Publications by authors named "Charles Sèbiyo Batcho"

21 Publications

  • Page 1 of 1

Global and Leisure-Time Physical Activity Levels Among People Living With HIV on Antiretroviral Therapy in Burundi: A Cross-sectional Study.

J Assoc Nurses AIDS Care 2021 Apr 27. Epub 2021 Apr 27.

Eric Havyarimana, PT, is a Physiotherapist, National Reference Center for Physiotherapy and Rehabilitation Medicine, Bujumbura, Burundi. Alexis Sinzakaraye, MD, is a Professor, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Burundi, Bujumbura, Burundi. Zéphyrin Ndikumasabo, MD, is a Physician, Kiganda District Hospital, Muramvya, Burundi. Gilles Caty, MD, PhD, is a Professor and Physician, Department of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint Luc, Brussels, Belgium. Chanelle Ella Ininahazwe, PT, is a Physiotherapist, National Reference Center for Physiotherapy and Rehabilitation Medicine, Bujumbura, Burundi. Charles Sébiyo Batcho, PT, PhD, is a Professor and Researcher, Department of Rehabilitation, Faculty of Medicine, University Laval, and Centre for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec, Canada.

Abstract: The latest recommendations for HIV therapeutic management emphasize the importance of regular physical activity (PA). This cross-sectional study assessed the self-reported level of PA, amount of leisure time PA (LTPA), and the predictors of PA practiced in 257 people living with HIV (PLWH) in Burundi. The World Health Organization recommends 150 min of PA per week. In our study, 80.2% of the participants met this recommendation. Participants were more engaged in PA at work (436.8 ± 682.1 min/week) compared with leisure time (231.7 ± 383.8 min/week) and transportation (235.9 ± 496.5 min/week). Multivariate analysis revealed that men (β = -101.65; p = .01) who were white-collar workers (β = 67.21; p < .03) with higher education level (β = 274.21; p < .001) reported higher levels of LTPA than other groups. Integrating PA counseling into the routine care and implementing community-based exercise programs could enhance participation in PA in PLWH.
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http://dx.doi.org/10.1097/JNC.0000000000000253DOI Listing
April 2021

Reliability of ActiGraph GT3X+ placement location in the estimation of energy expenditure during moderate and high-intensity physical activities in young and older adults.

J Sports Sci 2021 Jul 29;39(13):1489-1496. Epub 2021 Jan 29.

HAVAE (Handicap, Aging, Autonomy, Environment) EA6310, Limoges University, Limoges, France.

WHO defines physical activity (PA) as any bodily movement produced by skeletal muscles that requires energy expenditure (EE). The purpose of this study was to compare the EE estimations by ActiGraph GT3X+ with a gold standard measurement, the portable gas analyser in a set of 3 different PAs. This cross-sectional study involved 56 participants, age range (years, [min, max]: young people [20, 33], older adults [65, 83]). Participants completed a single session of three experimental PAs including biking, treadmill walking, and treadmill running. Each participant wore five GT3X+ triaxial accelerometers and a portable gas analyser used as the gold standard measurement. The GT3X+ were placed on the wrists, the waist (centred at the pelvis), and the ankles. ActiGraph GT3X+ and MetaMax3B records were investigated through intraclass correlation coefficient. Magnitude of measurement error was estimated using Effect Size. The GT3X+ wrist and GT3X+ waist underestimated EE regardless of the PA type. The GT3X+ ankles strongly overestimated EE during biking (mean bias = 489 ± 392%) and walking (mean bias = 106 ± 58%), while it underestimated EE during running (mean bias = -47 ± 27%). The ActiGraph GT3X+ does not provide accurate EE estimates across a range of placement locations during moderate and high-intensity PA.
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http://dx.doi.org/10.1080/02640414.2021.1880689DOI Listing
July 2021

Cardiorespiratory strain during stroke rehabilitation: Are patients trained enough? A systematic review.

Ann Phys Rehabil Med 2021 Jul 28;64(4):101443. Epub 2020 Oct 28.

Department of rehabilitation, Laval University, 1050, avenue de la Médecine, QC, G1V0A6 Quebec, Canada; Centre for Interdisciplinary Research in Rehabilitation and Social Integration, 525, boulevard Wilfrid-Hamel, QC, G1M 2S8 Quebec City, Canada. Electronic address:

Background: Rehabilitation is a mandatory component of stroke management, aiming to recover functional capacity and independence. To that end, physical therapy sessions must involve adequate intensity in terms of cardiopulmonary stress to meet the physiological demands of independent living.

Objective: The aim of this systematic review was to determine the current level of cardiopulmonary strain during rehabilitation sessions in stroke patients.

