A Culture of Early Mobilization in Adult Intensive Care Units: Perspective and Competency of Physicians.

BACKGROUND: Early mobility (EM) is vital in the intensive care unit (ICU) to counteract immobility-related effects. A multidisciplinary approach is key, as it requires precise initiation knowledge. However, physicians' understanding of EM in adult ICU settings remains unexplored. This study was conducted to investigate the knowledge and clinical competency of physicians working in adult ICUs toward EM. METHODS: This cross-sectional study enrolled 236 physicians to assess their knowledge of EM. A rigorously designed survey comprising 30 questions across the demographic, theoretical, and clinical domains was employed. The criteria for knowledge and competency were aligned with the minimum passing score (70%) stipulated for physician licensure by the medical regulatory authority in Saudi Arabia. RESULTS: Nearly 40% of the respondents had more than 5 years of experience. One-third of the respondents received theoretical knowledge about EM as part of their residency training, and only 4% of the respondents attended formal courses to enhance their knowledge. Almost all the respondents (95%) stated their awareness of EM benefits and its indications and contraindications and considered it safe to mobilize patients on mechanical ventilators. However, 62.3% of the respondents did not support EM for critically ill patients on mechanical ventilators until weaning. In contrast, 51.7% of respondents advised EM for agitated patients with RASS > 2. Only 113 (47.9%) physicians were competent in determining the suitability of ICU patients for EM. For critically ill patients who should be mobilized, nearly 60% of physicians refused to initiate EM. CONCLUSIONS: This study underscores insufficient practical knowledge of ICU physicians about EM criteria, which leads to suboptimal decisions, particularly in complex ICU cases. These findings emphasize the need for enhanced training and education of physicians working in adult ICU settings to optimize patient care and outcomes in critical care settings.

Cross-cultural adaptation and validation of the Arabic version of the Multiple Sclerosis Impact Scale-29.

PURPOSE: The Multiple Sclerosis Impact Scale-29 (MSIS-29) is a patient self-reported outcome (PRO) that measures patients' quality of life, and it is divided into two sub-scales for the physical (PHYS) and psychological (PSYCH) domains. This study aimed to translate the MSIS-29 into Arabic, cross-culturally adapt it, and examine its psychometric properties. MATERIALS AND METHODS: One hundred fifty patients with MS completed the MSIS-29-Ar, the Functional Assessment of Multiple Sclerosis (FAMS), and the Short-Form Health Survey (SF-36). After one week, 60 participants were asked to complete the MSIS-29-Ar again to examine test-retest reliability. RESULTS: The MSIS-29-Ar was clear and understandable among patients with MS in Saudi Arabia. The internal consistency for the MSIS-29-Ar-PHYS was excellent, with a Cronbach's alpha of 0.955, and was good for the MSIS-29-Ar-PSYCH, with a Cronbach's alpha of 0.891. The test-retest reliability for MSIS-29-Ar-PHYS was ICC2,1 = 0.97; 95% confidence interval (0.93, 0.99) and ICC2,1 = 0.95.; 95% confidence interval (0.897, 0.976) for MSIS-29-Ar-PSYCH domains. The minimal detectable change with 95% confidence (MDC95) was 10.28 and 13.37 for the MSIS-29-Ar-PHYS and MSIS-29-Ar-PSYCH, respectively. No floor and ceiling effects were observed. Convergent and divergent validity was supported by 75% of the predefined hypotheses and correlated with the other health-related quality-of-life measures, SF-36 and FAMS. CONCLUSION: The MSIS-29-Ar questionnaire is a valid and reliable outcome measure among Saudi patients with MS.IMPLICATION FOR REHABILITATIONRehabilitation specialists can confidently interpret patient scores in the MSIS-29-Ar to measure physical and psychological factors impacting patients' quality of life with Multiple Sclerosis (MS).Patients with unchanged clinical status will have similar scores in the MSIS-29-Ar with repeated scale administrations over time.The MSIS-29-Ar can be used in clinical practice and research studies to measure factors that impact the quality of life in Arabic-speaking patients with MS.

