Psychometric Properties and Efficiency of the Computerized Adaptive Testing System for Measuring Self-Care Performance in Taiwanese Children With Developmental Disabilities.

OBJECTIVE: To investigate the psychometric properties and efficiency of the computerized adaptive testing system for measuring self-care performance (CAT-SC). The psychometric properties included intrarater and interrater reliabilities, concurrent validity, minimal detectable change, minimal important difference, and responsiveness. DESIGN: Criterion standard study. SETTING: A teaching hospital. PARTICIPANTS: A convenience sample of 60 caregivers of children with developmental disabilities was recruited at the initial assessment, and 95% of the children (N=57) were followed-up at 3 and 6 months. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The CAT-SC and the Pediatric Evaluation of Disability Inventory Chinese version were used at the initial assessment. We assessed the CAT-SC and asked caregivers to rate children's changes in self-care performance with a separate question rated on a 15-point Likert-type scale at the 3- and 6-month follow-ups. RESULTS: The CAT-SC had excellent intrarater and interrater reliabilities (intraclass coefficient=0.99 and 0.92, respectively), high concurrent validity with the Pediatric Evaluation of Disability Inventory (r=0.91-0.92), and trivial to small responsiveness at 3- and 6-month follow-ups (effect size=0.02 and 0.12, standardized response mean=0.08 and 0.33). The minimal detectable change of intrarater reliabilities and the minimal important difference at the first follow-up were 0.22 and 0.17 logits, respectively. The administration time of the CAT-SC was about 5 minutes. CONCLUSIONS: The results of our study validated the sound psychometric properties and good efficiency of the CAT-SC. Moreover, the values of the minimal detectable change and minimal smallest change can be used as a reference for clinicians and caregivers to interpret children's progress.

Effectiveness of Tailored Rehabilitation Education in Improving the Health Literacy and Health Status of Postoperative Patients With Breast Cancer: A Randomized Controlled Trial.

BACKGROUND: The improvement of breast cancer treatment and the extension of survivorship have led to the development of postoperative complications among cancer survivors. Health literacy (HL), defined as patients' capability of using health information to maintain their health status, can enable breast cancer patients to manage postoperative complications. OBJECTIVE: The aims of this study were to develop a tailored rehabilitation education (TRE) program and examine the effectiveness of this program in improving the HL and health status with breast cancer. METHODS: This randomized controlled trial recruited 99 breast cancer patients (49 and 50 in the intervention and control groups, respectively) within 1 week after surgery. Four-week individualized TRE programs were implemented to improve their HL and health status. RESULTS: Our results showed that the TRE program produced significant improvements in HL and health status in the components of the International Classification of Functioning, Disability and Health. However, no significant difference was observed in the activity scores obtained using the Barthel Index between the 2 groups. CONCLUSION: Our finding supports the effectiveness of 1-month TRE in improving HL and all components of the International Classification of Functioning, Disability and Health status, except the activity component among breast cancer in Taiwan. IMPLICATIONS FOR PRACTICE: Clinicians could incorporate the TRE techniques in the rehabilitation sessions according to the healthcare, disease prevention, and health promotion domains to improve the clinical outcomes as well as change their health behaviors and attitudes of patients with breast cancer.

Evaluating the European Health Literacy Survey Questionnaire in Patients with Stroke: A Latent Trait Analysis Using Rasch Modeling.

BACKGROUND: The effective self-management and treatment of long-term disability after stroke depends greatly on the health literacy of patients. The European Health Literacy Survey Questionnaire (HLS-EU-Q) is a comprehensive and theory-based measure that captures multiple self-perceived competencies of health literacy and covers a diverse range of health contexts. However, there is no psychometric evidence on the HLS-EU-Q in the stroke population. OBJECTIVE: The aim of this study was to examine the validity of the HLS-EU-Q in patients with stroke using Rasch analysis. METHODS: We compared the model deviance among the one-domain, three-domain, four-domain, and 12-domain structures using likelihood ratio tests to determine the dimensionality of the HLS-EU-Q. Thereafter, we examined the unidimensionality of each domain, local independence, item fit, response categories, and differential item functioning (DIF) for the best fitting structure. RESULTS: A total of 311 patients with stroke participated in this study. Rasch analysis revealed that the 12-domain HLS-EU-Q demonstrated the best data-model fit. The original 4-point scales showed disordering, which can be corrected by rescaling them as 3-point scales with the two middle categories collapsed. All 47 items in the rescaled HLS-EU-Q fit the 12-domain Rasch model, demonstrated local independence, assessed the 12 unidimensional domains respectively, and had invariant difficulties between different age or education groups of the patients with stroke. CONCLUSION: We recommend using the 12-domain scores of the rescaled HLS-EU-Q to comprehensively and accurately capture the competencies to access, understand, appraise, and apply health information within the three health contexts of healthcare, disease prevention, and health promotion for patients with stroke.

