Reliability and validity of on-road driving tests in vulnerable adults: a systematic review The on-road driving test is considered a ‘gold standard’ evaluation; however, its validity and reliability have not been sufficiently reviewed. This systematic review aimed to map out and synthesize literature regarding on-road driving tests using the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. Cochrane Library, PubMed, CINAHL, and Web of Science databases were searched from initiation through February 2018. All articles addressing reliability or validity of on-road driving tests involving adult rehabilitation patients were included. The search output identified 513 studies and 36 articles, which were included in the review. The Washington University Road Test/Rhode Island Road Test, performance analysis of driving ability, test ride for investigating practical fitness-to-drive, and K-score demonstrated high reliability and validity in regard to the Consensus-based Standards for the Selection of Health Measurement Instruments checklist. The Washington University Road Test/Rhode Island Road Test and test ride for investigating practical fitness-to-drive were analyzed based on Classical Test Theory techniques, and performance analysis of driving ability and K-score were analyzed based on Item Response Theory techniques. The frequency of studies were Washington University Road Test/Rhode Island Road Test (n=9), Test Ride for Investigating Practical fitness-to-drive (n=8), performance analysis of driving ability (n=4), and K-score (n=1). From the viewpoint of accuracy and generalization, the Washington University Road Test/Rhode Island Road Test, test ride for investigating practical fitness-to-drive, and performance analysis of driving ability were identified as highly qualified concerning on-road driving tests. However, the ability to assess real-world driving depends on various environmental conditions.

Effect of arm cycling and task-oriented exercises on fatigue and upper limb performance in multiple sclerosis: a randomized crossover study Rehabilitation treatments have been proven to be a viable way to reduce fatigue and upper limb impairments in people with multiple sclerosis (PwMS). Our aim was to examine which treatment has better short-term and carryover effects on fatigue and manual dexterity in multiple sclerosis population. Twenty PwMS participated in a 16-week randomized crossover study composed of 20 sessions. The participants were divided into two groups (group A and group B). Sessions containing combined arm cycling and task-oriented exercises were administered by a physical therapist in hospital setting. Each group received 20 sessions of aerobic training and task-oriented exercises and then an 8-week rest period or vice versa with group A receiving sessions first. Fatigue was assessed by using the Modified Fatigue Impact Scale (MFIS) and Motor Fatigability Index (MFI), which was assessed using an engineered glove during a fatiguing finger tapping task. To measure manual dexterity, the nine hole peg test (NHPT) and a rate of tapping at maximum velocity task (RATE-MV) were utilized. Treatment effects were assessed by t-test or Mann–Whitney test at the end of both periods checking for carryover effects. After treatment the combined (Groups A and B) between-period differences were MFIS: 5.2 (10.7) points, P = 0.05; MFI: −0.007 (<0.001)Hz/s, P = 0.05 and RATE-MV: 0.2 (0.4) Hz/s, P = 0.05 in favor of the treatment period. No statistically significant between-period differences were found for the NHPT: 3.6 (25.0) s, P = 0.63. No carryover effects (P > 0.05) were observed. In conclusion, sessions of arm cycling and tailored task-oriented exercises have shown to be a viable resource for treating manual dexterity and fatigue in PwMS.

Early body weight-supported overground walking training in patients with stroke in subacute phase compared to conventional physiotherapy: a randomized controlled pilot study Among the new rehabilitation strategies aimed at improving independent walking after stroke, the body weight-support training allows an early and controlled ambulatory training. To date, most available studies are based on treadmill body weight-support (BWS) training and involve patients with chronic stroke sequelae. In contrast, the effects of a BWS training performed on the ground in patients with subacute hemiparesis (stroke within 4 weeks), with significant gait deficiencies, is unknown. The primary aim of this study was to evaluate the efficacy of a rehabilitative program that combines conventional approach with an early overground body weight-support training, in terms of recovery of independent walking focussing on patients with subacute stroke. The secondary aim was to evaluate the impact of body weight-support also on functional mobility, overall disability, and gait endurance. A total of 37 participants were enrolled and randomized to experimental group or control group for the baseline evaluations. In the experimental group, body weight-supported overground walking was added to conventional physiotherapy for 4 weeks. The outcome measurements used were: Functional Ambulation Classification (FAC), Rivermead Mobility Index, Barthel Index, and the 6-minute Walk Test. At the evaluation 1 week after the end of the intervention period, experimental group reached a statistically significant increase of independent walking as detected by FAC (experimental group: 3 vs. control group: 2, P < 0.01). No differences were observed by the other evaluation outcome measures. We conclude that BWS training may be more effective than conventional therapy alone in improving walking autonomy in persons with subacute stroke.

