Reliability and validity of the patellofemoral disability index as a measure of functional performance and subjective pain in subjects with patellofemoral pain syndrome원문보기
Alshaharani, Mastour Saeed
(Rehabilitation Science, School of Allied Health Professions, Loma Linda University)
,
Lohman, Everett Bernell
(Department of Physical Therapy, School of Allied Health Professions, Loma Linda University)
,
Bahjri, Khaled
(Pharmaceutical & Administrative Science, School of Pharmacy, Loma Linda University)
,
Harp, Travis
(AccentCare-home Healthcare Service)
,
Alameri, Mansoor
(Department of Physical Therapy, School of Allied Health Professions, Loma Linda University)
,
Daher, Noha S.
(Allied Health Studies, School of Allied Health Professions, Loma Linda University)
Objective: Patellofemoral pain syndrome (PFPS) is a condition that is characterized by patellar discomfort or pain that is aggravated during certain activities such as ascending/descending stairs. The Patellofemoral Disability Index (PDI) was developed to assess the effect of pain on functional acti...
Objective: Patellofemoral pain syndrome (PFPS) is a condition that is characterized by patellar discomfort or pain that is aggravated during certain activities such as ascending/descending stairs. The Patellofemoral Disability Index (PDI) was developed to assess the effect of pain on functional activities in individuals with PFPS. The objectives of the current study were to determine the internal consistency, test-retest reliability, and validity of this index. Design: Cross-sectional study. Methods: Forty-one subjects who had PFPS with a mean age of $28.8{\pm}5.0years$ and a mean body mass index of $25.6{\pm}4.7kg/m^2$ participated in the study. All subjects were concurrently enrolled in a clinical trial for which they were instructed to complete hamstring-resistance exercises for 4 weeks. Over the course of the intervention, they completed both the PDI and the Oswestry Disability Index (ODI) at baseline after two weeks, and after four weeks. Pearson correlation coefficient was used to assess the criterion validity. Cronbach's ${\alpha}$ was used to examine the internal consistency. Intraclass correlation coefficients with 95% confidence interval were computed to examine test-retest reliability. Results: Subjects' responses within both the PDI and the ODI yielded Pearson correlation coefficient values that were positive and highly significant (range, 0.73-0.97; p<0.001). There was a high level of internal consistency (Cronbach's ${\alpha}{\geq}0.8$), with the exception of stair climbing (Cronbach's ${\alpha}=0.65$). Intraclass correlation ranged from 0.87 to 0.92, indicating high levels of test-retest reliability. Conclusions: The PDI is a valid, reliable, and feasible method of assessing pain and functional ability in patients with PFPS.
Objective: Patellofemoral pain syndrome (PFPS) is a condition that is characterized by patellar discomfort or pain that is aggravated during certain activities such as ascending/descending stairs. The Patellofemoral Disability Index (PDI) was developed to assess the effect of pain on functional activities in individuals with PFPS. The objectives of the current study were to determine the internal consistency, test-retest reliability, and validity of this index. Design: Cross-sectional study. Methods: Forty-one subjects who had PFPS with a mean age of $28.8{\pm}5.0years$ and a mean body mass index of $25.6{\pm}4.7kg/m^2$ participated in the study. All subjects were concurrently enrolled in a clinical trial for which they were instructed to complete hamstring-resistance exercises for 4 weeks. Over the course of the intervention, they completed both the PDI and the Oswestry Disability Index (ODI) at baseline after two weeks, and after four weeks. Pearson correlation coefficient was used to assess the criterion validity. Cronbach's ${\alpha}$ was used to examine the internal consistency. Intraclass correlation coefficients with 95% confidence interval were computed to examine test-retest reliability. Results: Subjects' responses within both the PDI and the ODI yielded Pearson correlation coefficient values that were positive and highly significant (range, 0.73-0.97; p<0.001). There was a high level of internal consistency (Cronbach's ${\alpha}{\geq}0.8$), with the exception of stair climbing (Cronbach's ${\alpha}=0.65$). Intraclass correlation ranged from 0.87 to 0.92, indicating high levels of test-retest reliability. Conclusions: The PDI is a valid, reliable, and feasible method of assessing pain and functional ability in patients with PFPS.
