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Publisher: Maugeri Foundation Books - I libri della Fondazione Maugeri

PI-ME Press

Via Vigentina 136

A

PAVIA 27100, Italy

Tel. 0382.572169 - Fax 0382.572102

E-mail: tipografia@pime-editrice.it

ADVANCES INREHABILITATION• AGGIORNAMENTI INMEDICINARIABILITATIVA

Vol. 16, 2004 (ISBN 88-7963-180-2)

ADVANCES IN REHABILITATION (AGGIORNAMENTI IN MEDICINA RIABILITATIVA) is published by Maugeri Foundation Books and PI-ME Press (Via Vigentina 136 A , Pavia 27100, Italy) P OSTMASTER: Send Address Changes To MAUGERI FOUNDATION BOOKS Advances in Rehabilitation - Aggiornamenti in MedicinaRiabilitativa - Via Ferrata, 8; PAVIA 27100 (Italy)

Series Editor: Marcello Imbriani, M.D.

Assessment in Physical

Medicine and Rehabilitation

VIEWS ANDPERSPECTIVES

Michel Barat

Franco Franchignoni

Editors

Advances inRehabilitation

AGGIORNAMENTI IN MEDICINA RIABILITATIVA

Maugeri Foundation BooksVol. 16, 2004

I libri della Fondazione MaugeriPavia, Italy

AcadŽmie EuropŽenne

de MŽdecine de RŽadaptation FSM

Centro Studi Fondazione Maugeri

ADVANCES IN REHABILITATION

A

GGIORNAMENTI INMEDICINARIABILITATIVA

Vol. 16, 2004

ASSESSMENT IN PHYSICAL MEDICINE AND REHABILITATION V

IEWS ANDPERSPECTIVES

Michel Barat, Franco Franchignoni

Editors

CONTENTS

Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

M. Anne Chamberlain, Alex Chantraine

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Michel Barat, Franco Franchignoni

Chap. 1 - Assessment in rehabilitation: but which conceptual framework of functioning? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Alphons J. van Dijk

Chap. 2 - Principals and practice of measuring outcome . . . . . . . . . . 35

Alan Tennant

Chap. 3 - Generic and specific measures for outcome assessment in Orthopaedic and Rheumatologic Rehabilitation . . . . . . . . . . . . . . . . 45

Franco Franchignoni, Fausto Salaffi

Chap. 4 - Clinical and radiological assessment of patients with spinal cord and cauda equina injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

Wagih S. El Masry

Chap. 5 - Assessment in other central neurological diseases . . . . . . . . 105

Michel Barat, Patrick Dehail

Chap. 6 - The physiological basis of posture and gait . . . . . . . . . . . . . . 123 Antonio Nardone, Grégoire Courtine, Marco Schieppati Chap. 7 - Assessment of posture and balance in ageing and disease . . 143

Antonio Nardone, Marco Schieppati, Micaela Schmid

v viCONTENTS Chap. 8 - Assessment of cognitive impairments in adults . . . . . . . . . . . 179 Jean-Michel Mazaux, Muriel D. Lezak, Jean-Michel Giroire, Pierre-Alain Joseph,

Michel Barat

Chap. 9 - Assessment of assistive technology in Physical Medicine

and Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195

Jean-Marie André, Jean Paysant, Hélène Dorey, Olivier Dossmann,

Catherine Keller

Chap. 10 - Instruments for long term activity monitoring in Physical

and Rehabilitation Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Andrea Giordano, Alessandro Giustini

