Luciana Sciumè

ISYQOL: a rasch-consistent questionnaire for measuring health-related quality of life in adolescents with spinal deformities

BACKGROUND CONTEXT Spinal deformities are commonly associated with poor health-related quality of life (HRQOL). Several questionnaires (eg, Scoliosis Research Society-24 [SRS-24] and Scoliosis Research Society-22 [SRS-22]) have been developed to evaluate HRQOL in these conditions. In adults as well as during growth, the HRQOL is considered one of the most relevant outcomes of both conservative and surgical treatments. Rasch analysis is a powerful statistical technique for developing high-quality and valid questionnaires. The SRS-24 and SRS-22 have been evaluated using the Rasch analysis but showed poor measurement properties. Thus, a proper measure of HRQOL in people with a spine condition is still missing. PURPOSE This study aimed to develop a new questionnaire that is totally Rasch consistent for measuring the HRQOL in young people with a spine condition. STUDY DESIGN This is a cross-sectional study for developing a new HRQOL measure. PATIENT SAMPLE A total of 402 participants with adolescent idiopathic scoliosis or Scheuermann juvenile kyphosis were included in the study. OUTCOME MEASURE The outcome measure used was the Italian Spine Youth Quality of Life (ISYQOL) questionnaire. MATERIALS AND METHODS The study consisted of different stages: a conventional approach content analysis, an opinion poll among clinicians trained in spine deformities, and the Rasch analysis (partial credit model). RESULTS The Rasch analysis showed that all items of the ISYQOL questionnaire had ordered thresholds and a good fit to the model. Differential item functioning was present for Item 1, with bracing only, and was solved with a conventional items splitting procedure. The ISYQOL item map spans an adequate range of HRQOL. The principal component analysis for Rasch residuals showed, in practical terms, the ISYQOL unidimensionality. The reliability of ISYQOL was high enough so that approximately three significantly different levels of HRQOL could be discerned. Two questionnaire versions were provided for patients with and without the brace, respectively. CONCLUSIONS ISYQOL is the first HRQOL questionnaire developed according to the Rasch analysis. It was developed in a conservative treatment setting for all types of spinal deformities, including also patients with surgical curves. Validation in many languages is already under way.

Is my patient actually getting better? Application of the McNemar test for demonstrating the change at a single subject level

Abstract Purpose: The aim of the current work is to provide a novel method for demonstrating the modification of a single patient’s performance on questionnaires and scales. The minimal detectable change (MDC), a statistics indicating the minimal change in measure not attributable to random variation, is commonly used in rehabilitation for this purpose. However, the MDC has some important drawbacks (e.g. it cannot be calculated on scores from ordinal tests and it can be only used for full questionnaire). Method: Review of the MDC and its limitations and application of the McNemar test on simulated data from single subjects. Results: We propose to use the McNemar test to check if the proportion of test items affirmed by a patient after rehabilitation is significantly different from the same proportion before rehabilitation. A significant McNemar test would indicate a non-random modification of the patient’s score and thus a true modification of his/her performance. Conclusions: The application of the McNemar test to questionnaires and scales offers a simple method for demonstrating the modification of a single patient’s performance. This use of the McNemar test overcomes the weaknesses of the MDC and gives support to the clinician in assisting him/her to convincingly communicate a non-negligible modification of the patient’s status. IMPLICATIONS FOR REHABILITATION Measuring the change in patients’ status is of paramount importance in medicine and rehabilitation. However, tracking the change in rehabilitation is difficult. For example, the minimal detectable change cannot be calculated on scores from ordinal questionnaires and tests, which are widely used as rehabilitative outcome measures. We propose here to use a McNemar test to check if the proportion of test items affirmed or passed by is significantly different between two conditions (e.g. before vs. after rehabilitation). Similar to the minimal detectable change, the significant McNemar test would indicate a non-random modification of the patient’s test score. In addition, the McNemar test can be calculated on ordinal data, thus overcoming some of the minimal detectable change weaknesses.

Lower limbs kinematic assessment of the effect of a gym and hydrotherapy rehabilitation protocol after knee megaprosthesis : a case report

[Purpose] To quantitatively assess the effect of a personalized rehabilitation protocol after knee megaprosthesis. [Subject and Methods] The gait patterns of a 33-year-old male patient with knee synovial sarcoma were assessed by a computerized analysis before and after 40 rehabilitation sessions. [Results] The rehabilitation protocol improved the gait pattern. After rehabilitation, hip flexion was nearly symmetric, with normalized affected limb hip flexion, and improved ankle flexion. Ankle in/eversion was asymmetric and did not improve after physiotherapy. Before physiotherapy, the hip flexion on the affected side anticipated the movement but nearly normalized in the follow-up assessment. Hip abduction range of motion increased, with wider movements and good balance. Knee range of motion nearly symmetrized, but maintained an anticipated behavior, without shock absorption at heel-strike. [Conclusion] Instrumental gait analysis allowed us to gain evidence about the training and how to expand rehabilitative interventions to improve efficacy. In particular, we recommend quadriceps and gastrocnemius eccentric contraction training (to improve the shock absorption phase, preventing early failures of the prosthesis); one-leg standing performance (to improve the support phase of the affected limb); adductor strength training (to aid in hip control during the swing phase); and peroneus strength training (to increase ankle joint stabilization).

