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To translate, adapt, and test the reliability, validity, and responsiveness of the Korean version of the Shoulder Disability Questionnaire (SDQ) and the Shoulder Rating Questionnaire (SRQ).
The international guideline for the adaptation of questionnaires was referenced for the translation and adaptation of the original SDQ and SRQ. Correlations of the SDQ-K and SRQ-K with the Shoulder Pain and Disability Index (SPADI) and the Numeric Rating Scale (NRS) were assessed to determine the reliability and validity of the questionnaires. To evaluate reliability, surveys were performed at baseline and a mean of 6 days later in 29 subjects who did not undergo any treatment for shoulder problems. To evaluate responsiveness, assessments were performed at baseline with 4-week intervals in 23 subjects with adhesive capsulitis who were administered triamcinolone injection into the glenohumeral joint.
Fifty-two subjects with shoulder-related problems were surveyed. Cronbach alpha for internal consistency was 0.82 for the summary SDQ-K and 0.75 for the summary SRQ-K. The test-retest reliability of the SDQ-K, SRQ-K, and domains of the SRQ-K ranged from 0.84 to 0.95. The SDQ-K and SRQ-K summary scores correlated well with the SPADI and NRS summary scores. Generally, the effect sizes and standardized response means of the summary scores of the SDQ-K, SRQ-K, and domains of the SRQ-K were large, reflecting their responsiveness to clinical changes after treatment.
The reliability, validity, and responsiveness of the SDQ-K and SRQ-K were excellent. The SDQ-K and SRQ-K are feasible for Korean patients with shoulder pain or disability.
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To investigate the relationship of the patient's criteria of successful treatment to emotional factors in patients with chronic musculoskeletal pain.
Patients who visited our outpatient hospital due to chronic musculoskeletal pain were evaluated using a questionnaire survey. Patients were evaluated with the Patient-Centered Outcomes Questionnaire (PCOQ) to investigate their expectation and criteria for success regarding treatment of chronic musculoskeletal pain. Beck Depression Inventory and State-Trait Anxiety Inventory were used to check for psychological variables. Correlations among each of the variables were evaluated statistically.
Patients with higher levels of depression and anxiety needed larger improvements to consider the treatment as a success in the pain domain (depression, r=0.398, p=0.04; anxiety, r=0.447, p=0.02) and emotional distress domain (depression, r=0.617, p=0.001; anxiety, r=0.415, p=0.03), but had lower level of expectation of the treatment in the pain domain (depression, r=-0.427, p=0.01; anxiety, r=-0.441, p=0.004), emotional distress domain (depression, r=-0.454, p=0.01; anxiety, r=-0.395, p=0.04), and interference of daily activities domain (depression, r=-0.474, p=0.01; anxiety, r=-0.396, p=0.04). Patients were classified into 3 clusters based on the importance rating of each domain via a hierarchical analysis. The cluster of the patients with the higher rating of importance across all domains (importance of pain domain, 9.54; fatigue domain, 9.08; emotional distress domain, 9.23; interference of daily activities domain, 9.23) had the highest level of depression and anxiety.
Consideration of psychological factors, especially in patients who require larger improvements in all treatment domains, may be helpful for the successful treatment of chronic musculoskeletal pain.
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To translate the English version of the Pain Disability Questionnaire (PDQ) into Korean and to investigate the reliability and validity of the Korean version of the PDQ (K-PDQ) in patients suffering chronic disabling musculoskeletal disorders (CDMDs).
The English version of the PDQ was translated into Korean. Ten patients with CDMDs were randomly selected for a pilot study to assess the comprehensibility of the pre-final version. One hundred and thirty-nine patients suffering from CDMDs for more than 3 months were enrolled in this study. Follow-up questionnaires were obtained to examine the test-retest reliability. Concurrent validity was evaluated by comparing the K-PDQ with the visual analogue scale (VAS). Construct validity was evaluated by comparing the K-PDQ with the brief form of the World Health Organization quality of life assessment instrument (WHOQOL-BREF) using Pearson correlation coefficient. Reliability was assessed using the intraclass correlation coefficient (ICC), and internal consistency was determined by Cronbach's alpha.
Test-retest reliability was assessed in 70 patients, with an average time interval of 12 days. The ICC was 0.958 (p<0.001). Internal consistency reached Cronbach's alpha of 0.933 for the functional component and 0.870 for the psychosocial component. The correlation coefficient for the K-PDQ when compared with the VAS was 0.834 in the first assessment and 0.831 in the second assessment. All domains of the WHOQOL-BREF showed a significant negative correlation with the K-PDQ.
