Sehim Kutlay

Adaptation and validation of the Turkish version of the Rheumatoid Arthritis Quality of Life Scale

Abstract Objective. The aim of this study was to adapt the Rheumatoid Arthritis Quality of Life (RAQoL) questionnaire for use in Turkey and to test its reliability and validity. Methods. The translation process included the recent guidelines for cross-cultural adaptation. Reliability of the Turkish RAQoL was assessed by internal consistency and test-retest reliability, internal construct validity by Rasch analysis, and external construct validity by associations with impairments, disability, and general health status. Cross-cultural validity was tested through analysis of differential item functioning (DIF) by comparison with data from the UK version of the RAQoL. Results. Reliability of the adapted version was good, with high internal consistency (Cronbachs alpha 0.95 and 0.96 at times 1 and 2, respectively) and test-retest reliability (Spearmans rho 0.874). Internal construct validity was confirmed by excellent fit to the Rasch model (mean item fit 0.236, SD 1.113) and external construct validity by expected associations. The DIF for culture was found in four items. Conclusions. Adaptation of the RAQoL for use in Turkey was successful. The instrument can be used in both national and international studies for cross-cultural comparison with the UK, as long as adjustments are made for the few items displaying DIF for culture.

PSYCHOMETRIC PROPERTIES OF THE MINI-MENTAL STATE EXAMINATION IN PATIENTS WITH ACQUIRED BRAIN INJURY IN TURKEY

OBJECTIVE To evaluate the psychometric properties of Mini-Mental State Examination (MMSE) in patients with acquired brain injury in Turkey. METHODS A total of 207 patients with acquired brain injury were assessed. Reliability was tested by internal consistency and the person separation index; internal construct validity by Rasch analysis; external construct validity by correlation with cognitive disability; and cross-cultural validity by differential item functioning analysis compared with Italian MMSE data. RESULTS Reliability was adequate with a Cronbachs alpha of 0.75 and person separation index of 0.76. After collapsing some categories, and adjustment for differential item functioning, internal construct validity was supported by fit of the data to Rasch model. Differential item functioning for culture was found in 2 items and after adjustment, data could be pooled between Turkey and Italy. External construct validity was supported by expected associations. CONCLUSION The Turkish version of the Mini-Mental State Examination can be used as a cognitive screening tool in acquired brain injury. Cross-cultural validity between Italy and Turkey is supported, given appropriate adjustment for differential item functioning. However, shortfalls in reliability at the individual level, as well as the presence of differential item functioning suggest that a better instrument should be developed to screen for cognitive deficits following acquired brain injury.

Preliminary study to evaluate the validity of the mini-mental state examination in a normal population in Turkey.

Although the Mini-Mental State Examination (MMSE) is widely used in clinical practice, normative scores for a healthy population have not been documented in Turkey. The aim in this study was to validate the MMSE in a healthy population and to provide normal scores. Internal construct validity of the Turkish version of MMSE among a preliminary sample of 406 normal people was assessed by Rasch unidimensional measurement model. Scores of the normal sample varied according to age and education but not according to sex. The data derived from this sample showed poor fit to the Rasch model (mean item fit, −2.082, SD 3.022). Only four of 11 items met model expectations. There was also differential item functioning by education and age for most items. Thus the internal construct validity of the Turkish MMSE in a normative sample could not be demonstrated by Rasch analysis. The scale failed modern psychometric criteria for scalability. We would therefore suggest other large normative MMSE data sets to be tested in terms of internal construct validity. If these findings are replicated, the validity of MMSE norms and their consequent use in clinical practice should be reconsidered.