Gender-related differences in psychometric properties of WHO Disability Assessment Schedule 2.0 Objective of this study was to investigate the gender-related differential item function of 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. This was a cross-sectional survey study among 1,988 patients at a university Physical and Rehabilitation Medicine outpatient clinic. To assess DIF, WHODAS 2.0 items were dichotomized as `none’ rated by respondents as `0’ versus `any limitation’ rated as `1,2,3 or 4’. The item response theory analysis was used to define discrimination and difficulty parameters of a questionnaire. The probit logistic regression was used to test uniformity of DIF between gender groups. The results of DIF analysis were presented and evaluated graphically as item characteristic curves based on 2-parameter IRT analysis of dichotomized responses. High to perfect discrimination ability was observed for all the items except one. Difficulty levels of eight items were shifted towards the elevated disability level, four items demonstrated a perfect difficulty property. Significant DIF between genders was observed in seven of 12 items. The detected DIFs were uniform. For item `household’, `emotional affection’ and `work’, men had to experience slightly worse disability than women to achieve the same score. A reverse effect was observed for items `concentration’, `washing’, `dressing’ and dealing with strangers. In this study, significant DIF between genders was found in seven of twelve items of 12-item WHODAS 2.0. amongst 1988 patients with chronic musculoskeletal pain. All the detected DIFs were uniform. Regardless gender-related DIF shown in seven out of 12 items, we recommend using and studying 12-item WHODAS 2.0 in different populations.

An instrument to measure perceptions of people with disabilities regarding the application of international vocational rehabilitation standards This study aimed to create a valid and reliable instrument to measure people with disabilities’ perceptions regarding the extent of application of international standards issued by the Council of Europe, International Labour Organization, and the International Classification of Functioning, Disability and Health in vocational rehabilitation centers in the Basque country, Spain. The instrument items were selected from international recommendations and conventions issued by the International Labour Organization, Council of Europe, International Classification of Functioning, Disability and Health, and a vocational rehabilitation literature review. The instrument was translated from English to Spanish, and the content validity index of an expert panel survey was used to assess content validity. For the Spanish version of the instrument, internal consistency reliability, confirmatory factor analysis and factor analysis were examined with 186 people with disabilities in 10 vocational rehabilitation centers in the Basque country. The coefficient alpha estimate was 0.945, indicating excellent internal consistency. Three factors were identified: job-related services, aims of vocational rehabilitation center, and vocational rehabilitation guidance. The instrument appears to have good validity and reliability but requires further validation. Support is provided for its use in both English and Spanish. Implications for vocational rehabilitation practice and suggestions for future research are provided.

The effect of motor imagery and mirror therapy on upper extremity function according to the level of cognition in stroke patients This study was conducted to investigate the effects of motor imagery (MI) and mirror therapy (MT) on upper extremity function according to the level of cognition in stroke patients. Twenty-four participants who were diagnosed with stroke were divided into a mild cognitive group (n = 12) and a severe cognitive group (n = 12). Then, the two groups were again divided into MI group (n = 6) and MT group (n = 6). The participants were evaluated for function of upper extremity using the Box and Block Test (BBT), the Jebsen–Taylor Hand Function Test (JTHFT), and Manual Function Test (MFT). There were significant differences between the two groups of cognitive function of mild level in the post-test of JTHFT (p < 0.05). In the MI group, significant differences were found in the pre- and post-test scores for all variance (p < 0.05). In the MT group, significant differences were found in the pre- and post-test scores for JTHFT and MFT (p < 0.05). There were significant differences between the two groups of cognitive function of severe level in the post-test of all variances (p < 0.05). Furthermore, in the MT group, significant differences were found in the pre- and post-test scores for all variances (P < 0.05). The results of this study suggest that applying MI to the mild cognitive group is effective and that applying MT to the severe cognitive group is effective.

Effects of adjuvant mental practice using inverse video of the unaffected upper limb in subacute stroke: a pilot randomized controlled study Mental practice has shown some positive effects on arm and hand ability and mobility after stroke. This study’s objective was to investigate the adjuvant effects of mental practice using an inverse video of the unaffected limb in subacute stroke patients with severe motor impairment on motor improvement, functional outcomes, and activities of daily living. Participants (n = 20) with severe hemiplegia after a unilateral first-ever stroke within 6 months were divided into two groups. The intervention group performed additional mental practice using an inverse video of the unaffected limb for 20 minutes before every session of their rehabilitation program. The primary outcomes were the Fugl-Meyer assessment for the upper extremity (FMA-UE) and manual function test (MFT). Assessments were performed at baseline and after 4 weeks of rehabilitation intervention. Significant differences were found from baseline to postintervention assessments within both groups on FMA-UE and FIM scores, whereas there were no statistically significant differences in mean FMA-UE, MFT, and FIM scores between groups. We cannot draw conclusions about the superiority of adjuvant mental practice training using inverse video compared with conventional occupation therapy alone in subacute poststroke patients.