The K-PDQ is a reliable and valid instrument for measuring disability and can be used to assess disability and treatment outcomes in Korean patients with CDMD.
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To translate the MD Anderson Dysphagia Inventory (MDADI) which is a self-administered questionnaire that assesses effect of dysphagia on the quality of life for patients with head and neck cancer, into Korean and to verify the validity and reliability of the Korean version of MDADI.
We performed 6 steps for the cross-cultural adaptation which consisted of translation, synthesis, back translation, review by an expert committee, cognitive debriefing, and final proof reading. A total of 34 dysphagia patients with head and neck cancers from Seoul National University Hospital answered the translated version of the questionnaire for the pre-testing. The patients answered the same questionnaire 2 weeks later to verify the test-retest reliability.
One patient was excluded at second survey because he changed his feeding strategy. Overall, 33 patients completed the study. Linguistic validations were achieved by each step of cross-cultural adaptation. We gathered statistically strong construct validity (Spearman rho for subdomain scores to total score correlation range from 0.852 to 0.927), internal consistency for subdomains (Cronbach's alpha coefficients range from 0.785 to 0.889) and test-retest reliability (intra-class correlation coefficient range from 0.820 to 0.955)
The Korean version of the MDADI achieved linguistic validations and demonstrated good construct validity and reliability. It can be a useful tool for screening and treatment planning for the dysphagia of patients with head and neck cancers.
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To investigate the intra- and inter-rater reliability of the Korean version of the ABILOCO questionnaire (K-ABILOCO).
The original ABILOCO questionnaire was translated into Korean and back-translated into English. Stroke patients (n=30) with hemiplegia were evaluated using the K-ABILOCO at one week interval. At each visit, the physiatrist also evaluated patient performance of the activities described in the K-ABILOCO, and the total logit scores were recorded. The total scores were used to evaluate intraclass correlation (ICC). Test-retest scores and each test scores were compared to obtain the intra- and inter-rater reliability.
The K-ABILOCO showed good intra-rater correlation at one week interval in both patient and physiatrist evaluations (ICC=0.81, 0.91), respectively. It also showed a high inter-rater correlation between the patient and physiatrist at both the first and second visits (ICC=0.76, 0.84), respectively.
The K-ABILOCO is a useful tool that may reliably evaluate the locomotion ability in hemiplegic stroke patients.
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To evaluate concurrent validity between the Korean-Ages and Stages Questionnaires (K-ASQ) and the Denver Developmental Screening Test II (DDST II), and to evaluate the validity of the K-ASQ as a screening tool for detecting developmental delay of Korean children.
A retrospective chart review was done to examine concurrent validity of the screening potentials for developmental delay between the K-ASQ and the DDST II (n=226). We examined validity of the K-ASQ compared with Capute scale (n=141) and Alberta Infant Motor Scale (AIMS) (n=69) as a gold standard of developmental delay. Correlation analysis was used to determine the strength of the associations between tests.
A fair to good strength relationship (k=0.442, p<0.05) was found between the K-ASQ and the DDST II. The test characteristics of the K-ASQ were sensitivity 76.3-90.2%, specificity 62.5-76.5%, positive likelihood ratio (PLR) 2.41-3.40, and negative likelihood ratio (NLR) 0.16-0.32.
Evidence of concurrent validity of the K-ASQ with DDST II was found. K-ASQ can be used for screening of developmental delay.
Citations
Method: We did the recognition survey using 12-item self administrated questionnaire over 2 months in 2001. The questionnaires were sent to 613 physiatrists. Eighty-eight physiatrists of the 613 completed the questionnaires.
Results: Eighty-three of 88 completed the questionnaires were performing their procedure under roentgen environment. The mean procedure time per week was 2.1 hours. Their common procedures doing under roentgen environment were as follows: swallowing videofluoroscopic study (60.2%), voiding cystourethrography (49.3%), arthrography (37.3%), epidurography 25.3%, and so on. 8.5 % of the 83 physiatric interventionists wore the radiation dosimeter and received regular assessment of radiation safety. 62.7% of the participants were wearing one piece apron, and 24.1% wore one piece apron and thyroid shield. Of the radiation related symptoms, fatigue was most common.