Methods: Three electronic databases (PubMed, CINAHL and Embase. com) were searched to identify observational studies that documented cardiopulmonary strain during rehabilitation sessions in post-stroke patients (last search performed in February 2019). A manual cross-referencing search was also performed. To be included, articles needed to report data related to both cardiopulmonary strain (heart rate, oxygen consumption or energy expenditure) and active therapy time. The methodological quality of each study was assessed with the Evidence-Based Librarianship Critical Appraisal Tool. Data related to both cardiorespiratory strain and active therapy time were extracted from selected articles.

Results: Four of 43 full-text articles assessed for eligibility met the inclusion criteria. Results extracted from these articles suggested that the intensity of rehabilitation sessions was insufficient to induce a cardiopulmonary training effect in a post-stroke context as measured by metabolic stress. Patients were inactive from 21% to 80% of the therapy time. The Evidence-Based Librarianship tool scores ranged from 65% (15/23) to 91% (21/23), which indicates questionable to good quality.

Conclusion: The current literature on cardiopulmonary solicitation during stroke rehabilitation sessions is poor in terms of both the number of studies available and their methodological quality. Summarized results tend to support previous claims that rehabilitation sessions offered to stroke patients are of suboptimal cardiopulmonary strain, which can interfere with their capacity to regain functional independence.
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http://dx.doi.org/10.1016/j.rehab.2020.09.007DOI Listing
July 2021

Activity and participation in stroke survivors in a low-income setting: A cross-sectional study.

Physiother Res Int 2020 Oct 20;25(4):e1846. Epub 2020 Apr 20.

Faculté de Médecine, Université Laval, Quebec, Quebec, Canada.

Objectives: To describe patients' activity and participation levels and to compare these levels across different groups of stroke survivors according to their walking speed (WS).

Methods: In this cross-sectional study, 67 stroke survivors (43 men, mean age: 58.4 ± 12.9 years old) were assessed using the stroke impairment assessment set (SIAS), ACTIVLIM-Stroke, 10-m walk test (10MWT), 6-min walk test (6MWT) and Reintegration to Normal Living Index (RNLI). The sample was afterwards split into three WS sub-groups (<0.4 m/s, 0.4-0.8 m/s and >0.8 m/s) based on 10MWT scores.

Results: ACTIVLIM-Stroke, 10MWT and 6MWT mean scores (±SD) were, respectively, 69.4 ± 20.2%, 0.9 ± 0.6 m/s and 282.1 ± 182 m. RNLI median score (range) was 5 (0-20). Sub-group analyses indicated that 26.9% (n = 18) obtained WS < 0.4 m/s, 13.4% (n = 9) WS between 0.4 and 0.8 m/s, and 59.7% (n = 40) WS > 0.8 m/s. Significant differences (p < .001) were found between WS sub-groups for both activity and participation.

Conclusion: Stroke survivors in Kinshasa presented a good performance for basic-activities of daily life (basic-ADLs). However, some of them still had difficulties with some community activities. Differences in WS seemed to discriminate well stroke survivors in terms of activity and participation, since the higher WS, the more they performed in basic-ADLs, walking distance and participation, and inversely.
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http://dx.doi.org/10.1002/pri.1846DOI Listing
October 2020

Test-retest reliability of an adapted version of the International Physical Activity Questionnaire for healthy individuals and stroke survivors.

Ann Phys Rehabil Med 2020 Nov 22;63(6):581-583. Epub 2020 Jan 22.

Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale Nationale (CIUSSS-CN), 525 Wilfrid-Hamel, Quebec City, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050 avenue de la médecine, Quebec City, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.rehab.2019.11.006DOI Listing
November 2020

Applicability of International Classification of Functioning, Disability and Health-based participation measures in stroke survivors in Africa: a systematic review.

Int J Rehabil Res 2020 Mar;43(1):3-11

Center for Interdisciplinary Research in Rehabilitation and Social Integration.

To appraise available International Classification of Functioning, Disability and Health (ICF)-based tools for the measurement of participation after stroke and to examine their applicability in the African sociocultural context. Pubmed/Medline, Science Direct, Cochrane Library, and Hinari databases were systematically searched. The literature search was limited to studies published in the English or French language from January 2001 up to May 2019. Two reviewers independently screened all identified studies and selected eligible articles. Disagreements about inclusion or exclusion of studies were resolved by consensus. Two reviewers independently extracted the psychometric properties of each instrument using the Consensus-based Standard for the Selection of Health Measurement Instruments checklist and examined the methodological quality of each selected study using the MacDermid checklist. A total of 1030 articles were systematically reviewed for relevance, yielding 22 studies that met inclusion criteria. These studies were related to nine participation tools. The MacDermid scores ranged from 13 to 21 out of 24. The number of investigated psychometric properties and the number of ICF participation domains covered by each tool varied among studies. This systematic review revealed nine ICF-based tools for the measurement of participation after stroke. We examined the content of these tools and provided valuable information that can be used to guide researchers in Africa in their selection of the most appropriate tool for the measurement of participation after stroke.
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http://dx.doi.org/10.1097/MRR.0000000000000377DOI Listing
March 2020

Validity of the Walked Distance Estimated by Wearable Devices in Stroke Individuals.

