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L Tesio

Publications and source records attributed to L Tesio.

At least 19 recordsLinked to original sources
PubMed2006

A multicenter international study on the Spinal Cord Independence Measure, version III: Rasch psychometric validation.

BACKGROUND: A third version of the Spinal Cord Independence Measure (SCIM III), made up of three subscales, was formulated following comments by experts from several countries and Rasch analysis performed on the previous version. OBJECTIVE: To examine the validity, reliability, and usefulness of SCIM III using Rasch analysis. DESIGN: Multicenter cohort study. SETTING: Thirteen spinal cord units in six countries from North America, Europe, and the Middle-East. SUBJECTS: 425 patients with spinal cord lesions (SCL). INTERVENTIONS: SCIM III assessments by professional staff members. Rasch analysis of admission scores. MAIN OUTCOME MEASURES: SCIM III subscale match between the distribution of item difficulty grades and the patient ability measurements; reliability of patient ability measures; fit of data to Rasch model requirements; unidimensionality of each subscale; hierarchical ordering of categories within items; differential item functioning across classes of patients and across countries. RESULTS: Results supported the compatibility of the SCIM subscales with the stringent Rasch requirements. Average infit mean-square indices were 0.79-1.06; statistically distinct strata of abilities were 3 to 4; most thresholds between adjacent categories were properly ordered; item hierarchy was stable across most of the clinical subgroups and across countries. In a few items, however, misfit or category threshold disordering were found. CONCLUSIONS: The scores of each SCIM III subscale appear as a reliable and useful quantitative representation of a specific construct of independence after SCL. This justifies the use of SCIM in clinical research, including cross-cultural trials. The results also suggest that there is merit in further refining the scale.

Activities of Daily Living↗
PubMed2006

Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study.

PURPOSE: Quality of life in multiple sclerosis has been often measured through the SF-36 questionnaire. In this study, validation of the SF-36 summary scores, its 'physical' component, and its 'mental' component was attempted by exploring the joint predictive power of disability (EDSS score), of anxiety and depression (HADS-A and -D scores, respectively), and of disease duration, progression type, age, gender and marital status. METHOD: The sample consisted of 75 patients suffering from multiple sclerosis admitted to an inpatient rehabilitation unit. The interplay between potential predictors was assessed through a particular regression model (classification and regression tree, CART). Two main advantages of this technique are its robustness with respect to distributional assumptions (rarely met by scores coming in from questionnaires) and its sensitivity to high-order interactions, between independent variables, difficult to detect through conventional multiple regression. RESULTS: Predictive variables for physical component of the SF-36 were EDSS and HADS-D (36.8% variance explanation). The only predictive variable for mental component of SF-36 was HADS-D (39.1% variance explanation). CONCLUSION: Results confirm previous findings showing that in patients with multiple sclerosis quality of life is heavily determined by person's mood, whatever his/her neurological or functional severity. The usefulness and validity of the SF-36 as an index representative of quality of life is debatable, as long as depression explains much of its variance. Further refinement of quality of life definition and measurement is worth further psychometric and statistical research.

Adult↗
PubMed2006

Cross-cultural validity of FIM in spinal cord injury.

OBJECTIVE: To analyse cross-culture validity of the Functional Independence Measure (FIM) in patients with a spinal cord injury using a modern psychometric approach. SETTINGS: A total of 19 rehabilitation facilities from four countries in Europe. PARTICIPANTS: A total of 647 patients at admission, median age 46 years, 69% male. METHODS: Data from the FIM, collected on inpatient admission, was fitted to the Rasch model. A detailed analysis of scoring functions of the seven categories of the FIM items was undertaken before to testing fit to the model. Categories were rescored where necessary. Fit to the model was assessed initially within country, and then in the pooled data. Analysis of differential item functioning (DIF) was undertaken in the pooled data for each of the FIM motor and social cognitive scales, respectively. Final fit to the model was tested for breach of local independence by principle components analysis (PCA). RESULTS: The present scoring system for the FIM motor and cognitive scales, that is a seven category scale, was found to be invalid, necessitating extensive rescoring. Following this, DIF was found in a number of items within the motor scale, requiring a complex solution of splitting items by country to allow for the valid pooling of data. Five country-specific items could not be retained within this solution. The FIM cognitive scale fitted the Rasch model after rescoring, but there was a substantial ceiling effect. CONCLUSIONS: Data from the FIM motor scale for patients with spinal cord injury should not be pooled in its raw form, or compared from country to country. Only after fit to the Rasch model and necessary adjustments could such a comparison be made, but with a loss of clinical important items. The FIM cognitive scale works well following rescoring, and data may be pooled, but many patients were at the maximum score.