Validation of the Middlesex Elderly Assessment of Mental State (MEAMS) as a cognitive screening test in patients with acquired brain injury in Turkey

Purpose. Assessment of cognitive impairment with a valid cognitive screening tool is essential in neurorehabilitation. The aim of this study was to test the reliability and validity of the Turkish-adapted version of the Middlesex Elderly Assessment of Mental State (MEAMS) among acquired brain injury patients in Turkey. Methods. Some 155 patients with acquired brain injury admitted for rehabilitation were assessed by the adapted version of MEAMS at admission and discharge. Reliability was tested by internal consistency, intra-class correlation coefficient (ICC) and person separation index; internal construct validity by Rasch analysis; external construct validity by associations with physical and cognitive disability (FIM); and responsiveness by Effect Size. Results. Reliability was found to be good with Cronbachs α of 0.82 at both admission and discharge; and likewise an ICC of 0.80. Person separation index was 0.813. Internal construct validity was good by fit of the data to the Rasch model (mean item fit −0.178; SD 1.019). Items were substantially free of differential item functioning. External construct validity was confirmed by expected associations with physical and cognitive disability. Effect size was 0.42 compared with 0.22 for cognitive FIM. Conclusion. The reliability and validity of the Turkish version of MEAMS as a cognitive impairment screening tool in acquired brain injury has been demonstrated.

Exercise and cognitive-behavioural treatment in fibromyalgia syndrome.

Fibromyalgia syndrome is a nonarticular rheumatic disorder characterised by diffuse musculoskeletal pain, stiffness, fatigue, disturbed sleep and tender points. The pathophysiology is not well understood and treatment remains a challenge. Although pharmacological therapy is still the primary treatment choice, a long-term effective intervention has not been demonstrated yet. Thus, besides pharmacotherapy, other multimodal interventions are often used. Exercise and cognitive-behavioural treatments which exist in the multimodal approach and encompass largely self-managed strategy, are reviewed in this article. Although, there is a great number of exercise studies, the large diversity of outcome measures and measurement instruments that have been used in studies, varying intensity and types of exercises, small sample sizes, high attrition rates, large variability in baseline function, symptom severity and psychosocial status limit to come to a conclusion about the efficacy of exercise in the treatment of fibromyalgia syndrome. There are also inconclusive results about the efficacy of cognitive-behavioural treatment because of limited number of studies with small sample sizes of patients with fibromyalgia syndrome. However, the results of the trials overall demonstrate the beneficial effects of both different types of exercise and cognitive-behavioural treatment, on the other hand, there is still a need for larger, more systematic and randomised controlled trials to evaluate the effectiveness.

Clinical feasibility of Xbox KinectTM training for stroke rehabilitation: A single-blind randomized controlled pilot study.

OBJECTIVE To evaluate the feasibility and safety of Xbox KinectTM training of the upper extremity in subacute stroke rehabilitation. DESIGN A single-blind, randomized controlled, pilot study. PATIENTS Twenty consecutive patients with stroke. METHODS Participants were allocated randomly to 2 groups: the control group received conventional therapy and the experimental group received additional Xbox KinectTM training for 20 sessions. Feasibility and safety were evaluated by treatment attendance rate, patient feedback, proportion of adverse events, and Borg Scale (Borg CR10). RESULTS Twenty of 131 screened individuals were recruited. Data for 19 patients (73.7% male; mean age 62 years (range 38-79)) were analysed. Treatment attendance ratio for total training time and training time/session was 87% and 90%, respectively. All participants reported that training with the Xbox KinectTM was enjoyable and beneficial. No serious adverse events occurred. Fatigue was the most common adverse event. The mean Borg CR10 score was 7.80, reflecting a very high level of fatigue. The experimental group showed significantly greater improvement than the control group in the Box and Blocks Test, Wolf Motor Function Test and Brunnstrom motor recovery stages. CONCLUSION Xbox KinectTM training appears feasible and safe in upper extremity ehabilitation after stroke. It could enhance motor and functional recovery of the affected upper extremity as an adjunctive method.

AbobotulinumtoxinA (Dysport(®)) Improves Function According to Goal Attainment in Children With Dynamic Equinus Due to Cerebral Palsy.