Reliability and Validity of Kansas City Cardiomyopathy Questionnaire in Arabic Patients with Chronic Heart Failure.

Background: The Kansas City Cardiomyopathy Questionnaire (KCCQ) is the most specific and widely used questionnaire for assessing health-related quality of life (HRQoL) in chronic heart failure (CHF). This study aimed to examine reliability and validity of the KCCQ in Arabic patients with CHF. Material and Methods: Patients with CHF filled out the Arabic versions of the Minnesota Living with Heart Failure (MLHF) and KCCQ questionnaire, and performed a six-minute walk test (6MWT) on their first visit. On the return, the patients filled out the KCCQ along with the global rating of change (GRC) scale. Internal consistency, test-retest reliability, and construct validity were examined. Results: A total of 101 Arabic patients with CHF, with a mean (SD) age of 55 (11) years old, completed the study. The Cronbach's alpha was 0.97, and the ICC2,1 = 0.95 (95%CI: 0.92 to 0.97, p < 0.001). The Arabic version of KCCQ was correlated with the MLHF (r = -0.57, p = 0.01) and with the 6MWT (r = 0.70, p < 0.001). Conclusions: The Arabic version of KCCQ is a reliable and valid measure of HRQoL, which could be utilized in routine clinical practice for Arabic-speaking patients with CHF.

Psychometric Properties and Factorial Analysis of the Arabic McGill-QoL Questionnaire in Breast Cancer.

Purpose: This study aimed to assess the psychometric properties of the Arabic McGill Quality of Life Questionnaire-Revised (MQOL-R) in breast cancer survivors. Patients and Methods: One-hundred-forty breast cancer survivors were recruited and completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). MQOL-R scores were correlated with Global Health Status/QoL and functional subscales of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) for convergent validity. Reliability was estimated using Cronbach's alpha and intraclass correlation coefficients (ICC). Results: CFA reproduced a four-factor model (ie, physical, psychological, existential, and social) with good fit indices (comparative fitting index = 0.980; root mean square error of approximation = 0.091), with all items significantly loading on their respective subscales. The total MQOL-R scores were correlated with the global health status/QoL and functional subscales of the EORTC QLQ-C30 (r = -0.172, P < 0.01). Known-group validity was proven by different MQOL-R scores according to functional status (50.62 ± 6.35 vs 45.98 ± 7.19, P < 0.01). Reliability was supported by good internal consistency and high test-retest correlation coefficients for the Arabic MQOL-R and its subscales (ICC range, 0.83-0.95). Conclusion: The Arabic MQOL-R demonstrated adequate construct validity, factor structure, excellent test-retest reliability, and good internal consistency. This tool is valuable for assessing the quality of life in research and physical therapy rehabilitation settings among Arabic-speaking breast cancer survivors.

Responsiveness and Minimal Important Change of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) in Patients with Upper Extremity Musculoskeletal Disorders.

The aim of this study was to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand (DASH) and to quantify its minimal important change (MIC) for improvement. People with upper extremity musculoskeletal problems who were receiving physical therapy were evaluated at baseline and again during a follow-up appointment, with a median time frame of 7 days between the two testing sessions (range of 6 to 72 days). The participants completed the Arabic DASH, Global Assessment of Function (GAF), Numeric Pain Rating Scale (NPRS) and Global Rating of Change Scale (GRC). The responsiveness of the Arabic DASH was assessed by examining the pre-specified hypotheses. The MIC for improvement was determined using the receiver operating characteristic method (MICROC) and the predictive modeling method (MICpred). As hypothesized, a change in the Arabic DASH demonstrated a significant positive correlation with changes in the GAF (r = 0.69), NPRS (r = 0.68) and GRC (r = 0.73). Consistent with our hypotheses, the DASH change scores could be used to differentiate between participants who improved and those who did not improve (area under the receiver operating characteristic curve = 0.87), and they showed a large magnitude of change (effect size = 1.53, standardized response mean = 1.42) in patients who improved. All the hypotheses specified a priori were supported by the results. The Arabic DASH MICROC and MICpred were estimated to be 14.22 and 14.85. The interaction between the DASH change and baseline score was not a significant predictor of status (improved vs. not improved) (p = 0.75), indicating that the DASH MIC was not baseline-dependent. The Arabic DASH demonstrated sufficient responsiveness, supporting the idea that the Arabic DASH is capable of detecting changes in upper extremity function over time. The value of the Arabic DASH MIC was similar when estimated using the predictive modeling and ROC methods, and the MIC was not dependent on baseline status.

