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Objective: To investigate dimensionality and the measurement properties of the Italian Lower Extremity Functional Scale using both classical test theory and Rasch analysis methods, and to provide insights for an improved version of the questionnaire., Design: Rasch analysis of individual patient data., Setting: Rehabilitation centre., Participants: A total of 135 patients with musculoskeletal diseases of the lower limb., Results: Patients were assessed with the Lower Extremity Functional Scale before and after the rehabilitation. Rasch analysis showed some problems related to rating scale category functioning, items fit, and items redundancy. After an iterative process, which resulted in the reduction of rating scale categories from 5 to 4, and in the deletion of 5 items, the psychometric properties of the Italian Lower Extremity Functional Scale improved. The retained 15 items with a 4-level response format fitted the Rasch model (internal construct validity), and demonstrated unidimensionality and good reliability indices (person-separation reliability 0.92; Cronbach's alpha 0.94). Then, the analysis showed differential item functioning for six of the retained items. The sensitivity to change of the Italian 15-item Lower Extremity Functional Scale was nearly equal to the one of the original version (effect size: 0.93 and 0.98; standardized response mean: 1.20 and 1.28, respectively for the 15-item and 20-item versions)., Conclusion: The Italian Lower Extremity Functional Scale had unsatisfactory measurement properties. However, removing five items and simplifying the scoring from 5 to 4 levels resulted in a more valid measure with good reliability and sensitivity to change.

Background: Outcome measures are the scientific basis for assessment and comparison of the effects of rehabilitative interventions. Among the instruments proposed for the evaluation of musculoskeletal disorders of the upper limb, the Upper Limb Functional Index (ULFI) was recently validated and translated into several languages, but it does not yet exist an Italian version yet., Objective: To obtain an Italian validated version of ULFI, called ULFI-I., Materials & Methods: The translation process was conducted following the international guidelines of the forwardlbackward translation. The ULFI-I was subsequently validated by calculating: (1) internal consistency (Cronbach's a and item-to-total correlation), (2) criterion validity (correlation r with the Disabilities of the Arm, Shoulder and Hand Questionnaire, DASH), and (3) test-retest reliability (ICC(2,1)) and measurement error (Standard Error of measurement, SEM and Minimal Detectable Change, MDC90. For the first two points we used a sample of 57 patients with upper limb orthopedic conditions, while the analysis of the. reliability required a further administration of the questionnaire carried out 3 days before on 33 subjects. I. Statistical analysis showed good levels of internal consistency (Cronbach's alpha=.90, item-to-total correlation between .45 and .73), high criterion validity (r=.81, P<0.01) and excellent reliability test-retest reliability (ICC(2,1)=.94, CI=.89-.97). The SEM was found to be equal to 5 points, with a MDC90 estimated at 12 points., Conclusion: In this study the ULFI-I showed good psychometric properties, combined with speed and ease of administration and scoring. Its use will facilitate the comparison of data collected in Italy with international studies, ensuring greater uniformity of assessment.

Objective: To perform a comprehensive analysis of the psychometric properties and dimensionality of the Upper Limb Functional Index (ULFI) using both classical test theory and Rasch analysis (RA)., Design: Prospective, single-group observational design., Setting: Freestanding rehabilitation center., Participants: Convenience sample of Italian-speaking subjects with upper limb musculoskeletal disorders (N=174)., Interventions: Not applicable., Main Outcome Measures: The Italian version of the ULFI. Data were analyzed using parallel analysis, exploratory factor analysis, and RA for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices., Results: Parallel analysis revealed 2 factors explaining 32.5% and 10.7% of the response variance. RA confirmed the failure of the unidimensionality assumption, and 6 items out of the 25 misfitted the Rasch model. When the analysis was rerun excluding the misfitting items, the scale showed acceptable fit values, loading meaningfully to a single factor. Item separation reliability and person separation reliability were .98 and .89, respectively. Cronbach alpha was .92., Conclusions: RA revealed weakness of the scale concerning dimensionality and internal construct validity. However, a set of 19 ULFI items defined through the statistical process demonstrated a unidimensional structure, good psychometric properties, and clinical meaningfulness. These findings represent a useful starting point for further analyses of the tool (based on modern psychometric approaches and confirmatory factor analysis) in larger samples, including different patient populations and nationalities., (Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Valid and reliable outcome measures are fundamental for evaluating and comparing the effects of rehabilitation. Among the different tools used for the assessment of musculoskeletal disorders of the lower limb, the Foot and Ankle Ability Measure (FAAM) has been shown to have good psychometric properties. However, it has not yet been translated into Italian. The module regarding the performance of daily living activities (FAAM/ADL), in particular, can be applied also in an occupational setting., Objective: To obtain an Italian version of the FAAM, and to validate the FAAM-I/ADL., Methods: The cultural adaptation was performed according to international guidelines for forward/backward translation. The activities of daily living (ADL) module of the FAAM-I (FAAM-I/ADL) was validated with classical test theory methods in a convenience sample of 57 patients. Different parameters were calculated: internal consistency (Cronbach's α and item-to-total correlation); criterion validity, through Pearson's correlation (r) with the Lower Extremity Functional Scale (LEFS); test-retest reliability (ICC2,1); Standard Error of Measurement (SEM); and Minimal Detectable Change (MDC95)., Results: The statistical analysis showed good internal consistency (Cronbach's α=.96, item-to-total correlation ranged between .51 and .85), high criterion validity (r=.66, p&lt;0.01) and excellent test-retest reliability (ICC2, 1=.98, CI95%=.97-.99). The SEM was 2.7 points, with a MDC95 of 7.5 points., Conclusions: FAAM-I/ADL shows good psychometric properties, together with speed and ease of administration and scoring. Its use will facilitate the comparison of Italian data with international studies, ensuring greater uniformity of assessment.

