ArticleMeasuring activity limitations in climbing stairs: development of a hierarchical scale for patients with lower-extremity disorders living at home1☆,
Section snippets
Instrument development
To create a detailed measurement instrument, items were derived from an extensive literature review on climbing stairs. A first-draft version of the scale was subjected to the opinions of experts (physicians, physical and occupational therapists, sociologists), and pretested. A second draft version was tested in 345 patients with orthopedic and rheumatologic disorders of the lower extremity,13, 14 resulting in rewording of some items. The final version of the instrument that was tested was a
Participants
Of the 822 patients enrolled in our study, 63 stated that they did not climb stairs at all. These 63 patients were excluded from the scale analysis. As a consequence, data on 759 patients were included in the scale analysis. The mean age ± standard deviation of these patients was 59.8±15.0 years, and the gender of 48% (n=364) of the patients was male. Patients had the following diagnoses: stroke (n=65)15; poliomyelitis (n=89)16; hip OA (n=203)17; knee OA (n=79); transfemoral amputation (n=74);
Discussion
The objective of our study was to develop and test a measurement instrument to provide a detailed assessment of activity limitations in climbing stairs for patients with lower-extremity disorders living at home. To test the instrument on patients living at home, only outpatients were sampled for this study. In addition, and in order to test the instrument on patients with different lower-extremity disorders, the patients who were sampled had different disorders of the lower extremity,
Conclusions
A measurement instrument with excellent scaling characteristics has been developed to provide a detailed assessment of activity limitations in climbing stairs in patients with different lower-extremity disorders living at home. However, the results of the measurements made with this instrument should be interpreted with some caution when comparing amputees and nonamputees.
Acknowledgements
We thank Dr. Ivo W. Molenaar for his comments on the manuscript. Other members of the Measuring Mobility Study Group are Fred A. de Laat, MD, Roessingh Research and Development, Enschede, and Rehabilitation Center Tolbrug, ‘s Hertogenbosch; Ide C. Heyligers, MD, PhD, VU University Medical Center, Amsterdam; Jacob J. Caron, MD, Onze Lieve Vrouwe Gasthuis, Amsterdam; Bart J. Burger, MD, PhD, Medisch Centrum Alkmaar, Alkmaar; Frans Nollet, MD, PhD, VU University Medical Center, Amsterdam; Irene E.
References (28)
- et al.
The development of a short generic version of the Sickness Impact Profile
J Clin Epidemiol
(1994) - et al.
Measuring functional limitations in rising and sitting downdevelopment of a questionnaire
Arch Phys Med Rehabil
(1996) - et al.
Disability and functional assessment in former polio patients with and without postpolio syndrome
Arch Phys Med Rehabil
(1999) - et al.
The treatment of complex regional pain syndrome type I with free radical scavengersa randomized controlled study
Pain
(2003) - et al.
Is stair negotiation measured appropriately in functional assessment scales?
Clin Rehabil
(2003) - et al.
Functional evaluationthe Barthel index
Md State Med J
(1965) - et al.
A quantitative approach to perceived health statusa validation study
J Epidemiol Community Health
(1980) - et al.
The Sickness Impact Profiledevelopment and final revision of a health status measure
Med Care
(1981) - et al.
The functional independence measurea new tool for rehabilitation
Adv Clin Rehabil
(1987) - et al.
The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection
Med Care
(1992)
Traumatic arthritis of the hip after dislocation and acetabular fracturestreatment by mold arthroplasty. An end-result study using a new method of result evaluation
J Bone Joint Surg Am
The dimensions of health outcomesthe health assessment questionnaire, disability and pain scales
J Rheumatol
Validation study of WOMACa health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee
J Rheumatol
Rationale of the Knee Society clinical rating system
Clin Orthop
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Supported by the SGO Health Research Promotion Program.
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