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To determine the effectiveness of the "Plants for Joints" multidisciplinary lifestyle program in patients with metabolic syndrome-associated osteoarthritis (MSOA). Patients with hip or knee MSOA were randomized to the intervention or control group. The intervention group followed a 16-week program in addition to usual care based on a whole food plant-based diet, physical activity, and stress management. The control group received usual care. The patient-reported Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) total score (range 0–96) was the primary outcome. Secondary outcomes included other patient-reported, anthropometric, and metabolic measures. An intention-to-treat analysis with a linear-mixed model adjusted for baseline values was used to analyze between-group differences. Of the 66 people randomized, 64 completed the study. Participants (84% female) had a mean (SD) age of 63 (6) years and body mass index of 33 (5) kg/m2. After 16 weeks, the intervention group (n = 32) had a mean 11-point larger improvement in WOMAC-score (95% CI 6–16; p = 0.0001) compared to the control group. The intervention group also lost more weight (–5 kg), fat mass (–4 kg), and waist circumference (–6 cm) compared to the control group. Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue, pain interference, C-reactive protein, hemoglobin A1c, fasting glucose, and low-density lipoproteins improved in the intervention versus the control group, while other PROMIS measures, blood pressure, high-density lipoproteins, and triglycerides did not differ significantly between the groups. The "Plants for Joints" lifestyle program reduced stiffness, relieved pain, and improved physical function in people with hip or knee MSOA compared to usual care. [ABSTRACT FROM AUTHOR]

To compare dimensionality, item-level characteristics, scale-level reliability, and construct validity of PROMIS Physical Function short forms (PROMIS-PF) and 24-item Roland Morris Disability Questionnaire (RMDQ-24) in patients with chronic low back pain (LBP). Cross-sectional study. Secondary care center for rehabilitation and rheumatology. Patients with nonspecific LBP ≥3 months (N=768). Mean age was 49±13 years, 77% were female, and 54% displayed pain for more than 5 years. Not applicable. Dutch versions of the 4-, 6-, 8-, 10-, and 20-item PROMIS-PF and of the RMDQ-24. PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited sufficient unidimensionality (confirmatory factor analysis: comparative fit index>0.950, Tucker-Lewis index>0.950, root means square error of approximation<0.060), whereas the other instruments did not. All instruments were free of local dependence except PROMIS-PF-20 with 4 item pairs with clear residual correlations. Mokken scale analysis found 1 nonmonotone item for PROMIS-PF-20 and 8 for RMDQ-24 (ie, the probability of endorsing these items was not increasing with increasing level on the underlying construct). PROMIS-PF-20 displayed 2 misfitting items (S-χ2 P value>.001). Two-parameter item response theory models found 2 items with low discrimination for RMDQ-24. All other instruments had adequate fit statistics and item parameters. PROMIS-PF-20 displayed the best scale-level reliability. Construct validity was sufficient for all instruments as all hypotheses on expected correlations with other instruments and differences between relevant subgroups were met. PROMIS-PF-6, PROMIS-PF-8, and RMDQ-24 exhibited better unidimensionality, whereas PROMIS-PF-4, PROMIS-PF-6, PROMIS-PF-8, and PROMIS-PF-10 showed superior item-level characteristics. PROMIS-PF-20 was the instrument with the best scale-level reliability. This study warrants assessment of other measurement properties of PROMIS-PF short forms in comparison with disease-specific physical functioning instruments in LBP. [ABSTRACT FROM AUTHOR]

We studied the psychometric properties of the 39-item v1.1 Dutch-Flemish Patient-Reported Outcomes Measurement Information System Pain Behavior item bank in a sample of 1,602 patients with musculoskeletal complaints. We evaluated the assumptions of the underlying item response theory (IRT) model (unidimensionality and local dependency with confirmatory factor analyses), and monotonicity with scalability coefficients). We studied the IRT model fit of all items and estimated the item parameters of the IRT model. Differential item functioning (DIF) was studied for age and gender, and DIF for language was studied as a measure of cross-cultural validity. Confirmatory factor analyses showed suboptimal fit of a unidimensional model, but a bifactor model showed low risk of bias when a unidimensional model was assumed (Omega H = .92, explained common variance of .70). Fifteen item pairs (2%) were locally dependent. Five items showed poor scalability. All items fitted the IRT model; slope parameters ranged from .60 to 2.00, and threshold parameters from -2.05 to 6.80. One item showed DIF for age, 1 item DIF for gender, and 5 items showed DIF for language, but the impact on total scores was low. Our study shows limitations of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System Pain Behavior item bank when used in a primary care population with musculoskeletal complaints. PERSPECTIVE: We studied the psychometric properties of the Dutch-Flemish Patient-Reported Outcomes Measurement Information System Pain Behavior item bank in a large primary care population of patients with musculoskeletal complaints. It showed that the Pain Behavior item bank has limitations when used in this population. [ABSTRACT FROM AUTHOR]

