Adaptation of the Patient Benefit Assessment Scale for Hospitalised Older Patients: development, reliability and validity of the P-BAS picture version

Background The Patient Benefit Assessment Scale for Hospitalised Older Patients (P-BAS HOP) is a tool developed to both identify the priorities of the individual patient and to measure the outcomes relevant to him/her, resulting in a Patient Benefit Index (PBI), indicating how much benefit the patient had experienced from the hospitalisation. The reliability and the validity of the P-BAS HOP appeared to be not yet satisfactory and therefore the aims of this study were to adapt the P-BAS HOP and transform it into a picture version, resulting in the P-BAS-P, and to evaluate its feasibility, reliability, validity, responsiveness and interpretability. Methods Process of instrument development and evaluation performed among hospitalised older patients including pilot tests using Three-Step Test-Interviews (TSTI), test-retest reliability on baseline and follow-up, comparing the PBI with Intraclass Correlation Coefficient (ICC), and hypothesis testing to evaluate the construct validity. Responsiveness of individual P-BAS-P scores and the PBI with two different weighing schemes were evaluated using anchor questions. Interpretability of the PBI was evaluated with the visual anchor-based minimal important change (MIC) distribution method and computation of smallest detectable change (SDC) based on ICC. Results Fourteen hospitalised older patients participated in TSTIs at baseline and 13 at follow-up after discharge. After several adaptations, the P-BAS-P appeared feasible with good interviewer’s instructions. The pictures were considered relevant and helpful by the participants. Reliability was tested with 41 participants at baseline and 50 at follow-up. ICC between PBI1 and PBI2 of baseline test and retest was 0.76, respectively 0.73. At follow-up 0.86, respectively 0.85. For the construct validity, tested in 169 participants, hypotheses regarding importance of goals were confirmed. Regarding status of goals, only the follow-up status was confirmed, baseline and change were not. The responsiveness of the individual scores and PBI were weak, resulting in poor interpretability with many misclassifications. The SDC was larger than the MIC. Conclusions The P-BAS-P appeared to be a feasible instrument, but there were methodological barriers for the evaluation of the reliability, validity, and responsiveness. We therefore recommend further research into the P-BAS-P.

Psychometric Properties of the Barthel Index Used at Intensive Care Unit Discharge

Background The Barthel Index, originally developed and validated to assess activities of daily living in patients with neuromuscular disorders, is commonly used in research and clinical practice involving critically ill patients. Objectives To evaluate the internal consistency, reliability, measurement error, and construct validity of the Barthel Index used at intensive care unit discharge. Methods In this observational study, 2 physiotherapists measured the physical functioning of 122 patients at intensive care unit discharge, using the Barthel Index and other measurement instruments. Results The patients had a median (IQR) age of 56 (47-66) years, and 62 patients (51%) were male. The primary reason for intensive care unit admission was sepsis (28 patients [23%]), and 83 patients (68%) were receiving mechanical ventilation. The Cronbach α value indicating internal consistency was 0.81. For interrater reliability, the intraclass correlation coefficient for the total score was 0.98 (95% CI, 0.97-0.98; P < .001) and the κ statistic for the individual items was 0.54 to 0.94. The standard error of measurement was 7.22, the smallest detectable change was 20.01, and the 95% limits of agreement were –10.3 and 11.8. The Barthel Index showed moderate to high correlations with the other physical functioning measurement instruments (ρ = 0.57 to 0.88; P < .001 for all). Conclusion The Barthel Index is a reliable and valid instrument for assessing physical functioning at intensive care unit discharge.

Novel Ultrasonographic Thickness and Strength Assessments of the Flexor Digitorum: A Reliability Analysis

