Self-reported impairments and the impact on walking and life - - PowerPoint PPT Presentation

Self-reported impairments and the impact on walking and life satisfaction

Christina Brogårdh, RPT, PhD Associate Professor Lund University Sweden

Self-reported impairments and the impact on walking and life satisfaction

• A new rating scale assessing self-reported

impairments and its phychometric properties

• How the impairments can impact on walking and

life satisfaction

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Background

• Previous studies have assessed whether or not persons

with late effects of polio experience a particular symptom

• r impairment
• No widely used standardized rating scale that assesses

to what degree the impairments are experienced

• Therefore, we developed a new rating scale to increase

the understanding of self-reported impairments in persons with late effects of polio

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181.

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Self-reported Impairments in Persons with late effects of Polio (SIPP)

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Self-reported Impairments in Persons with late effects of Polio (SIPP)

• 13 items:

– impairments typical of and directly related to prior polio and indirectly associated with prior polio but commonly reported by patients

• “How bothered have you been during the last 2 weeks”:

1 = not at all, 2 = a little, 3 = moderately, 4 = quite a bit,

5 = extremely

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Respondents

• 273 persons with verified polio (mean age 63 years)

responded to SIPP

• Mean age at the acute poliomyelitis infection 7 years
• 91% of Swedish or Scandinavian origin
• 20% had a part-time or full disability pension

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Aim and Method

• Aim: to establish the construct validity of SIPP
• Method: The Rasch model – which can be applied to

investigate the psychometric properties of self-reported

• utcome measures

– Ordinal scales that fit the Rasch model (unidimensional) can be transformed into interval measurements, enabling a summation of the score and parametric analyses

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Results of the Rasch analyses

• Step 1: the initial analysis showed disordered categories,

misfit to the model for some of the items

• Step 2: rescoring of the response categories into a

4-category rating scale: – 1 = not at all, 2 = a little, 3 = quite a bit, 4 = extremely – Fit to the model was achieved but the scale still showed signs of multidimensionality

• Step 3: correlations among some of the items. 13 items

were combined into 5 testlets, which gave fit to the model and unidimensionality

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Conclusion

• After adjustment of the scale, SIPP was considered as

unidimensional

• The good psychometric properties implies that SIPP

with 4 response categories could be a useful scale to increase our understanding of the impairments that persons with late effects of polio can experience

• This scale may assist the clinicians in the planning

and evaluation of appropriate rehabilitation interventions

Brogårdh C, Lexell J, Lundgren-Nilsson Å. Construct Validity of a New Rating Scale for Self- Reported Impairments in Persons With Late Effects of Polio. PM R 2013; 5:176-181

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Test-retest reliability of SIPP

Table 1: Reliability of the SIPP responded by 51 individuals with late effects of polio (n=51).

Measurement ICC2.1 95% CI for ICC d¯ 95% CI for d¯ SEM SRD SIPP (sum score) 0.88 0.80 to 0.93 0,29

• 0,52 to 1,10

2,03 5,63 ICC, intraclass correlation coefficient; 95% CI, 95% confidence interval; SEM, standard error of measurement; SRD, smallest real difference

Brogårdh C, Lexell J. In manuscript

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Test-retest reliability of SIPP

• High Intraclass correlation coefficients > 0.8
• Small measurement error (mean differens 0.29)
• Real clinical difference

– >2 points for a group of individuals (max 52 points) – >5 points for a single individual

• Further supports the good psychometric properties of SIPP

to assess self-reported impairments

Brogårdh C, Lexell J. In manuscript

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

How impairments in lower limbs can impact on walking ability

• 122 participants with mild to moderate late effects of polio

– mean age 63 years

• All post-polio class III-V (indicating clinically stable or

clinically unstable polio) in at least one of the lower limbs

• 96% muscle weakness in one lower limb

– 26% used a walking aid – 28% used an Ankle Foot Orthosis (AFO) or a Knee- Ankle-Foot Orthosis (KAFO)

Brogårdh, C et al. Relationship between self-reported walking ability and objectively assessed gait performance in persons with late effects of polio. NeuroRehabilitation 33 (2013) 127–132

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

How impairments in lower extremity can impact om walking ability

• Walking Impact Scale (Walk-12)

– 12 items: asks about limitations during the past two weeks in activities related to walking and standing:

• More than 50% of the participants reported limitations

(moderately or quite a bit) related to – standing or walking, climbing stairs, walking speed and distance, concentration and effort as well as gait quality aspects (i.e., the ability to walk smoothly).

• 58% reported that their ability to run was extremely limited

Brogårdh, C et al. Relationship between self-reported walking ability and objectively assessed gait performance in persons with late effects of polio. NeuroRehabilitation 33 (2013) 127–132

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Self-reported impairments and life satisfaction

• 169 persons with late effects of polio (mean age 61 years)

participated

• Responded to

– LiSat-11 (assessing satisfaction with life as a whole and 10 domains of life satisfaction) – SIPP (13 items about self-reported impairments)

Lexell J, Brogårdh, C. Life satisfaction and self-reported impairments in persons with late effects of polio. Annals of Physical and Rehabilitation Medicine 55 (2012) 577–589

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Self-reported impairments and life satisfaction

• A majority was to some degree satisfied with life as a whole

and with all 10 domains of life satisfaction in LiSat-11 – less than 20% was very satisfied or satisfied with their somatic health

• Muscle fatigue, muscle weakness, general fatigue, muscle

and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments

• Those who reported significantly higher degrees of

impairment reported were less satisfied with life

Lexell J, Brogårdh, C. Life satisfaction and self-reported impairments in persons with late effects of polio. Annals of Physical and Rehabilitation Medicine 55 (2012) 577–589

Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum

Self-reported impairments and life satisfaction

• The correlations between the items in LiSat-11 and the

items in the SIPP varied from 0.01 to 0.64

• Rehabilitation interventions must address not only self-

reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio

• Important to use outcome measures with good

psychometric properties

Lexell J, Brogårdh, C. Life satisfaction and self-reported impairments in persons with late effects of polio. Annals of Physical and Rehabilitation Medicine 55 (2012) 577–589