Yeliz Prior

The reliability and validity of the English version of the Evaluation of Daily Activity Questionnaire for people with rheumatoid arthritis

Objectives. The Evaluation of Daily Activity Questionnaire (EDAQ) includes 138 items in 14 domains identified as important by people with RA. The aim of this study was to test the validity and reliability of the English EDAQ. Methods. A total of 502 participants completed two questionnaires 3 weeks apart. The first consisted of the EDAQ, HAQ, RA Quality of Life (RAQoL) and the Medical Outcomes Scale (MOS) 36-item Short-Form Health Survey (SF-36v2), and the second consisted of the EDAQ only. The 14 EDAQ domains were tested for: unidimensionality—using confirmatory factor analysis; fit, response dependency, invariance across groups (differential item functioning)—using Rasch analysis; internal consistency [Person Separation Index (PSI)]; concurrent validity—by correlations with the HAQ, SF-36v2 and RAQoL; and test–retest reliability (Spearman’s correlations). Results. Confirmatory factor analysis of the 14 EDAQ domains indicated unidimensionality, after adjustment for local dependency in each domain. All domains achieved a root mean square error of approximation <0.10 and satisfied Rasch model expectations for local dependency. DIF by age, gender and employment status was largely absent. The PSI was consistent with individual use (PSI = 0.94 for all 14 domains). For all domains, except Caring, concurrent validity was good: HAQ (rs = 0.72–0.91), RAQoL (rs = 0.67–0.82) and SF36v2 Physical Function scale (rs = −0.60 to −0.84) and test–retest reliability was good (rs = 0.70–0.89). Conclusion. Analysis supported a 14-domain, two-component structure (Self care and Mobility) of the EDAQ, where each domain, and both components, satisfied Rasch model requirements, and have robust reliability and validity.

The effects of compression gloves on hand symptoms and hand function in rheumatoid arthritis and hand osteoarthritis: a systematic review

Objective: to evaluate the effects of compression gloves in adults with rheumatoid arthritis and hand osteoarthritis. Data sources: Systematic review of randomized controlled trials identified from MEDLINE, CINAHL, AMED, PEDro, OT Seeker, The Cochrane Library, ISI Web of Knowledge, Science Direct and PubMed from their inceptions to January 2015. Review methods: Methodological quality of identified trials was evaluated using the PEDro scale by three independent assessors. Effects were summarized descriptively. Results: Four trials (n=8-24; total n=74), comparing night wear of full-length finger compression gloves with placebo gloves, were assessed. Three were of moderate (PEDro score 4-5) and one low (score 3) methodological quality. Effect sizes or standardized mean differences could not be calculated to compare trials due to poor data reporting. In rheumatoid arthritis, finger joint swelling was significantly reduced, but results for pain and stiffness were inconclusive and no differences in grip strength and dexterity were identified. One study reported similar effects in pain, stiffness and finger joint swelling from both compression and thermal placebo gloves. Only one study evaluated gloves in hand osteoarthritis (n=5) with no differences. Conclusions: All the trials identified were small with a high risk of Type I and II errors. Evidence for the effectiveness of compression gloves worn at night is inconclusive in rheumatoid arthritis and hand osteoarthritis.

Health care professionals’ views of the factors influencing the decision to refer patients to a stroke rehabilitation trial

BackgroundEffective recruitment is an essential element of successful research but notoriously difficult to achieve. This article examines health care professionals’ views on the factors influencing decision-making regarding referral to a stroke rehabilitation trial.MethodsSemi-structured interviews and a card-sorting task were undertaken with stroke service staff in acute and community hospital trusts. Data analysis used a thematic framework approach.ResultsTwenty-seven qualified health care professionals from 12 (6 acute and 6 community) hospital trusts and one charity participated. Four main factors emerged: patient-related, professional views, the organisation and research logistics, which all contributed to staff’s decision about whether to refer patients to a trial.Clinicians identified patient-related factors as the most frequent influence and considered themselves the patients’ advocate. They used their knowledge of the patient to anticipate the patients’ reaction to possible participation and tended to only refer those whom they perceived would respond positively.Participants also identified experience of research, a sense of ownership of the project and a positive view of the intervention being evaluated as factors influencing referral. The need to prioritise clinical matters, meet managerial demands and cope with constant change were organisational factors impacting negatively on referral. Staff often simply forgot about recruitment in the face of other higher priorities. Quick, simple, flexible research processes that were closely aligned with existing ways of working were felt to facilitate recruitment.ConclusionsPatient- and professional-related factors were the most frequent influence on clinicians’ recruitment decisions, which often had a ‘gate-keeping’ effect. Managerial and clinical responsibility to juggle multiple (often higher) priorities was also an important factor.To facilitate recruitment, researchers need to develop strategies to approach potential participants as directly as possible to enable them to make their own decisions about participation; ensure that research processes are as quick and simple as possible; align with existing clinical pathways and systems; and give regular reminders and ongoing support to promote recruitment.Trial registrationISRCTN, 98287938. Registered 6 May 2015