Responsiveness of the Arabic Quick Disabilities of the Arm, Shoulder and Hand in Patients with Upper Extremity Musculoskeletal Disorders.

This study aimed to examine the responsiveness of the Arabic Disabilities of the Arm, Shoulder and Hand short version (Quick-DASH) in patients with upper extremity musculoskeletal disorders. Participants with upper extremity musculoskeletal disorders (N = 88) under physical therapy care were assessed at initial visit and later at a follow-up visit, and they completed the Arabic Quick-DASH, DASH, Numeric Pain Rating Scale (NPRS), Global Assessment of Function (GAF), and the Global Rating of Change Scale (GRC). Responsiveness of the Arabic Quick-DASH was assessed by examining six pre-defined hypotheses. Consistent with the pre-defined hypotheses, the Arabic Quick-DASH changes scores exhibited significant positive correlation with the change in DASH (r = 0.98), GAF (r = 0.67), NPRS (r = 0.72), and the GRC (r = 0.78). As hypothesized, the Arabic Quick-DASH showed a large effect size above the pre-determined level (ES = 1.61, SRM = 1.49) in patients who reported improved upper extremity function. The Arabic Quick-DASH change score discriminated between patients who reported improvement versus no improvement in upper extremity function (area under the receiver operating characteristic curve = 0.90). The results supported 100% (six out of six) of the pre-defined hypotheses. The Arabic Quick-DASH demonstrated sufficient responsiveness where all the pre-defined hypotheses were supported, leading to the established validity of the Arabic Quick-DASH change score as a measure of change in upper extremity function and symptoms. The minimal importance change in the Arabic Quick-DASH needs to be determined in future studies.

Measurement Properties' Evaluation of the Arabic Version of the Patient-Specific Functional Scale in Patients with Multiple Sclerosis.

Purpose: The aim of this study was to assess the reliability and validity of the Arabic version of the patient-specific functional scale (PSFS-Ar) in patients with multiple sclerosis (MS) disorder. Materials and Methods: Reliability and validity were examined in patients with multiple sclerosis using a longitudinal cohort study design. One hundred (N = 100) patients with MS were recruited to examine the PSFS-Ar, test-retest reliability (using the interclass correlation coefficient model 2,1 (ICC2,1)), construct validity (using the hypothesis testing method), and floor-ceiling effect. Results: A total of 100 participants completed the PSFS-Ar (34% male, 66% female). The PSFS-Ar showed an excellent test-retest reliability score (ICC2,1 = 0.87; 95% confidence interval, 0.75-0.93). The SEM of the PSFS-Ar was 0.80, while the MDC95 was 1.87, indicating an acceptable measurement error. The construct validity of the PSFS-Ar was 100% correlated with the predefined hypotheses. As hypothesized, the correlation analysis revealed positive correlations between the PSFS-Ar and the RAND-36 domains of physical functioning (0.5), role limitations due to physical health problems (0.37), energy/fatigue (0.35), and emotional well-being (0.19). There was no floor or ceiling effect in this study. Conclusions: The study results showed that the PSFS-Ar is a self-reported outcome measure that is useful for detecting specific functional difficulties in patients with multiple sclerosis. Patients are able to express and report a variety of functional limitations easily and effectively, as well as to measure their response to physical therapy. The PSFS-Ar is, therefore, recommended for use in Arabic-speaking countries for clinical practice and research for patients with multiple sclerosis.

Measurement Property Evaluation of the Arabic Version of the Patient-Specific Functional Scale for Patients with Stroke.