Sensors (Basel) 2019 May 31;19(11). Epub 2019 May 31.

(Handicap, Aging, Autonomy, Environment) HAVAE EA6310, University of Limoges, 87042 Limoges Cedex, France.

Background: Health professionals need valid devices to assess a stroke individual's ability to walk. The aim was to evaluate the validity of the estimation of the walked distance by wearable devices and the impact of the sensor's position in stroke individuals.

Methods: Post-stroke patients able to walk without human assistance were equipped with several wearable devices: pedometers, Actigraph, and Sensewear Armband placed according to the manufacturers' recommendations. Participants walked for 6 min at a comfortable speed wearing all sensors at the same time. We analyzed the validity of sensor-estimated distances according to their position using Bland-Altman analysis, root-mean-square error, and coefficient of correlation.

Results: In total, 35 individuals were included (mean age = 65 ± 15 years). The best estimations were given by the Actigraph worn on the unaffected ankle (mean bias (MB) = 22.6 ± 32.4 m; = 0.37) and by the pedometer worn on the unaffected hip (MB = 20.5 ± 24.6 m; = 0.46). The other sensors and positions provided large estimation errors over 95 m ( < 0.05).

Conclusion: This study led to a recommendation of a pedometer worn on the unaffected hip or an Actigraph worn on the unaffected ankle to get a valid estimation of the distance walked by stroke individuals.
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http://dx.doi.org/10.3390/s19112497DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6604102PMC
May 2019

Validity and Reliability of 2-Dimensional Video-Based Assessment to Analyze Foot Strike Pattern and Step Rate During Running: A Systematic Review.

Sports Health 2019 Sep/Oct;11(5):409-415. Epub 2019 May 30.

Centre for Interdisciplinary Research in Rehabilitation and Social Integration, CIUSSS-CN, Quebec City, Quebec, Canada.

Context: Two-dimensional (2D) video-based analysis is often used by clinicians to examine the foot strike pattern (FSP) and step rate in runners. Reliability and validity of 2D video-based analysis have been questioned.

Objective: To synthesize the psychometric properties of 2D video-based analysis for assessing runners' FSP and step rate while running.

Data Sources: Medline/PubMed, Science Direct, Embase, EBSCOHost/CINAHL, and Scielo were searched from their inception to August 2018.

Study Selection: Studies were included if (1) they were published in English, French, Portuguese or Spanish; (2) they reported at least 1 psychometric property (validity and/or reliability) of 2D video-based analysis to assess running kinematics; and (3) they assessed FSP or step rate during running.

Study Design: Systematic review.

Level Of Evidence: Level 2.

Data Extraction: Studies were screened for methodological (MacDermid checklist) and psychometric quality (COSMIN checklist) by 2 independent raters.

Results: Eight studies, with a total of 702 participants, were included. Seven studies evaluated the reliability of 2D video to assess FSP and found very good to excellent reliability (0.41 ≤ κ ≤ 1.00). Two studies reported excellent reliability for the calculation of step rate (0.75 ≤ intraclass correlation coefficient [ICC] ≤ 1.00). One study demonstrated excellent concurrent validity between 2D and 3D (gold standard) motion capture systems to determine FSP (Gwet agreement coefficient [AC] > 0.90; ICC > 0.90), and another study found excellent concurrent validity between 2D video and another device to calculate step rate (0.84 ≤ ICC ≤ 0.95).

Conclusion: Strong evidence suggests that 2D video-based analysis is a reliable method for assessing FSP and quantifying step rate, regardless of the experience of the assessor. Limited evidence exists on the validity of 2D video-based analysis in determining FSP and calculating step rate during running.
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http://dx.doi.org/10.1177/1941738119844795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745811PMC
November 2019

Canadian-French adaptation and test-retest reliability of the leisure time physical activity questionnaire for people with disabilities.

Ann Phys Rehabil Med 2019 May 11;62(3):161-167. Epub 2019 Jan 11.

Center for interdisciplinary research in rehabilitation and social integration (CIRRIS), centre intégré universitaire de santé et de services sociaux de la capitale national (CIUSSS-CN), institut de réadaptation en déficience physique de Québec (IRDPQ), 525, Wilfrid-Hamel, G1M 2S8 Quebec City, QC, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, 1050, avenue de la Médecine, G1V 0A6 Quebec City, QC, Canada. Electronic address:

Objectives: The Leisure Time Physical Activity Questionnaire (LTPAQ) measures the duration of physical activities performed during the past 7 days, and results are expressed in minutes. This study aimed to translate this questionnaire into Canadian-French and to evaluate the content validity and its test-retest reliability in people with physical disabilities.