OBJECTIVES: Clinical conditions such as focal dystonia often require the assessment of atrophy and weakness of the finger muscles. However, due to a lack of well-established protocols, the current investigation focused on assessing the reliability of thickness and strength assessments of the flexor digitorum (FD) muscle, including both the superficialis and profundus components. As a secondary assessment, the reliability of the strength measurement of the extensor digitorum muscle was examined as well. METHODS: Different thickness measurements of the FD were taken via ultrasonography and averaged to estimate the mean thickness of the FD. Likewise, individual finger strength measurements taken by a custom-made finger pressure device were averaged to compute the mean strength of the flexor and extensor digitorum muscles. Test-retest reliability of the above measurements performed at two different time points (about 6 months apart) were examined on the right and left hands of 10 participants. RESULTS: Findings indicated excellent test-retest reliability (ICC > 0.92) for the mean thickness assessment of the FD and mean strength of the flexor and extensor digitorum for both dominant and non-dominant hands. The standard error of measurement was ≤4.3% for all three mean assessments, indicating high sensitivity. Likewise, the smallest detectable change was also sufficiently small for the mean thickness and mean strength of the flexor digitorum (≤5.1%) and moderately small (≤12%) for the strength of the extensor digitorum. CONCLUSIONS: Results indicated an excellent relative and absolute reliability, for both hands, for the mean thickness and strength assessments of the flexor digitorum muscle and for the mean strength of the extensor digitorum (measured for both hands). These measurements can be used for future investigations and can contribute to the establishment of more precise methods for assessing the muscles in the forearms which serve the hand.

Test–retest reliability of outcome measures: data from three trials in radiographic and non-radiographic axial spondyloarthritis

ObjectivesAim of this study was to assess test–retest reliability of candidate instruments for the mandatory domains of the Assessment of Spondyloarthritis international Society (ASAS)-Outcome Measures in Rheumatology core set for axial spondyloarthritis (axSpA).MethodsScreening and baseline data from COAST-V, COAST-X and RAPID-axSpA was used to evaluate test–retest reliability of each candidate instrument for the mandatory domains (disease activity, pain, morning stiffness, fatigue, physical function, overall functioning and health). A maximum time interval of 28 days between both visits was used for inclusion in this study. Test–retest reliability was assessed by intraclass correlation coefficient (ICC). Bland and Altman plots provided mean difference and 95% limits of agreement, which were used to calculate the smallest detectable change (SDC). Data were analysed for radiographic and non-radiographic axSpA separately.ResultsGood reliability was found for Ankylosing Spondylitis Disease Activity Score (ICC 0.79, SDC 0.6), C reactive protein (ICC 0.72–0.79, SDC 12.3–17.0), Bath Ankylosing Spondylitis Functional Index (ICC 0.87, SDC 1.1) and 36-item Short-Form Health Survey (ICC Physical Component Summary 0.81, SDC 4.7, Mental Component Summary 0.80, SDC 7.3). Moderate reliability was found for Bath Ankylosing Spondylitis Disease Activity Index (ICC 0.72, SDC 1.1), patient global assessment (ICC 0.58, SDC 1.5), total back pain (ICC 0.64, SDC 1.3), back pain at night (ICC 0.67, SDC 1.3), morning stiffness (ICC 0.52–0.63, SDC 1.5–2.2), fatigue (ICC 0.65, SDC 1.3) and ASAS-Health Index (ICC 0.74, SDC 2.5). Reliability and SDC for the radiographic and non-radiographic axSpA subgroups were similar.ConclusionOverall reliability was good, and comparable levels of reliability were found for patients with radiographic and non-radiographic axSpA, even though most instruments were developed for radiographic axSpA. Composite measures showed higher reliability than single-item measures in assessing disease activity in patients with axSpA.

Test–Retest Reliability of Physiological Variables During Submaximal Seated Upper-Body Poling in Able-Bodied Participants

Purpose: To investigate the test–retest reliability of physiological variables across four different test days and four different submaximal exercise intensities during seated upper-body poling (UBP).Methods: Thirteen abled-bodied, upper-body trained men (age 29±3years; body mass 84±12kg; height 183±5cm) performed four submaximal 4-min stages of seated UBP on four separate test days. The four submaximal stages were set at individual power outputs corresponding to a rating of perceived exertion of 9, 11, 13, and 15. The absolute reliability for pairwise test-day comparisons of the physiological variables was investigated with the smallest detectable change percentage (%SDC) and the relative reliability with the interclass correlation coefficient (ICC).Results: Absolute and relative reliability across test-day comparisons and submaximal stages were moderate to excellent for all variables investigated (V̇O2 – %SDC range: 5–13%, ICC range: 0.93–0.99; HR – %SDC range: 6–9%, ICC range: 0.91–0.97) other than blood lactate, for which absolute reliability was poor and relative reliability highly variable (%SDC range: 26–69%, ICC range: 0.44–0.92). Furthermore, absolute and relative reliability were consistent across the low-to-moderate exercise intensity spectrum and across test days.Conclusion: Absolute and relative test–retest reliability were acceptable for all investigated physiological variables but blood lactate. The consistent test–retest reliability across the exercise intensity spectrum and across test days indicates that a familiarization period to the specific exercise modality may not be necessary. For generalizability, these findings need to be confirmed in athletes with a disability by future large-scale studies.