A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis: Perspectives of therapists and their line managers.

Introduction Occupational therapy-led work rehabilitation for employed people with inflammatory arthritis and work problems was piloted in five hospitals in the United Kingdom. This qualitative study explored the views of participating occupational therapists and their line managers about the work rehabilitation training received and conducting the intervention, with particular focus on the structured interview used, the Work Experience Survey – Rheumatic Conditions. Method Face-to-face semi-structured interviews were conducted with occupational therapists (n = 9), followed by telephone interviews with their line managers (n = 2). Interviews were audio-recorded, transcribed verbatim and thematically analysed by three researchers to maximize validity. Results The main themes emerging from the occupational therapists’ interviews were: varying levels of prior knowledge and experience of work rehabilitation, initial concerns about the feasibility of a lengthy work assessment in practice and increased confidence in delivering work rehabilitation as the study progressed. The line managers’ interviews generated themes around the positive impact of the work rehabilitation training the occupational therapists received, and changes in their practice. Conclusion The Work Experience Survey – Rheumatic Conditions was considered a good choice of work assessment which can be implemented in practice. Once therapists had provided the work intervention several times, their confidence and skills increased.

Linguistic validation and cultural adaptation of an English version of the Evaluation of Daily Activity Questionnaire in rheumatoid arthritis

BackgroundTo linguistically validate and culturally adapt the Evaluation of Daily Activity Questionnaire (EDAQ) for use in rheumatoid arthritis (RA) from Swedish to British English. The EDAQ is a patient reported outcome measure of daily activity ability. It includes 11 activity domains (Eating and Drinking; Personal Care; Dressing; Bathing; Cooking; Moving Indoors; House Cleaning; Laundry; Moving and Transfers; Communication; Moving Outdoors) and was developed for use in rheumatoid arthritis (RA).MethodsThe EDAQ was translated from Swedish to English using standard methods. Activity diaries, cognitive debriefing interviews and focus groups were completed with people with RA to: generate new culturally applicable items; identify important items in the Swedish version to retain in the English version; and develop the English EDAQ based on their views of content and layout. Content validity was established by linking the EDAQ to the International Classification of Functioning RA Core Set.ResultsThe English EDAQ translation was harmonized with the Swedish version to ensure equivalence of meaning. Sixty-one people with RA participated. 156 activities were identified from 31 activity diaries and included in a draft English EDAQ. Following interviews (n = 20) and four focus groups, 138 activities were retained and three additional domains added (Gardening/Household Maintenance; Caring; and Leisure/Social Activities). Most ICF RA Core Set activities are in the EDAQ.ConclusionsThe English EDAQ is a detailed self-report measure of ability in RA with good content validity.

Linguistic validation, validity and reliability of the British English versions of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and QuickDASH in people with rheumatoid arthritis

