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
Background • Previous studies have assessed whether or not persons with late effects of polio experience a particular symptom or 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 outcome 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 Lunds universitet / Fakultet / Institution / Enhet / Dokument / Datum
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