Using telerehabilitation to improve cognitive function in post-stroke survivors: is this the time for the continuity of care? Post-stroke cognitive disorders can affect different domains, depending on typology of stroke and lesion localization, onset time, age and diagnostic tools used. In recent years, telerehabilitation using virtual reality has been used to reduce the healthcare costs encouraging continuity of care. The aim of our study is to evaluate the efficacy of a virtual reality rehabilitation system in improving cognitive function in stroke survivors. Forty patients affected by stroke were enrolled in this study and randomized into either the control or the experimental groups in order of recruitment. The study lasted 6 months, and included two phases: (1) during the first phase the experimental group underwent cognitive rehabilitation training using the Virtual Reality Rehabilitation System-Evo, whereas the control group was submitted to standard cognitive training; (2) in the second phase (after discharge), the experimental group was treated by means of virtual reality rehabilitation system Home Tablet (three sessions a week, each session lasting about 50 minutes), and the control group continued the traditional training, with the same amount of treatment. The patients underwent a neuropsychological evaluation before and at the end of the treatment. Linear mixed-effects analysis results showed that the scores of Montreal overall cognitive assessment, attentive matrices, Trail Making Test B, Phonemic Fluency, Semantic Fluency, Rey Auditory Verbal Learning Test I, Hamilton Rating Scale-Anxiety and Hamilton Rating Scale-Depression were affected by the type of the rehabilitative treatment. Our data show the effectiveness of telerehabilitation for the treatment of cognitive disorders following stroke.

Feasibility of de Morton Mobility Index for adult patients of all ages at low and basic functioning level: a study using the Slovenian translation We investigated metric properties of the Slovenian translation of de Morton Mobility Index in patients with musculoskeletal impairments during rehabilitation. The study included 30 inpatients, aged 22–84 years, with musculoskeletal impairments with or without impairment of peripheral nerves. They were assessed repeatedly with de Morton Mobility Index, Functional Ambulation Classification, Ten-metre Walk Test, Six-minute Walk Test, Berg Balance Scale and the motor subscale of the Functional Independence Measure. Convergent validity of de Morton Mobility Index was confirmed by good to very good correlations with the other measurements. Known-groups validity was demonstrated by significant differences in de Morton Mobility Index scores between patients who were not able to walk and those who were able to walk with or without waking aid, at admission and after 4 weeks. Predictive validity of de Morton Mobility Index for functional independence after 4 weeks of rehabilitation was moderate. Minimal clinically important difference of de Morton Mobility Index was estimated to be five points. De Morton Mobility Index was responsive after 2 and 4 weeks of rehabilitation (Cohen’s d 1.15 and 0.95, respectively). No floor or ceiling effects were identified. Internal validity of de Morton Mobility Index was confirmed by Rasch analysis. Hence, de Morton Mobility Index is a valid, unidimensional, and responsive measure of mobility for patients with musculoskeletal impairments at rehabilitation regardless of age. Its use is recommended for adult patients at low and basic functioning level.

The effects of electromyography-triggered neuromuscular electrical stimulation plus tilt sensor functional electrical stimulation training on gait performance in patients with subacute stroke: a randomized controlled pilot trial The effects of electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation on ankle dorsiflexion during walking are unclear. This study investigated whether combined electrical stimulation training affects gait performance in patients with stroke. Thirty-six patients were randomly assigned to a control (n = 13), electromyography-triggered neuromuscular electrical stimulation training (single electrical stimulation group, n = 12), or a combined electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training (combined electrical stimulation group, n = 11) group. Both experimental groups undertook 60-minute interventions for two weeks. All patients’ gait performances were evaluated according to walking speed and trunk acceleration during 10-meter walking tests undertaken pre-intervention and at two weeks post-intervention. A wireless triaxial accelerometer measured trunk acceleration, and the root mean square values of the vertical, mediolateral, and anterioposterior planes were calculated from randomly selected 10-step sequences. Compared with baseline, the 10-meter walking tests improved significantly after two weeks in the single and combined electrical stimulation groups. In the combined electrical stimulation group, the 10-meter walking tests scores and root mean square of the mediolateral plane improved significantly compared with those in the control group. Electromyography-triggered neuromuscular electrical stimulation and tilt sensor functional electrical stimulation training may improve body perturbation stability and walking quality.