Test-retest reliability and responsiveness of the Barthel Index-based Supplementary Scales in patients with stroke.

BACKGROUND: A lack of evidence on the test-retest reliability and responsiveness limits the utility of the BI-based Supplementary Scales (BI-SS) in both clinical and research settings. AIM: To examine the test-retest reliability and responsiveness of the BI-based Supplementary Scales (BI-SS) in patients with stroke. DESIGN: A repeated-assessments design (1 week apart) was used to examine the test-retest reliability of the BI-SS. For the responsiveness study, the participants were assessed with the BI-SS and BI (treated as an external criterion) at admission to and discharge from rehabilitation wards. SETTING: Seven outpatient rehabilitation units and one inpatient rehabilitation unit. POPULATION: Outpatients with chronic stroke. METHODS: Eighty-four outpatients with chronic stroke participated in the test-retest reliability study. Fifty-seven inpatients completed baseline and follow-up assessments in the responsiveness study. RESULTS: For the test-retest reliability study, the values of the intra-class correlation coefficient and the overall percentage of minimal detectable change for the Ability Scale and Self-perceived Difficulty Scale were 0.97, 12.8%, and 0.78, 35.8%, respectively. For the responsiveness study, the standardized effect size and standardized response mean (representing internal responsiveness) of the Ability Scale and Self-perceived Difficulty Scale were 1.17 and 1.56, and 0.78 and 0.89, respectively. Regarding external responsiveness, the change in score of the Ability Scale had significant and moderate association with that of the BI (r=0.61, P<0.001). The change in score of the Self-perceived Difficulty Scale had non-significant and weak association with that of the BI (r=0.23, P=0.080). CONCLUSIONS: The Ability Scale of the BI-SS has satisfactory test-retest reliability and sufficient responsiveness for patients with stroke. However, the Self-perceived Difficulty Scale of the BI-SS has substantial random measurement error and insufficient external responsiveness, which may affect its utility in clinical settings. CLINICAL REHABILITATION IMPACT: The findings of this study provide empirical evidence of psychometric properties of the BI-SS for assessing ability and self-perceived difficulty of ADL in patients with stroke.

A Systematic Review of Tests Assessing Stroke Knowledge.

BACKGROUND: Accurate assessment of stroke knowledge (SK) is fundamental to the successful understanding of, monitoring of, and intervening to improve the SK of patients and the public. PURPOSE: The purpose of this study is to perform a systematic review of the existing SK tests and appraise their conceptual basis, feasibility, and psychometric properties. We conducted 2-step searching of MEDLINE, CINAHL, PsycINFO, and Scopus electronic databases from January 1, 2000, to December 31, 2014, to identify relevant SK tests for the appraisal. RESULTS: Our study found 59 SK tests, out of a total of 93 articles, with full content available that had been referred to in the published literature. Ten of them had been used in more than 1 study, and 2 (the Stroke Knowledge Test and the Stroke Action Test) of them have had at least 1 of their psychometric properties validated. Only 1 test (the Stroke Knowledge Test) was developed using rigorous methodology, covers a wide range of concepts, and met all feasibility criteria; however, its limitations include no articulated conceptual basis, inadequate internal consistency reliability (α = .65), and lack of some validated psychometric properties. CONCLUSIONS: Our study revealed that current available tools are not sufficiently able to accurately and reliably assess SK to promote stroke prevention and management. CLINICAL IMPLICATIONS: This study highlights the attention of applying current SK tests and need for revising existing tests or developing a new test.

