Background: Although the original version of the health-related quality of life (HRQOL) questionnaires are found to be acceptable, the cross-culturally adapted versions may not be comparable to their original version. Objects: To examine dimensionality and construct validity of two Korean versions of the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) and EuroQOL-5 dimension (EQ-5D) questionnaires. Methods: A total of 77 cancer survivors undergoing palliative rehabilitation programs from two rehabilitation institutes was recruited from April 16, 2018 to June 26, 2019. The WHOQOL- BREF and the EQ-5D were filled out by the various cancer survivors following a particular session of rehabilitation programs. The scores were analyzed with Winsteps Rasch analysis computer program using the rating scale model. Rasch fit statistics were used to determine the dimensionality and the item difficulty calibrations of WHOQOL-BREF and EQ-5D. Results: All items except two, negative feeling, need treatment function and pain prevent activity (mean square [MnSq] = 2.42, 1.82 and 2.51, respectively), were found to be acceptable, while two items of the EQ-5D, anxiety/depression and self-care, were misfit (infit MnSq = 1.65 and 0.38, respectively). Item difficulty calibrations of WHOQOL-BREF match person ability measures (i.e., HRQOL) fairly well. However, the person ability distribution showed obvious ceiling effects for EQ-5D. All items of EQ-5D were appeared to be less challenged in comparison with those of WHOQOL-BREF. Conclusion: Item-level analysis using the Rasch model supports the quality of culturally adapted items used to measure the HRQOL one exception; that is, whether or not to include misfit items as part of the HRQOL measurements. Additionally, cancer survivors undergoing palliative rehabilitation programs appear to have more of a tendency to view the EQ-5D items as being more challenging than the WHOQOL-BREF.

Background: To improve muscle flexibility, static stretch is the most common type and is considered safe and effective for improving overall flexibility of muscles. During the stretch, the intensity is more likely to be determined by the degree of an athlete’s pain and practitioner’s skills rather than quantitative measures of stretch. It is necessary to determine the optimal intensity for the stretch. Objects: The purpose of this study is to explore the relationship between hand held dynamometer (HHD) and verbal rating scale (VRS) in comparison of the effects of continuance time on active (walking) and inactive (sitting) movement after static stretch. Methods: A cross-sectional study was conducted with a sample (n=62) recruited from a university. Participants were randomly assigned to 2 different groups (n=31 for each group) based on participants’ positions either remaining in sitting or freely walking around for a series of re-assessments. Data was collected at pre-warm up, pre-stretch, post-stretch, and additional assessments at the time of 3, 6, 9, 12, 15, 20 and 30 minutes after the stretch. Results: Relationship between VRS and HHD scores represents very weak correlation (Spearman’s p=-.16, p>.05). Pearson’s correlation analysis was conducted following the logarithmic transformation of the two scores. Pearson’s correlation after the transformation still showed a very low relationship and a poor linear relationship between the two scores (Pearson’s r=-.18, p>.05). Conclusion: The optimal intensity for stretch cannot be solely determined by the subjective pain perception. The objective measurement such as HHD could be used in conjunction with the pain perception.

Background: Given the potential benefits of wellness programs promoting physical activity of the community-dwelling frail elderly, it is recommended that comprehensive wellness programs combined with the component of physical activity. This may improve overall health and potentially lower the health care cost of the frail elderly. In general, the frail elderly residing in community or those after being discharged from hospitals are often committed to enhancing the status of participation in physical activity. Objects: The purposes of this study were to identify specific shortcomings of current wellness programs as part of continuum of community rehabilitation services and to propose alternatives for the care of the community-dwelling frail elderly. Through this study, geriatric health care professionals may be able to implement assessments and programs to successfully promote an effective continuum of care for the frail elderly. Methods: Article reviews were summarized and evaluated. Results: A model elaborating the relationship between components of successful wellness program and participation in physical activities for the community-dwelling frail elderly are recommended. First, periodic monitoring the levels of physical activity by the use of online measurement system should be considered. Second, individualized adaptive technologies for selecting optimal physical activities for the elderly may be better fit to individuals’ current status of physical activity. Conclusion: The current status of physical activity in community-dwelling frail elderly can be monitored by online assessment systems. Through the innovative measurement system, elderly may assess his/her physical activity status overtime, select optimal physical activities matching the status, and create the elderly’s own adaptive wellness programs that match to the status while residing in his/her community.