viiviiIt gives us great pleasure to write the preface to this book, the third in a series of monographs produced by members of the European Acade- my of Rehabilitation Medicine and the first published by the Foundation ÒSalvatore MaugeriÓ. We have great pleasure in thanking the Foundation for its generous support. Whilst it is increasingly accepted that rehabilitation is effective much remains to be done to enlarge the evidence base for practice. Evi- dence can be no better than the measurement tools used in its produc- tion. The whole process of rehabilitation rests on these and accurate as- sessments. Assessment is not easy; similarly measures may not be suffi- ciently sensitive for the proper evaluation of interventions, or they may not be robust enough for clinical practice. A decision often has to be made as to whether one should use a generic or a specific measure. We therefore need to be sure that established measures have good psycho- metric properties; where they do not Ð and only then Ð we need to pro- duce new ones. Both are included in this text by authorities in their fields whose experience has been used in the selection of appropriate assess- ment schedules and methods. This accessible state of the art monograph will inform new research and practice; we anticipate that it will be useful to established practitioners as well as those in training and to the re- searchers who work with them. The European Academy of Rehabilitation Medicine consists of se- nior doctors in the field, distinguished in their profession, noted for their major clinical and often, also, research contributions. They are doctors who are particularly concerned with the human dimension of the spe- cialty and with doing all in their power, in terms mainly of teaching, ethics and research, to improve services for people with disabilities. The Academy meets regularly and discussion on contemporary matters is lively. It is currently supporting an annual training course for all Euro- pean trainees, in the University of Marseille, as well as other courses. Be- lieving that Rehabilitation is better understood and practised if there is access to the best information it has launched a series of monographs.

Two books have already been published:

ÐLa plasticitŽ de la fonction motrice, ed. J.P. Didier. Springer, 2004. ÐVocational Rehabilitation, eds. C. Gobelet & F. Franchignoni. Springer, 2004.

PREFACE

viiiPREFACE and further are in preparation: ÐLes fonctions des sphincters, eds. G. Amarenco & A. Chantraine.

Springer, 2005.

ÐCancer and Rehabilitation, ed. H. DelbrŸck. Springer, 2005. We have no doubt that these will provide the most up to date evi- dence for practice and will find their place in University libraries as well as on the bookshelves of all persons interested in the problems they dis- cuss.

M. Anne Chamberlain Alex Chantraine

President Hon. Secretary

AcadŽmie EuropŽenne de MŽdecine de RŽadaptation / European Academy of Rehabilitation Medicine ixAssessment is fundamental in medical sciences Ð as in any other sci- ence Ð by virtue of the need to replace an empirical approach to the sick person with a scientific methodology, and thereby improve the effective- ness of clinical practice. The validation of progress in all health fields is strictly linked to the accuracy of the assessment process. Rehabilitation Medicine needs to follow the same line, for its present and future stand- ing and for its accountability as health service provider. Further, Rehabilitation Medicine holds a distinctive place. It is a dis- ciplinary crossroads which deals with many diseases and impairments and aims to alleviate the consequences of illness for the individual, mini- mizing disablement and improving the patientÕs ability to fulfil functions and obligations. In this view, assessment is often Ð as Wade states: "the process whereby the health care professional (or team) collects and analyses data to identify the problems a patient has, to determine all factors relevant to the resolution of those difficulties, and to set goals for action".Thus, as- sessment in our discipline must rely on the tools of each medical disci- pline in question (orthopaedics, rheumatology, neurology...), but also on specific outcome measures analyzing the personal, psychological and so- cial repercussions of health-related states (i.e. paying attention Ð accord- ing to the International Classification of Functioning, Disability and Health, ICF Ð not only to body functions and structures, and impair- ments, but also to activity and participation). The assessment process has many targets. First of all it indicates a rigorous and objective analysis and a comparison within considerable ho- mogeneous groups, so helping the clinical decision-making process. Then, standards for measurements and evaluation procedures improve evi- dence-based medicine and quality of practice, define shared working methods, unify professional perspectives, and enhance the rigour of re- search. The quality of a measurement instrument is based on the quality of its development process. Confusion or inconsistency in conceptual mod- els, theoretical assumptions or working definitions related to assessment procedures (due to poor methodology) generate questionable results lead- ing to mistakes in interpretation and unsuitable extrapolations. The wide number of assessment tools (rating scales and question- naires) for a given medical situation often complicates judgements and choices, and hinders reliable comparisons. A critical starting point is to exactly define what is to be measured for what purpose (and at what cost). A number of papers present guidelines for the criteria that should be considered in selecting, using and evaluating assessment tools and out-