Objectives To systematically review and synthesize the effects of soft braces on pain and on self-reported and performance-based physical function in patients with knee osteoarthritis. Data Sources The following electronic databases were searched from inception to April 20, 2016: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, CINAHL, SPORTDiscus, Web of Science, and PEDro. Study Selection Randomized controlled trials (RCTs) and nonrandomized controlled trials (non-RCTs), such as controlled clinical trials, crossover studies, and case-control studies, were included. Two reviewers independently screened articles and determined inclusion through predefined criteria. Data Extraction Data related to participant demographics, study design and methods, interventions, and outcomes, including numerical means and SDs, were extracted by 1 reviewer. Methodological quality assessment was independently performed by 2 reviewers. Data Synthesis Eleven studies were identified, including 6 RCTs and 5 non-RCTs. The methodological quality of included RCTs was low. There was a moderate improvement in pain (standardized mean difference [SMD]=.52; 95% confidence interval [CI], .14–.89; P =.007; 284 participants) in favor of wearing a brace compared with not wearing a brace for the immediate, within-group comparison. There was a moderate improvement in pain (SMD=.61; 95% CI, .33–.89; P <.001; 206 participants) and a small to moderate improvement in self-reported physical function (SMD=.39; 95% CI, .11–.67; P =.006; 206 participants) in favor of patients receiving a soft brace versus standard care for the prolonged effect, between-group comparison. Conclusions Currently available evidence indicates that soft braces have moderate effects on pain and small to moderate effects on self-reported physical function in knee osteoarthritis. These findings highlight the importance of soft braces as a technique to improve pain and physical function in both the short- and long-term. Additional high-quality studies are warranted to improve confidence in the findings. [ABSTRACT FROM AUTHOR]

Objective To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity. Design A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders. Setting A rehabilitation and rheumatology center. Participants Subjects (N=146) with early symptomatic knee OA from the CHECK study. Interventions Not applicable. Main Outcome Measures Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test. Results A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures ( B =−1.12, B =−5.83, and B =−1.25, respectively). Proprioception and laxity did not moderate this association. Conclusions In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To study the necessity and ability to climb stairs in persons after a lower-limb amputation (LLA) and the relation of this ability with personal and clinical variables. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: Persons with an LLA (N=155; mean age ± SD, 64.1±11.2y; 73% men). Interventions: Not applicable. Main Outcome Measures: The necessity to climb stairs was assessed with the Prosthetic Profile of the Amputee. Several indicators of the ability to climb stairs were assessed including: (1) independence in climbing stairs with a handrail and (2) without a handrail, according to the Locomotor Capabilities Index; (3) numbers of floors actually climbed, according to a rating scale; and (4) limitations in climbing stairs, according to the Climbing Stairs Questionnaire (range, 0–100, with higher scores indicating less limitations). Multivariate logistic regression analysis was used to investigate the associations between the ability to climb stairs and personal and clinical variables. Results: Of the participants, 47% had to climb stairs. The ability to climb stairs was: (1) 62% independently climbed stairs with a handrail and (2) 21% without a handrail; (3) 32% didn't climb any stairs, 34% climbed half a floor or 1 floor, and 34% climbed ≥2 floors; (4) the median sum score (interquartile range) of the Climbing Stairs Questionnaire was 38 (19–63), indicating marked limitations. Older participants and women were less able to climb stairs with and without a handrail. Conclusions: A considerable number of persons with an LLA have to climb stairs in their home environment. Many of them, especially older participants and women, are particularly hampered in their ability to climb stairs. [Copyright &y& Elsevier]