Background: Functional capacity evaluations (FCEs) are designed to systematically assess the capacity to perform work-related tasks and to determine worker’s ability to return to the previous job following work-related injuries. These evaluations may be rated either by clinician or worker. There has been a lack of consensus between the two scoring methods. Objects: This study aimed: 1) to confirm if the data are fit to the Rasch rating scale model and 2) to investigate the item-level concordance rate between the ratings of clinician and injured worker of the FCE. Methods: A cross-sectional study was conducted with a sample (n=124) of a rehabilitation program with the Occupational Rehabilitation Data Base for workers with low back pain. The functional capacity evaluation at admission and discharge was administered to clinicians and workers. The data were analyzed using both classical test theory-based Pearson’s r and intra-class coefficient followed by item-level analysis with Rasch rating scale model. Results: All items of the FCE, except sitting items rated by clinician at admission and handling items rated by both clinician and worker throughout admission and discharge, were acceptable fit statistics with minor out of ranges for a misfit criterion. This may indicate that the items of the FCE overall fit to the Rasch rating scale model. Few problematic items responding differently to clinician and worker both at admission and discharge were detected with the differential item functioning analysis despite the excellent concordance rate using the two conventional statistics-sitting and handling items at admission and handling item at discharge. Conclusion: The item-level speculations using Rasch analysis of the FCE demonstrate that the ratings of clinician and self ratings of worker were psychometrically acceptable though there was an apparent discrepancy between the raters both at admission and discharge.

Background: Losing balance during locomotive actions becomes an increasing threat to both the community-dwelling elderly and elderly with Parkinson disease (PD). Those with PD may be at a high risk of fall due to particular characteristics during the turn. Turning around during locomotive actions may be one of problematic factors causing losing balance. Objects: This study is part of a larger study, which in part aims to identify turning strategies, to compare the strategies in the elderly with and without idiopathic PD aged 51 years and older and to distinguish whether the turning strategies can predict the elderly at risk of falls. Methods: A total of 22 community-dwelling elderlies (10 elderlies with idiopathic PD and 12 healthy elderlies) were investigated for the turning strategies during the timed up and go test. Results: There were some significant differences between the two groups during turning (p<.05). The idiopathic PD group had a tendency of challenging on taking more number of steps, more time to accomplish and staggering more for the turn relative to the control group. Conclusion: Taking more number of steps and more time to turn may be useful for distinguishing the characteristics of PD from that of the healthy elderly in turning strategy.

Background: Parametric statistical procedures are typically conducted under the condition in which a sample distribution is statistically identical with its population. In reality, investigators use inferential statistics to estimate parameters based on the sample drawn because population distributions are unknown. The uncertainty of limited data from the sample such as lack of sample size may be a challenge in most rehabilitation studies. Objects: The purpose of this study is to review the bootstrapping method to overcome shortcomings of limited sample size in rehabilitation studies. Methods: Articles were reviewed. Results: Bootstrapping method is a statistical procedure that permits the iterative re-sampling with replacement from a sample when the population distribution is unknown. This statistical procedure is to enhance the representativeness of the population being studied and to determine estimates of the parameters when sample size are too limited to generalize the study outcome to target population. The bootstrapping method would overcome limitations such as type II error resulting from small sample sizes. An application on a typical data of a study represented how to deal with challenges of estimating a parameter from small sample size and enhance the uncertainty with optimal confidence intervals and levels. Conclusion: Bootstrapping method may be an effective statistical procedure reducing the standard error of population parameters under the condition requiring both acceptable confidence intervals and confidence level (i.e., p=.05).