Neurological disorders refer to disorders that occur due to disease or damage to the nervous system. Stroke is one of the most common neurological disorders in which individuals commonly present with motor and sensory deficits, leading to the limitations on the activities of daily life. Outcome measures are used to assess and monitor patients' condition change. The patient-specific functional scale (PSFS) is an outcome measure used to assess changes in performance levels in participants with a functional disability during daily activities. This study aimed to assess the reliability and validity of the Arabic version of the patient-specific functional scale (PSFS-Ar) in individuals with stroke. A longitudinal cohort study was used to examine the reliability and validity of the PSFS-Ar in patients with stroke. All participants completed the PSFS-Ar in addition to other outcome measures. Fifty-five individuals participated (fifty male, five female). The PSFS-Ar showed excellent test-retest reliability, with ICC2,1 = 0.96, p < 0.001. The SEM and MDC95 of the PSFS-Ar were 0.37 and 1.03, respectively. No floor and ceiling effect was observed in this study. Additionally, the construct validity of the PSFS-Ar showed 100% satisfaction with the pre-defined hypotheses. Since the number of female participants was very small in this study, the findings were established for male individuals with stroke. This study showed that the PSFS-Ar is a reliable and valid outcome measure for male individuals with stroke.

Cross-cultural adaptation and validation of the Arabic version of McGill quality of life: revised questionnaire in the patients with cancer.

PURPOSE: The aims of this study were to translate and culturally adapt the McGill Quality of Life Questionnaire-revised (MQOL-R) to modern standard Arabic and to examine its reliability, construct, and discriminative validity in Arab patients with cancer. MATERIALS AND METHODS: Translation and cultural adaptation of the English MQOL-R to modern standard Arabic were performed according to international guidelines. For psychometric evaluation, 125 participants with cancer were selected and completed the MQOL-R along with Global Health Status/QoL and functional subscales of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), and Eastern Cooperative Oncology Group performance status rating (ECOG-PS). The MQOL-R was tested for internal consistency, test-retest reliability, and construct validity. RESULTS: The Arabic MQOL-R questionnaire had adequate internal consistency with Cronbach's alphas between 0.75 and 0.91. Test-retest reliability was very strong (ICC2.1 =0.91 to 0.96, p < 0.001). As hypothesized, the Arabic MQOL-R subscales demonstrated moderate to excellent correlation with functional subscales of EORTC QLQ-C30, and moderate to good correlation with Global health status/QoL. CONCLUSION: The Arabic MQOL-R Questionnaire has adequate psychometric properties. Hence, it can be utilized in rehabilitation settings and research to measure health-related quality of life in the Arabic-speaking cancer population.IMPLICATIONS FOR REHABILITATIONThe Arabic version of McGill Quality of Life- Revised Questionnaire (MQOL-R) has been successfully translated, adapted, and validated into Modern Standard Arabic language.The Arabic MQOL-R is reliable and valid for measuring health-related quality of life in the Arabic-speaking cancer population.The Arabic MQOL-R can be used for clinical, rehabilitation and research purposes to evaluate the health-related quality of life in the Arabic-speaking cancer population.

Responsiveness of the Arabic Upper Extremity Functional Index in Patients with Upper Extremity Musculoskeletal Disorders.

The aim of this study was to examine the ability of the Arabic Upper Extremity Functional Index (UEFI) to detect change over time in upper extremity function (responsiveness) in patients with upper extremity musculoskeletal disorders. Patients receiving physical therapy care for their upper extremity musculoskeletal disorders completed the Arabic UEFI; Disabilities of the Arm, Shoulder and Hand (DASH); Numeric Pain Rating Scale (NPRS); Global Assessment of Function (GAF); and the Global Rating of Change Scale (GRC) at the initial visit and later at a follow-up assessment. Responsiveness was examined by testing predefined hypotheses regarding the correlations between the change scores in the Arabic UEFI and the other measures. The Arabic UEFI change scores demonstrated a significant positive correlation with the change in the DASH (r = 0.94), GAF (r = 0.65), NPRS (r = 0.63), and GRC (r = 0.73), which was in line with the predefined hypotheses. The Arabic UEFI change scores demonstrated a pattern of correlation with changes in other outcome measures that are consistent with the argument that the Arabic UEFI change scores represent a change in upper extremity function. The responsiveness of the Arabic UEFI was supported, and its use to monitor changes in upper extremity function in patients with upper extremity musculoskeletal disorders was supported.

