Shamay S. Ng

5-Repetition Sit-to-Stand Test in Subjects With Chronic Stroke: Reliability and Validity

OBJECTIVESnTo examine the (1) intrarater, interrater, and test-retest reliability of the 5-repetition sit-to-stand test (5-repetition STS test) scores, (2) correlation of 5-repetition STS test scores with lower-limb muscle strength and balance performance, and (3) cut-off scores among the 3 groups of subjects: the young, the healthy elderly, and subjects with stroke.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnA convenience sample of 36 subjects: 12 subjects with chronic stroke, 12 healthy elderly subjects, and 12 young subjects.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESn5-Repetition STS test time scores; hand-held dynamometer measurements of hip flexors, and knee flexors and extensors; ankle dorsiflexors and plantarflexors muscle strength; Berg Balance Scale (BBS); and limits of stability (LOS) test using dynamic posturography.nnnRESULTSnExcellent intrarater reliability of intraclass correlation coefficient (ICC) (range, .970-.976), interrater reliability (ICC=.999), and test-retest reliability (ICC range, .989-.999) were found. Five-repetition STS test scores were also found to be significantly associated with the muscle strength of affected and unaffected knee flexors (rho=-.753 to -.830; P<.00556) of the subjects with stroke. No significant associations were found between 5-repetition STS test and BBS and LOS tests in subjects with stroke. Cut-off scores of 12 seconds were found to be discriminatory between healthy elderly and subjects with stroke at a sensitivity of 83% and specificity of 75%.nnnCONCLUSIONSnThe 5-repetition STS test is a reliable measurement tool that correlates with knee flexors muscle strength but not balance ability in subjects with stroke.

Contribution of ankle dorsiflexor strength to walking endurance in people with spastic hemiplegia after stroke.

OBJECTIVESn(1) To determine the relationships of ankle dorsiflexor strength, ankle plantarflexor strength, and spasticity of the ankle plantarflexors with walking endurance; (2) to determine whether affected ankle dorsiflexor strength makes an independent contribution to walking endurance; and (3) to quantify its relative contribution to the walking endurance of people with spastic hemiplegia after stroke.nnnDESIGNnA cross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnSubjects (N=62) with spastic hemiplegia.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnWalking endurance was measured by the distance covered in the six-minute walk test (6MWT). Ankle dorsiflexor and plantarflexor strength were measured using a load-cell mounted on a custom-built foot support. Plantarflexor spasticity was measured using the Composite Spasticity Scale.nnnRESULTSnThe six-minute walk distances showed stronger positive correlation with affected dorsiflexor strength (r=.793, P≤.000) when compared with affected plantarflexor strength (r=.349, P=.005). Results of the regression model showed that after adjusting for basic demographic and stroke-related impairments, affected ankle dorsiflexor strength remained independently associated with six-minute walk distance, accounting for 48.8% of the variance.nnnCONCLUSIONSnThis is the first study, to our knowledge, to document the importance of ankle dorsiflexor strength as an independent determinant of walking endurance in stroke survivors with spastic plantarflexors. Our findings suggest that stroke rehabilitation programs aiming to improve walking endurance should include strengthening exercises for the ankle dorsiflexors.

Walkway Length, But Not Turning Direction, Determines the Six-Minute Walk Test Distance in Individuals With Stroke

OBJECTIVESnTo examine (1) the effect of different walkway distances, and (2) turning directions on the six-minute walk test (6MWT) in subjects with stroke.nnnDESIGNnA cross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnSubjects (N=26) with chronic stroke.nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnTotal distance covered and number of turns in the 6MWT with different walkway lengths (10-, 20-, and 30-m walkway distances) and turning directions (turning to affected side and unaffected side); rate of perceived exertion (RPE) using Borg Scale, and heart rate (HR) using handheld pulse oximeter recorded before and immediately after the test.nnnRESULTSnThe distance covered and the number of turns in the 6MWT were significantly different between different walkway lengths (P<.05), with the longest distance covered and lowest number of turns in the 30-m walkway distance. For all walkway lengths, turning to the affected or unaffected side did not result in significant differences in the distance covered and the number of turns in the 6MWT. Significant increases were found between the pretest and posttest for the HR and RPE (P<.05) in all testing conditions. There was no significant effect of walkway distance and turning direction on the change in HR and RPE between the 6 conditions of the 6MWT.nnnCONCLUSIONSnDifferent walkway distances have a significant effect on the distance covered in the 6MWT, whereas turning direction did not significantly affect the distance covered in the 6MWT.

