Objective: to Report the Theoretical Foundation of Generic Pa- Tient-reported Outcomes for Measuring Functioning Related to Upper Extremity Musculoskeletal Disorders and Perform Content Coverage Analysis and Content Comparison Using the International Classification of Functioning, Disability and Hea (original) (raw)
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Journal of Rehabilitation Medicine, 2014
Objective: To report the theoretical foundation of generic patient-reported outcomes for measuring functioning related to upper extremity musculoskeletal disorders and perform content coverage analysis and content comparison using the International Classification of Functioning, Disability and Health (ICF). Methods: A literature search was performed to identify commonly used patient-reported outcomes. A comparison of their theoretical foundations and a linking exercise between the measures' meaningful concepts and the ICF and Brief ICF Core Set for Hand Conditions was accomplished based on established rules. Results: Fifteen measures were selected. Multiple theoretical foundations were identified, and only 7 measures were developed based on a known conceptual model. Six measures were chosen for the linking process with 232 meaningful concepts retrieved and linked to 54 ICF categories. No concept was linked to the Body Structures component and two measures stood out for their Activity and Participation coverage. No measure covered all Brief ICF Core Set for Hand Conditions recommended categories. Conclusion: Some heterogeneity was observed with regards to the theoretical foundations on which the identified measures are based. The results of the linking process should help reduce these inconsistencies. They enable easy identification of content coverage and content comparison between measures using a common framework and can be used as a reference when selecting the most appropriate patient-reported outcome measure.
PM&R, 2011
Objective: To provide information regarding the (1) responsiveness and reliability of different outcome measures used with persons who have impairments in upper extremity function and (2) their content validity based on the International Classification of Functioning, Disability, and Health (ICF). Data Sources: MEDLINE, CINAHL, PsycINFO, and EMBASE databases were systematically searched for studies on outcome measures used to evaluate upper extremity function; only studies written in English and published between July 1997 and July 2010 were considered. Study Selection: One investigator reviewed titles and abstracts of the identified studies to determine whether the studies met predefined eligibility criteria (eg, study design, age Ͻ18 years). Another investigator did the same for 70% of the studies. Data Extraction: All types of outcome measures in the included studies were extracted, and the information retrieved from these outcome measures was linked to the ICF by 2 independent investigators who used standardized linking rules. In addition, studies reporting the clinical responsiveness, interrater reliability, and test-retest reliability of the outcome measures were identified. Data Synthesis: From among the 894 studies that were included in this review, 17 most frequently used outcome measures in the different study populations were identified. Five were patient-reported outcome measures and 12 were clinical outcome measures. The outcome measures show large variability with regard to the areas of functioning and disability addressed. Reliability and responsiveness data are missing for a few outcome measures or for certain populations for which they have been used. Conclusion: This systematic review provides an overview of the outcome measures used to address functioning and disability as they are related to the upper extremity. The results of this study may help clinicians and researchers select the most appropriate outcome measure for their clinical population or research question according to ICF-based content validity, and additional information on the reliability and responsiveness of the measures is provided. Our findings also can provide directions for further research.
Reliability and Validity of Two Versions of the Upper Extremity Functional Index
Physiotherapy Canada, 2014
Purpose: To examine the reliability, validity, and sensitivity to change of the 20-item version and the Rasch-refined 15-item version of the Upper Extremity Functional Index (UEFI-20 and UEFI-15, respectively) and to determine the impact of arm dominance on the positive minimal clinically important difference (pMCID). Methods: Adults with upper-extremity (UE) dysfunction completed the UEFI-20, Upper Extremity Functional Scale (UEFS), Pain Limitation Scale, and Pain Intensity Scale at their initial physiotherapy assessment (Time 1); 24–48 hours later (Time 2); and 3 weeks into treatment or at discharge, whichever came first (Time 3). Demographics, including working status, were obtained at Time 1. Global ratings of change (GRC) were provided by the treating physiotherapist and patient at Time 3. The UEFI-15 was calculated from relevant items in the UEFI-20. The intra-class correlation coefficient (ICC) and minimal detectable change (MDC) quantified test–retest reliability (Time 1–Tim...