Methods: The LTPAQ was translated from English to French by forward and backward translation. To assess content validity, 9 adults with physical disabilities read and provided comments regarding the relevance, wording and understanding of the items of the preliminary Canadian-French version of the questionnaire. For test-retest reliability, 37 adults with physical disabilities completed the questionnaire 2 or 3 times at T1 (baseline), T2 (2 days from baseline) and T3 (7 days from baseline). The test-retest reliability was investigated by intra-class correlation coefficients (ICCs), paired t test and Bland and Altman tests.

Results: The translation and the content validation process resulted in a Canadian-French version of the LTPAQ (LTPAQ-CF). Total LTPAQ-CF scores between T1-T2 and T1-T3 featured strong ICCs, 0.90 and 0.75 (P≤0.01). Paired t tests and Bland and Altman analyses confirmed the good reproducibility of results.

Conclusion: The LTPAQ-CF has good test-retest reliability when self-administered or administered by interview to people with physical disabilities.
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http://dx.doi.org/10.1016/j.rehab.2018.12.002DOI Listing
May 2019

Quantification of upper limb position sense using an exoskeleton and a virtual reality display.

J Neuroeng Rehabil 2018 03 16;15(1):24. Epub 2018 Mar 16.

Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Boulevard Wilfrid-Hamel, Quebec City (QC), G1M 2S8, Canada.

Background: Proprioceptive sense plays a significant role in the generation and correction of skilled movements and, consequently, in most activities of daily living. We developed a new proprioception assessment protocol that enables the quantification of elbow position sense without using the opposite arm, involving active movement of the evaluated limb or relying on working memory. The aims of this descriptive study were to validate this assessment protocol by quantifying the elbow position sense of healthy adults, before using it in individuals who sustained a stroke, and to investigate its test-retest reliability.

Methods: Elbow joint position sense was quantified using a robotic device and a virtual reality system. Two assessments were performed, by the same evaluator, with a one-week interval. While the participant's arms and hands were occluded from vision, the exoskeleton passively moved the dominant arm from an initial to a target position. Then, a virtual arm representation was projected on a screen placed over the participant's arm. This virtual representation and the real arm were not perfectly superimposed, however. Participants had to indicate verbally the relative position of their arm (more flexed or more extended; two-alternative forced choice paradigm) compared to the virtual representation. Each participant completed a total of 136 trials, distributed in three phases. The angular differences between the participant's arm and the virtual representation ranged from 1° to 27° and changed pseudo-randomly across trials. No feedback about results was provided to the participants during the task. A discrimination threshold was statistically extracted from a sigmoid curve fit representing the relationship between the angular difference and the percentage of successful trials. Test-retest reliability was evaluated with 3 different complementary approaches, i.e. a Bland-Altman analysis, an intraclass correlation coefficient (ICC) and a standard error of measurement (SEm).

Results: Thirty participants (24.6 years old; 17 males, 25 right-handed) completed both assessments. The mean discrimination thresholds were 7.0 ± 2.4 (mean ± standard deviation) and 5.9 ± 2.1 degrees for the first and the second assessment session, respectively. This small difference between assessments was significant (- 1.1 ± 2.2 degrees), however. The assessment protocol was characterized by a fair to good test-retest reliability (ICC = 0.47).

Conclusion: This study demonstrated the potential of this assessment protocol to objectively quantify elbow position sense in healthy individuals. Futures studies will validate this protocol in older adults and in individuals who sustained a stroke.
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http://dx.doi.org/10.1186/s12984-018-0367-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857112PMC
March 2018

Use and psychometric properties of the Reintegration to Normal Living Index in rehabilitation: A systematic review.

Ann Phys Rehabil Med 2018 Jul 6;61(4):262-269. Epub 2018 Jan 6.

Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Université Laval, Quebec City, Canada; Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec City, Canada. Electronic address:

Background: Reintegration to Normal Living Index (RNLI) is a generic 11-item questionnaire-based instrument that measures the degree to which individuals achieve reintegration to normal social activities.

Objectives: This systematic review aimed to provide an overview of the use of this questionnaire in rehabilitation (objective 1) and to analyze its psychometric properties (objective 2).

Methods: We searched the literature in 4 electronic databases (MEDLINE via PubMed, Embase, CINAHL and Web of Science) for articles published in English or French between 1988 and 2017. Studies that used RNLI or investigated at least one of its psychometric properties were included and analyzed according to the PRISMA statement. Data extraction and critical methodological appraisal of the articles were independently performed by 2 authors.