This secondary analysis of a large (n = 241), randomized, double-blind study evaluated the efficacy of 2 doses of abobotulinumtoxinA + standard of care (SOC) versus placebo + SOC in enabling children with dynamic equinus due to cerebral palsy to achieve their functional goals using Goal Attainment Scaling. Most parents/caregivers selected goals targeting aspects of gait improvement as most relevant. Mean (95% confidence interval) Goal Attainment Scaling T scores at week 4 were higher for both abobotulinumtoxinA groups versus placebo (treatment difference vs placebo: 10 U/kg/leg: 5.32 [2.31, 8.32], P = .0006, and 15 U/kg/leg 4.65 [1.59, 7.71], P = .0031). Superiority of both abobotulinumtoxinA doses versus placebo was maintained at week 12. Best goal attainment T scores were higher in the abobotulinumtoxinA groups versus placebo for the common goals of improved walking pattern, decreased falling, decreased tripping, and improved endurance. These findings demonstrate that single injections of abobotulinumtoxinA (10 and 15 U/kg/leg) significantly improved the ability of pediatric cerebral palsy patients to achieve their functional goals.

Validation of the Behavioural Inattention Test (BIT) in patients with acquired brain injury in Turkey

The aim of this descriptive study was to evaluate the construct validity and reliability of the Behavioural Inattention Test (BIT) in patients with acquired brain injury in Turkey. One hundred and eighteen acquired brain injury patients undergoing rehabilitation were assessed by the BIT. Internal construct validity was tested by Rasch analysis; reliability by internal consistency and the Person Separation Index; and external construct validity by associations with physical and cognitive disability. Analysis of the data revealed that some subtests deviated from Rasch model expectation and the conventional subscale of the BIT had an unsatisfactory reliability for individual use. Consequently, a common 10-item scale (BIT-10) was derived from both the behavioural and conventional subscales of the BIT. Reliability of .87 met expectation for individual use. The BIT-10 correlated at .52 with cognitive disability upon admission. As a conclusion the original BIT adapted for use in Turkey was shown to lack reliability and internal construct validity. A revised 10-item new version, BIT-10, gave a valid unidimensional summed score, with high sensitivity and specificity to the original cut points. Reliability of the BIT-10 was high and external construct validity was as expected.

Kinaesthetic ability training improves unilateral neglect and functional outcome in patients with stroke: A randomized control trial

OBJECTIVE To investigate the effects of kinaesthetic ability training with the Kinesthetic Ability Trainer (KAT) on unilateral neglect and functional outcomes in stroke patients. STUDY DESIGN An assessor-blinded, randomized controlled, clinical trial. METHODS A total of 64 stroke patients with unilateral neglect (mean age 61 (standard deviation (SD) 12) years, 60.4% male, mean time since stroke 6.4 (SD 10.4) months, left hemiplegia 92.5%) were randomly assigned to a conventional rehabilitation programme (control group, n = 32) or KAT plus a conventional rehabilitation programme (KAT group, n = 32) for 4 weeks. Patients were assessed with the Behavioral Inattention Test (BIT) and Functional Independence Measure (FIM) before and after therapy. RESULTS Both groups showed significant improvements in all subscales of the BIT (conventional and behavioural) (p < 0.001) and the FIM motor scale (p < 0.001) after therapy. Recovery from neglect was assessed, based on the BIT cut-off scores. The recovery rate for behavioural BIT was 40% in the KAT group and 17.9% in the control group (p = 0.07), whereas recovery rates according to the conventional BIT were 16% and 10.7% in the KAT and control groups, respectively. CONCLUSION Kinaesthetic ability training provides clinically meaningful improvement in stroke patients with unilateral neglect. It may be useful as an adjunctive therapy for rehabilitation in these patients.

A major improvement in social participation of two children with cerebral palsy by a single botulinum toxin injection

Elif Yalcin MD, Physical Medicine Rehabilitation Specialist, Sehim Kutlay MD, Physical Medicine Rehabilitation Specialist, Olcay Ilgu MD, Physical Medicine Rehabilitation Specialist, Mufit Akyuz MD, Physical Medicine Rehabilitation Specialist a Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine & Rehabilitation Training and Research Hospital of the Ministry of Health, Ankara, Turkey b Department of Physical Medicine and Rehabilitation, Ankara University of Faculty of Medicine, Ankara, Turkey c Department of Physical Medicine and Rehabilitation, Ankara Physical Medicine & Rehabilitation Training and Research Hospital of the Ministry of Health, Ankara, Turkey