Cross-cultural adaptation and validation of the Arabic version of the Pain Self-Efficacy Questionnaire in Arab people with chronic low back pain.

BACKGROUND: The Pain Self-Efficacy Questionnaire (PSEQ) is widely used worldwide to measure pain self-efficacy. However, an Arabic translation is not available yet. OBJECTIVE: The study aimed to culturally adapt and validate the Arabic version of the Pain Self-Efficacy Questionnaire (PSEQ-A) in Arab people with Chronic Low Back Pain (LBP). METHODS: This study was conducted in two phases. The first phase involved translation and cross-cultural adaptation of the PSEQ into Arabic. The second phase aimed to examine the reliability and validity of the PSEQ-A. One hundred Arab people with chronic LBP completed the PSEQ-A and some self-report questionnaires, such as pain intensity, fear of movement, disability, and life quality. RESULTS: Cronbach's alpha for the PSEQ-A was 0.90. The interclass correlation coefficient of the PSEQ-A was 0.79. The standard error of the measurement and the minimal detectable change of the PSEQ-A scores were 5.27 and 14.60, respectively. The PSEQ-A has one factor structure. The PSEQ-A correlated significantly (P < .01) with disability, fear of movement, and quality of life in the expected hypothesized directions. CONCLUSION: The PSEQ-A was well accepted and exhibited validity and acceptable reliability in Arab people with chronic LBP.

Psychometric properties of the Arabic version of Duke Activity Status Index in patients with chronic obstructive pulmonary disease.

PURPOSE: To translate and cross-culturally adapt the original Duke Activity Status Index (DASI) into the Arabic language and examine its psychometric properties in Arabic speaking patients with Chronic Obstructive Pulmonary Disease (COPD). MATERIALS AND METHODS: The DASI was translated into the Arabic language and tested on 70 Arabic patients with COPD. Patients with COPD completed also the Six-Minute Walk Test (6MWT) and Saint George Respiratory Questionnaire (SGRQ) on the first visit. On the second visit, the patients with COPD completed the Arabic version of DASI along with the global rating of change scale (GRC). The internal consistency, test-retest reliability and construct validity were examined. RESULTS: Seventy Arabic speaking patients with COPD (56 males), mean (SD) age was 63.2 (11.1) year, completed the study. The patients reported no difficulty in understanding and completing the scale. Three items were modified and adapted to the Arabic culture. The Cronbach's alpha was 0.87, and the ICC2,1 was 0.95. The Arabic version of DASI correlated with the 6MWT (r = 0.55), the total score of SGRQ (r = -0.64) and its activity domain (r = -0.67), all p < 0.001. CONCLUSION: The Arabic version of DASI is a simple, quick, reliable, and valid measure of functional capacity in Arabic speaking patients with COPD.Implications for practiceThe Arabic DASI can be used in all Arabic-speaking countries given that the scale was adapted to standard Arabic language.The Arabic DASI would yield similar scores with administrations over time in patients with unchanged condition and stable COPD.This questionnaire could be used for screening of functional capacity in COPD in primary care settings.

The Arabic version of the Lower Extremity Functional Scale is a reliable and valid measure of activity limitation in people with chronic obstructive pulmonary disease.

