Health and Functional Literacy in Physical Rehabilitation Patients.

BACKGROUND: People with disabilities, who face multiple barriers to care, experience health disparities, yet few studies have measured health literacy in this population. OBJECTIVE: This study evaluated functional literacy, health literacy, fluid cognitive function, and self-reported health in people who live in community dwellings with spinal cord injury, stroke, or traumatic brain injury. METHODS: Participants with a traumatic spinal cord injury, stroke, or traumatic brain injury, one-year postinjury, and age 18 to 85 years, completed a battery of instruments at three medical centers in the Midwestern U.S.: functional literacy (word recognition, vocabulary knowledge), health literacy (comprehension of prose, document, and quantitative health information), fluid cognitive function (memory, executive function, and processing speed), and patient-reported outcomes (mobility, fatigue, sadness, anxiety, social function, and overall health). KEY RESULTS: There were strong correlations between functional literacy, health literacy, and fluid cognitive function. After adjustment for sociodemographic and clinical characteristics, higher health literacy was associated with better mobility, less anxiety, and better overall health; higher functional literacy was associated with less anxiety and better overall health; and higher fluid cognitive function was associated with better mobility, less sadness, better social function, and better overall health. CONCLUSIONS: To effectively address limited health literacy among people with spinal cord injury, stroke, and traumatic brain injury, and ensure that they are able to be informed partners in their health care, intervention is required at the level of patients, providers, and health care delivery systems. A special consideration is to ensure that health information is both well-targeted to people's health literacy levels and accessible for people with a range of physical, cognitive, and sensory limitations. The multimedia self-administered health literacy measure used in this study could be useful to rehabilitation providers and designers of health information and interfaces. [Health Literacy Research and Practice. 2017;1(2):e71-e85.]. PLAIN LANGUAGE SUMMARY: Health literacy represents people's abilities to obtain, understand, and use health information to make informed decisions about their health and health care. People with disabilities face physical, attitudinal, economic, and structural barriers to care. Consideration of health literacy in rehabilitation practice can enhance the effectiveness of the patient-clinician relationship and help address the needs of this population.

Grip and knee extension muscle strength reflect a common construct among adults.

INTRODUCTION: Both grip and knee extension strength are often used to characterize overall limb muscle strength. We sought to determine if the measures actually reflect a common construct. METHODS: The isometric grip and knee extension strength of 164 healthy men and women (range, 18-85 years) were measured bilaterally using standard procedures. Pearson correlations (r), Cronbach alpha, principal components analysis, and multiple regression/correlation were used to investigate the dimensionality of the measures. RESULTS: Left and right grip forces and knee extension torques were highly correlated, internally consistent, and loaded on a single component. Gender and age explained the variance in both measures, but height added to the explanation of grip strength, whereas weight added to the explanation of knee extension strength. CONCLUSIONS: Among healthy adults, grip and knee extension strength reflect a common underlying construct. The measures, however, are affected differently by height and weight.

Assessing dexterity function: a comparison of two alternatives for the NIH Toolbox.

STUDY DESIGN: Clinical measurement. INTRODUCTION: Manual dexterity is an important aspect of motor function across the age span. PURPOSE OF THE STUDY: To identify a single measure of manual dexterity for inclusion in the National Institutes of Health (NIH) Toolbox Assessment of Neurological and Behavioral Function. METHODS: A total of 340 subjects participated in our study. Two alternatives, Rolyan® 9-Hole Peg Test (9-HPT) and Grooved Pegboard test, were compared by assessing their score range across age groups (3-85 yr) and their test-retest reliability, concurrent, and known groups validity. RESULTS: The 9-HPT was a simple, efficient, and low-cost measure of manual dexterity appropriate for administration across the age range. Test-retest reliability coefficients were 0.95 and 0.92 for right and left hands, respectively. The 9-HPT correlated with Bruininks-Oseretsky Test (BOT) of Motor Proficiency, dexterity subscale, at -0.87 to -0.89 and with Purdue Pegboard at -0.74 to -0.75. The Grooved Pegboard had good test-retest reliability (0.91 and 0.85 for right and left hands, respectively). The Grooved Pegboard correlated with BOT at -0.50 to -0.63 and with Purdue Pegboard at -0.73 to -0.78. However, the Grooved Pegboard required longer administration time and was challenging for the youngest children and oldest adults. CONCLUSIONS: Based on its feasibility and measurement properties, the 9-HPT was recommended for inclusion in the motor battery of the NIH Toolbox. LEVEL OF EVIDENCE: NA.

Adequacy of belt-stabilized testing of knee extension strength.