Effect of walkway length and turning direction on the distance covered in the 6-minute walk test among adults over 50 years of age: a cross-sectional study

OBJECTIVEnTo examine the effect of walkway length and turning direction on the distance covered in the 6-minute walk test (6MWT) in healthy adults aged ≥50 years.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation centre.nnnPARTICIPANTSnTwenty-five healthy adults aged ≥50 years.nnnOUTCOME MEASURESnDistance covered in the 6MWT (6MWD) was recorded in metres. Number of turns during the test using walkways of various lengths (10, 20 and 30m) and different turning directions (turning towards dorminant and non-dorminant side), rate of perceived exertion and heart rate were recorded before and after the test.nnnRESULTSnThe 6MWD and the number of turns differed significantly with walkway length (P<0.05). The greatest 6MWD and the lowest number of turns were recorded in the 30-m walkway. Significant increases in heart rate and rate of perceived exertion (P<0.05) were found between the pre-test and post-test for all testing conditions. No significant difference was found between the two turning directions for any distance covered.nnnCONCLUSIONnThe length of the walkway had a significant effect on the 6MWD, but the turning direction did not. This suggests that subjects can turn in either direction without significantly affecting the results when using a standard walkway in the 6MWT.

Reliability and Concurrent Validity of Four Square Step Test Scores in Subjects With Chronic Stroke: A Pilot Study

OBJECTIVESnTo establish (1) the intrarater and interrater reliability of Four Square Step Test (FSST) times in persons with chronic stroke; (2) the concurrent validity of FSST times with standing balance and functional mobility measures; and (3) the FSST cutoff score for distinguishing the differences in dynamic balance performance of persons with chronic stroke from healthy control adults.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnConvenience sample of subjects (N=30) consisting of community-dwelling persons with chronic stroke (n=15) and healthy control adults (n=15).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnFSST scores; balance and functional mobility measured using Berg Balance Scale (BBS) scores; Timed Up & Go (TUG) test scores; and limits of stability (LOS) measured by dynamic posturography.nnnRESULTSnFSST times showed good intrarater reliability, with intraclass correlation coefficients ranging from .82 to .83 and an interrater reliability >.99. An FSST cutoff score of 11 seconds was able to discriminate between healthy adults older than 50 years and persons with stroke (sensitivity, 73.3%; specificity, 93.3%). FSST times were correlated with LOS scores for directional control in the backward direction (r=.64; P=.01). FSST was approaching a significant correlation with TUG scores (r=.59; P=.02) and LOS scores for endpoint excursion in the forward direction (r=-.58; P=.02). However, there was no correlation with BBS scores.nnnCONCLUSIONnFSST is an easy-to-administer clinical test with good intrarater and interrater reliability in persons with chronic stroke to assess dynamic standing balance. FSST times of 11 seconds are able to differentiate between persons with chronic stroke and healthy adults older than 50xa0years. The correlation of FSST times with standing balance and functional mobility measures requires further research with a larger sample size.

Reliability and Validity of Step Test Scores in Subjects With Chronic Stroke

OBJECTIVESnTo establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the STs known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnConvenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test.nnnRESULTSnST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg.nnnCONCLUSIONSnThe ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years.

Parallel Walk Test: Its Correlation With Balance and Motor Functions in People With Chronic Stroke

OBJECTIVESnTo investigate (1) the intrarater, interrater, and test-retest reliability of the times and scores generated in the parallel walk test (PWT); (2) their correlations with impairments and activity limitations of individuals with stroke; and (3) the cutoff times that best discriminate individuals with stroke from healthy elderly subjects.nnnDESIGNnCross sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnParticipants (N=72) comprised individuals with stroke (n=37) and healthy individuals (n=35).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnThe PWT was administered along with the Fugl-Meyer Motor Assessment of the Lower Extremities (FMA-LE), handheld dynamometer measurements of ankle dorsiflexor and plantarflexor muscle strength, the 5-Times-Sit-to-Stand Test, the Berg Balance Scale (BBS), a limits of stability (LOS) test, the 10-m walk test (10-MWT), and the timed Up and Go (TUG) test.nnnRESULTSnPWT times and scores showed good to excellent intrarater, interrater, and test-retest reliability in individuals with stroke. PWT times using paths of 3 different widths significantly correlated with FMA-LE scores, 5-Times-Sit-to-Stand Test times, BBS scores, some LOS test results, 10-MWT gait speed, and TUG test times. PWT times of 6.30 to 7.48 seconds, depending on the path width, were shown reliably to discriminate individuals with stroke from healthy individuals.nnnCONCLUSIONnThe PWT is a reliable, easy-to-administer clinical tool for assessing dynamic walking balance in individuals with chronic stroke.