The Journal of Hand Surgery: Journal of the British Society for Surgery of the Hand, 2005
The Disability of Arm, Shoulder and Hand (DASH) questionnaire is a standardized measure which captures the patients' own perspective of their upper extremity health status. Based on the scores of the DASH modules: symptoms, function and sport, this follow-up study of 590 hand-injured subjects from 11 diagnostic groups evaluated impairments and disabilities perceived 2 to 5 years postoperatively. Secondly, we explored the relationships between the diagnostic groups at the individual DASH item level.
The Journal of Hand Surgery, 2013
Part 1 of this article outlined the basic characteristics of useful clinical measurement instruments and described scales used to measure general health, pain, and patient satisfaction. Part 2 describes the features of some of the scales most commonly used in clinical research in the hand, wrist, elbow, and shoulder. Keywords Measurement; outcome instruments; upper extremity HAND AND WRIST The scales that dominate the measurement of outcomes related to the hand and wrist are the Disabilities of the Arm, Shoulder, and Hand (DASH) 1 and the Michigan Hand Outcomes Questionnaire (MHQ). 2 The Upper Extremity Function Scale 3 is also a region-specific instrument. The Patient-Related Wrist Evaluation (PRWE) 4 focuses solely on wrist function. A number of disease-specific scales are relevant to the hand, including the Boston Carpal Tunnel Questionnaire, 5 the Health Assessment Questionnaire (HAQ) 6 and the Arthritis Impact Measurement Scale (AIMS), 7 the latter 2 of which measure outcomes related to rheumatoid arthritis, 8 and the Australian/Canadian Hand Osteoarthritis Index 9 which focuses on osteoarthritis.
Construction and pilot assessment of the Upper Limb Assessment in Daily Living Scale
Journal of Neurology, Neurosurgery & Psychiatry, 2012
Objective The upper limb function of hemiplegic patients is currently evaluated using scales that assess physical capacity or daily activities under test conditions. The present scale, the Upper Limb Assessment in Daily Living (ULADL) Scale, was developed to explore the subjective and objective functional capacities of such patients in a proximal to distal sequence. Methods A group of experts constructed a scale addressing 17 upper limb functions (five active passive and 12 active) which could be explored by a questionnaire (Q) and a test (T). Reproducibility, internal consistency, concurrent validity (Rivermead Motor Assessment (RMA)) and learning effect were estimated in a multicentre study. Results 49 stroke patients were each rated three times within 7 days by a total of 21 physicians, yielding a total of 142 ratings. The ULADL took 1668 min to complete compared with 965 min for the RMA. Cronbach's alpha coefficient was 0.95 for Q and 0.97 for the practical tests (T). The global Q and T scores, and in particular the global Q score, were slightly higher at the second rating. The intra-rater intraclass correlation coefficient (ICC) was 0.65 (95% CI (0.44 to 0.79)) for Q and 0.97 (0.95 to 0.98) for T, and the inter-rater ICC was 0.95 for both Q and T. The Bland and Altman method showed good intraand inter-rater reliability with no systematic trend. Correlation coefficients for ULADL versus RMA were >0.80 for both Q and T. Conclusions The ULADL Scale has good psychometric properties and can explore patients with different degrees of upper limb impairment. < Additional materials are published online only. To view these files please visit the journal online
Journal of Hand Therapy, 2007
The objective of this study was to explore whether the items from a specific outcome measure, that is, Disabilities of the Arm, Shoulder, and Hand (DASH), for quantifying limb symptoms and functions in musculoskeletal disorders fit into the framework of the International Classification of Functioning, Disability and Health (ICF). All DASH items were compared to the ICF according to eight linking rules. Two groups of researchers performed the linking independently, and the results were compared by correlation. The 30 DASH items and four items from the optional modules were linked to 63 ICF categories and 11 chapters: 15 categories belong to the ICF body functions component and 48 to the activities and participation component. There were no items coded under the components body structure or environmental factors. Kappa index showed an agreement of 0.73 (p , 0.001). The results showed that the content of the DASH does link well with the ICF framework. Clinicians and researchers must attend to the fact that certain domains and categories from the ICF are not covered by the DASH. Limitations of the instrument may be overcome by simultaneously using other instruments that address the intended content.