BackgroundAlthough the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is widely used in the UK, no British English version is available. The aim of this study was to linguistically validate the DASH into British English and then test the reliability and validity of the British English DASH, (including the Work and Sport/Music DASH) and QuickDASH, in people with rheumatoid arthritis (RA).MethodsThe DASH was forward translated, reviewed by an expert panel and cognitive debriefing interviews undertaken with 31 people with RA. Content validity was evaluated using the ICF Core Set for RA. Participants with RA (n = 340) then completed the DASH, Health Assessment Questionnaire (HAQ), Short Form Health Survey v2 (SF36v2) and Measure of Activity Performance of the Hand (MAPHAND). We examined internal consistency and concurrent validity for the DASH, Work and Sport/Music DASH modules and QuickDASH. Participants repeated the DASH to assess test-retest reliability.ResultsMinor wording changes were made as required. The DASH addresses a quarter of Body Function and half of Activities and Participation codes in the ICF RA Core Set. Internal consistency for DASH scales were consistent with individual use (Cronbach’s alpha = 0.94–0.98). Concurrent validity was strong with the HAQ (rs = 0.69–0.91), SF36v2 Physical Function (rs = − 0.71 - − 0.85), Bodily Pain (rs = − 0.71 - − 0.74) scales and MAPHAND (rs = 0.71–0.93). Test-retest reliability was good (rs = 0.74–0.95).ConclusionsBritish English versions of the DASH, QuickDASH and Work and Sport/Music modules are now available to evaluate upper limb disabilities in the UK. The DASH, QuickDASH, Work and Sport/Music modules are reliable and valid to use in clinical practice and research with British people with RA.

A qualitative evaluation of occupational therapy-led work rehabilitation for people with inflammatory arthritis : patients' views

Introduction This qualitative study, nested in a pilot feasibility randomised controlled trial, explored the views of working people with inflammatory arthritis on the impact of a work rehabilitation programme received. Method Thirty-two participants, drawn from the 55 participants in the associated randomised controlled trial, were recruited from secondary care in the United Kingdom. Semi-structured telephone and face-to-face interviews were conducted at six (n = 32) and nine months follow-up (n = 31). Interviews were audio-recorded, transcribed, and analysed using a constant comparative approach, under the theoretical framework of critical realism. Findings Three overarching themes emerged: (1) intervention group participants valued the work rehabilitation programme received, and highlighted the benefits of occupational therapy; (2) control group participants reported no benefits in relation to the written work advice pack, and lacked future aspirations to stay employed; (3) the majority of participants reported not reading the written work advice pack provided, which was the only work advice received by the control group. Conclusion Working people with inflammatory arthritis highly valued the practical support received from the therapists, and emphasised the value of the therapeutic relationship in the rehabilitation process. A tailor-made work rehabilitation programme, which incorporates cognitive-behavioural strategies into patient education, may help to reduce work instability in people with inflammatory arthritis, and increase their perceived self-efficacy.

The content validity and acceptability of the Evaluation of Daily Activity Questionnaire in musculoskeletal conditions

Introduction The Evaluation of Daily Activity Questionnaire is a detailed self-report measure of activity limitations. It has two parts, 10 scales of symptom severity and 14 daily activity domains, including 138 activities. It has good psychometric properties in rheumatoid arthritis. The aim was next to establish its content validity and acceptability in seven musculoskeletal conditions: ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic hand/upper limb musculoskeletal disorders; and primary Sjögrens syndrome. Method Participants completed the Evaluation of Daily Activity Questionnaire in their own time, followed by a cognitive debriefing interview to identify their views of importance of including each item and Evaluation of Daily Activity Questionnaire acceptability. Results Six to 12 people with each condition were interviewed (n = 70): 17 men and 53 women, 57.38 (SD 12.83) years of age and with 13.15 (SD 11.02) years condition duration. Overall, all 10 scales and 138 activities were considered important to include. Most found it: had clear instructions (93%); was easy to complete (87%); included about the right amount of activities (77%); and would help an occupational therapist gain insight into the effects of the persons conditions (87%). Conclusion The Evaluation of Daily Activity Questionnaire has good content validity and acceptability in these seven conditions.

The psychometric properties of the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions

Abstract Purpose: The purpose of this study is to psychometrically test the Evaluation of Daily Activity Questionnaire in seven musculoskeletal conditions. Materials and methods: One thousand and two hundred people with ankylosing spondylitis; osteoarthritis; systemic lupus erythematosus; systemic sclerosis; chronic pain; chronic upper limb disorders; or Primary Sjögren’s syndrome completed the Evaluation of Daily Activity Questionnaire, Health Assessment Questionnaire and Short-Form Health Survey v2. We examined internal construct validity using Rasch analysis, internal consistency, concurrent validity with the Health Assessment Questionnaire and Short-Form Health Survey v2. Participants repeated the Evaluation of Daily Activity Questionnaire to assess test–retest reliability. Results: The 12 domains satisfied Rasch model expectations for fit, local dependency, unidimensionality and invariance by age and gender, in each musculoskeletal condition. Internal consistency was consistent with individual use (Cronbach’s α > 0.90); concurrent validity was strong (Health Assessment Questionnaire: rs = 0.60–0.92; Short-Form Health Survey v2 Physical Function: rs = −0.61 to −0.91) and test–retest reliability excellent (Intra-Class Correlation Coefficient(2,1) = 0.77–0.96). Conclusion: The Evaluation of Daily Activity Questionnaire satisfied Rasch model requirements for construct validity and has good reliability and validity in each MSC. The Evaluation of Daily Activity Questionnaire can be used as a measure of everyday activity in practice and research with people with musculoskeletal conditions. Implications for rehabilitation The Evaluation of Daily Activity Questionnaire evaluates users’ ability to perform common daily activities (in 12 domains) that were identified as problematic by people with seven musculoskeletal conditions (i.e., osteoarthritis, systemic lupus, ankylosing spondylitis, chronic pain, chronic upper limb conditions, systemic sclerosis, Sjogren’s syndrome). Most patients considered the Evaluation of Daily Activity Questionnaire was the right length and would be helpful for discussing everyday problems with an occupational therapist. The 12 domains have good reliability and validity and can be combined into two components: Self-Care and Mobility. The Evaluation of Daily Activity Questionnaire is suitable for use both in clinical practice and research and a User Manual is available for therapists and researchers.

A pilot trial of compression gloves in early inflammatory and rheumatoid arthritis

