Lorraine H DeSouza

Reliability and validity of functional balance tests post stroke

Objective: To contribute to the reliability and validity of a series of functional balance tests for use post stroke. Design: Within-session, test-retest and intertester reliability was tested using the kappa coefficient and intraclass correlations. The tests were performed three times and the first and third attempts compared to test the within-session reliability. The tests were repeated a few days later to assess test-retest reliability and were scored simultaneously by two physiotherapists to assess the intertester reliability. To test criterion-related validity the tests were compared with the sitting section of the Motor Assessment Scale, Berg Balance Scale and Rivermead Mobility Index using Spearmans rho. Setting: Stroke physiotherapy services of six National Health Service hospitals. Participants: People with a post stroke hemiplegia attending physiotherapy who had no other pathology affecting their balance took part. Thirty-five people participated in the reliability testing and 48 people took part in the validity testing. Main outcome measures: The following functional balance tests were used: supported sitting balance, sitting arm raise, sitting forward reach, supported standing balance, standing arm raise, standing forward reach, static tandem standing, weight shift, timed 5-m walk with and without an aid, tap and step-up tests. Results: The ordinal level tests (supported sitting and standing balance and static tandem standing tests) showed 100% agreement in all aspects of reliability. Intraclass correlations for the other tests ranged from 0.93 to 0.99. All the tests showed significant correlations with the appropriate comparator tests (r=0.32-0.74 p≤0.05), except the weight shift test and step-up tests which did not form significant relationship with Berg Balance Scale (r=0.26 and 0.19 respectively). Conclusion: These functional balance tests are reliable and valid measures of balance disability post stroke.

Development of the Brunel Balance Assessment: a new measure of balance disability post stroke

Objective: To report the psychometric properties of the Brunel Balance Assessment (BBA), a new test of balance disability post stroke. Design: Data from 92 subjects were collected and cohorts used to test hierarchical scaling, reliability and validity. Data from 80 people were used to test the hierarchical scaling using an inter-item correlation for redundancy, coefficient of reproducibility (CR) and scalability (CS) for the hierarchy and Cronbachs alpha coefficient for the internal consistency. Thirty-seven people participated in the reliability testing. Test / retest and inter-tester reliability were tested using the kappa coefficient. The testing was repeated on consecutive days to assess test / retest reliability and was scored simultaneously by two physiotherapists for inter-tester reliability. Fifty-five people participated in validity testing. The BBA was compared with the sitting Motor Assessment Scale (MAS), Berg Balance Test (Berg), Rivermead Mobility Index (RMI) using Spearmans rho. Setting: Physiotherapy stroke services of six UK NHS trusts. Participants: Hemiplegic stroke patients were recruited from physiotherapy services and the BBA used to assess their balance. Results: The order of the items was revised and the original 14-point scale reduced to 12 points in the scale development. The revised scale formed a hierarchical scale. Inter-item correlations were < 0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively and Cronbachs alpha was 0.92. Reliability was high (100% agreement) for both aspects of reliability. Correlations with other balance measures were significant (0.83 / 0.97, p<0.01) indicating validity as measure of balance disability. Conclusion: The BBA is a reliable, valid, hierarchical measure of balance disability post stroke that is suitable for use in the clinical setting.

The effect of core stability exercises on variations in acceleration of trunk movement, pain, and disability during an episode of acute nonspecific low back pain: a pilot clinical trial.

OBJECTIVE The purpose of this preliminary study was demonstrate if it was feasible to evaluate variations in acceleration of trunk movement, pain, and disability during an episode of acute nonspecific low back pain comparing regular trunk exercises to regular exercises in addition to core stability exercises. METHODS A pilot randomized controlled trial was used to evaluate 33 participants recruited from a National Health Service physiotherapy musculoskeletal provider in the London district of Hillingdon. Participants were allocated to 2 groups; a regular exercise group (male, 2; female, 15) with a mean (SD) age of 35.8 (9.1) years and intervention group (male, 3; female, 13) with a mean (SD) age of 36.2 (9.8) years. The regular exercise group received exercise that consisted of a core stability class including both specific and global trunk exercises. The intervention group, in addition to these core exercises, received further instruction on 8 specific stabilization muscles involving the transversus abdominis and the lumbar multifidus. Trunk sagittal acceleration, pain, and disability were measured using a Lumbar Motion Monitor, pain visual analog scale, and Roland Morris Disability Questionnaire, respectively. Measures were taken at baseline, 3 and 6 weeks, and a 3-month follow-up. Multiple regression with adjustment for baseline value was used to analyze each outcome. All outcomes were log transformed to correct skewness and so presented as ratio of geometric means with 95% confidence interval. RESULTS Differences in mean trunk sagittal acceleration between the regular exercise and intervention groups was not statistically significant at any time point (ratio of means [95% confidence interval]: 3 weeks 1.2 [0.9-1.6], P = .2; 6 weeks 1.1 [0.8-1.5], P = .7; 3 months: 1.2 [0.8-1.9], P = .9). Similarly, the effects on neither pain score nor disability score were significant (pain score: 3 weeks 1.3 [0.8-2.2], P = .3); 6 weeks 1.2 [0.7-2.0], P = .6; 3 months 1.0 [0.5-1.9], P = 1.0); disability score: 6 weeks 1.0 [0.7-1.5], P = 1.0; 3 months 1.3 [0.8-1.9], P = .3). Outcome measures for both groups improved over time. CONCLUSIONS This pilot study demonstrated that a study of this nature is feasible. Both the regular exercise and the intervention groups demonstrated improvements in mean trunk sagittal acceleration at 3, 6, and 12 weeks. The preliminary findings showed that evidence was inconclusive for the beneficial effect of adding specific core stability exercises for acute low back pain. The results of this study demonstrated an increase in acceleration accompanied by a reduction in pain, which may suggest that acute nonspecific low back pain may induce the pain-spasm-pain model rather than the pain adaptation model.

