title: Functional index-2: Validity and reliability of a disease-specific measure of impairment in patients with polymyositis and dermatomyositis.
abstract: OBJECTIVE
  To revise the content of the Functional Index in myositis (FI) and to evaluate measurement properties of a revised FI.
  
  
  METHODS
  Previously performed FI (n = 287) were analyzed for internal redundancy and consistency, and ceiling and floor effects. Content was evaluated and a preliminary revised FI was developed. To evaluate the construct validity of the preliminary revised FI, it was compared with isokinetic measurements of muscular strength and endurance, the Myositis Activities Profile, disease impact on general wellbeing, and creatine phosphokinase levels. Minor adjustments were made and the revised FI was investigated for interrater reliability and intrarater reliability over a 1-week period. After this, some minor, additional adjustments were made leading to the final version, FI-2.
  
  
  RESULTS
  Five tasks were removed from the original FI due to ceiling effects. Performance pace and number of repetitions were modified for the remaining tasks. A moderate correlation (r(s) = 0.58) was found between the shoulder flexion task of the preliminary revised FI and isokinetic measurements of shoulder flexion endurance. Intraclass correlation coefficient (ICC) for interrater reliability of the revised FI varied from 0.86-0.99 with no systematic differences. ICC for intrarater reliability varied from 0.56-0.99 with systematic differences (P < 0.05) between test and retest in 3 of the tasks. The sit-up task was excluded due to low intrarater reliability resulting in the final 7-item FI-2. There was a good correlation between tasks on the right and left side suggesting that the FI-2 could be performed unilaterally.
  
  
  CONCLUSIONS
  The FI-2 is a valid and reliable outcome measure of impairment for patients with polymyositis or dermatomyositis. It is well tolerated and the unilateral FI-2 requires a maximum of 20 minutes to perform. Further evaluation of sensitivity to change and testing in healthy individuals needs to be conducted.
authors.affiliation: Physical Therapy Department, Rheumatology Unit D2:07, Karolinska Institutet and Karolinska University Hospital, Solna, SE-171 76 Stockholm, Sweden. helene.alexanderson@karolinska.se
authors.forename: Helene
authors.initials: H
authors.lastname: Alexanderson
authors.forename: Lisbet
authors.initials: L
authors.lastname: Broman
authors.forename: Anna
authors.initials: A
authors.lastname: Tollbäck
authors.forename: Annika
authors.initials: A
authors.lastname: Josefson
authors.forename: Ingrid E
authors.initials: IE
authors.lastname: Lundberg
authors.forename: Christina H
authors.initials: CH
authors.lastname: Stenström
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003882:Dermatomyositis / Q000175:diagnosis* / Q000503:physiopathology*; D004185:Disability Evaluation; D005080:Exercise Test / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009129:Muscle Tonus; D015588:Observer Variation; D010807:Physical Endurance; D017285:Polymyositis / Q000175:diagnosis* / Q000503:physiopathology*; D015203:Reproducibility of Results