Abstract: Roorda LD, Green JR, Houwink A, Bagley PJ, Smith J, Molenaar IW, Geurts AC. Item hierarchy–based analysis of the Rivermead Mobility Index resulted in improved interpretation and enabled faster scoring in patients undergoing rehabilitation after stroke. Objective: To enable improved interpretation of the total score and faster scoring of the Rivermead Mobility Index (RMI) by studying item ordering or hierarchy and formulating start-and-stop rules in patients after stroke. Design: Cohort study. Setting: Rehabilitation center in the Netherlands; stroke rehabilitation units and the community in the United Kingdom. Participants: Item hierarchy of the RMI was studied in an initial group of patients (n=620; mean age ± SD, 69.2±12.5y; 297 [48%] men; 304 [49%] left hemisphere lesion, and 269 [43%] right hemisphere lesion), and the adequacy of the item hierarchy–based start-and-stop rules was checked in a second group of patients (n=237; mean age ± SD, 60.0±11.3y; 139 [59%] men; 103 [44%] left hemisphere lesion, and 93 [39%] right hemisphere lesion) undergoing rehabilitation after stroke. Interventions: Not applicable. Main Outcome Measures: Mokken scale analysis was used to investigate the fit of the double monotonicity model, indicating hierarchical item ordering. The percentages of patients with a difference between the RMI total score and the scores based on the start-and-stop rules were calculated to check the adequacy of these rules. Results: The RMI had good fit of the double monotonicity model (coefficient H T =.87). The interpretation of the total score improved. Item hierarchy–based start-and-stop rules were formulated. The percentages of patients with a difference between the RMI total score and the score based on the recommended start-and-stop rules were 3% and 5%, respectively. Ten of the original 15 items had to be scored after applying the start-and-stop rules. Conclusions: Item hierarchy was established, enabling improved interpretation and faster scoring of the RMI. [ABSTRACT FROM AUTHOR]

Abstract: Roorda LD, Green JR, Houwink A, Bagley PJ, Smith J, Molenaar IW, Geurts AC. The Rivermead Mobility Index allows valid comparisons between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion. Objective: To investigate differential item functioning or item bias of the Rivermead Mobility Index (RMI) and its impact on the drawing of valid comparisons with the RMI between subgroups of patients after stroke who differ with respect to age, sex, or side of lesion. Design: Cross-sectional study. Setting: A rehabilitation center in the Netherlands and 2 stroke rehabilitation units and the wider community in the United Kingdom. Participants: The RMI was completed for patients undergoing rehabilitation after stroke (N=620; mean age ± SD, 69.2±12.5y; 297 [48%] men; 269 [43%] right hemisphere lesion, and 304 [49%] left hemisphere lesion). Interventions: Not applicable. Main Outcome Measures: Mokken scale analysis was used to investigate differential item functioning of the RMI between subgroups of patients who differed with respect to age (young vs older), sex (men vs women), and side of stroke lesion (right vs left hemisphere). Results: No differential item functioning was found for any of the comparison subgroups. Conclusions: The RMI allows valid comparisons to be made between subgroups of patients undergoing rehabilitation after stroke who differ with respect to age, sex, or side of lesion. [Copyright &y& Elsevier]

Abstract: de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Walking Questionnaire in people with a lower limb amputation. Objective: To investigate the construct validity and test-retest reliability of the Walking Questionnaire, a patient-reported measure of activity limitations in walking in people with a lower limb amputation. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: People with a lower limb amputation (N=172; mean age ± SD, 65±12y; 71% men; 82% vascular cause) participated in the study, 33 of whom also participated in the reliability study. Interventions: Not applicable. Main Outcome Measures: Construct validity was investigated by testing 11 hypotheses: limitations in walking according to the Walking Questionnaire will be greater in people with a lower limb amputation who (1) are older, (2) have a bilateral amputation, (3) have a higher level of amputation, (4) underwent their rehabilitation treatment in a nursing home, (5) walk less (in terms of time), and (6) walk shorter distances. Furthermore, limitations in walking will be positively related to activity limitations according to the (7) Locomotor Capabilities Index, (8) “distance walked” question on the Prosthetic Profile of the Amputee Questionnaire, (9) Questionnaire Rising and Sitting Down, (10) Climbing Stairs Questionnaire, and (11) Special Interest Group on Amputation Medicine/Dutch Working Group on Amputations and Prosthetics mobility scale. Construct validity was quantified by using the Mann-Whitney U test and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient. Results: Construct validity (10 of 11 hypotheses not rejected) and test-retest reliability were good (intraclass correlation coefficient =.73; 95% confidence interval, .43–.88). Conclusions: The Walking Questionnaire has good construct validity and test-retest reliability in people with a lower limb amputation. [Copyright &y& Elsevier]