Results: A total of 117 studies met the inclusion criteria for objective 1. Half of these studies were conducted in North America (50.4%), mainly with stroke patients. The RNLI was used according to 7 different response formats. The 0-10 visual analog scale and 3-point Likert scale were the most commonly used response formats. For objective 2, 10 studies had evaluated the psychometric properties of the RNLI. Their results suggested good test-retest reliability (intraclass coefficient: 0.83-0.87); good internal consistency (Cronbach α: 0.73-0.97); poor to good construct validity, with Pearson's or Spearman's correlation coefficients between the RNLI and scores for many other well-known questionnaires ranging from 0.25 to 0.77. Other types of psychometric properties (e.g., responsiveness) were poorly investigated.

Conclusion: Despite the increasing use of RNLI in clinical studies, some aspects of its psychometric properties are still poorly evaluated. In addition to the validity and reliability shown in different studies, further studies are needed to investigate other measurement properties such as responsiveness.
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http://dx.doi.org/10.1016/j.rehab.2017.12.004DOI Listing
July 2018

Measuring Participation After Stroke in Africa: Development of the Participation Measurement Scale.

Arch Phys Med Rehabil 2018 04 26;99(4):652-659. Epub 2017 Oct 26.

Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium; University Hospital Saint-Luc, Physical and Rehabilitation Medecine Department, Catholic University of Louvain, Brussels, Belgium. Electronic address:

Objective: To develop a valid stroke-specific tool, named the Participation Measurement Scale (PM-Scale), for the measurement of participation after stroke.

Design: Observational study and questionnaire development.

Setting: Outpatient rehabilitation centers.

Participants: Patients with stroke (N=276; mean age, 58.5±11.1y; 57% men).

Interventions: Not applicable.

Main Outcome Measures: Participants completed a 100-item experimental questionnaire of the PM-Scale. Items were scored as "not at all," "weakly," or "strongly." The Hospital Anxiety and Depression Scale was used to evaluate depression, and the modified Rankin Scale was used to categorize the severity of disability on the basis of observation.

Results: After successive Rasch analyses using unrestricted partial credit parameterization, a valid, unidimensional, and linear 22-item scale for the measurement of participation was constructed. All 22 items fulfilled the measurement requirements of overall and individual item and person fits, category discrimination, invariance, and local response independence. The PM-Scale showed good internal consistency (person separation index, .93). The test-retest reliability of item difficulty hierarchy (r=.96; P<.001) and patient location (r=.99; P<.001) were excellent. This patient-based scale covers all 9 International Classification of Functioning, Disability and Health domains of participation.

Conclusions: The PM-Scale has good psychometric qualities and provides accurate measures of participation in patients with stroke in Africa.
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http://dx.doi.org/10.1016/j.apmr.2017.10.004DOI Listing
April 2018

Functional recovery after stroke in Benin: A six-month follow-up study.

J Rehabil Med 2016 Oct;48(8):671-675

, Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.

Objective: Stroke is a major public health problem in developing countries. However, few studies have quantified the functional recovery of stroke patients in sub-Saharan Africa. This study examined the functional recovery of stroke patients in the Republic of Benin.

Methods: A total of 68 patients with acute stroke were recruited from hospitals and health centres in Benin. Patients were evaluated at enrolment and 1, 3 and 6 months post-stroke. The ACTIVLIM-Stroke scale, Barthel Index, and modified Rankin Scale were used to assess activity limitations, functional autonomy, and overall level of disability, respectively.

Results: Over the 6-month follow-up period, 18 patients died and 9 dropped out. Overall, the 3 measures highlighted progressive and significant functional recovery during the first 6 months. At enrolment, the mean score on ACTIVLIM-Stroke was 16% (standard deviation (SD) 9), indicating that patients were almost totally dependent and unable to perform most activities of daily living. At 6 months, the mean score for activity limitation reached 67% (SD 15) and most patients were able to perform some basic tasks easily. Patients had difficulty with tasks requiring walking and remained unable to perform certain activities requiring manual dexterity.

Conclusion: The study sample showed significant functional recovery (~50%) during the first 6 months post-stroke. We recommend the integration of group-based brisk walking into a cost-effective rehabilitation programme as a suitable way to increase functional recovery of chronic stroke patients in sub-Saharan Africa after hospital discharge.
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http://dx.doi.org/10.2340/16501977-2128DOI Listing
October 2016

How robust is ACTIVLIM for the follow-up of activity limitations in patients with neuromuscular diseases?

Neuromuscul Disord 2016 Mar 21;26(3):211-20. Epub 2015 Dec 21.

Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium; Arsalis SPRL, Glabais, Belgium. Electronic address:

This study aims to investigate the clinimetric properties of ACTIVLIM, a measure of activity limitations, when it is used in daily practice in a large nationwide representative cohort of patients with neuromuscular diseases. A cohort of 2986 patients was assessed at least once over 2 years in 6 national neuromuscular diseases reference centers. Successive Rasch analyses were conducted in order to investigate the scale validity, reliability, consistency across demographic and clinical sub-groups and its sensitivity to change. ACTIVLIM confirmed excellent fit to a unidimensional scale, with stable but 3-times more accurate item calibrations compared to the original publication. It showed a good reliability (R = 0.95), an appropriate targeting for 87% of the sample and an excellent invariance across age, gender, language and time. Despite some variations in the item difficulty hierarchy across diagnoses, ACTIVLIM exhibited a good capability to quantify small but significant changes in activity for various diagnostic groups. Overall, ACTIVLIM demonstrated very good clinimetric properties, allowing accurate quantitative measurement of activity limitations in both children and adults with a variety of neuromuscular diseases.
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http://dx.doi.org/10.1016/j.nmd.2015.12.004DOI Listing
March 2016

Measuring functional recovery in stroke patients: the responsiveness of ACTIVLIM-stroke.

J Neurol Neurosurg Psychiatry 2014 Dec 9;85(12):1337-42. Epub 2014 Apr 9.

Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.

Background And Purpose: To determine the efficacy of the ACTIVLIM-Stroke questionnaire in detecting changes in functional status of stroke patients.

Method: Sixty-eight Benin and Belgian stroke patients participated in this 2-month longitudinal study, involving baseline and follow-up assessments. Outcome measures combined ACTIVLIM-Stroke questionnaire, Barthel Index (BI), 6-minute-walk test (6MWT) and modified Rankin scale (MRS). Responsiveness of ACTIVLIM-Stroke was investigated through different methodological approaches and compared with BI, 6MWT and MRS. Statistical analyses were performed using the paired t tests, effect size (ES) and correlation tests.

Results: ACTIVLIM-Stroke detected changes in the whole sample (p<0.001, ES=0.78) and even in a subgroup of patients (p<0.001, ES=0.29) that were classified as stable according to the MRS. Moreover, ACTIVLIM-Stroke permitted the classification of patients into more discriminative groups, including those showing an important improvement (p<0.001, ES=1.87), a slight but non-clinically meaningful improvement (p<0.001, ES=0.38), and no improvement (p=0.1, ES=0.11), demonstrating its high sensitivity to change. Furthermore, there were concordant relationships between ACTIVLIM-Stroke change and any observed changes in BI, 6MWT and MRS scores (r≥0.50, p<0.001), confirming the external responsiveness of ACTVLIM-Stroke.

Conclusions: ACTIVLIM-Stroke showed good responsiveness and can detect accurately clinical changes in the functional status of stroke patients. The BI and the 6MWT were also responsive and may provide complementary information while investigating change in functional status. However, in addition to being highly sensitive to change, ACTIVLIM-Stroke presents significant methodological advantages for quantifying functional changes in stroke patients.
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http://dx.doi.org/10.1136/jnnp-2013-307171DOI Listing
December 2014

Assessing locomotion ability in West African stroke patients: validation of ABILOCO-Benin scale.

Arch Phys Med Rehabil 2014 Aug 19;95(8):1470-6.e3. Epub 2014 Mar 19.

Institute of Neuroscience, Catholic University of Louvain, Brussels, Belgium. Electronic address:

Objective: To calibrate and validate the Benin version of ABILOCO, a Rasch-built scale developed to assess locomotion ability in stroke patients.

Design: Prospective study and questionnaire development.

Setting: Rehabilitation centers.

Participants: Stroke patients (N=230; mean age ± SD, 51.1±11.6 y; 64.3% men).

Intervention: Not applicable.

Main Outcome Measures: Participants completed a preliminary list of 36 items including the 13 items of ABILOCO. Items were scored as "impossible," "difficult," or "easy." The mobility subdomain of FIM (FIM-mobility), the Functional Ambulation Classification (FAC), the 6-minute walk test (6MWT), and the 10-meter walk test (10MWT) were used to evaluate and elucidate the validity of the ABILOCO-Benin scale.

Results: Successive Rasch analyses led to the selection of 15 items that define a unidimensional, invariant, and linear measure of locomotion ability in stroke patients. This modified version of the ABILOCO scale, named ABILOCO-Benin, showed an excellent internal consistency, with a Person Separation Index of .93, and excellent test-retest reliability with high intraclass correlation coefficients of .95 (P<.001) for item difficulty and .93 (P<.001) for subject measures. It also presented good construct validity compared with FAC, FIM-mobility, 6MWT, and 10MWT (r≥.75, P<.001).

Conclusions: ABILOCO-Benin presents good psychometric properties. It allows valid, reliable, and objective measurements of locomotion ability in stroke patients.
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http://dx.doi.org/10.1016/j.apmr.2014.03.002DOI Listing
August 2014

Brisk walking can promote functional recovery in chronic stroke patients.