PURPOSE: To examine the psychometric properties of the Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) in people with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Stable individuals with COPD (N = 70) confirmed by spirometry were asked to complete the LEFS-Ar, St George's Respiratory Questionnaire (SGRQ) and performed the Six-Minute Walk Test (6MWT). Participants were also asked to complete LEFS-Ar for the second time within 10 days. The LEFS-Ar floor and ceiling effects, internal consistency, test-retest reliability, measurement error, and construct validity were examined. RESULTS: The LEFS-Ar had excellent internal consistency with Cronbach's alpha of 0.95 and excellent test-retest reliability (ICCagreement=0.91) with no floor and ceiling issues. Standard error of measurement was 4.78 points while the minimal detectable change at 90% confidence was 11.15 points. Consistent with our hypotheses, the LEFS-Ar scores correlated significantly with 6MWT (r= -0.66, p < 0.001), activity domain of the SGRQ (r = 0.55, p < 0.001), and were significantly different according to COPD disease severity (p= 0.02). CONCLUSIONS: In people with COPD, the LEFS-Ar has excellent reliability with no floor or ceiling effects. The LEFS-Ar demonstrated evidence supporting its validity as a measure of activity limitation that can be used in clinical practice and in research studies.Implications for rehabilitationThe Arabic version of the Lower Extremity Functional Scale (LEFS-Ar) is a reliable measure in people with chronic obstructive pulmonary disease (COPD).Rehabilitation specialists can use the LEFS-Ar to validly measure activity limitation in people with COPD.

The Arabic version of the ABILOCO-Kids scale is valid and reliable in children with cerebral palsy.

Background: The ABILOCO-Kids is a parent-reported outcome measure that quantifies locomotion ability and has been reported to have satisfactory measurement properties. An Arabic version of the scale is needed for Arabic-speaking population.Objective: To cross-culturally adapt the ABILOCO-Kids into Arabic and to examine its measurement properties in children with cerebral palsy.Methods: Forward and backward translations, then expert committee followed by preliminary testing were conducted to produce the Arabic ABILOCO-Kids. Structural validity of the scale as a unidimensional measure was examined using Rasch analysis. Internal consistency, test-retest reliability, and construct validity of the adapted scale were examined in children with cerebral palsy (N = 154).Results: Rasch analysis supported the structural validity of the Arabic ABILOCO-Kids after combining two items (χ2 = 18.17, p = .44). The scale had excellent internal consistency (person separation index = 0.88), excellent test-retest reliability (intraclass correlation coefficient = 0.98) but had a floor effect (24% reaching the minimum score). Eighty percent of the predefined hypotheses regarding the correlation between the Arabic ABILOCO-Kids and the Gross Motor Function Classification System (GMFCS) (r = -0.65) and the Functional Independence Measure for Children (WeeFIM) subscales (r = 0.34 to 0.70) were supported by the results.Conclusion: The Arabic ABILOCO-Kids is a unidimensional interval-level measure of walking ability in children with cerebral palsy with evidence supporting its structural validity, internal consistency, test-retest reliability and construct validity.

Cross-cultural adaptation and measurement properties of the Arabic version of the Patient-Specific Functional Scale in patients with lower extremity musculoskeletal disorders.

PURPOSE: To cross-culturally adapt the Patient-Specific Functional Scale (PSFS) into Arabic language and to examine its measurement properties in patients with lower extremity musculoskeletal disorders. MATERIALS AND METHODS: The original English version of the PSFS was cross-culturally adapted into modern standard Arabic language following Beaton's guidelines. Patients with lower extremity musculoskeletal disorders (N = 116) were recruited to examine the test-retest reliability, measurement error, floor and ceiling effects, and construct validity of the Arabic PSFS. Construct validity was tested by examining eight predefined correlational hypotheses. RESULTS: Participants in the current study indicated that the Arabic PSFS was clear and understandable. The Arabic PSFS had very good test-retest reliability (ICC = 0.86) with no floor or ceiling issues. The standard error of measurement and the minimal detectable change of the Arabic PSFS were 0.64 and 1.49 points respectively indicating acceptable measurement error. The majority of the predefined construct validity hypotheses (75%) were supported by the results justifying the construct validity of the Arabic PSFS. CONCLUSIONS: The Arabic PSFS is a comprehensible and easy to use measure. The Arabic PSFS has very good test-retest reliability, acceptable measurement error, and evidence supporting its construct validity as measure of activity limitation in patients with lower extremity musculoskeletal disorders.Implications for rehabilitationRehabilitation specialist can confidently interpret patient's score in the Arabic PSFS to represent the extent of activity limitation.Patients with unchanged clinical status will have similar scores in the Arabic PSFS with repeated administrations of the scale over time.The Arabic PSFS can be used in daily clinical practice and in research studies to measure activity limitation in Arabic-speakers with lower extremity musculoskeletal disorders.The Arabic PSFS enables rehabilitation specialist to quantify activity limitation in a way that is relevant to the culture and life style of Arabic-speakers.