Abstract: Houwink A, Roorda LD, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in patients after stroke: reliability and validity of the Stroke Upper Limb Capacity Scale. Objective: To investigate the interrater reliability and construct validity of the Stroke Upper Limb Capacity Scale (SULCS). Design: Cohort study. Setting: Inpatient department of a rehabilitation center. Participants: Patients after stroke (N=21; mean age ± SD, 61.7±7.9y; 57% men), undergoing inpatient rehabilitation. Interventions: Not applicable. Main Outcome Measures: The SULCS was administered by occupational therapists (OTs) within 6 weeks after stroke (t1), 3 months after t1 by the same OT (t2), and within 1 week after t2 by another OT (t3). Interrater reliability, the repeatability between different raters, was assessed by calculating the intraclass correlation coefficient (ICC) based on the scores at t2 and t3. Construct validity, indicating agreement with hypotheses concerning the construct that is being measured, was assessed with Spearman rank correlation coefficient (ρ). The SULCS scores were cross-sectionally correlated with those of the Action Research Arm Test (ARAT) and the Rivermead Motor Assessment (RMA) at t1, and longitudinally with the respective change scores between t1 and t2. Results: The SULCS (range, 0–10) had a high ICC (.94; 95% confidence interval, .86–.97) and strong cross-sectional correlation with both the ARAT and the RMA (ρ=.91 and ρ=.85, respectively), while the respective change scores showed a strong correlation with the ARAT (ρ=.71) and a moderate correlation with the RMA (ρ=.48). Conclusions: The SULCS has good interrater reliability and construct validity. [Copyright &y& Elsevier]

Abstract: de Laat FA, Rommers GM, Geertzen JH, Roorda LD. Construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down in lower-limb amputees. Objective: To investigate the construct validity and test-retest reliability of the Questionnaire Rising and Sitting Down (QR&S), a patient-reported measure of activity limitations in rising and sitting down, in lower-limb amputees. Design: Cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: Lower-limb amputees (N=171; mean age ± SD, 65±12y; 71% men; 83% vascular cause) participated in the study, 33 of whom also participated in the reliability study. Interventions: Not applicable. Main Outcome Measures: Construct validity was investigated by testing 8 hypotheses: limitations in rising and sitting down according to the QR&S would be: (1) greater in lower-limb amputees who are older, (2) independent of level of amputation, (3) greater in lower-limb amputees with a bilateral amputation, and (4) greater in lower-limb amputees who had rehabilitation treatment in a nursing home. Furthermore, limitations in rising and sitting down will be positively related to activity limitations according to (5) the Locomotor Capabilities Index (LCI), (6) the questions about rising and sitting down in the LCI, (7) the Climbing Stairs Questionnaire, and (8) the Walking Questionnaire. Construct validity was quantified with an independent t test and Pearson correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified with the intraclass correlation coefficient (ICC), standard error of measurement, and smallest detectable difference (SDD). Results: Construct validity (7 of 8 null hypotheses not rejected) and test-retest reliability were good (ICC=.84; 95% confidence interval, .65–.93; standard error of the measurement=6.7%; SDD=18.6%). Conclusions: The QR&S has good construct validity and good test-retest reliability in lower-limb amputees. [Copyright &y& Elsevier]