Activities of Daily Living↗
PubMed2001

The use of outcome measures in physical medicine and rehabilitation within Europe.

The aim of the study was to survey the use of outcome measures in rehabilitation within Europe. It was envisaged that this would provide the basis for further studies on the cross-cultural validity of outcome measures. A postal questionnaire was distributed in November 1998 to 866 units providing rehabilitation. In total, 418 questionnaires were returned, corresponding to a response rate of 48%. These 418 centres treated an estimated 113,000 patients annually, undertaking 360,000 assessments. The survey focused on nine diagnostic groups: hip and knee replacement, low back pain, lower limb amputees, multiple sclerosis, neuromuscular disorders, rheumatoid arthritis, spinal cord lesions, stroke and traumatic brain injury. It identified a relatively small number of dominant outcome assessments for each diagnostic group and some variation in the preference for measures across regions. A large number of measures, however, are being used in one or a small number of locations and with relatively few patients. For rehabilitation of orthopaedic patients the majority of assessments undertaken are at the impairment level. For patients with neurological disorders the emphasis is mostly upon measures of disability.

Amputees↗
PubMed2001

The ABILHAND questionnaire as a measure of manual ability in chronic stroke patients: Rasch-based validation and relationship to upper limb impairment.

BACKGROUND AND PURPOSE: Chronic hemiparetic patients often retain the ability to manage activities requiring both hands, either through the use of the affected arm or compensation with the unaffected limb. A measure of this overall ability was developed by adapting and validating the ABILHAND questionnaire through the Rasch measurement model. ABILHAND measures the patient's perceived difficulty in performing everyday manual activities. METHODS: One hundred three chronic (>6 months) stroke outpatients (62% men; mean age, 63 years) were assessed (74 in Belgium, 29 in Italy). They lived at home and walked independently and were screened for the absence of major cognitive deficits (dementia, aphasia, hemineglect). The patients were administered the ABILHAND questionnaire, the Brunnström upper limb motricity test, the box-and-block manual dexterity test, the Semmes-Weinstein tactile sensation test, and the Geriatric Depression Scale. The brain lesion type and site were recorded. ABILHAND results were analyzed with the use of Winsteps Rasch software. RESULTS: The Rasch refinement of ABILHAND led to a change from the original unimanual and bimanual 56-item, 4-level scale to a bimanual 23-item, 3-level scale. The resulting ability scale had sufficient sensitivity to be clinically useful. Rasch reliability was 0.90, and the item-difficulty hierarchy was stable across demographic and clinical subgroups. Grip strength, motricity, dexterity, and depression were significantly correlated with the ABILHAND measures. CONCLUSIONS: The ABILHAND questionnaire results in a valid person-centered measure of manual ability in everyday activities. The stability of the item-difficulty hierarchy across different patient classes further supports the clinical application of the scale.

Adult↗
PubMed2001

Falls in the elderly: the development of a risk questionnaire and posturographic findings.