J Rehabil Med 2013 Sep;45(9):854-9

Institute of Neuroscience (IoNS), Université catholique de Louvain (UCL), 1200 Brussels, Belgium.

Objective: To determine whether regular brisk walking can promote functional recovery in community-dwelling stroke patients.

Patients: A total of 44 chronic stroke patients, recruited in Belgium and Benin, respectively European high-income and African low-income countries.

Methods: This longitudinal, single-cohort, observational study with 1 intervention period and 4 time-points of assessments (2 baseline, 1 post-intervention and 1 follow-up) was structured in 3 periods: pre-intervention period (1 month), intervention period (3 months) and follow-up period (3 month). Intervention consisted of a 3 times/week group-based brisk walking programme. Primary outcome measures were ACTIVLIM-Stroke questionnaire and the 6-minute walk test (6MWT). Secondary outcome measures were the Stroke Impairment Assessment Set (SIAS), the Hospital Anxiety and Depression Scale (HADS), and the Berg Balance Scale (BBS).

Results: All outcome measures were stable during the pre-intervention period (p ≥ 0.16). They all improved significantly after intervention (p ≤ 0.01), except the HADS (p = 0.058). However, during the follow-up period, SIAS (p = 0.002) and BBS (p = 0.001) decreased, while ACTIVLIM-Stroke, 6MWT and HADS showed no significant change (p ≥ 0.13).

Conclusion: This study suggests regular brisk walking as an effective approach to promote functional recovery in chronic stroke survivors. However, further studies are required before generalizing these results to the whole stroke population.
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http://dx.doi.org/10.2340/16501977-1211DOI Listing
September 2013

Can manual ability be measured with a generic ABILHAND scale? A cross-sectional study conducted on six diagnostic groups.

BMJ Open 2012 31;2(6). Epub 2012 Oct 31.

Physical and Occupational Therapy Departments, Paramedical Category, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium.

Objectives: Several ABILHAND Rasch-built manual ability scales were previously developed for chronic stroke (CS), cerebral palsy (CP), rheumatoid arthritis (RA), systemic sclerosis (SSc) and neuromuscular disorders (NMD). The present study aimed to explore the applicability of a generic manual ability scale unbiased by diagnosis and to study the nature of manual ability across diagnoses.

Design: Cross-sectional study.

Setting: Outpatient clinic homes (CS, CP, RA), specialised centres (CP), reference centres (CP, NMD) and university hospitals (SSc).

Participants: 762 patients from six diagnostic groups: 103 CS adults, 113 CP children, 112 RA adults, 156 SSc adults, 124 NMD children and 124 NMD adults.

Primary And Secondary Outcome Measures: Manual ability as measured by the ABILHAND disease-specific questionnaires, diagnosis and nature (ie, uni-manual or bi-manual involvement and proximal or distal joints involvement) of the ABILHAND manual activities.

Results: The difficulties of most manual activities were diagnosis dependent. A principal component analysis highlighted that 57% of the variance in the item difficulty between diagnoses was explained by the symmetric or asymmetric nature of the disorders. A generic scale was constructed, from a metric point of view, with 11 items sharing a common difficulty among diagnoses and 41 items displaying a category-specific location (asymmetric: CS, CP; and symmetric: RA, SSc, NMD). This generic scale showed that CP and NMD children had significantly less manual ability than RA patients, who had significantly less manual ability than CS, SSc and NMD adults. However, the generic scale was less discriminative and responsive to small deficits than disease-specific instruments.

Conclusions: Our finding that most of the manual item difficulties were disease-dependent emphasises the danger of using generic scales without prior investigation of item invariance across diagnostic groups. Nevertheless, a generic manual ability scale could be developed by adjusting and accounting for activities perceived differently in various disorders.
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http://dx.doi.org/10.1136/bmjopen-2012-001807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3533037PMC
November 2012

PWC 75%/kg, a fitness index not linked to resting heart rate: testing procedure and reference values.

Arch Phys Med Rehabil 2012 Jul 8;93(7):1196-200. Epub 2012 Mar 8.

Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.

Objectives: To develop a fitness index unlinked to resting heart rate and suitable for clinical use, and to obtain reference values of this new index for healthy subjects.

Design: Cross-sectional study.

Setting: Research laboratory.

Participants: A volunteer sample of healthy subjects (N=100; 50 men; age range, 20-70y) randomly recruited from the general community.

Interventions: Not applicable.

Main Outcome Measures: Participants performed a submaximal, multistage cycle ergometer test. A new fitness index, the physical working capacity at 75% of the predicted maximal heart rate per kilogram of body weight (PWC(75%)/kg), was calculated. Its concordance with a previously described fitness index and its relationship with age were examined, as well as differences attributable to sex and lifestyle. Reference values of the PWC(75%)/kg (mean ± SD and 95% confidence interval) were calculated and categorized by age classes of 10 years and by sex.