Abstract: Dallmeijer AJ, Scholtes VA, Becher J, Roorda LD. Measuring mobility limitations in children with cerebral palsy: Rasch model fit of a mobility questionnaire, MobQues28. Objective: To develop a Rasch-based version of a mobility questionnaire (MobQues28) for children with cerebral palsy (CP). Design: Cross-sectional study. Setting: Private physical therapy practices and outpatient departments of hospitals and rehabilitation centers. Participants: Parents of 323 ambulatory children with CP (Gross Motor Function Classification System [GMFCS] level I-IV; aged, 2–13y). Interventions: Not applicable. Main Outcome Measure: The mobility questionnaire measures mobility limitations in children with CP by rating the difficulty of executing 47 mobility activities, as reported by the parents. Items for the Rasch-based version were selected based on fit to the Rasch measurement (partial credit) model and invariance of item characteristics across GMFCS level, age group, or sex. Results: Analysis revealed a fitting model when nonambulant and/or 2- and 3-year aged children were excluded (leaving a final sample of n=246) and answering categories were collapsed from 9 to 5. Thirteen items were removed from the questionnaire due to misfit to the model, 5 because of disordered thresholds, and 1 because of invariance across age group. Twenty-eight items out of the original 47 items showed good fit to the model. Conclusions: The 28-item version of the mobility questionnaire (MobQues28) provides sound measurement properties for measuring mobility limitations in ambulant children with CP, aged 4 to 13 years, and shows promise as an instrument for research purposes. [Copyright &y& Elsevier]

Abstract: Roorda LD, Houwink A, Smits W, Molenaar IW, Geurts AC. Measuring upper limb capacity in poststroke patients: development, fit of the monotone homogeneity model, unidimensionality, fit of the double monotonicity model, differential item functioning, internal consistency, and feasibility of the Stroke Upper Limb Capacity Scale, SULCS. Objectives: To develop an easy-to-use scale that measures upper limb capacity, according to the International Classification of Functioning, Disability and Health definition, in patients after stroke, and to investigate certain psychometric properties of this scale. Design: Cohort study. Setting: Inpatient department of a rehabilitation center. Participants: Patients (N=546; mean age ± SD, 60.1±11.2y; 56% men) undergoing rehabilitation after stroke. Interventions: Not applicable. Main Outcome Measures: Mokken scale analysis was used to investigate the following psychometric properties: (1) fit of the monotone homogeneity model, indicating that the items form a scale; (2) unidimensionality, indicating that the items measure only 1 concept (or construct); (3) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (4) differential item functioning (DIF), indicating the validity of comparison between subgroups; and (5) internal consistency, indicating the degree of interrelatedness of the items. The mean time needed to complete the scale was calculated to indicate (6) feasibility. Results: The Stroke Upper Limb Capacity Scale (SULCS) was developed on the basis of interviews with experts. Ten of 15 items had (1) good fit of the monotone homogeneity model (coefficient H=.88), were (2) unidimensional, and had (3) good fit of the double monotonicity model (coefficient H T =.71), (4) absence of DIF (Crit-values <40), and (5) good internal consistency (coefficient ρ=.96). When applying start-and-stop rules, the (6) feasibility of the SULCS was good (6min). Conclusions: The SULCS is an easy-to-use, unidimensional, hierarchical, and internally consistent scale that assesses upper limb capacity in patients after stroke. [Copyright &y& Elsevier]

Abstract: Ursum J, Horsten NC, Hoeksma AF, Dijkmans BA, Knol DL, van Schaardenburg D, Dekker J, Roorda LD. Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis. Objectives: To identify early predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis (RA). Design: A longitudinal study of an inception cohort. Setting: A large outpatient clinic. Participants: Consecutive patients who attended the Early Arthritis Clinic for at least 2 years and fulfilled the American College of Rheumatology criteria for RA at baseline and/or at the 1-year follow-up were invited to participate until 200 patients were included. Interventions: Not applicable. Main Outcome Measures: Stenosing tenosynovitis, assessed by means of a standardized physical examination. Hand-related activity limitations, assessed with the Disabilities of Arm, Shoulder and Hand questionnaire (DASH). A DASH score above the upper limit of the 95% range of the normative score was defined as abnormal. Prognostic factors: demographic and disease activity–related variables, radiographic damage, the Health Assessment Questionnaire (HAQ) total score and category scores at the 2-year follow-up. Results: The mean age ± SD of the patients was 59.7±10.7 years (75% female). The mean time ± SD between the 2-year follow-up and the assessment of the dependent variables was 3.9±2.7 years. Stenosing tenosynovitis was present in 33%. The median (interquartile range) DASH score was 26.7 (10.8–42.5); 30% were abnormal. Stenosing tenosynovitis was predicted by the HAQ subscale regarding the use of hands (HAQ-hand) at the 2-year follow-up (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2–4.2). Hand-related activity limitations were predicted by the Disease Activity Score in 28 joints (OR, 1.8; 95% CI, 1.3–2.4) and HAQ-hand (OR, 2.4; 95% CI, 1.3–5.8) at the 2-year follow-up. Conclusions: Stenosing tenosynovitis in patients with RA was predicted by HAQ-hand at the 2-year follow-up, and hand-related activity limitations were predicted by disease activity and HAQ-hand at the 2-year follow-up. [Copyright &y& Elsevier]