A Systematic Review of Methods to Measure Balance and Walking Post-Stroke. Part 1: Ordinal Scales

Abstract The rehabilitation of balance and walking is a cornerstone of stroke physiotherapy and our main interest is to assess the effectiveness of physiotherapy interventions. We therefore reviewed the literature to seek outcome measures which would be suitable for such a purpose. This article is limited to ordinal scales. CINAHL, Medline and Embase databases were searched for measurement tools which measured balance and/or walking post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, scale development, suitability for use in clinical settings and with a wide range of stroke severity. Twenty-six measurement tools were identified. All had some information about their psychometric properties but few had been rigorously tested. They were generally reliable and valid, but sensitivity to change was poor or untested and few showed a true hierarchy. None of the measurement tools fulfilled all the assessment criteria.

THE MEASUREMENT OF BALANCE AND WALKING POST-STROKE. PART 2: FUNCTIONAL PERFORMANCE TESTS

Abstract The rehabilitation of balance and walking is a primary goal of stroke physiotherapy and our main interest is to assess the effectiveness of physiotherapy interventions. The literature was reviewed to seek functional performance tests (ratio and interval tests which require the subject to perform a balance or walking task) that would be suitable for such a purpose. CINAHL, Medline and Embase databases were searched for tests which measured balance and/or walking post-stroke and could be used in clinical settings. They were assessed for reliability, validity, sensitivity to change, suitability for use in clinical settings and with a wide range of stroke severity. Fourteen tests were identified. All had some information about their psychometric properties. They were generally reliable, valid, and sensitive to change, easy to use and suitable for community and hospital settings. An exception was timed balance tests, which showed poor reliability and validity. The main disadvantage is that any test is only suitable for a narrow range of ability, there is also insufficient information about the measurement error to be able to judge whether they could be used to assess the effects of specific interventions.

Influence of a Walking Aid on Temporal and Spatial Parameters of Gait in Healthy Adults

To determine the effect of using a walking aid on temporal and spatial parameters of gait when used for balance versus support on the dominant and nondominant hand side.

The Brunel Balance Assessment: A new measure of balance disability post-stroke

OBJECTIVE To report the psychometric properties of the Brunel Balance Assessment (BBA), a new test of balance disability post stroke. DESIGN Data from 92 subjects were collected and cohorts used to test hierarchical scaling, reliability and validity. Data from 80 people were used to test the hierarchical scaling using an inter-item correlation for redundancy, coefficient of reproducibility (CR) and scalability (CS) for the hierarchy and Cronbachs alpha coefficient for the internal consistency. Thirty-seven people participated in the reliability testing. Test-retest and inter-tester reliability were tested using the kappa coefficient. The testing was repeated on consecutive days to assess test-retest reliability and was scored simultaneously by two physiotherapists for inter-tester reliability. Fifty-five people participated in validity testing. The BBA was compared with the sitting Motor Assessment Scale (MAS), Berg Balance Test (Berg), Rivermead Mobility Index (RMI) using Spearmans rho. SETTING Physiotherapy stroke services of six UK NHS trusts. PARTICIPANTS Hemiplegic stroke patients were recruited from physiotherapy services and the BBA used to assess their balance. RESULTS The order of the items was revised and the original 14-point scale reduced to 12 points in the scale development. The revised scale formed a hierarchical scale. Inter-item correlations were < 0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively and Cronbachs alpha was 0.92. Reliability was high (100% agreement) for both aspects of reliability. Correlations with other balance measures were significant (0.83-0.97, p < 0.01) indicating validity as measure of balance disability. CONCLUSION The BBA is a reliable, valid, hierarchical measure of balance disability post stroke that is suitable for use in the clinical setting.

Changing physical activity behaviour for people with multiple sclerosis: protocol of a randomised controlled feasibility trial (iStep-MS)

Introduction Although physical activity may reduce disease burden, fatigue and disability, and improve quality of life among people with multiple sclerosis (MS), many people with MS are physically inactive and spend significant time in sedentary behaviour. Behaviour change interventions may assist people with MS to increase physical activity and reduce sedentary behaviour. However, few studies have investigated their effectiveness using objective measures of physical activity, particularly in the long term. Further, interventions that have proven effective in the short term may not be feasible in clinical practice because of the large amount of support provided. The iStep-MS trial aims to determine the safety, feasibility and acceptability of a behaviour change intervention to increase physical activity and reduce sedentary behaviour among people with MS. Methods and analysis Sixty people with MS will be randomised (1:1 ratio) to receive a 12-week intervention or usual care only. The intervention consists of four physical activity consultations with a physiotherapist supported by a handbook and pedometer. Outcomes assessed at baseline, 12 weeks and 9 months are physical activity (ActiGraph wGT3X-BT accelerometer), sedentary behaviour (activPAL3µ), self-reported activity and sitting time, walking capability, fatigue, self-efficacy, participation, quality of life and health service use. The safety of the intervention will be determined by assessing change in pain and fatigue and the incidence of adverse events during the follow-up period. A parallel process evaluation will assess the feasibility and acceptability of the intervention through assessment of fidelity to the programme and semistructured interviews exploring participants’ and therapists’ experiences of the intervention. The feasibility of conducting an economic evaluation will be determined by collecting data on quality of life and resource use. Ethics and dissemination Research ethics committee approval has been granted from Brunel University London. Results of the trial will be submitted for publication in journals and distributed to people with MS and physiotherapists. Trial registration number ISRCTN15343862 (doi 10.1186/ISRCTN15343862). Protocol version: 1.0; Pre-results.