Timed 360° Turn Test for Assessing People With Chronic Stroke

OBJECTIVESnTo investigate (1) the intrarater, interrater, and test-retest reliability of the timed 360° turn test in subjects with stroke; (2) the concurrent validity of the timed 360° turn test by exploring its correlation with other measures of stroke-specific impairments; and (3) the cutoff times that best discriminate individuals with stroke from healthy older adults.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnIndividuals with chronic stroke (n=72) and healthy individuals (n=35) of similar age (N=107).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnThe timed 360° turn test was administered along with the Fugl-Meyer assessment of the lower extremity, measurement of muscle strength of ankle dorsiflexors and plantarflexors using a handheld dynamometer, Berg Balance Scale, limit of stability test, five times sit-to-stand (FTSTS) test, 10-m walk test, and timed Up and Go (TUG) test.nnnRESULTSnThe 360° turn times showed excellent intrarater, interrater, and test-retest reliability in individuals with stroke. A minimal detectable change of .76 seconds was found for subjects turning toward the affected side and 1.22 seconds for subjects turning toward the unaffected side. The 360° turn times were found to correlate significantly with Fugl-Meyer assessment of the lower extremity scores, dosiflexor strength of the affected ankle, plantarflexor strength of both ankles, FTSTS test times, balance performance, gait speed, and TUG test times. The 360° turn times of 3.43 to 3.49 seconds were shown to discriminate reliably between individuals with stroke and healthy older adults.nnnCONCLUSIONSnThe timed 360° turn test is a reliable and an easily administered clinical tool to assess the turning ability of subjects with chronic stroke.

Fear Avoidance Behavior, Not Walking Endurance, Predicts the Community Reintegration of Community-Dwelling Stroke Survivors

OBJECTIVEnTo examine the contribution of walking endurance, subjective balance confidence, and fear avoidance behavior to community reintegration among community-dwelling stroke survivors.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnPatients with chronic stroke (N=57) aged ≥50 years.nnnINTERVENTIONSnNone.nnnMAIN OUTCOME MEASUREnThe Chinese version of the Community Integration Measure (CIM).nnnRESULTSnOur correlation analyses revealed that fear avoidance behavior as measured by the Chinese version of the Survey of Activities and Fear of Falling in the Elderly (SAFE) scores had the highest significant negative correlation with CIM scores among all the variables tested. Our regression analyses also revealed that walking endurance and subjective balance confidence were not significant predictors of CIM scores. Based on scores on the number of falls in the previous 6 months, Chinese version of the Geriatric Depression Scale scores, distance covered in the 6-minute walk test, and Chinese versions of the Activities-specific Balance Confidence Scale scores and SAFE scores, our final regression model predicted 49.7% of the variance in the Chinese version of the CIM scores.nnnCONCLUSIONSnThe levels of walking endurance and subjective balance confidence are not significant predictors of community reintegration of community-dwelling stroke survivors but the fear avoidance behavior. Future studies addressing fear avoidance behavior is clearly warranted for stroke rehabilitation.

Reliability and Validity of the Timed Up and Go Test With a Motor Task in People With Chronic Stroke

OBJECTIVESnTo examine (1) the intra-rater, interrater, and test-retest reliabilities of the timed Up and Go test with a motor task (TUGmotor) in terms of the number of steps taken in the test and completion time in a population with chronic stroke; (2) the relation between stroke-specific impairments and the number of steps taken in the test and the completion time; (3) the minimum detectable change in TUGmotor times; and (4) the cutoff time that best discriminates the performance of people with stroke from that of older adults without stroke.nnnDESIGNnCross-sectional study.nnnSETTINGnUniversity-based rehabilitation center.nnnPARTICIPANTSnA sample (N=65) of chronic stroke survivors (n=33) and healthy older adults (n=32).nnnINTERVENTIONSnNot applicable.nnnMAIN OUTCOME MEASURESnTUGmotor times and number of steps taken; Fugl-Meyer Assessment for the Lower Extremities score; handheld dynamometer measurements of hip abductor, knee flexor and extensor, and ankle dorsiflexor and plantar flexor muscle strength; 5-times sit-to-stand test time, Berg Balance Scale score; conventional timed Up and Go test time, and Activities-specific Balance Confidence scale and Community Integration Measure questionnaire scores.nnnRESULTSnThe TUGmotor completion times and number of steps demonstrated excellent intra-rater, interrater, and test-retest reliabilities. The TUGmotor times correlated significantly with the Fugl-Meyer Assessment for the Lower Extremities and Berg Balance Scale scores, with hip abductor, knee flexor, ankle dorsiflexor and plantar flexor strength on the paretic side, with 5-times sit-to-stand test times, and with times on the conventional timed Up and Go test. The minimum detectable change in TUGmotor time was 3.53 seconds in stroke survivors. A TUGmotor cutoff time of 13.49 seconds was found to best discriminate the performance of stroke survivors from that of older adults without stroke.nnnCONCLUSIONSnThe TUGmotor is a reliable, valid, and easy-to-administer clinical tool for assessing advanced functional mobility after a stroke.