Construct validity and test-retest reliability of the Climbing Stairs Questionnaire in lower-limb amputees. Objective: To investigate the construct validity and test-retest reliability of the Climbing Stairs Questionnaire, a patient-reported measure of activity limitations in climbing stairs, in lower-limb amputees. Design: A cross-sectional study. Setting: Outpatient department of a rehabilitation center. Participants: Lower-limb amputees (N=172; mean ± SD age, 65±12y; 71% men; 82% vascular cause) participated in the study; 33 participated in the reliability study. Interventions: Not applicable. Main Outcome Measure(s): Construct validity was investigated by testing 10 hypotheses: limitations in climbing stairs according to the Climbing Stairs Questionnaire will be greater in lower-limb amputees who: (1) are older, (2) have a vascular cause of amputation, (3) have a bilateral amputation, (4) have a higher level of amputation, (5) have more comorbid conditions, (6) had their rehabilitation treatment in a nursing home, and (7) climb fewer flights of stairs. Furthermore, limitations in climbing stairs will be related positively to activity limitations according to: (8) the Locomotor Capabilities Index, (9) the Questionnaire Rising and Sitting down, and (10) the Walking Questionnaire. Construct validity was quantified by using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman correlation coefficient. Test-retest reliability was assessed with a 3-week interval and quantified using the intraclass correlation coefficient (ICC). Results: Construct validity (8 of 10 null hypotheses not rejected) and test-retest reliability were good (ICC=.79; 95% confidence interval, .57–.90). Conclusion: The Climbing Stairs Questionnaire has good construct validity and test-retest reliability in lower-limb amputees. [Copyright &y& Elsevier]

Abstract: Roorda LD, Scholtes VA, van der Lee JH, Becher J, Dallmeijer AJ. Measuring mobility limitations in children with cerebral palsy: development, scalability, unidimensionality, and internal consistency of the Mobility Questionnaire, MobQues47. Objectives: To develop a questionnaire that specifically and comprehensively measures mobility limitations in children with cerebral palsy (CP) and to investigate certain psychometric properties (scalability, unidimensionality, internal consistency) of this questionnaire. Design: Cross-sectional study. Setting: Private physical therapy practices and outpatient departments of hospitals and rehabilitation centers. Participants: Children with CP undergoing physical therapy or rehabilitation. The Mobility Questionnaire, 47-item (MobQues47), was completed by the mothers of these children (N=323; mean age ± SD, 7.1±2.9y; 57% boys; Gross Motor Function Classification levels: I [48%], II [26%], III [19%], IV [7%]). Interventions: Not applicable. Main Outcome Measures: Mokken scale analysis was used to investigate (1) scalability, indicating that the items form a scale; (2) unidimensionality, indicating that the items measure only 1 concept; and (3) internal consistency, indicating the degree of interrelatedness of the items. Results: The MobQues47, made up of 47 items, was developed on the basis of 3 pilot studies and careful operationalization of the concept (or construct) of mobility limitations. The scalability (coefficient H=.70), unidimensionality, and internal consistency (coefficient ρ=.99) of the MobQues47 were found to be very good. Conclusions: The MobQues47 is a unidimensional scale with excellent internal consistency that can be used to measure caregiver-reported mobility limitations in children with CP. [ABSTRACT FROM AUTHOR]

