Sugalya Amatachaya

Reliability and validity of three functional tests in ambulatory patients with spinal cord injury.

Study design:A cross-sectional study.Objectives:To investigate reliability, discriminative ability and concurrent validity of three functional tests (including the 10-meter walk test (10MWT), timed up and go test (TUGT) and five times sit-to-stand test (FTSST)) using the Functional Independence Measure Locomotor (FIM-L) scores as a standard criterion.Setting:A tertiary rehabilitation center, Thailand.Methods:Subjects were 66 patients with spinal cord injury (SCI), who were able to walk at least 50 m unassisted with or without a walking device (FIM-L scores 6–7). They were tested for functional ability using the 10MWT, TUGT and FTSST. Sixteen subjects also assessed the ability using three assessors to evaluate the inter-tester reliability of the tools.Results:The three functional tests demonstrated excellent inter-tester reliability (intraclass correlation coefficient (3,3)=0.997–1.00) and could clearly distinguish between subjects who walked with and without a walking device. In addition, the tests showed significant correlation with walking categories or FIM-L scores (rpb=0.778, −0.692 and −0.595 for the 10MWT, TUGT and FTSST, respectively, P<0.001).Conclusion:The findings support reliability and validity of the 10MWT, TUGT and FTSST to assess levels of independences in ambulatory subjects with SCI.

Functional abilities, incidences of complications and falls of patients with spinal cord injury 6 months after discharge.

Study design:A prospective study.Objectives:To evaluate the changes of functional abilities, incidences of complications and falls of patients with spinal cord injury (SCI) 6 months after discharge.Setting:A major tertiary referral hospital, Thailand.Methods:Forty-four patients with SCI completed the study. Their average age and post-injury time were 45.23±13.78 years and 51.52±47.87 months respectively. Functional abilities of the subjects were measured by using the Spinal Cord Independence Measure II (SCIM II). Incidences of complications and falls were prospectively assessed every month by using a questionnaire.Results:After 6 months, the SCIM II scores of subjects showed a slight decrease (58.60±21.22–58.37±22.06 scores). The significant decrement was illustrated in self-care and mobility scores of subjects with chronic motor incomplete SCI (P<0.05). Forty subjects experienced at least one medical complication (range 1–5 times) which 11 of them had to re-admit for 3–30 days. Twenty-four subjects sustained at least one fall in 6 months (range 1–24 times) which one subject had metatarsal bone fracture after fall.Conclusion:The functional ability of subjects with SCI, particularly those with chronic motor incomplete SCI, significantly decreased after discharge. The subjects also encountered a high risk of complications and falls that might associate with the decrement of functional ability. The findings confirmed important roles of community rehabilitation after discharge.

Incidence and factors associated with falls in independent ambulatory individuals with spinal cord injury: a 6-month prospective study.

Background Sensorimotor impairments following spinal cord injury (SCI) affect mobility and subsequently increase the risk of falls to patients. However, most of the fall data for these patients were retrospectively gathered. Objectives This study prospectively assessed falls and intrinsic factors associated with falls in 89 independent ambulatory individuals with SCI over the course of 6 months. In addition, functional ability between participants who did and did not fall was compared. Methods Participants were interviewed and assessed for their baseline data and functional ability using the Timed “Up & Go” Test and the Six-Minute Walk Test. Then they were interviewed by telephone to complete a self-report questionnaire once per week to gather fall data for 6 months. A stepwise multiple logistic regression was utilized to determine the effects of demographics and SCI characteristics on occurrence of falls. The functional data between participants who fell and those who did not fall were compared using the Mann-Whitney U test. Results Thirty-five participants (39%) experienced at least 1 fall during 6 months (range=1–11). Two participants required medical attention due to patellar and sternum fractures after falling. Participants with an educational level of high school graduate or greater, an American Spinal Injury Association Impairment Scale C (AIS-C) classification, and a fear of falling (FOF) significantly increased their risk of falls approximately 4 times more than those who graduated primary education, had an AIS-D classification, and did not have FOF. Moreover, the functional abilities of participants who fell were significantly poorer than those who did not fall. Limitations The sample size was calculated based on the primary objective (incidence of falls), which may not be sufficient to clearly indicate factors associated with falls for the participants. Conclusions More than one third of the independent ambulatory participants with SCI experienced at least 1 fall during the 6-month period of the study. The findings suggest the importance of functional improvement on the reduction of fall risk in these individuals.

