Validation of a manual ability questionnaire in patients with systemic sclerosis

Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium.
Arthritis & Rheumatology (Impact Factor: 7.76). 05/2009; 61(5):695-703. DOI: 10.1002/art.24426
Source: PubMed


To adapt and validate a manual ability questionnaire, the ABILHAND, developed through the Rasch methodology in patients with systemic sclerosis (SSc).
The original version of the ABILHAND, which includes 81 manual daily activities, was presented to 156 patients with SSc. They were asked to provide their perceived difficulty in performing each manual activity on a 3-level scale: impossible, difficult, or easy. Items were selected from well-established psychometric criteria. The patients were reassessed 1 month later to test the reproducibility. Concomitantly, they were clinically evaluated for their disease activity/severity, and their functional ability was tested with the Health Assessment Questionnaire (HAQ).
The 26 selected items defined a unidimensional and linear measure of manual ability and showed a continuous progression in their difficulty. The item difficulty hierarchy was invariant across 12 patient-related factors and the manual ability score was reproducible over time. Finally, the manual ability was significantly poorer in SSc patients with more severe disease, and was negatively correlated with the HAQ score (rho = -0.733).
The SSc-adapted ABILHAND questionnaire is a reliable, valid, reproducible, linear, and unidimensional measure to assess and followup on the manual ability of patients with SSc; therefore, it could become a useful additional tool in clinical trials to assess treatment efficacy.

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    • "Curiously enough, further research evolved toward again 'tailoring' the instrument to specific classes of patients. This was the case for: children versus adults (ABILHAND-Kids, 21 items of which only 11 are shared by the AH-ST 23–3 , Arnould et al., 2004); upper limb amputees, (ABILHAND- ULA 1.0, 22 items of the original 46, of which 11 are shared by the AH-ST 23–3 , with four levels; Burger et al., 2009); systemic sclerosis (SSc-adapted ABILHAND, 26 items of the original 46, of which 15 are shared by the AH- ST 23–3 ,with three levels; Vanthuyne et al., 2009); a revised version for rheumatoid arthritis (a 27 items of the original 46, of which 14 are shared by the AH-ST 23–3 , on three levels, Durez et al., 2007), and a 'neuromuscular' ageindependent version (22 items, 11 of which are shared by the AH-ST 23–3 , Vandervelde et al., 2010). This heralds the arrival of numerous new versions, specific to a variety of clinical conditions. "
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    ABSTRACT: ABILHAND is, in its original version, a 46-item, 4-level questionnaire. It measures the difficulty perceived by patients with rheumatoid arthritis as they do various daily manual tasks. ABILHAND was originally built through Rasch analysis. In a later study, it was simplified to a generic 23-item, three-level questionnaire, showing both cross-cultural (Belgium vs. Italy) and cross-impairment (rheumatoid arthritis vs. stroke) validity. Later research returned to the development of impairment-specific versions, with modified item sets and levels. Each version has its own Rasch-derived item difficulty calibrations, which are required to extract the patient's measure from the individual string of responses, through computerized algorithms. All of these hamper the practical application of the scale in rehabilitation units, where patients with diverse conditions may share similar impairments and treatment approaches. In this study through Rasch analysis the 'generic' scale was applied to 126 chronic patients with different upper limb impairments, and to 24 healthy controls. It was supported that the generic questionnaire remains valid across a variety of motor impairments. To further facilitate clinical application, a normative cut-off (>79 of 100) is suggested. Rasch-based item calibrations are provided together with a software routine designed to calculate, on individual patients, linear 0-100 measures and error estimates from the raw scores.
    International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 03/2011; 34(2):131-40. DOI:10.1097/MRR.0b013e328343d4d3 · 1.28 Impact Factor
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    ABSTRACT: Neuromuscular disorders (NMDs) can lead to specific manual disabilities due to hand muscle weakness and atrophy, myotonia or loss of sensory function. The aim of this study was to adapt and validate the ABILHAND questionnaire in children and adults with NMDs using the Rasch model. This questionnaire contained specific manual activities for children and for adults, as well as common manual activities. 124 adult patients and the parents of 124 paediatric patients were asked to provide their perceived difficulty in performing each manual activity on a three level scale: impossible (0), difficult (1) or easy (2). Items were selected from well established psychometric criteria (ordered categories, equal item discrimination, adequate fit to the Rasch model, lack of redundancy) using the Rasch Unidimensional Measurement Models (RUMM2020) computer programme. The 22 selected items contain four children specific items, four adult specific items and 14 items commonly applicable to both children and adults. They define a unidimensional and linear measure of manual ability and demonstrate continuous progression in their difficulty. The item hierarchy of difficulty was invariant across six patient related factors. The scale exhibited good precision (r=0.95) and the 22 items were well targeted to the patients' locations. The ABILHAND measures were strongly related to the ACTIVLIM measures (r=0.76) and poorly related to grip strength (r=0.36 for the right hand and r=0.40 for the left hand). This scale can be used for adults and children, allowing manual ability to be assessed from childhood to adulthood.
    Journal of neurology, neurosurgery, and psychiatry 10/2009; 81(5):506-12. DOI:10.1136/jnnp.2009.177055 · 6.81 Impact Factor
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    ABSTRACT: To identify upper limb questionnaires used in the brachial plexus injury (BPI) literature to assess activities and to evaluate their clinimetric properties. DATA SOURCES; STUDY SELECTION; This systematic review was undertaken in 2 stages. In stage 1, 10 electronic databases and 1 Internet journal were searched for quantitative studies (ie, randomized controlled trials, comparative studies, case series, and case studies) that evaluated outcome after BPI, irrespective of language or date of publication, from date of database inception to September 2010. All outcome instruments used were extracted and classified using the International Classification of Functioning, Disability and Health framework. Questionnaires were identified that apportioned >50% of the total score to the assessment of upper limb activity. In stage 2, 4 electronic databases were searched for papers that evaluated the clinimetric properties of all identified activity questionnaires with respect to peripheral nerve injuries of the upper limb. Two independent reviewers assessed the clinimetric properties of identified questionnaires according to standardized criteria. Stage 1 identified 4324 papers, of which 265 met the inclusion criteria. One hundred and three outcome measures were identified, the majority of which assess body function or body structure. Twenty-nine questionnaires assessed upper limb activity. Two questionnaires, the ABILHAND and Disability of the Arm, Shoulder and Hand (DASH), attributed >50% of the overall score to activity of the upper limb. The DASH had some published evidence of clinimetric properties in individuals with peripheral nerve injuries. Neither had been clinimetrically evaluated for BPI, nor met all quality criteria. Day-to-day activities of the upper limb are infrequently evaluated after BPI. While attempts have been made to measure activity, there is a paucity of clinimetric evidence on activity questionnaires for individuals with BPI. We recommend that a core set of items be developed which evaluate activity, as well a body structure, body function, and participation.
    Archives of physical medicine and rehabilitation 12/2011; 92(12):2082-9. DOI:10.1016/j.apmr.2011.07.188 · 2.57 Impact Factor
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