Objective: There is no consensus on the best method to determine the minimal important change (MIC) of patient-reported outcomes. Recent publications recommend the use of multiple methods. Our aim was to assess whether different methods lead to consistent values for the MIC.Study Design and Setting: We used two commonly used anchor-based methods and three commonly used distribution-based methods to determine the MIC of the subscales: pain and physical functioning of the Western Ontario and McMaster University Osteoarthritis Index questionnaire in five different studies involving patients with hip or knee complaints. We repeated the anchor-based methods using relative change scores, to adjust for baseline scores.Results: We found large variation in MIC values by the same method across studies and across different methods within studies. We consider it unlikely that this variation can be explained by differences between disease groups, disease severity, or lengths of follow-up. The variation persisted when using relative change scores. It was not possible to conclude whether this variation is because of true differences in MIC values between populations or to conceptual and methodological problems of the MIC methods.Conclusion: To better disentangle these two possible explanations, the MIC methodology should be improved and standardized. In the meantime, caution is needed when interpreting and using published MIC values. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To provide a practical example showing how to relate measurement error to minimal important change (MIC) to estimate sample sizes required for detecting important changes in research, and to determine the usefulness of patient-reported outcomes (PROs) in daily clinical practice. Study Design and Setting: The standard error of measurement (SEM) can be calculated as a parameter of measurement error. MIC can be determined by taking the mean change in score on the questionnaire in the subgroup of patients that reported to be “a little better” or “better” on a global rating scale minus the mean change in score in the subgroup of patients that reported to be “not changed.” Based on SEM and MIC, formulas are presented that can be used to estimate sample sizes and to determine whether the questionnaire can be used to monitor changes in individual patients in daily clinical practice. Results: A fully worked-out example is presented, using Western Ontario and McMaster University Osteoarthritis Index data from a cohort of patients undergoing hip or knee replacement. Conclusion: We strongly recommend investigators to present the SEM and MIC of PROs and use these to estimate sample sizes for research and to determine the usefulness of these outcomes in daily clinical practice. [Copyright &y& Elsevier]

Abstract: Roorda LD, Roebroeck ME, van Tilburg T, Molenaar IW, Lankhorst GJ, Bouter LM, and the Measuring Mobility Study Group. Measuring activity limitations in walking: development of a hierarchical scale for patients with lower-extremity disorders who live at home. Objective: To develop a hierarchical scale that measures activity limitations in walking in patients with lower-extremity disorders who live at home. Design: Cross-sectional study. Setting: Orthopedic workshops and outpatient clinics of secondary and tertiary care centers. Participants: Patients (N=981; mean age ± standard deviation, 58.6±15.4y; 46% men) living at home, with different lower-extremity disorders: stroke, poliomyelitis, osteoarthritis, amputation, complex regional pain syndrome type I, and diabetic and degenerative foot disorders. Interventions: Not applicable. Main Outcome Measures: (1) Fit of the monotone homogeneity model, indicating whether items can be used for measuring patients; (2) fit of the double monotonicity model, indicating invariant (hierarchical) item ordering; (3) intratest reliability, indicating repeatability of the sum score; (4) robustness, addressing the clinimetric properties within subgroups of patients; and (5) differential item functioning, addressing the validity of comparisons between subgroups of patients. Results: Thirty-five of 41 dichotomous items had (1) good fit of the monotone homogeneity model (coefficient H=.50), (2) good fit of the double monotonicity model (coefficient H T =.33), (3) good intratest reliability (coefficient ρ=.95), (4) satisfactory robustness (within subgroups of patients defined by age, sex, and diagnosis), and (5) some differential item functioning (6 items in amputees compared with nonamputees). Conclusions: A hierarchical scale, with excellent scaling characteristics, was developed to measure activity limitations in walking in patients with lower-extremity disorders who live at home. The measurements should be interpreted cautiously when making comparisons between amputees and nonamputees. [Copyright &y& Elsevier]