To develop an effective and efficient measurement system for tracking changes of functional status across two measures, it is essential to integrate information and communicate scores across two measures. The lack of communication between two measures leads to score incompatibility. A potential solution would be the development of a crosswalk table between those measures. Prior to creating a crosswalk table, selecting common items between two measures is critical. By using the Oswestry low back pain disability questionnaire (Oswestry) and a short form measuring disability resulting from low back pain, item level statistics as well as differential item functioning (DIF) using the Rasch measurement were investigated. Eighty-two participants with known group validity were recruited. Based on the application of the Rasch measurement model, item difficulties across the two measures were logically and hierarchically ordered. Ceiling effects for both measures were detected, which were not be able to be effectively measured with the two measures. The DIF analysis across the two measures confirmed that five paired items were found to have DIF and five common items were selected for common items. Although five paired items function differently across the Oswestry and the short form, all items of both measures were well targeted study participants. The common items selected by the Rasch measurement model may be effective when creating a crosswalk table between the Oswestry and the short form.

The versions of the Oswestry disability questionnaire (ODQ) is regarded as one of the most extensively used condition-specific instruments measuring disability resulting from low back pain. It has been shown to have adequate psychometrics, reliability, validity, and responsiveness as a whole, yet the summated total score of the instrument often provide little information to rehabilitation clinicians. A keyform analysis based on Rasch measurement model is an innovative way of illustrating the specific test items that an individual may or may not perform. By applying the keyform of the Rasch measurement model to the ODQ, rehabilitation clinicians may able to select more challenging ODQ items matching an individual’s ability and document them as attainable treatment goals. The results demonstrated how a keyform analysis assist to setting possible goals for the treatment of individuals with low back pain. Forty-two individuals with low back pain were recruited from rehabilitation clinics in Gainesville, Florida. A series of Rasch analyses on the 10 items of the ODQ were performed using Winsteps software. The performance of two individuals on those 10 items was illustrated on the keyform. The keyform analysis of the Rasch measurement model may be translated into a useful tool for making clinical judgements.

The aim of the present study was to compare measurement precisions of the Oswestry Back Pain Disability Questionnaire (ODQ) and a computer adaptive testing (CAT) method. The ODQ has been regarded as one of the most reliable condition-specific measure for back pain for decades. Cross-sectional study was carried out with two independent convenient samples from two out-patient rehabilitation clinics for back pain (n1=42) and non-back pain group (n2=42). Participants were asked to fill out the ODQ and CAT of International Classification of Functioning, Disability and Health-Activity Measure (ICF-AM). A series of Rasch analyses were performed to calculate person ability measures. The CAT measures had greater relative precision in discriminating the groups than did the ODQ measure in comparisons of the relative precision. The CAT measure appears to be more effective than did the ODQ measure in terms of measurement precision. By administering test items calibrated in a way, CAT measures using item response theory may promise a means with measurement precision as well as efficiency.

The purposes of this study were: 1) to show the item difficulty hierarchy of walking/moving construct of the International Classification of Functioning, Disability and Health-Activity Measure (ICF-AM), 2) to evaluate the item-level psychometrics for model fit, 3) to describe the relevant physical activity defined by level of activity intensity expressed as Metabolic Equivalent of Tasks (MET), and 4) to explore what extent the empirical activity hierarchy of the ICF-AM is linked to the conceptual model based on the level of energy expenditure described as MET. One hundred and eight participants with lower extremity impairments were examined for the present study. A newly created activity measure, the ICF-AM using an item response theory (IRT) model and computer adaptive testing (CAT) method, has a construct on walking/moving construct. Based on the ICF category of walking and moving, the instrument comprised items corresponding t walking short distances, walking long distances, walking on different surfaces, walking around objects, climbing, and running. The item difficulty hierarchy was created using Winstep software for 20 items. The Rasch analyses (1-parameter IRT model) were performed on participants with lower extremity injuries who completed the paper and pencil version of walking/moving construct of the ICF-AM. The classification of physical activity can also be performed by the use of METs that is often preferred to determine the level of physical activity. The empirical item hierarchy of walking, climbing, running activities of the ICF-AM instrument was similar to the conceptual activity hierarchy based on the METs. The empirically derived item difficulty hierarchy of the ICF-AM may be useful in developing MET-based activity measure questionnaires. In addition to convenience of applying items to questionnaires, implications of the finding could lead to the use of CAT method without sacrificing the objectivity of physiologic measures.