Psychometric properties of the Arabic version of the anxiety inventory for respiratory disease in patients with COPD.

PURPOSE: The Anxiety Inventory for Respiratory Disease (AIR) is a reliable and valid scale for examining the anxiety in patients with COPD. This study aimed to cross-culturally adapt and translate the original AIR scale into the Arabic language and to examine its reliability and validity in Arab patients with COPD. MATERIAL AND METHODS: This was a validation study conducted on 70 Arabic patients with COPD. The AIR-A and the Hospital Anxiety and Depression Scale (HADS) were completed on the first assessment. After two weeks, 55 patients completed the AIR-A scale again. The reliability was assessed by Cronbach's α and intraclass correlation coefficients (ICC2,1). Exploratory factor analysis (EFA), and the confirmatory factor analysis (CFA) were used to measure the structural validity. The construct validity was also explored. RESULTS: The AIR-A questionnaire had a Cronbach's α of 0.91 and ICC2,1 of 0.86. The EFA revealed that the AIR-A was unidimensional. The CFA showed the single-factor model required minor modifications to reach the best fit. The AIR-A was correlated with the HADS- anxiety (r = 0.89, p < 0.001). CONCLUSION: The Arabic version of AIR scale is reliable, and valid for assessing the anxiety disorder in Arabic speaking patients with COPD worldwide.Implications for PracticeThe Arabic version of AIR will be useful for examining anxiety in Arabic speaking patients with COPD worldwide.The Arabic version of AIR will help clinicians to monitor the effect of interventions in Arabic speaking patients with COPD who suffer from anxiety.The Arabic version of AIR assess only the anxiety.

Cross-cultural adaptation and validation of the Arabic version of the upper extremity functional index.

PURPOSE: The purpose of this study was to translate and cross-culturally adapt the UEFI into Modern Standard Arabic language and to examine its psychometric properties among patients with upper extremity musculoskeletal disorders. MATERIALS AND METHODS: Translation and cross-cultural adaptation were done following Beaton's guidelines. Internal consistency, test-retest reliability, measurement error and floor and ceiling effects for the Arabic UEFI were tested among 109 patients with upper extremity musculoskeletal disorders. Construct validity of the Arabic UEFI was also examined. RESULTS: Translation and cross-cultural adaptation processes were generally smooth with no major issues. The Arabic UEFI was considered appropriate and comprehensible by the participants. Internal consistency for Arabic UEFI was adequate (Cronbach's alpha = 0.96). Test-retest reliability for Arabic UEFI was excellent with ICC2,1=0.92. Measurement error was acceptable with a standard error of measurement of 5.5 and minimal detectable change of 12.8 points. Arabic UEFI shows no floor or ceiling effects. The results supported the majority of the construct validity predefined hypotheses (78%) supporting the construct validity of Arabic UEFI as a measure of upper extremity function. CONCLUSION: The Arabic UEFI is an appropriate, valid and reliable outcome measure for Arabic-speaking patients with upper extremity musculoskeletal disorders.Implication for Rehabilitation:The Arabic UEFI is an acceptable, clear and comprehensible outcome measure.The Arabic UEFI has excellent internal consistency, test-retest reliability, and acceptable measurement error with no floor and ceiling effects.The Arabic UEFI is a valid measure of upper extremity activity limitation.

Structural validity of the Arabic version of the disabilities of the Arm, Shoulder and Hand (DASH) using Rasch measurement model.