Moral distress in nursing students: Cultural adaptation and validation study

Background: Moral distress, defined as moral suffering or a psychological imbalance, can affect nursing students. However, many new instruments or adaptations of other scales that are typically used to measure moral distress have not been used for nursing students. Aim: This study aimed to translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Moral Distress Scale for Nursing Students (It-ESMEE) for use with delayed nursing students (students who could not graduate on time or failed the exams necessary to progress to the next level). Research design: The study used a cross-sectional research design. Participants and research context: Incidental sampling resulted in a sample of 282 delayed nursing students (mean age = 26.73 ± 4.43 years, 73% female) enrolled between May and August 2020 in a University of central Italy. Ethical considerations: The research protocol was approved by the internal review board of the university, and all participants provided their written informed consent. Results: The study confirmed a multidimensional second-order factorial structure for the It-ESMEE with five dimensions: improper institutional conditions to teach user care, authoritarian teaching practices, disrespect for the ethical dimension of vocational training, lack of competence of the teacher and commitment of ethical dimension of user care. The internal consistency was high (0.753–0.990 across the factors), and the standard error of measurement and smallest detectable change were adequate. Discussion: The It-ESMEE is able to assess moral distress in delayed nursing students with good validity and reliability. It can be used in research and to determine moral distress levels, helping teachers to monitor the condition in nursing students. Conclusion: This instrument can help in comprehending moral distress, enabling students to develop coping and intervention strategies to maintain their well-being, and to ensure the quality of nurse education.

French translation and validation of the Keele STarT MSK Tool

Background The Keele STarT MSK Tool is a 10-item questionnaire developed to classify patients suffering from one of the five most common types of musculoskeletal pain into 3 sub-groups of risk of chronic pain (i.e. low risk, medium risk and high risk). Objective The objective of the present study was to translate the Keele STarT MSK Tool into French and to evaluate its main psychometric properties. Methods The translation and intercultural adaptation of the questionnaire were carried out using a 6-step process. The following psychometric properties were investigated: floor and ceiling effects, construct validity, internal consistency and test-retest reliability including Standard Error of Measurement and Smallest Detectable Change. Results 101 patients suffering from musculoskeletal pain participated in the study. No floor nor ceiling effects were observed. A Cronbach’s alpha of 0.65 was found, revealing a moderate internal consistency. Nevertheless, all items were demonstrated to be significantly correlated with the total score (range of correlations: r=0.2 for item 7 to r=0.78 for item 1). A good construct validity was also found with a significant correlation of r=0.78 between the French Keele STarT MSK Tool and the ÖMPSQ-short. Test-retest reliability was excellent (Intraclass Correlation Coefficient 0.97). A Standard Error of Measurement of 0.42 and a Smallest Detectable Change of ±1.17 were measured. Conclusion A validated French version of the Keele STarT MSK Tool is now available and can be used by health practitioners to stratify patients as being at low, medium or high risk of persistent musculoskeletal pain.

Reproducibility and responsiveness of the Frailty Index and Frailty Phenotype in older hospitalized patients