Falls in independent ambulatory patients with spinal cord injury: incidence, associated factors and levels of ability

Study Design:A 6-month retrospective study.Objectives:To investigate incidence and factors associated with falls in independent ambulatory patients with spinal cord injury (SCI), and to compare levels of ability in those with and without a history of falls.Setting:A tertiary rehabilitation center and community hospitals.Methods:Seventy-seven independent ambulatory subjects with SCI were interviewed for fall data during 6 months before participation in the study. Subjects were also assessed for their functional ability using the timed up and go test (TUGT) and the 6-min walk test (6MinWT).Results:Twenty-six subjects (34%) reported falls during 6 months (range 1–6 times). After falls, two subjects required medical attention due to wrist joint fracture and back pain. Walking without a walking device significantly increased the risk of fall, whereas using a walker significantly reduced the risk of fall (P<0.05). Moreover, faller subjects showed significantly better levels of ability than the non-faller subjects (P<0.005 for the TUGT and P<0.05 for the 6MinWT).Conclusion:Approximately one-third of the independent ambulatory subjects with SCI experienced falls. Notably, faller subjects had better functional ability than the non-faller subjects. Thus, apart from emphasizing the ability to walk independently, rehabilitation professionals may need to seek strategies that improve balance and safety.

Effects of external cues on gait performance in independent ambulatory incomplete spinal cord injury patients

Study design:An experimental, cross-sectional study.Objective:To investigate effects of external information or external cues on gait performance in independent ambulatory incomplete spinal cord injury (iSCI) patients (American Spinal Injury Association C or D, and functional independence measure walking scores=5–7).Setting:A university hospital, Thailand.Method:Gait performance was assessed in 29 patients with iSCI under four conditions including self-determined fastest walking speed, and fastest walking with the use of visual, auditory and visuotemporal cues. Average gait speed, stride length, cadence and percent step symmetry of these conditions were compared.Results:The use of external cues facilitated subjects to walk faster with a greater stride length, cadence and percent step symmetry than their own determination. The visuotemporal cue assisted subjects to increase their walking speed by 0.17 m s−1. The visual cue helped subjects to walk with a significantly greater stride length than the self-determined fastest pace condition (P<0.05). However, the visual cue made subjects walk with the lowest cadence and significantly lower than the visuotemporal cue condition (P<0.05).Conclusion:External information helped subjects to reorganize movement characteristics and perform a more efficient spatiotemporal gait pattern. The findings imply a significant role of external information on gait performance in patients with iSCI.

Concurrent validity of the 10-meter walk test as compared with the 6-minute walk test in patients with spinal cord injury at various levels of ability

Study design:Cross-sectional design.Objectives:To evaluate the concurrent validity of the 10-meter walk test (10MWT) as compared with the 6-minute walk test (6MinWT) in patients with spinal cord injury (SCI) at various levels of walking ability, as determined using the criteria from the functional independence measure locomotor (FIM-L) scores.Setting:A major tertiary referral hospital in Thailand.Methods:Ninety-four independent ambulatory subjects with SCI (FIM-L scores 5–7) were assessed for their functional abilities using the 10MWT and 6MinWT.Results:The data of the 10MWT and the 6MinWT had excellent correlation in subjects with FIM-L 7 (r=0.83, P<0.001), good correlation in subjects with FIM-L 6 (r=0.74, P<0.001), but poor correlation in subjects with FIM-L 5 (r=0.31, P>0.05).Conclusion:The 6MinWT is a thorough assessment to reflect functional endurance, but it requires a long time and a large area to administer. The findings confirm the utility of the 10MWT as an alternative monitoring tool to the 6MinWT, but only for the patients with rather good walking ability.