Tester strength can limit the forces that can be measured using a hand-held dynamometer (HHD). A solution is to use belt stabilization in conjunction with an HHD. The purposes of this study were to determine if a portable belt-stabilized HHD (BSHHD) setup was capable of measuring a broad range of isometric knee extension torques and whether isometric knee extension torques measured using a portable BSHHD system were comparable to those obtained using a Biodex isokinetic dynamometer. Participants in the study were 113 women and 71 men (14-85 years of age) community-dwelling enrollees in the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function. Knee extension torques measured using a BSHHD ranged from 35.0-416.0 N·m. Torques measured with the BSHHD were significantly lower (p < 0.001) than those measured using the isokinetic dynamometer (mean difference: 35.6 N·m left, 33.7 N·m right). However, the measures were highly correlated (r > 0.86, p < 0.001). Torques obtained with a BSHHD may not equal the maximum that individuals can generate, but they reflect such torques. We conclude, therefore, that a portable BSHHD setup is a viable option for measuring a wide spectrum of knee extension torques in diverse settings.

Relative reliability of three objective tests of limb muscle strength.

If measures of muscle strength are to be broadly applied, they should be objective, portable, quick, and reliable. Through this component of the NIH Toolbox study we sought to compare the test-retest reliability of 3 tests of muscle strength that are objective, portable, and quick: the five-repetition sit-to-stand test (FRSTST), hand-grip dynamometry (HGD), and belt-stabilized hand-held dynamometry (BSHHD) of knee extension. Three sets of each test were performed- 1 warm-up and 2 maximal. Measures from the maximal tests obtained 4 to 10 days apart were compared. Reliability was described using descriptive statistics, intraclass correlation coefficients (ICCs) and 4 measures of response stability: standard error of measurement (SEM), method error (ME), coefficient of variation of SEM (SEM CV ), and coefficient of variation of variation of ME (ME CV ). The ICCs of all tests were good (≥ 0.853). Measures of response stability showed less variability between test and retest for FRSTST and HGD than for BSHHD. In conclusions all 3 tests demonstrated good test-retest reliability. However, greater differences would need to be observed between tests sessions to conclude that a real change had occurred in measures obtained by BSHHD.

Sit-to-stand test: Performance and determinants across the age-span.

Although the validity of the sit-to-stand (STS) test as a measure of lower limb strength has been questioned, it is widely used as such among older adults. The purposes of this study were: 1) to describe five-repetition STS test (FRSTST) performance (time) by adolescents and adults and 2) to determine the relationship of isometric knee extension strength (force and torque), age, gender, weight, and stature with that performance. Participants were 111 female and 70 male (14-85 years) community-dwelling enrollees in the NIH Toolbox Assessment of Neurological and Behavioral Function. The FRSTST was conducted using a standard armless chair. Knee extension force was measured using a belt-stabilized hand-held dynamometer; knee extension torque was measured using a Biodex dynamometer. The mean times for the FRSTST ranged from 6.0 sec (20-29 years) to 10.8 sec (80-85 years). For both the entire sample and a sub-sample of participants 50-85 years, knee extension strength (r = -0.388 to -0.634), age (r = 0.561 and 0.466), and gender (r = 0.182 and 0.276) were correlated significantly with FRSTST times. In all multiple regression models, knee extension strength provided the best explanation of FRSTST performance, but age contributed as well. Bodyweight and stature were less consistent in explaining FRSTST performance. Gender did not add to the explanation of FRSTST performance. Our findings suggest, therefore, that FRSTST time reflects lower limb strength, but that performance should be interpreted in light of age and other factors.

Participation following traumatic spinal cord injury: an evidence-based review for research.

BACKGROUND/OBJECTIVE: To report an evidence-based review of participation instruments that have been used in spinal cord injury (SCI) clinical practice and research. METHODS: Rehabilitation literature was searched for instruments used by at least 2 independent SCI researchers since 2000. Each instrument was reviewed by 2 committee members. One person reviewed the scale and documented the level of use and psychometric properties. The second committee member verified the values and made suggestions for changes. RESULTS: Three instruments met the review criteria: Craig Handicap Assessment and Reporting Technique (CHART), Assessment of Life Habits (LIFE-H), and the Impact on Participation and Autonomy (IPA). Each instrument incorporates different perspectives in the measurement of participation. The LIFE-H uses a qualitative approach, whereas the CHART adopts a quantitative approach; both are based on societal norms of participation. In contrast, the IPA integrates individual choice and control in defining participation. CHART is the most widely used instrument, although its development predates the development of the ICF. The IPA is a relatively new instrument, and its psychometric properties have only recently published. CONCLUSIONS: Continuing research is needed to develop conceptually and psychometric valid measures of participation for use with people with SCI. Priorities include understanding the relationship between objective and subjective indicators of participation, describing the dimensions of participation, and identifying appropriate measurement models and psychometric approaches to evaluate the nonhierarchical character of participation. Researchers and clinicians should be aware of the strengths and limitations of existing measures to make informed decisions about appropriate instruments.