Results: The intraclass correlation coefficient (ICC) between PWC(75%)/kg and the working capacity index at 65% of the heart rate reserve per kilogram of body weight (WCI(65%HRreserve)/kg) was very high (ICC=.96, P<.001), indicating that the fitness index can be estimated without measuring the resting heart rate. PWC(75%)/kg decreased as age increased. The average PWC(75%)/kg was significantly higher in men than in women (P<.001), and in active than in inactive subjects (P<.01).

Conclusions: This study presents a new fitness index, the PWC(75%)/kg, which is suitable for measuring fitness in active and sedentary people aged 20 to 70 years. It may also be a suitable fitness index for selected chronically ill individuals. This study also provides reference values of the PWC(75%)/kg obtained from healthy men and women.
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http://dx.doi.org/10.1016/j.apmr.2012.02.021DOI Listing
July 2012

ACTIVLIM-Stroke: a crosscultural Rasch-built scale of activity limitations in patients with stroke.

Stroke 2012 Mar 5;43(3):815-23. Epub 2012 Jan 5.

Institut of Neuroscience, Université catholique de Louvain, Brussels, Belgium, 53 avenue Mounier, COSY-B1.53.04, B-1200 Brussels, Belgium.

Background And Purpose: This study describes the development of a Rasch-built scale measuring activity limitations in stroke patients, named ACTIVLIM-Stroke.

Method: This new Rasch-built measure was constructed based on stroke patients' perceptions of difficulty in performing daily activities. Patients were recruited from inpatient and outpatient rehabilitation departments in Belgium and Benin. A 73-item questionnaire was completed by 204 participants. A random subsample of 83 subjects was given the questionnaire a second time. Data were analyzed using RUMM2030 software.

Results: After successive Rasch analyses, the ACTIVLIM-Stroke questionnaire, a unidimensional and linear 20-item measure of activity limitations, was constructed. All 20 items fulfilled Rasch requirements (overall and individual item fit, category discrimination, invariance, local response independence, and nonredundancy in item difficulty). This simple patient-based scale encompasses a large range of activities related to self-care, transfer, mobility, manual ability, and balance. The ACTIVLIM-Stroke questionnaire exhibited high internal validity, excellent internal consistency, and good crosscultural validity. The test-retest reliability of item difficulty hierarchy (intraclass correlation coefficient=0.99) and patient location (intraclass correlation coefficient=0.92) were both excellent. Furthermore, it showed good external construct validity using correlations with the Functional Independence Measure motor and the Barthel Index and a higher discriminating capacity than either of these widely used indices.

Conclusions: The ACTIVLIM-Stroke questionnaire has good psychometric qualities and provides accurate measures of activity limitations in patients with stroke. It is recommended for evaluating clinical and research interventions in patients with stroke, because it provides a higher discrimination and might be more sensitive to change.
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http://dx.doi.org/10.1161/STROKEAHA.111.638965DOI Listing
March 2012

Responsiveness of the ABILHAND questionnaire in measuring changes in rheumatoid arthritis patients.

Arthritis Care Res (Hoboken) 2011 Jan;63(1):135-41

Université catholique de Louvain, Brussels, Belgium.

Objective: ABILHAND is a Rasch-built questionnaire that measures manual ability in rheumatoid arthritis (RA) patients. This study aimed to examine the test-retest reliability and the responsiveness of ABILHAND in RA patients.

Methods: Eighty-eight patients underwent 3 evaluations: the first evaluation was at baseline (time 1), the second was 2 weeks later (time 2), and the third was 1 year later (time 3). Disease activity was assessed using the Disease Activity Score in 28 joints using the C-reactive protein level (DAS28-CRP). Patients rated the intensity of their RA-related pain using a 100-mm visual analog scale for pain and completed questionnaires based on their activity limitations (ABILHAND and the Health Assessment Questionnaire) and quality of life.

Results: The responsiveness analyses were conducted by using global, group, and individual approaches. The global approach showed significant differences between the time 1 and time 3 scores of the DAS28-CRP (P = 0.04) and ABILHAND (P = 0.04). Based on the changes in disease activity scores and the European League Against Rheumatism response criteria, the sample was divided into 3 groups: deteriorated, stable, and improved. The mean ± SD changes in manual ability were higher in the deteriorated (-1.23 ± 1.53 logit) and in the improved (1.22 ± 2.06 logits) groups than in the stable group (0.48 ± 1.09 logit). The effect size and standardized response mean confirmed that observation. The minimal clinically important difference was assessed in each group of patients.

Conclusion: The ABILHAND questionnaire exhibited responsiveness in detecting slight changes in RA patients. Therefore, the ABILHAND tool can be used to evaluate the functional status of RA patients in clinical trials and settings.
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http://dx.doi.org/10.1002/acr.20346DOI Listing
January 2011
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