Background: Compression gloves are provided in rheumatoid arthritis (RA) to improve hand symptoms and function but there is little evidence for their effectiveness. As a group of Rheumatology Occupational Therapists we were unaware of clinical evidence to support use of gloves. Financial constraints lead to the need to justify effective use of resources. No recent quality studies of compression gloves in arthritis were available a feasibility study to support anecdotal evidence was required. The study aim was to evaluate gloves’ effects on hand symptoms and function. Methods: Members of the northwest COTSSR met to agree best clinical practice. Service users were involved. A systematic review of compression gloves trials undertaken all Studies were small and poor methodology. The last study undertaken was 21 years ago. The group agreed compression glove criteria, hand assessment, treatment protocols and patient information leaflet. Prior to recruitment the OTs attended a training day to standardize assessments and study procedures. A pre-post-test study was conducted. Participants wore Isotoner ¾ finger gloves. Hand assessments were completed at 0 and 4 weeks. Results: Outcomes demonstrated significant improvements in: pain, stiffness, swelling, finger flexion and hand function. Conclusion: Compression gloves improved hand symptoms and function. Lack of a control group means changes may not be due to glove-wear. A randomized controlled trial is required, including longer follow-up. References Braun, V, Clarke, V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology, 3 (2): 77–101 Dixon AStJ (1986) Trial for Isotoner gloves for morning stiffness and pain in rheumatoid arthritis. British Journal of Clinical Practice 40 (7): 271–272 Oostervelt FJG, Raskerr JJ (1990) The effect of pressure gradient and thermolactyl control gloves in arthritis patients with swollen hands. British Journal of Rheumatology 29:197–200Introduction and Background: Up to 80% of stroke survivors have impairments of the upper limb, which considerably affects participation in everyday activities and quality of life (Langhorne et al., 2009). Improving upper limb function to maximise functional potential is an integral part of a stroke survivor’s rehabilitation programme (Lum et al., 2009). The use of splinting to improve functional outcomes has been a source of debate in the literature as its application in practice is diverse and warrants further research to guide practice (Basaran et al., 2012). Methods: An in-depth case study approach was used to evaluate eight stroke survivors’ sensorimotor and functional outcomes following a splinting regime using either dorsal or volar splints. The ICF framework was used to develop and structure the study. Data collection occurred biweekly for 2 months and then at 6 months to evaluate the impact of splinting. Descriptive and nonparametric data analysis of sensorimotor, functional and quality of life measures was done using SPSS. Results and conclusion: All participants showed some degree of improvement in majority of the study measures following an 8-week splinting programme. For younger participants, improvements of sensorimotor components were significantly associated with an improvement in functional ability and quality of life. Impact: The findings highlight areas of splinting practice that are potentially effective for the rehabilitation of the upper limb of stroke survivors but require research on a larger population using randomised controlled trials to confirm the findings. Implications for practice: A 6 month splinting programme has the potential to effect sensorimotor, functional and quality of life outcomes for individuals in the chronic phase of Stoke rehabilitation. There are many variables that need to be considered and the structure of the ICF model is well suited in guiding OTs when using splints for the rehabilitation of the upper limb for stroke survivors. References Basaran, A., E e, U., Karadavut, K.I., Balbaloglu, O., Bulmus, N. (2012) Hand splinting for poststroke spasticity: a randomized controlled trial. Topics In Stroke Rehabilitation. 19(4), 329#8211337. Langhorne, P., Coupar, F., Pollock, A. (2009) Motor recovery after stroke: a systematic review. The Lancet Neurology. 8(8), 741#8211754. Lum, P.S., Mulroy, S., Amdur, R.L., Requejo, P., Prilutsky, B.I., Dromerick, A.W. (2009) Gains in upper extremity function after stroke via recovery or compensation: Potential differential effects on amount of real-world limb use. Topics In Stroke Rehabilitation. 16(4), 237#8211253. Keywords Neurological practice, Research, Practice – present and future, Voluntary/third sector services Contact E-mail Addresses roshni.khatri@northampton.ac.ukIntroduction: In recent years dementia care has been on the crest of Government agenda in the United Kingdom (UK)(Great Britain Department of Health, 2013). Just this week the Regulation and Quality Improvement Authority, Northern Ireland, called for new standards to provide activity in care homes (Miller, 2015). Occupational Therapists are proven to be well placed to help multidisciplinary teams meet the occupational needs of their clients (Brian et al, 2015). The following case analysis considers the impact a dementia training course had on the occupational engagement of people with dementia. Method: The eight week course was developed by a multidisciplinary team, and facilitate by an OT. The person centered content was heavily influenced by Kitwood, (1997) and 50% of the delivery was ‘modelled’ by facilitators working alongside care home residents and staff. For example, the Pool Activity Level instrument, (Pool, 2011), was presented, and then utilised to help carers plan appropriate activities. One participant gave consent to be interviewed following the course to determine how the training had influenced her practice. Consent was gained to publish the findings. The interview was recorded to collate qualitative data for analysis, then the recording destroyed. The anonymity of the staff member and the care home will be observed at all times to maintain confidentiality. Conclusion: The carer reported an increase in meaningful occupation taking place laying the table, leisure activities, socialising, and singing. It had also improved the carer’s confidence, work satisfaction and influenced day service culture. Impact on service users. In this case, the education of one person increased the occupational engagement of several people with dementia. The training also appeared to break down the wider socio-environmental barriers that had restricted meaningful occupation in the day service.Introduction: Disclosure of Lesbian, Gay and Bisexual (LGB) orientation is identified as a continual process with negative and positive experiences holding long and short-term health and wellbeing impacts (Ryan, Legate and Weinstein, 2015). Occupational therapists claim holistic practice encompassing individuals’ diverse values, beliefs, and behaviours, yet evidence in addressing issues related to sexuality and disclosure is limited. It remains an under-researched area and from some perspectives, its relevance to occupational therapy is contested as illustrated in Couldrick (2005). A lack of understanding of the impact of disclosure on people’s occupational lives emphasises a need for this review of existing knowledge and its relevance to occupational therapy. Method: A structured database search and critical appraisal identified 17 articles that met the review criteria relating to LGB, disclosure, health & wellbeing and occupation. Data were extracted and analysed for themes according to Aveyard (2014). Findings: The review identified the factors influencing disclosure and the impact of disclosing sexual orientation on people’s health and wellbeing. Disclosure was a need, which increased alongside LGB identity affirmation. Analysis revealed how nondisclosure or negative disclosure experiences contributed to occupational deprivation, reduced participation and occupational performance. A lack of education amongst health professionals and ‘heteronormative’ practice was one of the key factors for negative impacts of disclosure. Conclusion: Disclosure of sexual orientation is a complex process impacting on individuals’ occupational identity, performance and engagement. This confirms the importance of developing occupational therapists’ understanding in order to support service users with an LGB orientation whom they may encounter in practice. The review has presented some foundations for future research directions and professional practice.