Criterion validity of the instrumented timed up and go test: a partial least square regression study

The Timed Up and Go (TUG) test is a common mobility measure in rehabilitation. With the instrumental TUG test (ITUG; i.e. the TUG measured by inertial measurement units, IMUs), several movement measures are newly available. However, the clinical meaning of these new measures is not totally clear. Aim of the current work is to evaluate the validity of different ITUG parameters as a measure of balance. Neurological patients (n = 122; 52 females; 89 older than 65 years) completed the TUG test with IMUs secured to their back. IMUs signals were used to split the TUG test in five phases (sit-to-stand, walk1, turn1, walk2 and turn-and-sit) and twelve movement parameters were obtained. Experienced clinicians administered the Mini-BESTest (MB) scale, a sound balance measure. The partial least square regression (PLSR) was used to explore the association between the ITUG variables and the MB measure. A PLSR model with twelve ITUG variables had satisfactory fit parameters (RMSEP: 11%; R2: 0.41, 95% CI: 0.28-0.54; regression line: 1, 95% CI: 0.78-1.22). Three ITUG variables (i.e. turn1 vertical angular velocity, turn1 duration and turn2 vertical angular velocity) were found to be the most important predictors of the MB measure. A PLSR model with the turning variables only had fit parameters comparable to that of the twelve variables model. Turning parameters from the TUG test are good predictors of the MB scale. The mean angular velocity during turning and the duration of the turning phase are thus proposed as a valid, ratio-level measures of balance in neurological patients.

There is a need once again for a multifactorial assessment and intervention for fall prevention among the elderly

ogy and mortality of the acute traumatic spinal cord injury in the United States (from 1993 to 2012). The Authors described a two fold increase in the percentage of the spinal cord injuries associated with falls in the elderly, which passed from less than one third in the 1997–2000 period to two thirds in the 2010–2012 period. Jain and colleagues proposed that the increase in falls related spinal cord injuries “likely represents a more active 65- to 84-year-old US population currently compared with the 1990s.” 2 ICD-9-CM codes identifying an external cause of injury (i.e. E codes) were used to classify the spinal cord injury into three groups (associated with unintentional falls, associated with motor vehicle crashes and associated with firearm injuries). The unintentional falls group included different types of falls, such as falls from ladders (E881) and falls on same level from slipping, tripping, or stumbling

Squat exercise to estimate knee megaprosthesis rehabilitation: a pilot study.

[Purpose] This study evaluated a specific rehabilitation protocol using a half squat after total knee reconstruction with distal femur megaprosthesis and tibial allograft-prosthesis composite. [Subject and Methods] Squat execution was recorded by a three-dimensional system before and after a specific rehabilitation program on a 28-year-old patient. Squat duration, body center of mass trajectory, and vertical range of motion were determined. Step width and joint angles and symmetry (hip flexion, extension, and rotation, knee flexion, and ankle dorsal and plantar flexion) were estimated. Knee and hip joint symmetry was computed using a bilateral cyclogram technique. [Results] After rehabilitation, the squat duration was longer (75%), step width was similar, and vertical displacement was higher. Hip flexion increased by over 20%, and ankle dorsiflexion diminished by 14%. The knee had the highest symmetry gain (4.1–3.4%). Angle-angle plot subtended areas decreased from 108° to 40°2 (hip) and from 204° to 85°2 (knee), showing improvement in movement symmetry. [Conclusion] We concluded that the squat is an effective multifactorial exercise to estimate rehabilitation outcomes after megaprosthesis, also considering that compressive and shear forces are minimal up to 60–70° of knee flexion.

Rehabilitation After Urgent or Elective Orthopedic Surgery: The Role of Resilience in Elderly Patients

Purpose The aim of this investigation was to assess resilience within an elderly population during postacute rehabilitation for orthopedic surgery and to identify the role of resilience on rehabilitation outcomes by comparing hip fracture and elective patients (total knee and hip arthroplasty). Design We conducted a prospective study in an orthopedic rehabilitation department. Methods On admission and on discharge, 80 patients aged over 60 years underwent a multidimensional evaluation with the Resilience Scale, the Functional Independence Measure (FIM), the Multidimensional Prognostic Index, and the World Health Organization Quality of Life-BREF. Findings Hip-fractured patients had a lower level of resilience. High-resilient fracture patients achieved higher FIM scores. For elective patients, no differences on FIM score occurred for different resilience levels. Conclusions and Clinical Relevance Resilience plays a significant role in reaching optimal functional recovery in hip-fractured elderly people. Results suggest the introduction of early routine assessment of resilience in future outcome studies in rehabilitation.

La fragilità dei pazienti in degenza riabilitativa per chirurgia ortopedica: il ruolo della resilienza

La sintomatologia depressiva e una problematica spesso sottovalutata nell’anziano e la degenza ospedaliera la puo aggravare o slatentizzare, venendo cosi ad interferire negativamente sull’esito dei trattamenti riabilitativi. Al contrario la resilienza, intesa come capacita di resistere a eventi avversi quali l’ospedalizzazione, e importante per ottenere un soddisfacente recupero funzionale attraverso la riabilitazione. L’obiettivo del presente studio prospettico osservazionale e indagare i rapporti tra resilienza e intervento riabilitativo in pazienti che hanno subito interventi ortopedici in fase post-acuta. All’ingresso in reparto e prima della dimissione a ogni paziente (N = 84; eta media = 74,5, DS = 8), di cui erano registrati dati socio-demografici e anamnesi psicopatologica e farmacologica, sono stati applicati i seguenti strumenti: Resilience Scale, WHO Quality of Life, Multidimensional Prognostic Index, Functional Independence Measure. L’analisi dei punteggi ottenuti nei due momenti e le loro correlazioni mostrano che pazienti con alta resilienza e maggior benessere psicosociale e fisico all’ingresso ottengono una maggior indipendenza funzionale alla dimissione. Lo studio induce a concludere che e importante un’accurata valutazione dei pazienti con identificazione precoce di eventuali sintomi depressivi e il loro trattamento al fine di migliorarne la condizione e la collaborazione all’interno del processo riabilitativo.