BACKGROUND: The disabilities of the arm, shoulder and hand (DASH) is a commonly used region-specific patient-reported outcome measure (PROM) that quantify upper extremity function (activity limitation) and symptoms. Current evidence suggests that measurement properties of the adapted versions of the DASH are not sufficiently examined. The Arabic DASH has evidence supporting its internal consistency, test-retest reliability, construct validity and responsiveness. On the other hand, the validity of the assumed unidimensionality of the Arabic DASH has not been examined previously. The aim of this study was to examine the structural validity of the Arabic DASH in patients with upper extremity musculoskeletal disorders using Rasch measurement model. METHODS: Patients with upper extremity musculoskeletal disorders were recruited and were asked to complete the Arabic DASH at their initial visit to physical therapy departments. The overall fit of the Arabic DASH to the requirement of the Rasch measurement model was examined using chi-square statistics for item-trait interaction, mean item and person fit residuals. The fit of individual items, thresholds ordering, local dependency, differential item functioning (DIF), and unidimensionality using the t-test approach were also examined. RESULTS: The Arabic DASH did not fit the Rasch measurement model initially (χ2 = 179.04, p < 0.001) with major breach of local item independence and a pattern of high residual correlations among the activity-related items and among the impairment-related items. Combining items into activity-limitation and impairment testlets accommodated the local dependency and led to satisfactory fit of the Arabic DASH to the requirement of the Rasch measurement model (χ2 = 3.99, p = 0.41). CONCLUSIONS: Rasch measurement model supports the structural validity of the Arabic DASH as a unidimensional measure after the accommodation of local dependency.

The Upper Extremity Functional Index: Reliability and Validity in Patients with Chronic Obstructive Pulmonary Disease.

The aim of the current study was to examine the psychometric properties of the upper extremity functional index (UEFI) in patients with chronic obstructive pulmonary disease (COPD). Seventy patients with stable COPD completed the UEFI and St. George Respiratory Questionnaire (SGRQ) and performed lung function tests in the first testing session. They completed the UEFI and the Global Rating of Change Scale in the second session, which was within ten days of the first session. The UEFI floor and ceiling effects, internal consistency, test-retest reliability, measurement error, and construct validity were examined. The UEFI was found to have no floor and ceiling effects. The UEFI was also found to have an excellent internal consistency (Cronbach's alpha = 0.955) and an excellent test-retest reliability (ICC2,1 = 0.91). Totals of 4.85 points and 11.32 points represent the scale's standard error of measurement, and a minimal detectable change at 90% confidence was used. The UEFI scores showed a significant correlation with the SGRQ activity domain (r = -0.66, p < 0.001) and differed significantly between participants with severe disease and those with mild disease (p = 0.03). The UEFI had no floor or ceiling issues, an excellent internal consistency, a good test-retest reliability, and an acceptable measurement error. The UEFI also demonstrated evidence supporting its construct validity as a measure of upper extremity-related activity limitations in patients with COPD.

Validity and reliability of the Arabic quick disabilities of the arm, Shoulder and Hand (QuickDASH-Arabic).

BACKGROUND: The QuickDASH is a commonly used upper extremity region-specific outcome measure assessing activity limitation and symptoms. The Arabic version of QuickDASH is available in the official outcome measure website, but no prior studies have examined its psychometric properties. OBJECTIVE: To examine the psychometric properties of the Arabic QuickDASH in patients with upper extremity musculoskeletal disorders. METHODS: Participants with upper extremity musculoskeletal disorders were recruited (N = 109) using convenience sampling and completed the Arabic QuickDASH, Numeric Pain Rating Scale, Global Assessment of Function, and RAND 36-item Health Survey in two testing sessions (2-7 days apart). The Arabic QuickDASH structural validity, internal consistency, floor and ceiling effect, test-retest reliability, measurement error, and construct validity were examined. RESULTS: Exploratory factor analysis indicated a one factor underlying the Arabic QuickDASH. The Arabic QuickDASH had Cronbach's alpha of 0.90 and ICC2.1 of 0.91 indicating excellent internal consistency and test-retest reliability. None of the participant reached the minimum or the maximum score. The scale's standard error of measurement and minimal detectable change were 7.0 and 16.3. Five out of the six construct validity predefined hypotheses were supported by the results. CONCLUSION: The Arabic QuickDASH is a unidimensional scale with excellent internal consistency, test-retest reliability and acceptable measurement error. The Arabic Quick DASH is a valid and reliable outcome measure that can be used in Arabic speaking countries with Arabic patients suffering from various upper extremity activity limitations and symptoms.