Journal of Hand Therapy, 2006
Purpose. Current upper limb regional self-report outcome measures are criticized for poor clinical utility, including length, ease, and time to complete and score, missing responses, and poor psychometric properties. To address these concerns a new measure, the Upper Limb Functional Index (ULFI), was developed with reliability, validity, and responsiveness being determined in a prospective study. Methods. Patients from nine Australian outpatient settings completed the ULFI and two established scales, the Disabilities of the Arm, Shoulder, and Hand (DASH) (n ¼ 214) and the Upper Extremity Functional Scale (UEFS) (n ¼ 64) concurrently to enable construct and criterion validity to be assessed. Two subgroups were used to assess test-retest reliability at 48-hour intervals (n ¼ 46) and responsiveness through distribution-based methods (n ¼ 29). Internal consistency, change scores, and missing responses were calculated. Practical characteristics of the scale were assessed. Results. The ULFI correlated with the DASH (r ¼ 0.85; 95% CI) and UEFS (r ¼ 0.78; 95% confidence interval [CI]), demonstrated testretest reliability (intraclass correlation coefficient ¼ 0.96; 95% CI) and internal consistency (Cronbach alpha ¼ 0.89). The change scores of the ULFI with standard error of the measurement was 4.5% or 1.13 ULFI-points and minimal detectable change at the 90% CI was 10.4% or 2.6 ULFI-points. Responsiveness indices were standardized response mean at 1.87 and effect size at 1.28. The ULFI demonstrated an impairment range of 0-100%, with no missing responses and a combined patient completion and therapist scoring time of less than 3 minutes. Conclusions. The ULFI demonstrated sound psychometric properties, practical characteristics, and clinical utility thereby making it a viable clinical outcome tool for the determination of upper limb status and impairment. The ULFI is suggested as the preferred upper limb regional tool due to its superior practical characteristics and clinical utility, and comparable psychometric properties without a tendency toward item redundancy.
Disability and Rehabilitation, 2014
Purpose: The Upper Limb Functional Index (ULFI) is a self-report questionnaire assessing activity limitations and participation restrictions resulting from an upper limb musculoskeletal disorder (MSD). A French Canadian version of the ULFI (ULFI-FC) has recently demonstrated good internal consistency, and convergent validity, as well as clinical applicability in a rehabilitation context where clinicians have important time constraints. This study aimed to examine the test-retest reliability and responsiveness of the ULFI-FC. Methods: In order to study the ULFI-FC's responsiveness, 60 participants completed the ULFI-FC and a French Canadian version of the DASH (DASH-FC) twice at an interval of two to six weeks, based on the evolution of their upper limb MSD. Half of the sample also completed the ULFI-FC three days after the second assessment for the test-retest reliability analysis. Results: The ULFI-FC demonstrated high testretest reliability (ICC ¼ 0.92-0.97) and good internal responsiveness (Cohen's d ¼ 0.49-0.62; standardized responsive means ¼ 0.60-0.88). External responsiveness was further supported by moderate correlations of change scores with the DASH-FC (r ¼ 0.42-0.64). Conclusions: Study findings support the use of the ULFI-FC in rehabilitation as an outcome measure to monitor activity limitations and participation restrictions among French-speaking patients presenting with upper limb MSD.