Conclusion: We concluded that the special concern and education program to reduce radiation risk are required because of gradual increase of radiation exposure for physiatrists and lack about recognition of radiation exposure. (J Korean Acad Rehab Med 2003; 27: 265-268)
Objective: The purpose of this study is to evaluate the effect of visible light therapy for the management of somatic pain.
Method: Subjects consisted of 42 patients with pain and were divided into two groups; control (n=22) and experimental (n=20) groups. Control group received conventional physical therapy only, while experimental group received additional light therapy with blue light (light intensity 4080 lux, wave length 581 nm, distance from lamp 5 cm). Intensity of pain was assessed by visual analogue scale (VAS) and McGill pain questionnaire. Sympathetic skin response was measured to assess the status of autonomic nervous system. VAS and McGill pain questionnaire were administered before treatment and at 1 day, 2 days, 3 days, 1 week, and 2 weeks after treatment. Sympathetic skin response were performed before and 2 weeks after treatment.
Results: 1) In both experimental and control groups, VAS became significantly lower at two weeks after treatment compared to pretreatment scale (p＜0.05). 2) McGill pain questionnaire showed significantly lower scores two weeks after treatment compared to pretreatment score, only in experimental group (p＜0.05). 3) Experimental group showed significantly lower McGill pain questionnaire score than control group at two weeks after treatment (p＜0.05). 4) Latency and amplitude of sympathetic skin response showed no significant difference between experimental and control groups.
Conclusion: Visible light therapy can be used as an effective therapeutic modality for the management of symptomatic pain in combination with conventional physical therapy. (J Korean Acad Rehab Med 2002; 26: 81-85)
Objective: To evaluate the effect of compensation or secondary gain on the pain behavior and psychometric characteristics.
Method: We examined 88 patients who complained of chronic low back pain by the various pain questionnaires, electrodiagnostic study and magnetic resonance imaging (MRI). Total patients were classified into two groups (46 patients who wanted disability evaluation and 42 patients who did not).
Results: Mean score of visual analogue scale, total sum of McGill pain questionnaire and pain rating index on sensory, affective and miscellaneous dimensions were significantly higher in patients related to disability compensation than those in patients without compensation. Mean scores of pain disability index and symptom checklist-90-revision were significantly higher on various subclass in patients with compensation. Various pain scales were significantly correlated to each other in both group but the severity of electrodiagnostic study and MRI findings were not related with the degree of pain index score in both group.
Conclusion: Compensation or secondary gain affect pain behavior and psychometric characteristics in chronic low back patients. So when we evaluate or treat the patients with chronic low back pain, we should consider above results.
Objective: To evaluate the efficacy of epidural injections of steroid and local anesthetics with the modified Dallas pain questionnaire in the low back pain patients.
Method: Before and after epidural injections with triamcinolone and local anesthetics, we examined the patients with modified Dallas pain questionnaire. The efficacy was assessed by paired t test to compare the results of this questionnaire.
Results: Four aspects of the patient's life (daily activity, work and leisure activity, anxiety- depression, and social interest) were significantly improved after epidural injection in low back pain patients. And their improvements were more definite in patients diagnosed with herniatied lumbar disc, relatively acute onset of symptom, and more serious findings in MRI.
Conclusion: Epdiural injections of steroid and local anesthetics are effective for patients with low back pain, espercially for improving life quality of patients such as daily activity and work-leisure activity. It also decreases anxiety and increases social interest in some patients. However, validity of modified Dallas pain questionnaire must be proved in the future.
Objective: To evaluate the clinical features of lower extremity amputees and the process of prosthetic fitting and its use at follow up and to know the effects of prosthetic rehabilitation on adaptation to prosthesis and its long-term use.
Method: One hundred and twenty four patients who underwent amputation surgery in 3 major hospitals in Korea from 1990 to 1997 were enrolled.
They were evaluated by reviewing of medical records for anthropometry, level of amputation, causes of amputation, other coincidental medical problems, general physical states and followed up by telephone and mail questionnaire with respect to general outcome, prosthetic fitting, satisfaction of prosthesis, state of prosthetic use, functional state of prosthetic ambulation.
Results: The most common cause of amputation was trauma. The mean time to fit the prosthesis was 4.1 months and only 38 patients was supervised by rehabilitation programs. The patients who were supervised by rehabilitation program were fitted and able to ambulate significantly earlier than those who were not. They wore and used prosthesis significantly more often than those who were not supervised. The patients with above knee amputation who were supervised were significantly independent with walking aids.
