Translation and validation of the stroke self-efficacy questionnaire to a Portuguese version in stroke survivors.

BACKGROUND: Stroke Self-efficacy Questionnaire (SSEQ) is not available to Portuguese-Brazil.Objective: To translate, perform cross-cultural adaptation, and validate the Stroke Self-efficacy Questionnaire (SSEQ) to Portuguese-Brazil (SSEQ-B).Methods: It is a cross sectional study: 1) translation and cross-cultural adaptation of SSEQ - a five stage process, 2) validation and reliability study with 40 chronic stroke survivors. The outcomes were: Content Validity Index (CVI), Face validity index, Reliability, Internal consistency, Stability, Ceiling and floor effects Concurrent validity, Measurement error using Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). Results: There was high agreement for the English to Portuguese-Brazil translation. Adjustments were made to improve semantic equivalence. Intra-examiner reliability was high (ICC 0.86) as was inter-examiner reliability (ICC 0.91). Internal consistency was acceptable for the total score, the activity subscale and self-management domain, Cronbach alphas are 0.82, 0.77, 0.68, respectively. The stability of the SSEQ-B was high and good (r = 0.77 p < .001). Ceiling effects were evident in 7.5% of the sample. For concurrent validity, there was an inverse relationship between BDI and SSEQ-B (r = -0.43 p = .006), and a positive relationship between FIM (r = 0.52 p < .001), SIS (r = 0.64 p < .001) and SSEQ-B. SEM was 1.58 points of the SSEQ-B and the MDC was 4.38 points of SSEQ-B. Conclusion: SSEQ-B is a valid, reliable, and stable patient-reported outcome. It has concurrent validity with self-reported measures of depression, functional independence and a multi-dimensional measure of health status in chronic stroke survivors in Brazil.

A combination of multimodal physical exercises in real and virtual environments for individuals after chronic stroke: study protocol for a randomized controlled trial.

BACKGROUND: Multimodal physical exercises already have well-established benefits for the post-stroke population that influence gait functional capacity, balance, gait, cognition, and quality of life. This type of intervention can be performed in both real and virtual environments. Considering the characteristics of both environments, it is questioned to what extent the combination of interventions in real and virtual environments could result in improvement in post-stroke impairments. METHODS/DESIGN: We will conduct a randomized clinical trial with three groups: a real multimodal group (RMG), a virtual multimodal group (VMG), and a combined multimodal group (CMG). It was estimated that we will need a sample of 36 participants (12 per group). RMG individuals will only perform multimodal physical exercises in a real environment two times per week for 60 min per session for 15 weeks. VMG individuals will perform exercises of the same duration over the same time frame but only in a virtual environment. CMG individuals will hold a weekly session in a real environment and another weekly session in virtual environment. The primary outcome measure will be health-related quality of life, evaluated using the Stroke Impact Scale; effects on cognition (Montreal Cognitive Assessment), balance (Berg Balance Scale), mobility (Timed Up & Go), self-selected gait speed (10-meter walk test), and gait functional capacity (6-min walk test) will be investigated as secondary outcome measures. Participants will be evaluated before the beginning of the intervention, immediately after the end of the intervention, and at 1-month follow-up without exercise. If the data meet the assumptions of the parametric analysis, the results will be evaluated by analysis of variance (3 × 3) for the group factor, with repeated measures while taking into account the time factor. The post hoc Tukey test will be used to detect differences (α = 0.05). DISCUSSION: This study represents the first clinical trial to include three groups considering physical exercise in real and virtual environments, isolated and combined, that counterbalances the intensity and volume of training in all groups. This study also includes a control of progression in all groups along the 15-week intervention. The outcome measures are innovative because, according to International Classification of Functioning, Disability and Health, activity and participation are the targets for effectiveness evaluation. TRIAL REGISTRATION: Combinação de exercícios físicos multimodais em ambientes real e virtual para indivíduos pós acidente vascular cerebral crônico, RBR-4pt72m . Registered on 29 August 2016.

Effects of virtual reality for stroke individuals based on the International Classification of Functioning and Health: a systematic review.

OBJECTIVE: This review determines the effects of virtual reality interventions for stroke subjects based on the International Classification of Functioning, Disability,and Health (ICF) framework. Virtual reality is a promising tool for therapy for stroke rehabilitation, but the effects of virtual reality interventions on post-stroke patients based on the specific ICF domains (Body Structures, Body Functions, Activity, and Participation) have not been investigated. METHOD: A systematic review was conducted, including trials with adults with a clinical diagnosis of a chronic, subacute, or acute stroke. Eligible trials had to include studies with an intervention protocol and follow-up, with a focus on upper limbs and/or lower limbs and/or balance. The Physiotherapy Evidence Database (PEDro) was used to assess the methodological quality of randomized controlled trials. Each trial was separated according to methodological quality into a high-quality trial (PEDro ≥ 6) and a low-quality trial (PEDro ≤ 6). Only high-quality trials were analyzed specifically based on the outcome of these trials. RESULTS: In total, 54 trials involving 1811 participants were included. Of the papers included and considered high quality, 14 trials evaluated areas of the Body Structures component, 20 trials of the Body Functions domain, 17 trials of the Activity component, and 8 trials of the Participation domain. In relation to ICF Part 2, four trials evaluated areas of the Personal Factors component and one trial evaluated domains of the Environmental Factors component. DISCUSSION: The effects of virtual reality on stroke rehabilitation based on the ICF framework are positive in Body Function and Body Structure. However, the results in the domains Activity and Participation are inconclusive. More high-quality clinical trials are needed to confirm the effectiveness of virtual reality in the domains of Activity and Participation.