Trajectories of quality of life in patients with traumatic limb injury: a 2-year follow-up study.

PURPOSE: Traumatic limb injury (TLI) can have a negative impact on a patient's quality of life (QOL), and the patient's QOL may fluctuate over time. However, the longitudinal change patterns of QOL in patients with TLI are largely unknown. The aim of this study was to investigate the QOL trajectories in patients with TLI in 4 QOL domains: physical capacity, psychological well-being, social relationships, and environment. METHODS: The patients' QOL was assessed within 14 days and at 1, 3, 6, 12, and 24 months after injury. In each QOL domain, 4 latent growth curve models (LGMs, including non-growth, linear growth, quadratic growth, and cubic LGM) were adopted to examine the QOL trajectories across the 6 time points. RESULTS: A total of 499 patients completed the 6 assessments. For all 4 QOL domains, the cubic LGM had the best model fitting (root-mean-square error of approximation < 0.01) revealing that the patients' 4 QOL domains changed with cubic trajectories: QOL improved in the first 6 months, deteriorated in the second 6 months, and improved smoothly at 12-24 months after injury. CONCLUSIONS: This study found that the trajectories in the 4 QOL domains were cubic trajectories in patients with TLI. These findings indicate that clinicians should pay additional attention to improve the patients' QOL in the first 6 months after injury and to prevent or reduce QOL deterioration at 6-12 months.

Validation of the short-form Health Literacy Scale in patients with stroke.

OBJECTIVE: We aimed to validate a Mandarin version of the short-form Health Literacy Scale (SHEAL) in patients with stroke. METHODS: Each patient with stroke was interviewed with the SHEAL. The Public Stroke Knowledge Quiz (PSKQ) was administered as a criterion for examining the convergent validity of the SHEAL. The discriminative validity of the SHEAL was determined with age and education level as independent grouping variables. RESULTS: A total of 87 patients with stroke volunteered to participate in this prospective study. The SHEAL demonstrated sufficient internal consistency reliability (alpha=0.82) and high correlation with the PSKQ (r=0.62). The SHEAL scores between different age groups and education level groups were significantly different. The SHEAL, however, showed a notable ceiling effect (24.1% of the participants), indicating that the SHEAL cannot differentiate level of health literacy between individuals with high health literacy. CONCLUSION: The internal consistency reliability, convergent validity, and discriminative validity of the SHEAL were adequate. However, the internal consistency reliability and ceiling effect of the SHEAL need to be improved. PRACTICE IMPLICATIONS: The SHEAL has shown its potential for assessing the health literacy of patients with stroke for research purposes. For clinical usage, however, the SHEAL should be used with caution.

Validation of the EQ-5D in Patients with Traumatic Limb Injury.

PURPOSE: The measurement properties of the EQ-5D have not been explored for patients with traumatic limb injuries. The purpose of this study was to examine the construct validity, predictive validity, and responsiveness of the EQ-5D in patients with traumatic limb injuries. METHODS: A consecutive cohort of 1,167 patients was assessed with the EQ-5D and the World Health Organization Quality of Life instrument (WHOQOL-BREF) at baseline while the patients were hospitalized because of the injury, and the patients were followed up at 3 months (1,003 patients), 6 months (1,010 patients), and 12 months (987 patients) after injury via telephone interview. RESULTS: The utility and visual analogue scale (VAS) scores of the EQ-5D had moderate to high association with the physical and psychological domains and the two general questions (overall QOL and overall health) of the WHOQOL-BREF at all time points except baseline (Pearson's correlation coefficient >0.3), but the EQ-5D profiles were weakly associated with the social and environment domains of the WHOQOL-BREF (absolute value of Spearman's correlation coefficient <0.3). These results indicate that the EQ-5D has satisfactory construct validity. The utility and VAS scores of the EQ-5D at 3 and 6 months after injury can predict (with moderate to large relationships) the four domains and two general questions of the WHOQOL-BREF administered at 12 months after injury. The responsiveness of the utility and VAS of the EQ-5D were high (effect sizes >0.9) at 0-3, 0-6, and 0-12 months after injury. CONCLUSIONS: The EQ-5D has sufficient construct validity, predictive validity, and responsiveness, and also provides evidence for using the utility of the EQ-5D for cost-utility analyses of patients with traumatic limb injuries in the future.