Conclusion: Rehabilitation training program enables amtupees to be fitted and walk earlier with prosthesis. Also, this program lowered the dependency on walking aids in above knee amputees.
Objective: To find simple screening method for assessment of patients with diabetic neuropathy by use of brief questionnaire, scored physical examination including vibration perception threshold, and mixed median conduction study.
Method: Subjects were 24 patients with diabetes mellitus. Conventional nerve conduction study was performed in 24 patients and the patients were divided into two groups: 11 patients with polyneuropathy; 13 patients of normal findings. The questionnaires were given for evaluation of sensory function in all the subjects. The questionnaires were followed by physical examination including two point discrimination, vibration perception threshold by using biothesiometer, 10 gram filament test, pin prick test, DTR check, and muscle strength test. Abnormality was determined by the number of positive responses or abnormal clinical findings. Finally, we recorded the conduction velocity and amplitude of median mixed nerve and compared these parameters to values of 20 normal adults.
Results: The questionnaire and physical exam scores were higher in patients with polyneuropathy (p＜0.01). The patients with polyneuropathy showed higher vibration perception threshold values (p＜0.01) and slower conduction velocity and smaller amplitude of median mixed nerve (p＜0.05). In correlation with conventional nerve conduction study, the median mixed nerve conduction velocity had higher kappa value than amplitude in screening for diabetic polyneuropathy.
Conclusion: We suggest the questionnaires, scored physical examination, vibration perception threshold, and median mixed nerve conduction velocity to be a simple screening method for assessment of patients with diabetic plyneuropathy.
The Postpoliomyelitis syndrome(PPS) is characterized by new neuromuscular symptoms such as muscle weakness, joint pain, fatigue, and occasional new neuromuscular impairments. Although the development of PPS shows individual differences, it usually occurs many years after the recovery from an acute paralytic poliomyelitis. The purpose of this study was to investigate the incidence and the clinical features of PPS.
The subjects were 33 patients(26 males and 7 females) who had partial recoveries of motor function, ten or more years of functional stabilities, and residual muscle atrophies. The mean age was 36.8⁑7.7 years with the range of 23∼59 years. The average onset age of acute poliomyelitis was 2.3⁑1.5 years. The questionnaires asking their current physical conditions and three major categories of PPS symptoms, weakness, fatigue, and pain were used.
As the sequelae of poliomyelitis, 66.7% of the subjects showed scoliosis and 39.4% had claw toes. Thirty six percents of the subjects were using orthoses including wheelchair, KAFO, and crutches.
According to the questionnaire study, 72.5% of subjects had at least one of the three major symptoms. And 36.4% of them reported all of three categories of PPS symptoms. The onset age of the new neuromuscular symptoms was 34.2⁑8.3 years which was about 32 years after the original acute poliomyelitis.
Further researches to investigate the importance and the impacts of proper managements and to develop educational plans for the PPS including exercise programs, cardiopulmonary and energy-conservation trainings are recommended.
The McGill Pain Questionnaire consists primarily of 3 major classes in word descriptors-sensory, affective and evaluative-and is used in the studies of clinical and experimental pain. The purpose of the study is to analyze characteristics of the central pain in patients with spinal cord injury and to compare with the musculosleletal pain using McGill Pain Questionnaire(MPQ) Korean version.
The subjects of this study were ninety-nine patients with spinal cord injury who were admitted to Ajou University Hospital or registered with other social agencies, and thirty patients with musculoskeletal pain who were treated at the rehabilitation medicine out patient clinic of Ajou University Hospital. Central pain had significantly higher sensory, miscellaneous and total scores of MPQ Korean version than the musculoskeletal pain. There were no correlations between visual analogue scale and each dimension of MPQ Korean version except evaluative dimension in central pain. Central pain had significantly higher scores than musculoskeletal pain in subclasses such as spatial, punctate, incisive, thermal and coldness. The most frequently chosen words were "radiating"(46%) in central pain and "throbbing"(32%) in musculoskeletal pain of all subjects.
In conclusion, the central pain has no difference in pain intensity but shows bizzare and diverse character compared with the musculoskeletal pain. Authors suggest that MPQ Korean version can be an useful measuring tool for the evaluation and the follow up of the central pain of spinal origin.
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