Abstract: Roorda LD, Molenaar IW, Lankhorst GJ, Bouter LM, and the Measuring Mobility Study Group. Improvement of a questionnaire measuring activity limitations in rising and sitting down in patients with lower-extremity disorders living at home. Objective: To improve a self-administered questionnaire that includes 42 dichotomous items and measures activity limitations in rising and sitting down (R&S) in patients with lower-extremity disorders who live at home. Design: Cross-sectional study. Setting: Outpatient clinics of secondary and tertiary care centers. Participants: Patients (N=759; 47% men; mean age ± standard deviation, 60.7±15.2y) living at home, with lower-extremity disorders resulting from stroke, poliomyelitis, osteoarthritis, amputation, and complex regional pain syndrome type I. Interventions: Not applicable. Main Outcome Measures: (1) Unidimensionality, indicating that items assess only a single construct; (2) fit with the one-parameter logistic model (OPLM), yielding information about patient and item location parameters; (3) intratest reliability, indicating consistency of patients’ item scores; and (4) content validity, indicating completeness with which the items cover the important aspects of the construct that they are attempting to represent. Results: Thirty-nine of 42 items: (1) loaded on 1 component (variance explained, 59%; item component loadings, ≥.51), (2) showed good fit with the OPLM (P=.15), (3) had a good intratest reliability (Cronbach α=.96), and (4) had a good content validity (all important aspects represented). Conclusions: A unidimensional scale that fits with the OPLM has been developed for measuring activity limitations in R&S in patients with lower-extremity disorders who live at home. [Copyright &y& Elsevier]

To study the test-retest reliability and measurement error, construct validity, responsiveness, interpretability, and floor/ceiling effects of a Patient-Reported Outcomes Measurement Information System (PROMIS) short form designed to measure physical function in geriatric rehabilitation patients (PROMIS-PF-GR). Prospective cohort. Inpatient geriatric rehabilitation patients. We evaluated the test-retest reliability by re-administering PROMIS-PF-GR 3 to 5 days after the admission measurement. The intraclass correlation coefficient (ICC) was calculated to determine test-retest reliability; an ICC of ≥0.70 was considered sufficient. Measurement error was established by calculating the standard error of measurement and smallest detectable change. Construct validity and responsiveness were determined by testing a priori formulated hypotheses (criterion: ≥75% hypothesis not rejected). Interpretability was evaluated by calculating the minimal important change using predictive modeling and a global rating as criterion for change. Floor/ceiling effects were established by calculating the percentage patients with the minimum/maximum raw score (criterion: ≤15%) at admission and discharge. A total of 207 patients participated in the study [mean ± standard deviation age (80 ± 8.3 years), 58% female]. More than one-half of patients (56%) reported to be improved during rehabilitation. The ICC was 0.79 (95% confidence interval 0.70–0.84), the standardized error of measurement was 3.8, and the smallest detectable change 10.6. None of the 4 hypotheses for construct validity were rejected; 2 out of 5 hypotheses for responsiveness were rejected. The minimal important change was 8.0 (95% confidence interval 4.1–12.5). No floor/ceiling effects were found. The PROMIS-PG-GR showed sufficient test-retest reliability, measurement error, and construct validity. We did not find sufficient evidence for responsiveness, which may be due to the unexplained weak correlation between the PROMIS change score and the Global Rating Scale. We still recommend the use the PROMIS-PG-GR for measuring self-reported physical function in geriatric rehabilitation. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Determining “minimally important change” (MIC) facilitates the interpretation of change scores on multi-item instruments. This article focuses on how MIC values should be interpreted when applied to individual patients. Study Design and Setting: The MIC value of a hypothetical questionnaire “Q” was determined in a sample of 400 patients who improved and 100 patients who did not improve, using the receiver operating characteristic (ROC) method, and three methods to quantify the uncertainty. Results: The MIC value on questionnaire Q was 10.5. Firstly, the 95% confidence interval (CI) of the MIC value (for questionnaire Q: 5.6–14.2) quantifies the uncertainty of the estimation of the MIC value. Secondly, “how sure we are that this MIC value holds for every patient” is quantified by the values for sensitivity (74%) and specificity (91%). Thirdly, the smallest detectable change (SDC) on questionnaire Q is calculated (16.0) to consider whether the MIC value (10.5) falls outside or within the measurement error. Conclusion: For application in clinical research and practice, MIC values are always considered at the individual level, but determined in groups of patients. The interpretation comes with different forms of uncertainty. To appreciate the uncertainty, knowledge of the underlying distributions of change scores is indispensable. [Copyright &y& Elsevier]