In elderly people, owing to a perturbation at several levels, including the motor, sensory and cognitive levels, a condition of dizziness and unsteadiness complicated by frequent falls often appears. In this article, we review the most recent information about clinical and instrumental tools available for preventing mobility-related accidents and report the results of a comparative study of postural control, carried out through tetraataxiometry (by Tetrax, Tel Aviv, Israel), in two samples of elderly women belonging to two different populations: 24 Italian women (11 reporting falls and 13 without falls) having a mean age of 73.1 years, and 37 Israeli women (12 with falls and 25 without falls) having a mean age of 72.5 years. The posturographic findings show that the falling subjects, to maintain postural control, are highly dependent on somatosensory inputs and have a weaker "systeme postural fin" (fine postural system), according to Gagey. They also show that an elderly subpopulation exists that, for unknown reasons, is immune to destabilization and falls.

Accidental Falls↗
PubMed1999

Vasoactive hormones induce nitric oxide synthase mRNA expression and nitric oxide production in human endothelial cells and monocytes.

Isoform-2 nitric oxide synthase (NOS-2) mRNA expression and nitric oxide (NO) production are induced in endothelial cells and monocytes by cytokines such as gammaIFN and LPS. We evaluated NOS-2 and isoform-3 NOS (NOS-3) mRNA expression and NO production in human monocytes and human umbilical vein endothelial cells (HUVEC), under basal conditions and after incubation with physiologic concentrations of vasoactive hormones. NOS mRNA expression was detected by reverse transcription polymerase chain reaction (RT-PCR) and NO production by electronic paramagnetic resonance spectroscopy (EPR). We showed that NOS-2 mRNA expression and NO production were induced by stimulation with epinephrine, dopamine, endothelin-1, and angiotensin II, both in monocytes and HUVEC. NOS-3 mRNA expression and NO production were detected under basal conditions in monocytes and HUVEC and were not modified by the presence of vasoactive hormones. Human endothelial cells and monocytes express the NOS-2 and NOS-3 mRNA and the inducible NOS-2 mRNA expression increases after vasoactive hormone stimulation.

Adult↗
PubMed1998

Reliability of four simple, quantitative tests of balance and mobility in healthy elderly females.

Four common tests of balance and mobility were administered to 45 healthy women, aged 55-71 years: Sharpened Romberg (also defined as tandem stance), eyes open and closed; One-Legged Stance Test, eyes open and closed; Functional Reach; and Sit-To-Stand test. Two independent observers scored the tests, which were performed on two successive days. Inter-rater (IRR) and test-retest reliability (TRR) were good. Across the six different tests, Intraclass Correlation Coefficients ranged from 0.95 to 0.99 for scoring consistency between rates, and from 0.73 to 0.93 within raters. This is in line with previous findings based on similar subjects and similar, though not identical, testing procedures. Intercorrelations between the scores were moderate: r coefficients ranged 0.40-0.66. The results suggest that this simple test battery provides reliable scores, and that the different tests relate to a homogeneous construct, while not being redundant. It thus seems worthwhile to further investigate whether they represent and measure a unidimensional domain, rather than conceptually different dimensions, in view of achieving a unique measure of balance performance.

Aged↗
PubMed1998

ABILHAND: a Rasch-built measure of manual ability.

OBJECTIVE: To apply the Rasch measurement model to the development of a clinical tool for measuring manual (dis)ability (ABILHAND). DESIGN: Manual ability was evaluated in terms of the difficulty perceived by a hand-impaired patient on 57 representative unimanual or bimanual activities. SETTING: A clinical laboratory. PATIENTS: Eighteen rheumatoid arthritis patients (14 women, 4 men) were interviewed after wrist arthrodesis (10 right, 4 left, and 4 both wrists). Their ages ranged from 38 to 77 years, time since diagnosis ranged from 7 to 41 years, and time since surgery ranged from 0.5 to 17 years. MAIN OUTCOME MEASURE: ABILHAND, administered at a mean duration of 7 years after arthrodesis. RESULTS: Forty-six of the 57 items define a common, single manual ability continuum with widespread measurement range and regular item distribution. Items relating to feeding, grooming, and dressing upper body worked consistently with their counterparts in other disability scales. More difficult items extend the measurement range beyond that of most existing manual ability scales. CONCLUSION: Even in a small sample of patients, using the Rasch methodology enabled the investigators to produce a useful scale of manual (dis)ability and to define manual ability as a unique construct, at least in patients with rheumatoid arthritis.

