classical Test Theory methods and in only three papers was Rasch analysis carried out. This review shows the interest of researchers in the Mini-BESTest despite the short time frame since its first publication. The Mini-BESTest is used widely in both clinical practice and research. The results support the reliability, validity, and responsiveness of this instrument and it can be considered a standard balance measure. However, it would be valuable to learn more about how this scale performs in different diseases causing balance deficits and to better define the minimal clinically important difference for each disease.

Rasch analysis of the Italian Lower Extremity Functional Scale: Insights on dimensionality and suggestions for an improved 15-item version

Objective: To investigate dimensionality and the measurement properties of the Italian Lower Extremity Functional Scale using both classical test theory and Rasch analysis methods, and to provide insights for an improved version of the questionnaire. Design: Rasch analysis of individual patient data. Setting: Rehabilitation centre. Participants: A total of 135 patients with musculoskeletal diseases of the lower limb. Results: Patients were assessed with the Lower Extremity Functional Scale before and after the rehabilitation. Rasch analysis showed some problems related to rating scale category functioning, items fit, and items redundancy. After an iterative process, which resulted in the reduction of rating scale categories from 5 to 4, and in the deletion of 5 items, the psychometric properties of the Italian Lower Extremity Functional Scale improved. The retained 15 items with a 4-level response format fitted the Rasch model (internal construct validity), and demonstrated unidimensionality and good reliability indices (person-separation reliability 0.92; Cronbach’s alpha 0.94). Then, the analysis showed differential item functioning for six of the retained items. The sensitivity to change of the Italian 15-item Lower Extremity Functional Scale was nearly equal to the one of the original version (effect size: 0.93 and 0.98; standardized response mean: 1.20 and 1.28, respectively for the 15-item and 20-item versions). Conclusion: The Italian Lower Extremity Functional Scale had unsatisfactory measurement properties. However, removing five items and simplifying the scoring from 5 to 4 levels resulted in a more valid measure with good reliability and sensitivity to change.

Post-surgical scar assessment in rehabilitation: a systematic review

Abstract Manual therapies are frequently recommended to improve post-surgical scar pliability, e.g., its elasticity and glide capacity with respect to the underlying tissue. A significant percentage of scars are pathological, causing

Validation of the Arabic version of the client satisfaction with device module of the orthotics and prosthetics users survey.

BACKGROUND AND OBJECTIVES Assessing patient satisfaction with orthosis (PSwO) is a key point for clinical practice to increase a patient’s adherence to therapeutic programs and reduce orthotic-related costs. The Client Satisfaction with Device (CSD) module of the Orthotics and Prosthetics Users’ Survey (OPUS) is one of the most widely-used questionnaires for assessing PSwO, but its validated version in the Arabic language is lacking. The objective of this study is to generate and psychometrically validate an Arabic version of the CSD (CSD-Ar). DESIGN AND SETTINGS This is a cross-sectional study, conducted during February to June 2013 at 2 inpatient and outpatient rehabilitation departments in Riyadh, Saudi Arabia. PATIENTS AND METHODS Translation of CSD-Ar was carried out according to the guideline recommendations of Linacre. A convenience sample of 100 orthotic-user patients with various conditions (59% men, mean age 36 years) completed the CSD-Ar. Data were analyzed using exploratory factor analysis followed by Rasch analysis. RESULTS Factor analysis confirmed the unidimensionality of the CSD-Ar. Rasch criteria for the functioning of rating scale categories were fulfilled. All items showed an adequate fit to the Rasch model. The person separation reliability was .75 and Cronbach alpha .83. There was a borderline local dependency between items 1 (“My device fits well”) and 3 (“My device is comfortable throughout the day”). CONCLUSION The internal construct validity of the CSD-Ar in Arab patients with various types of orthotics has been confirmed. This study provides a useful starting point for the use of this outcome measure in Arabic-speaking countries.

Valutazione della destrezza e accuratezza diagnostica del Functional Dexterity Test in soggetti affetti da sindrome del tunnel carpale

BACKGROUND The diagnosis of carpal tunnel syndrome (STC) is centered on the symptoms. However, patients also show an impairment of sensorimotor functions, but the relationship between STC and manual dexterity has never been investigated. OBJECTIVES To analyze the correlation between manual dexterity and severity of the STC. Another objective was the diagnostic accuracy of the clinical battery including provocative tests (Phalen, Tinel) and Functional Dexterity Test (FDT). METHODS A sample of 80 subjects with suspected STC was subdivided into 4 groups based on EMG (severe/extreme-GrA, moderate-GrB, mild/minimal-GrC, negative-GrD) and evaluated in blind by Phalen, Tinel and FDT. The relationship between the FDT and the allocation of subjects was investigated by Spearmans rho, while the groups were compared with univariate ANOVA and Tukeys post hoc analysis. Diagnostic accuracy of the clinical battery was expressed by sensitivity, specificity, and likelihood ratios (LR). RESULTS A moderate (r=0.48, p minor of 0.001) correlation was found between FDT and the 4 groups. ANOVA has returned a significant difference between GrA vs. all others and between GrB vs. GrD. The battery showed a sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of 70%, 94%, 11.98 and 0.31 respectively. CONCLUSIONS The results of this study supported the hypothesis that STC patients also have a dexterity impairment. The FDT was able to discriminate between three levels of severity (negative, mild to moderate, severe to extreme), maintaining a good level of diagnostic accuracy in addition to provocative tests.

The EdUReP approach plus manual therapy for the management of insertional Achilles tendinopathy: a case report

Insertional Achilles tendinopathy (IAT) is a challenging overuse disorder. The aim of this case report was to study the feasibility of a comprehensive rehabilitative approach according to the Education, Unloading, Reloading, and Prevention (EdUReP) framework combined with Instrument-Augmented Soft Tissue Mobilization (I-ASTM). An active 51-year-old man patient with chronic IAT was studied. Clinical assessment battery was composed by visual analogue scale for pain during the Achilles tendon palpation test, passive straight leg raise test, single leg hop test, Patient-Specific Functional Scale, and Foot and Ankle Ability Measure. The patient was treated over a 8 weeks period using the EdUReP guidelines plus 8 sessions of I-ASTM, applied with a solid instrument to the Achilles tendon and to the muscle fibrotic areas previously identified during evaluation. Clinically significant improvements were observed in all outcome measures, and a resume of patients usual sports activities without pain or limitations was possible after treatment. Results lasted over a 6-month follow-up. To the best of our knowledge, this is the first study applying a comprehensive approach based on accurate physical assessment, and using the EdUReP theoretical model. The combination of the EdUReP model and manual therapy was effective in resolving the patients symptoms and restore his usual sport activities. While these results cannot be generalized, the present findings could provide a valuable foundation for future researches.