Study Design: Prospective, single-group observational design., Objectives: To determine the minimal clinically important difference (MCID) for the Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure and its shortened version (QuickDASH) in patients with upper-limb musculoskeletal disorders, using a triangulation of distribution- and anchor-based approaches., Background: Meaningful threshold change values of outcome tools are crucial for the clinical decision-making process., Methods: The DASH and QuickDASH were administered to 255 patients (mean ± SD age, 49 ± 15 years; 156 women) before and after a physical therapy program. The external anchor administered after the program was a 7-point global rating of change scale., Results: The test-retest reliability of the DASH and QuickDASH was high (intraclass correlation coefficient model 2,1 = 0.93 and 0.91, respectively; n = 30). The minimum detectable change at the 90% confidence level was 10.81 points for the DASH and 12.85 points for the QuickDASH. After triangulation of these results with those of the mean-change approach and receiver-operating-characteristic-curve analysis, the following MCID values were selected: 10.83 points for the DASH (sensitivity, 82%; specificity, 74%) and 15.91 points for the QuickDASH (sensitivity, 79%; specificity, 75%). After treatment, the MCID threshold was reached/surpassed by 61% of subjects using the DASH and 57% using the QuickDASH., Conclusion: The MCID values from this study for the DASH (10.83 points) and the QuickDASH (15.91 points) could represent the lower boundary for a range of MCID values (reasonably useful for different populations and contextual characteristics). The upper boundary may be represented by the 15 points for the DASH and 20 points for the QuickDASH proposed by the DASH website.

The aim of this study was to perform a comprehensive psychometric analysis of QuickDASH, using both classical test theory and Rasch analysis, in order to examine in detail its metric properties. A convenience sample of 283 patients with upper limb disorders was enrolled. The QuickDASH item responses were extracted from the subjects' responses to the official full-length Italian version of DASH. Rating scale diagnostics showed disordered thresholds in some response categories, that were collapsed to optimize categorization. Exploratory factor analysis established unidimensionality of the QuickDASH, except for item 10 'tingling'. Similarly, QuickDASH items fitted the Rasch model (MnSq between 0.7 and 1.3) except for item 10, that showed an underfit (Infit MnSq = 1.62; Outfit MnSq = 2.01) and thus was deleted. The Rasch reliability indices of this 10-item QuickDASH were good but not excellent. In conclusion, the unidimensionality of QuickDASH has not been confirmed. Item 10 'tingling' did not belong to the dominant trait. Moreover, the number (and/or wording) of the QuickDASH response categories should undergo further investigation, and the QuickDASH seems more useful for group decisions than for everyday clinical application (i.e. monitoring outcome in single patients). Future studies should consider a QuickDASH revision, restarting from the full-length DASH., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study. Objective: To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version. Design: Methodologic research on cross-sectional data from a convenience sample. Setting: A free-standing rehabilitation center. Participants: Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders. Main Outcome Measure: The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices. Interventions: Not applicable. Results: Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1–5, 7–11, 16–18, 20, 21), shoulder range of motion (items 6, 12–15, 19), and symptoms and consequences (items 22–30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items. Conclusions: Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire. [Copyright &y& Elsevier]