Background There is growing interest for interventions aiming at preventing frailty progression or even to reverse frailty in older people, yet it is still unclear which frailty instrument is most appropriate for measuring change scores over time to determine the effectiveness of interventions. The aim of this prospective cohort study was to determine reproducibility and responsiveness properties of the Frailty Index (FI) and Frailty Phenotype (FP) in acutely hospitalized medical patients aged 70 years and older. Methods Reproducibility was assessed by Intra-Class Correlation Coefficients (ICC), standard error of measurement (SEM) and smallest detectable change (SDC); Responsiveness was assessed by the standardized response mean (SRM), and area under the receiver operating characteristic curve (AUC). Results At baseline, 243 patients were included with a median age of 76 years (range 70–98). The analytic samples included 192 and 187 patients in the three and twelve months follow-up analyses, respectively. ICC of the FI were 0.85 (95 % confidence interval [CI]: 0.76; 0.91) and 0.84 (95% CI: 0.77; 0.90), and 0.65 (95% CI: 0.49; 0.77) and 0.77 (95% CI: 0.65; 0.84) for the FP. SEM ranged from 5 to 13 %; SDC from 13 to 37 %. SRMs were good in patients with unchanged frailty status (< 0.50), and doubtful to good for deteriorated and improved patients (0.43–1.00). AUC’s over three months were 0.77 (95% CI: 0.69; 0.86) and 0.71 (95% CI: 0.62; 0.79) for the FI, and 0.68 (95% CI: 0.58; 0.77) and 0.65 (95% CI: 0.55; 0.74) for the FP. Over twelve months, AUCs were 0.78 (95% CI: 0.69; 0.87) and 0.82 (95% CI: 0.73; 0.90) for the FI, and 0.78 (95% CI: 0.69; 0.87) and 0.75 (95% CI: 0.67; 0.84) for the FP. Conclusions The Frailty Index showed better reproducibility and responsiveness properties compared to the Frailty Phenotype among acutely hospitalized older patients.

Diffusion-weighted MR imaging in chronic non-bacterial osteitis: Proof-of-concept of the apparent diffusion coefficient as an outcome measure

Background The apparent diffusion coefficient (ADC), as determined by whole-body diffusion-weighted MRI, may be useful as an outcome measure for monitoring response to treatment in chronic non-bacterial osteitis. Purpose To test and demonstrate the feasibility of ADC-measurement methods for use as outcome measure in chronic non-bacterial osteitis. Materials and Methods Using data from a randomized pilot study, feasibility of change-score ADC between baseline and second MRI (ΔADC12) and third MRI (ΔADC13) as outcome measure was assessed in three settings: “whole-lesion,” “single-slice per lesion,” and “index-lesion per patient”. Bone marrow edema lesions were depicted on short tau inversion recovery sequence at baseline and copied to ADC maps at the three time-points. Correlations between the three settings were measured as were analysis of variances. Discriminant validity was assessed as inter- and intra-observer reproducibility and smallest detectable change. Results 12 subjects were enrolled, and MRI was performed at baseline and weeks 12 and 36. Pearson correlation was high ( r > 0.86; p ≤ 0.01) for ΔADC between single-slice—whole-lesion and whole-lesion—index-lesion and tended to be significant for single-slice—index-lesion settings ( p = 0.06). For ΔADC12 and ΔADC13, Bland–Altman plots showed small differences (0.02, 0.03) and narrow 95% limits-of-agreement (−0.13–0.09, −0.07–0.05 μm2/s) between whole-lesion and single-slice ROI settings. Inter-observer reproducibility measured by intra-class correlation coefficient was poor-to-fair (range: 0.09–0.31), whereas intra-observer reproducibility was good-to-excellent (range: 0.67–0.90). Smallest detectable changes were between 0.21–0.28 μm2/s. Conclusion ADC change-score as outcome measure was feasible, and the single-slice per lesion ROI setting performed almost equally to whole-lesion setting resulting in reduced assessment time.

Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale

Background: The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale is a reliable and valid tool for evaluation of psychological readiness to return to sport after ACL injury, but its responsiveness to change has not been extensively evaluated. Purpose: To determine the responsiveness of the ACL-RSI scale. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: The ACL-RSI scale and the knee confidence question from the Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale was completed at 6 and 12 months after ACL reconstruction surgery. Responsiveness was assessed using distribution and anchor-based methods for the full- and short-form versions of the scale and subgroup analyzed for sex. From distribution statistics, the standardized response mean (SRM) and the smallest detectable change (SDC) were calculated. Using the anchor-based method, the minimally important change (MIC) that was associated with an improvement in knee confidence was determined using receiver operating characteristic analysis. Results: A total of 441 patients (257 men, 184 women; mean age of 25 years) were included in this study. An SRM of 0.7 was found for both versions, indicating a moderate level of responsiveness. The MIC was 13.4 points for the full-form version and 15.1 points for the short-form version. These values were larger than SDC values at the group level but not at the individual patient level. Responsiveness was similar between male and female patients. Conclusion: The ACL-RSI scale had sufficient responsiveness to investigate the efficacy of an intervention at a group level, but it may be more limited at an individual patient level.