Minimal clinically important differenceof fatigue severity scale in patients with chronic stroke.

BACKGROUND: One of the most prevalent symptoms of stroke is fatigue. Fatigue severity scale is the most often used tool for evaluating fatigue in stroke patients, its minimal clinically important difference threshold has not been determined. This study aimed to identify the minimal clinically important difference of fatigue severity scale in stroke patients. METHODS: All study participants were examined using fatigue severity scale and multidimensional fatigue symptom inventory-short form before and after the intervention. The 6-week intervention combined graded activity training and pacing therapy employed to reduce fatigue severity. Participants reported changes in their fatigue severity after the intervention with the global rating of change and visual analog scale. The minimal clinically important difference of the fatigue severity scale calculated using both anchor- and distribution-based methods. RESULTS: A total of 117 stroke patients were included in the study. Using multidimensional fatigue symptom inventory-short form, global rating of change, and visual analog scale as an anchor, the minimal clinically important difference of fatigue severity scale was obtained at 3.5, 4.5, and 4.5, respectively. The minimal clinically important difference for fatigue severity scale varied from 4.28 to 12.90 using the distribution-based method, with SEM = 4.28 displaying the best sensitivity and specificity for use as minimal clinically important difference. CONCLUSIONS: The minimal clinically important difference value for the fatigue severity scale was estimated at 3.5_12.90 using anchor-based and distribution-based methods. The study's results can be utilized to understand the effectiveness of fatigue interventions in stroke patients in clinical and research settings.

Persian version of the Chalder Fatigue Questionnaire and Multidimensional Fatigue Symptom Inventory-Short Form: psychometric properties in Iranian chronic stroke survivors.

BACKGROUND: Post-stroke fatigue is a disturbing condition with various physical and psychological facets, which needs to be assessed by meaningful and psychometrically valid and reliable tools. The Chalder Fatigue Questionnaire (CFQ) and Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) have been designed to assess diverse dimensions of fatigue. OBJECTIVES: The present study aimed to investigate the psychometric properties of the CFQ and MFSI-SF in people with chronic stroke. METHODS: Both measures were translated according to forward-backward standard protocol. This cross-sectional study was conducted with 130 first-time stroke survivors. The multidimensional fatigue inventory, checklist individual strength, fatigue assessment scale, fatigue subscale of profiles of mood state, fatigue severity scale, visual analogue scale-fatigue, beck anxiety inventory, center for epidemiologic studies of depression scale, and 36-item short-form health survey were administered in addition to the CFQ and MFSI-SF. Reliability, precision, known-groups validity, and convergent validity were examined for the CFQ and MFSI-SF. RESULTS: The results showed an acceptable (Cronbach's alpha = 0.81-0.97) internal consistency and test-retest reliability (intra-class correlation = 0.75-0.97). The CFQ and MFSI-SF revealed good ability (P < 0.001) to differentiate chronic stroke survivors with different disability levels. Significant high correlation (P = -0.61-0.87) was found between CFQ and MFSI-SF and other fatigue scales. CONCLUSIONS: The results of this study showed that the CFQ and MFSI-SF have high reliability and validity for chronic stroke survivors.

Minimal and robust clinically important difference of three fatigue measures in chronic stroke survivors.

BACKGROUND: Fatigue assessment scale (FAS), fatigue subscale of the Profile of Mood States (POMS-F), and vitality subscale of the Short Form Health Survey (SF-36-VT) are among the first and most widely used adapted tools for assessing post-stroke fatigue. OBJECTIVE: To identify the minimal clinically important difference (MCID) and robust clinically important difference (RCID) of FAS, POMS-F, and SF-36-VT in stroke survivors. METHODS: Participants completed the FAS, POMS-F, and SF-36-VT before and after receiving 6-week intervention including graded activity training and pacing therapy. MCID was calculated using the distribution-based and anchor-based methods. Further, accuracy, sensitivity, and specificity of calculated values using the distribution-based method were used for determining RCID. RESULT: A total of 124 stroke survivors participated in this study. MCID for FAS, POMS-F, and SF-36-VT was found to be 4.86, 3.32, and -10.10 (using score change) and 3.5, 2.5, and -10.5 (using ROC analysis), respectively. Using the distribution-based method, the MCID value obtained for the FAS was in the range of 3.16 to 8.76, for the POMS-F was in the range of 1.49 to 5.63, and for the SF-36-VT was in the range of -15.43 to -5.58. ½SD for FAS, ½ SD and 1.96 SEM for POMS-F, and 1.96 SEM and SD for SF-36-VT showed the best discriminative ability to use as the RCID. CONCLUSIONS: The MCID and RCID were calculated for FAS, POMS-F, and SF-36-VT using different methods. The results can be used by researchers and clinicians for interpreting their findings in subjects similar to those who participated in this study.

Apathy exacerbates postural control impairments in stroke survivors: The potential effects of cognitive dual-task for improving postural control.

Apathy is a stressor and debilitating common condition for both stroke survivors and their caregivers. However, its effects on the postural control of these patients have not yet been investigated. Improved postural stability through withdrawing attention from postural control by concurrent cognitive task (i.e. dual-task condition) has been reported previously, but the effect of apathy, as a confounding factor, remains unknown. This study aimed to examine the effects of apathy and dual-task condition on postural control of chronic stroke survivors from biomechanical and neurophysiological perspectives. Twenty non-apathetic stroke survivors, 20 apathetic stroke survivors, and 20 sex-, age-, weight-, and height-matched healthy subjects were assessed using different postural sway measures and electromyography activity of ankle and hip muscles while quietly standing on rigid and foam surfaces under single-task, easy dual-task, and difficult dual-task conditions. The results showed postural instability and neuromuscular stiffening of stroke survivors, particularly apathetic stroke survivors, compared with healthy controls as evidenced by significantly greater postural sway measures and increased co-contraction of ankle muscles as well as hip muscles. Notably, concurrently performing a cognitive task significantly reduced postural instability and neuromuscular stiffening in chronic stroke survivors even in those with apathy. In conclusion, apathy exacerbates postural control impairments in chronic stroke survivors promoting an inefficient conscious mode of postural control. It is recommended that distracting the attention away from postural control by performing a concurrent cognitive task can be considered an effective strategy while designing interventions for improving postural control in apathetic stroke survivors.