Activities of Daily Living↗
PubMed1998

The 3-D motion of the centre of gravity of the human body during level walking. I. Normal subjects at low and intermediate walking speeds.

OBJECTIVE: To measure the mechanical energy changes of the centre of gravity (CG) of the body in the forward, lateral and vertical direction during normal level walking at intermediate and low speeds. DESIGN: Eight healthy adults performed successive walks at speeds ranging from 0.25 to 1.75 m s(-1) over a dedicated force platform system. BACKGROUND: In previous studies, it was shown that the motion of the CG during gait can be altered more than the motion of individual segments. However, more detailed normative data are needed for clinical analysis. METHODS: The positive work done during the step to accelerate the body CG in the forward direction, W(f), to lift it, W(v), to accelerate it in the lateral direction, W(I), and the actual work done by the muscles to maintain its motion with respect to the ground ('external' work), W(ext), were measured. This allowed the calculation of the pendulum-like transfer between gravitational potential energy and kinetic energy of the CG, (percentage recovery, R). At the optimal speed of about 1.3 m s(-1), this transfer allows saving of as much as 65% of the muscular work which would have been otherwise needed to keep the body in motion with respect to the ground. The distance covered by the CG at each step either forward (step length, S(I)), or vertically (vertical displacement, S(v)) was also recorded. RESULTS: W(I) was, as a median, only 1.6-5.9% of W(ext). This ratio was higher, the lower the speed. At each step, W(ext) is needed to sustain two distinct increments of the total mechanical energy of the CG, E(tot). The increment a takes place during the double stance phase; the increment b takes place during the single stance phase. Both of these increments increased with speed. Over the speed range analyzed, the power spent to to sustain the a increment was 2.8-3.9 times higher than the power spent to sustain the b increment.

Journal Article↗
PubMed1998

The 3-D motion of the centre of gravity of the human body during level walking. II. Lower limb amputees.

OBJECTIVE: To analyse the motion of the centre of gravity (CG) of the body during gait in unilateral lower limb amputees with good kinematic patterns. DESIGN: Three transtibial (below-knee, BK) and four transfemoral (above-knee, AK) amputees were required to perform successive walks over a 2.4 m long force plate, at freely chosen cadence and speed. BACKGROUND: In previous studies it has been shown that in unilateral lower limb amputee gait, the motion of the CG can be more asymmetric than might be suspected from kinematic analysis. METHODS: The mechanical energy changes of the CG due to its motion in the vertical, forward and lateral direction were measured. Gait speed ranged 0.75-1.32 m s(-1) in the different subjects. This allowed calculation of (a) the positive work done by muscles to maintain the motion of the CG with respect to the ground ('external' work, W(ext)) and (b) the amount of the pendulum-like, energy-saving transfer between gravitational potential energy and kinetic energy of the CG during each step (percent recovery, R). Step length and vertical displacement of the CG were also measured. RESULTS: The recorded variables were kept within the normal limits, calculated in a previous work, when an average was made of the steps performed on the prosthetic (P) and on the normal (N) limb. Asymmetries were found, however, between the P and the N step. In BK amputees, the P step R was 5% greater and W(ext) was 21% lower than in the N step; in AK amputees, in the P step R was 54% greater and W(ext) was 66% lower than in the N step. Asymmetries were also found in the relative magnitude of the external work provided by each lower limb during the single stance as compared with the double stance: a marked deficit of work occurred at the P to N transition.

Journal Article↗
PubMed1998

Length of stay of stroke rehabilitation inpatients: prediction through the functional independence measure.

