Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation–A systematic review

Abstract

Introduction This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. Methods 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. Results 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). Conclusions The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. Systematic review registration PROSPERO CRD42014013190.

Case Report: Stem cell therapy in amyotrophic lateral sclerosis

“…The FIM score declined to 96 points indicating he required minimal to moderate assistance with activities of daily living. 11 His DGI declined to 10 points categorizing him at high risk of falls. 12 REVISED Amendments from Version 1 I have added the age and gender of the patient with a brief about his symptom deterioration and decision to undergo SCT in the abstract.…”

“…He did not have other symptoms in the neural axis and was functionally independent. He scored 126 points on the Functional Independence Measure (FIM) 11 and 24 points on the Dynamic Gait Index (DGI) 12 indicating he was functionally independent and had excellent balance with no risk of falls. However, electrophysiological testing confirmed ALS.…”

Case Report: Stem cell therapy in amyotrophic lateral sclerosis

“…He did not have other symptoms in the neural axis and was functionally independent. He scored 126 points on the Functional Independence Measure (FIM) 8 and 24 points on the Dynamic Gait Index (DGI) 9 indicating he was functionally independent and had excellent balance with no risk of falls. However, electrophysiological testing confirmed ALS.…”

“…The FIM score declined to 96 points indicating he required minimal to moderate assistance with activities of daily living. 8 His DGI declined to 10 points categorizing him at high risk of falls. 9 At this point in time, the patient began considering undergoing stem cell therapy (SCT) because of his declining function.…”

“…He was still able to walk with a gutter frame with assistance for a distance of 10-20 meters before becoming fatigued. He was dependent on his family for his basic activities of daily living and was at high risk of falls (FIM Score 86 points 8 and DGI 4 points 9 ). Physical therapy focused on maintaining the available function and strength at this stage through functional training of lower limbs including sit-to-stand exercises, practicing transfers and gait training.…”