Validation of the Persian Version of the Engagement in Meaningful Activities Survey (EMAS) in an Iranian Stroke Population: Predictors of Participation in Meaningful Activities.

IMPORTANCE: The inability to participate in meaningful activities is one of stroke survivors' main difficulties and has a negative effect on their satisfaction and quality of life. OBJECTIVE: To assess the reliability and validity of the Persian version of the Engagement in Meaningful Activities Survey (EMAS-P) and predictors of participation in meaningful activity among chronic stroke survivors. DESIGN: Cross-sectional. SETTING: Medical and rehabilitation centers. PARTICIPANTS: One hundred twenty-three people (75 men, 48 women) with chronic stroke. OUTCOMES AND MEASURES: Participants were evaluated with the EMAS-P, Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies Depression Scale, Purpose in Life Test-Short Form (PIL-SF), 36-Item Short Form Health Survey (SF-36), and Life Satisfaction Index-Z (LSI-Z). RESULTS: The EMAS-P showed good internal consistency (Cronbach's α = .95) and test-retest reliability (intraclass correlation coefficient = .87 for EMAS-P total score). Test-retest reliability for each EMAS-P item was moderate (κ = .40-.65). A significant correlation between the EMAS-P and PIL-SF (r = .86), SWLS (r = .83), LSI-Z (r = .75), and SF-36 subscales (rs = .52-.83) indicated the appropriate convergent validity. The EMAS-P's discriminative validity was also confirmed for age, depression level, and disability level among people with chronic stroke. Depression, disability level, gender, and fatigue were significant predictors of EMAS-P score. CONCLUSIONS AND RELEVANCE: The results indicate that the EMAS-P has acceptable reliability and validity among Iranian people with chronic stroke. Moreover, the EMAS-P showed good discriminant validity for age, depression, and disability level among them. What This Article Adds: The EMAS-P is a reliable and valid scale for assessing the engagement of Iranian chronic stroke survivors in meaningful activities and thus should be helpful in both clinical research and practice.

Psychometric properties of Meaningful Activity Participation Assessment (MAPA) in chronic stroke survivors.

BACKGROUND: Meaningful Activity Participation Assessment (MAPA) is an appropriate tool for assessing both objective and subjective aspects of participation. OBJECTIVES: This study aimed to investigate the psychometric properties of MAPA in chronic stroke survivors. METHODS: Translation of MAPA was done according to the standard protocol of forward-backward translation. One hundred and seven chronic stroke survivors participated in this study. In addition to the MAPA, they were assessed by Satisfaction With Life Scale (SWLS), Center for Epidemiologic Studies of Depression Scale (CES-D), Life Satisfaction Index-Z (LSI-Z), Purpose in Life Test-Short Form (PIL-SF), and 36-Item Short-Form Survey (SF-36). To investigate the test-retest reliability, 37 participants were reassessed by MAPA after two weeks. Reliability, construct and known-groups validity were evaluated for MAPA. RESULTS: The results showed an acceptable internal consistency (Cronbach's α = 0.79) and good test-retest reliability (ICC = 0.92) of MAPA. A significant moderate to high correlation was found between the MAPA and PIL-SF, CES-D, LSI-Z, SWLS, and different subscales of SF-36 (r = 0.32-0.65). MAPA showed good ability to differentiate between young adults (age≤ 65 years) and older adults (age> 65 years) with chronic stroke (P = .005) as well as between chronic stroke survivors with different levels of disability (P < .001). CONCLUSIONS: The MAPA has appropriate reliability and validity in chronic stroke survivors and is suggested to be used in research and clinical settings.

Reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version for children with physical disabilities.

INTRODUCTION: Occupational therapy supports individuals to participate in meaningful activities. Participation in activities should be assessed with appropriate tools. The aim of the present study was to establish the reliability and validity of the Children Participation Assessment Scale in Activities Outside of School-Parent version (CPAS-P) for children with physical disabilities. METHODS: The participants were 304 parents of 6- to 12-year-old children with physical disabilities. Confirmatory factor analysis (CFA), internal consistency, convergent validity of the CPAS-P with the Vineland Adaptive Behavior Scale (VABS), and test-retest reliability were measured. RESULTS: Confirmatory factor analysis showed acceptable values for all indices of fit, namely goodness of fit index (GFI), adjusted GFI, normal fix index, comparative fit index, incremental fit index (i.e., greater than 0.90), and the value of root mean square error of approximation was 0.07, which was acceptable. High Cronbach's alpha coefficients (above 0.9) were reported for the total score of each scale (diversity = 0.94, frequency = 0.94, with whom = 0.92, enjoyment = 0.95, and parent satisfaction = 0.95). The convergent validity of the CPAS-P with the VABS was moderate to good and the test-retest reliability (ICC) for the total scores ranged from 0.90 to 0.96. CONCLUSION: The CPAS-P had good psychometric properties for parents reporting the activities of their 6- to 12-year-old children with physical disabilities and can be utilized in clinical practice.