Development of two Barthel Index-based Supplementary Scales for patients with stroke.

BACKGROUND: The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability. OBJECTIVE: The aims of this study were to develop two BI-based Supplementary Scales (BI-SS), namely, the Self-perceived Difficulty Scale and the Ability Scale, and to examine the construct validity of the BI-SS in patients with stroke. METHOD: The BI-SS was first developed by consultation with experts and then tested on patients to confirm the clarity and feasibility of administration. A total of 306 participants participated in the construct validity study. Construct validity was investigated using Mokken scale analysis and analyzing associations between scales. The agreement between each pair of the scales' scores was further examined. RESULTS: The Self-perceived Difficulty Scale consisted of 10 items, and the Ability Scale included 8 items (excluding both bladder and bowel control items). Items in each individual scale were unidimensional (H ≥ 0.5). The scores of the Self-perceived Difficulty and Ability Scales were highly correlated with those of the BI (rho = 0.78 and 0.90, respectively). The scores of the two BI-SS scales and BI were significantly different from each other (p<.001). These results indicate that both BI-SS scales assessed unique constructs. CONCLUSIONS: The BI-SS had overall good construct validity in patients with stroke. The BI-SS can be used as supplementary scales for the BI to comprehensively assess patients' ADL functions in order to identify patients' difficulties in performing ADL tasks, plan intervention strategies, and assess outcomes.

Validation of a Chinese version of the Frenchay Activities Index in patients with traumatic limb injury.

PURPOSE: The Frenchay Activities Index (FAI) is a frequently used measure that assesses instrumental activities of daily living (IADL). However, the measurement properties of the FAI are largely unknown for patients with traumatic limb injuries. The purpose of this study was to examine the measurement properties of a Chinese version of the FAI, including score distribution, internal consistency, construct validity, predictive validity, and responsiveness in patients with traumatic limb injuries. METHODS: We performed a secondary data analysis, primarily using non-parametric item response theory, on a data set. The FAI and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were administered via telephone interview to a cohort of patients at 3, 6, and 12 months after injury. Totals of 342 patients' data (at 3 months after injury), 1,010 patients' data (6 months), and 987 patients' data (12 months) were available for analysis. RESULTS: After the deletion of 5 items (i.e., travel outings, gardening, household/car maintenance, reading books, and gainful work), the 10-item revised FAI (R-FAI) formed a unidimensional construct. The R-FAI exhibited a unidimensional construct at each of the 3 time points. The R-FAI had sufficient score distribution, internal consistency, predictive validity, and responsiveness in patients with limb injuries. CONCLUSIONS: Our results support the conclusion that the R-FAI has satisfactory measurement properties. The R-FAI is useful for assessing IADL in patients with limb injuries.

Comparison between botulinum toxin and corticosteroid injection in the treatment of acute and subacute tennis elbow: a prospective, randomized, double-blind, active drug-controlled pilot study.

OBJECTIVE: To compare botulinum toxin type A injection with corticosteroid injection in the treatment of tennis elbow. DESIGN: In this prospective, randomized, double-blind, drug-controlled trial,19 affected elbows of 16 patients were randomly assigned to receive injection with botulinum toxin type A (Botox group) or triamcinolone acetonide (steroid group). We used the Visual Analog Scale, pain-free grip strength, and World Health Organization Quality of Life Brief Questionnaire to assess the perception of pain, grip strength, and quality of life, respectively. Measures were performed before and at 4, 8, and 12 wks after the treatment. RESULTS: Four weeks after the treatment, the Botox group had smaller decrease in pain (P = 0.02) but greater decrease in grip strength (P = 0.01). The difference in grip strength remained significant at 8 wks (P = 0.03). No significant differences in quality of life were observed throughout the study period. CONCLUSIONS: Corticosteroid is superior to botulinum toxin type A in relieving pain in tennis elbow at 4 wks after injection. Because botulinum toxin injection did not relieve pain significantly but is associated with weakness, the muscle weakness caused by botulinum toxin is unlikely to be the sole mechanism of the pain relief observed in previous studies.