A model for prediction of length of stay (LOS, in days) of stroke rehabilitation inpatients was developed, based on patients' age (years) and function at admission (scored on the Functional Independence Measure, FIMSM). One hundred and twenty-nine cases, consecutively admitted to three free-standing rehabilitation centres in Italy, were analyzed. A multiple linear regression using forward stepwise selection procedure was adopted. Median admission and discharge scores were: 57 and 75 for the total FIM score, 29 and 48 for the 13-item motor FIM subscore, 29 and 30 for the 5-item cognitive FIM subscore (potential range: 18-126, 13-91, 5-35, respectively). Median LOS was 44 days (interquartile range 30-62). The logLOS predictive model included three FIM items ("toilet transfer", TTr; "social interaction"; "expression") and patient's age (R2 = 0.48). TTr alone explained 31.3% of the variance of logLOS. These results are consistent with previous American studies, showing that FIM scores at admission are strong predictors of patients' LOS, with the transfer items having the greatest predictive power.

Activities of Daily Living↗
PubMed1998

[Validity and reliability of a new questionnaire on patient satisfaction in rehabilitative therapy].

BACKGROUND: The aim of this study was to examine some psychometric properties of a new questionnaire measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The instrument (called SAT-16) is composed of 16 four-level items and 2 open-ended questions. The construct validity of the 16-item section was already demonstrated in a previous study based on factorial analysis. In this study the concurrent validity, further aspects of the construct validity and test-retest reliability were analyzed. METHODS: The SAT-16 was administered to 339 inpatients, admitted consecutively to a Rehabilitation Center. RESULTS: 262 questionnaires (77%) were returned, of which 221 with all items filled in. The SAT-16 correlated well with two other measures of satisfaction (CSQ-8 and global satisfaction regarding the hospital stay). The answers to two open-ended questions came out to be consistent with those to the 16 closed-ended questions. The high values for the indices of test-retest reliability (ICC and kappa) are evidence of the stability of the scores in two repeated administrations. CONCLUSIONS: The SAT-16 was found to be provided with good psychometric characteristics. It can be proposed as a valid instrument for use in clinical practice for the continuous quality improvement of inpatient medical rehabilitation programmes.

Adult↗
PubMed1998

The functional assessment measure (FAM) in closed traumatic brain injury outpatients: a Rasch-based psychometric study.

The Functional Assessment Measure (FAM) has been proposed as a measure of disability in post-acute Traumatic Brain Injury (TBI) outpatients. It is comprised of the 18 items of The Functional Independence Measure (FIMSM), scored in terms of dependence, and of 12 newly designed items, scored in terms of dependence (7 items) or performance (5 items). The FIMSM covers the domains of self-care, sphincter management, mobility, locomotion, communication and social cognition. The 12 new items explore the domains of community integration, emotional status, orientation, attention, reading/writing skills, swallowing and speech intelligibility. By addressing a set of problems quite specific for TBI outpatients the FAM was intended to raise the ceiling of the FIMSM and to allow a more precise estimate of their disability. These claims, however, were never supported in previous studies. We administered the FAM to 60 TBI outpatient, 2-88 months (median 16) from trauma. Rasch analysis (rating scale model) was adopted to test the psychometric properties of the scale. The FAM was reliable (Rasch item and person reliability 0.91 and 0.93, respectively). Two of the 12 FAM-specific items were severely misfitting with the general construct, and were deleted. Within the 28-item refined FAM scale, 4 new items and 2 FIMSM items still retained signs of misfit. The FAM was on average too easy. The most difficult item (a new one, Employability) did not attain the average ability of the subjects. Also, it was only slightly more difficult than than the most difficult FIMSM item (Memory). The FAM does not seem to improve the FIMSM as a far as TBI outpatients are to be assessed.

Activities of Daily Living↗
PubMed1997

Trunk control test as an early predictor of stroke rehabilitation outcome.