INTRODUCTION

xINTRODUCTION come measures. The most important issue is to evaluate the appropriate- ness of an instrument, i.e. how well its content matches the purposes and questions which the specific clinical trial is intended to address (objec- tives, patient population, intervention, etc). Furthermore, it is crucial to ascertain acceptable levels of reliability, validity and responsiveness for the aims of a particular trial, and it is increasingly recognized that some pragmatic issues have also to be considered, such as the acceptability of an instrument (respondent burden) and its ease of administering and pro- cessing (administrative burden). As a result, the users have to choose a specific measure on the basis of the structure, the properties required for the intended purpose, previous use of the measure in similar situations, and practicality (i.e. an appropriate balance between the detail and accu- racy required, and the effort required for collecting data). Whatever the reason behind the assessment (diagnostic/prognostic; legal/administrative; research, etc.), the assessment procedure should not overlook the basic clinical target which is the care and attention paid by all members of the therapeutic team to the individual person. Hence as- sessment cannot be reduced to a ÒscoreÓ of disability or handicap scales, but should always aim to improve the global clinical approach and thera- peutic management. For this reason, the inclusion of patient perspectives (the so-called Òpatient-based measuresÓ, such as perceived health, quality of life, well-being, patient satisfaction, and so on) within the assessment framework is imperative. Taking into account the patientÕs opinion gives insights into individual perceptions of disease and treatment, and expec- tations, so capitalizing on patientÕs strengths in a positive manner. This book is organized into ten chapters. In chapter 1, Van Djik pre- sents a theoretical framework that might help us in the practice of reha- bilitation to select relevant variables for measurement, and subsequently make interpretations of the measurement outcomes that are relevant for this practice. Chapter 2 deals with the principles and practice of measur- ing outcome in P&RM, including issues about: how do we identify appro- priate outcomes? how do we judge the quality of an outcome measure? and how should we use such measures? Chapter 3 examines generic and specific measures for outcome assessment in the rehabilitation of or- thopaedic and rheumatologic diseases, including health-related quality of life measures and utility measures, as well as disease-specific and region- or site-specific instruments. Chapter 4 and 5 are devoted to the assess- ment of rehabilitation of neurological diseases, and examine the conse- quences of spinal cord injury (chapter 4) and chronic disabilities of pa- tients suffering from stroke, multiple sclerosis, severe traumatic brain in- jury, ParkinsonÕs disease, and so on (chapter 5). The following two chap- ters describe the recent advances in neurophysiological basis of posture and gait (chapter 6), in order to introduce the issues related to the assess- ment of postural control and balance in ageing and neurological diseases (chapter 7), with sections illustrating clinical tests of balance, multi-item balance scales, fear of falling and fall-efficacy scales, and instrumentation xiINTRODUCTION for kinetic and kinematic measures. The methodological issues of cogni- tive impairment are considered in chapter 8 that provides important cues for assessing cognition in brain-damaged adults. Chapter 9 examines the specific protocols for the evaluation of assistive technology devices in their particular context of use. The book's last chapter provides a detailed description of instruments for assessing mobility, in particular for long- term activity monitoring, an area of increasing interest in Rehabilitati on Medicine in the light of the World Health Organisation ICF framework. The list of contents for this book is not intended to be comprehensive. The field of outcome assessment in Physical and Rehabilitation Medicine is considerable and undergoing continual evolution. We have selected top- ics of pivotal interest that focus on paradigmatic themes. We hope that this book will be a valuable contribution to enable better understanding of the assessment process in Rehabilitation Medicine and its pivotal im- portance for clinical governance, audit, and research.

Michel Barat

Franco Franchignoni

1

ADVANCES IN REHABILITATION

A

GGIORNAMENTI INMEDICINARIABILITATIVA

Vol. 16, 2004. Pavia, Maugeri Foundation Books - I libri della Fondazione Maugeri

A.J. VAN DIJK

CHAPTER1

ASSESSMENT IN REHABILITATION:

BUT WHICH CONCEPTUAL

FRAMEWORK OF FUNCTIONING?

1.WHY IS A CONCEPTUAL FRAMEWORK

RELEVANT FOR ASSESSMENT?

Rehabilitation professionals focus on

changes in peopleÕs daily living. They try to find out how disturbances of daily living come about, and to find ways to assist the people concerned in their efforts to restore daily living. Assessment in individual pa- tient care is meant to help them to find these ways.

What is assessment? Wade (1) (p 16)

describes assessmentas the process of de- termining the meaning of the outcome of measurement. Measurementis the quan- tification of an observation by comparison with a standard. One could measure for ex-quotesdbs_dbs8.pdfusesText_14