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제안 방법
The present study was carried out in conjunction with a clinical trial in which subjects were prescribed hamstring-resistance exercises with either a knee brace or a sport cord. All subjects completed both the ODI and the PDI at baseline, after two weeks, and after four weeks of intervention.
Subjects were not screened for low back pain. All subjects were briefed on the purpose and methods of the study and were required to sign an informed consent form prior to randomization. The study was approved by the Institutional Review Board at Loma Linda University and was registered at http://clinicaltrials.
Recruitment was done through the use of emails, word of mouth, and flyers. In order to be included in the study, subjects must have exhibited patellofemoral pain for at least one month with a pain level of 3 or greater on the NPRS, experienced pain during at least two of the following activities: squatting, ascending/descending stairs, and running, and be between the ages of 18 and 45 years. Subjects who reported any of the following conditions were excluded from the study: traumatic injuries to the knee join/lower limbs, meniscus lesion or ligamentous-related pathology, neurological disorders, past and current medical history of diabetes, osteoarthritis, osteoporosis or rheumatoid arthritis, and/or use of over-the-counter pain medication during the study period.
Intraclass correlation of the ten PDI items was assessed at baseline, two weeks, and four weeks. The overall values with 95% CI ranged from 0.
The utility of the PDI lies principally in the targeted nature of the 10 questions within the index. Patients are asked to assess their condition during 10 ADL, among these running, jumping, sitting, kneeling, walking, limping, stair-climbing, squatting, standing, and instability. On the other hand, the Kujala Score consists of 8 questions that evaluate functional limitations and 5 questions that evaluate impairment.
It is currently considered one of the principal tools for assessing functional ability and quality of life in patients with low back pain [7]. The ODI consists of 10 items that cover a variety of activities which low back pain may limit, such as pain intensity, personal care, lifting, walking, sitting, standing, sexual activity, sleeping, traveling, and socializing. It also allows subjects to rate their pain level during each distinct activity.
The PDI includes 10 items about physical activities such as running and jumping, as well as other activities including sitting, kneeling, walking, limping, stair-climbing, squatting, standing, and instability. Like the ODI, there are six options within each category and the total score corresponds to a functional ability level ranging from no disability to complete disability.
The objectives of the current study are to determine the validity of the PDI, measure the internal consistency of the questions regarding sitting, standing, and walking within the PDI, and assess the test-retest reliability of the PDI.
The Patellofemoral Disability Index (PDI) was developed in 1995 and was first published in 1998 by Lohman [18]. This assessment tool provides physical therapists with a method of assessing functional limitations caused by peripatellar pain specifically in patients with PFPS.
데이터처리
Cronbach’s α was used to examine the internal consistency of PDI items within each type of activity. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were computed to examine test-retest reliability. The level significance was set at p≤0.
, Armonk, NY, USA). Pearson correlation coefficient was used to assess the criterion validity of the PDI at all times during sitting, walking, and standing. Cronbach’s α was used to examine the internal consistency of PDI items within each type of activity.
이론/모형
Measurements of patellar gliding/tilting, Q angle, and observations during the step-up and step-down test were also part of the screening exam. Meniscus and ligamentous pathologies were assessed using the McMurray Test [20] and the Anterior Drawer Test [21], respectively.
성능/효과
A modified version of the ODI was tested in a Persian population, and tests of internal consistency and test-retest reliability, and convergent validity yielded much lower values than those of the present study (ICC=0.43-0.80, Cronbach’s α=0.69, r=–0.54, p<0.001 for highest value, respectively) [27].
At baseline, subjects’ responses to questions regarding sitting, walking, and standing within both the PDI and the ODI yielded Pearson correlation coefficient that were positive, and highly significant.
Internal consistency was generally satisfactory, in view of the fact that the Cronbach’s α scores for each item were generally high with the exception of stair climbing. Test-retest reliability was also satisfactory, though it should be noted that the ICC was slightly greater at two weeks than at four weeks, suggesting a possible decrease in reliability over time.
The Hungarian ODI has been shown to have excellent internal consistency (Cronbach’s α=0.89), test-retest reliability (ICC=0.93), and validity, as compared to the physical subscale of the World Health Organization Quality of Life, which was also good (r=–0.705, p<0.001) [25].
Using the Roland-Morris Disability Questionnaire (RMDQ) as the standard for comparison, the test was also found to be valid (r=0.81, p<0.01).
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