BACKGROUND AND PURPOSE: The aim of this study was to investigate the construct and predictive validity of the Trunk Control Test (TCT) in postacute stroke patients by comparing TCT scores at admission and discharge with the Functional Independence Measure (FIM) scores. METHODS: Forty-nine patients participated in the study. The TCT examines four movements: rolling from a supine position to the weak side (T1) and to the strong side (T2), sitting up from a lying-down position (T3), and sitting balance (T4). The FIM is an 18-item scale (13 motor [motFIM] and 5 cognitive [cognFIM]) used to determine the level of dependence of patients in daily life. RESULTS: Thirty-six patients (73%) increased their TCT overall score at discharge. The TCT item-total correlations were high, both at admission and discharge (P < .0001). The individual TCT items were intercorrelated. Furthermore, the homogeneity of the TCT was confirmed by a high Cronbach's index. High correlations were found between admission and discharge scores in the different tests (TCT, FIM, and motFIM; P < .0001) and between TCT at admission and FIM (P < .0001) and motFIM (P < .0001) at admission. TCT at admission alone explained 71% of the variance in motFIM at discharge. CONCLUSIONS: The TCT showed a good sensitivity to change in assessing recovery of stroke patients. The high item-total correlation and Cronbach's alpha value of the TCT suggest that there is one homogeneous construct underlying the item list. The TCT construct validity was confirmed by the correlation between this test and the FIM scores. TCT at admission predicted motFIM at discharge even better than motFIM at admission alone. Possibly, the TCT captures basic motor skills that foreshadow the recovery of more complex behavioral skills described by the FIM.

Activities of Daily Living↗
PubMed1997

[Assessment of a patient satisfaction scale in rehabilitation].

BACKGROUND: A new scale is presented, measuring patients' satisfaction with respect to the quality of care during stay in a rehabilitation unit. The questionnaire is self-administered and anonymous, and it includes 15 items, scored 1 to 4. The cumulative score may thus range 15-60; the higher the score, the higher the patient's satisfaction. MATERIALS AND METHODS: The instrument was proposed to 175 disabled patients, admitted to a free-standing Centre for rehabilitation following neurological or orthopedic impairments. RESULTS: One hundred and forty questionnaires were completed. Of these, 131 could be analyzed. The mean score was > 3 in every item. Factor analysis disclosed that the questionnaire comprises 5 factors, which may be defined as "medical care", "physiotherapy", "nursing care", "food" and "physical environment and facilities". A satisfactory internal consistency of the items was found (item-remainder correlations > 0.5, Cronbach alpha > 0.9). This suggests that the scale is sufficiently unidimensional to permit cumulative summing of the item scores. CONCLUSIONS: The results suggest the content and construct validity of the scale. The questionnaire thus merits further psychometric investigation.

Adult↗
PubMed1996

The influence of age on length of stay, functional independence and discharge destination of rehabilitation inpatients in Italy.

Advanced age in itself does not predict a poor functional outcome or a longer length of stay in rehabilitation units. Seven hundred and sixty-four adult cases were analysed, from 14 post-acute rehabilitation facilities throughout Italy. Data came from the national database run by the agency distributing the Italian version of an internationally validated scale of disability, the FIM [symbol: see text] sm (Functional Independence Measure). The FIM is an 18-item scale rating independence in the domains of selfcare, sphincter control, mobility, locomotion, communication and social cognition. The total FIM score may range from 18 to 126 (higher score = greater independence). Patients were classified with respect to the cut-off age of 75 years (76+ and 75-, mean age 82 and 57 years, n = 203 and 561, 27% and 73% of the cases, respectively). The median interval between onset of disability and admission to the facility (onset-to-admission delay, OAD) was 36 and 45 days in the 76+ and the 75- group, respectively (p < 0.001). Mean admission FIM score was 70 (+/- 28) in the 76+ and 71 (+/- 27) in the 75- group. Discharge FIM scores were 84 +/- 29 and 93 +/- 26, respectively (p < 0.001). Median length of stay (LOS) was 34 days in the 76+ and 41 days in the 75- group, respectively (p < 0.005). The 76+ and 75- groups were discharged home in 86% and 90% of the cases, respectively (p = 0.053). The results suggest that inpatient rehabilitation is substantially effective and efficient for older as well as for younger patients.

Activities of Daily Living↗