Reference Values of Physical Performance in Thai Elderly People Who Are Functioning Well and Dwelling in the Community

Background Because the number of elderly people is rapidly increasing, reference values for the physical abilities necessary to independently conduct daily activities are crucial for promoting good health. Although a few studies have reported reference values for functional tests relating to these abilities, all of those values were derived from populations in developed countries, which have baseline demographic and anthropometric characteristics different from those of Thai people. Objective The purpose of this study was to describe reference values for 5 physical performance tests for Thai elderly people who were functioning well and dwelling in the community. Design A cross-sectional design was used in this study. Methods A total of 1,030 Thai elderly people who were functioning well were cross-sectionally assessed for their physical abilities with 5 functional tests: 10-Meter Walk Test, Berg Balance Scale, Timed “Up & Go” Test, Five Times Sit-to-Stand Test, and Six-Minute Walk Test. The data were reported with descriptive statistics according to decade of age and sex. Differences among the age decades and between the sexes were analyzed with a 1-way analysis of variance and an independent-sample t test, respectively. Multiple linear regression analyses were used to determine baseline characteristics important in functional abilities. Results Most of the values found for the performance-based measures were lower than those previously reported, with a significant trend toward age- and sex-related functional decline. Weight and height were important contributors to level of functional ability. Limitations Only a few elderly individuals older than 90 years of age participated in this study. Therefore, their findings were combined with those of participants aged 80 to 89 years. Conclusions The findings described here may be useful as reference values for 5 physical performance tests for Thai elderly people. Health practitioners can use this information to identify functional impairments early and to promote independence in Thai and other elderly populations with similar anthropometric characteristics, such as those in the Association of South East Asian Nations.

Five-times-sit-to-stand test in children with cerebral palsy: Reliability and concurrent validity

BACKGROUND/PURPOSE Five-times-sit-to-stand test (FTSST) is a reliable tool for measuring lower limb functional strength and balance ability. However, reports of the reliability of FTSST in children with cerebral palsy have been scarce. The purposes of this study were (1) to investigate the test-retest and inter-rater reliability of the FTSST and (2) to investigate the correlation between the FTSST and standard functional balance tests in children with cerebral palsy. STUDY DESIGN Cross-sectional study. MATERIALS AND METHODS Thirty-three school children aged from 6 to 18 years with Gross motor functional classification system expanded and revised version (GMFCS-E&R) level I to III were recruited. Reliability of the FTSST and concurrent validity between FTSST and Timed up and go test (TUG) and Berg balance scale (BBS) were determined using the Pearson product moment correlation. RESULTS The intra-class correlation coefficient (ICC) for test-retest and inter-rater reliability of FTSST were 0.91 and 0.88 respectively. FTSST showed moderate correlation with TUG (r = 0.552, P < 0.01) and with BBS (r = -0.561, P < 0.01). CONCLUSION FTSST is a reliable assessment tool and correlates with functional balance ability tests in children with mild to moderate cerebral palsy.

Factors related to obstacle crossing in independent ambulatory patients with spinal cord injury.

Abstract Background/Objectives: To evaluate factors related to the ability of ambulatory patients with spinal cord injury (SCI) to walk over small obstacles. Study Design: Cross-sectional study. Methods: Thirty-four patients with SCI (ASIA impairment scale [AIS] D) who were able to walk independently at least 10 m with or without walking devices were recruited for the study. Participants were required to walk over small obstacles (1,4, and 8 cm in height or width; total of 6 conditions). A “fail” was recorded when either the lower limbs or the walking device contacted the obstacle. Multiple logistic regression models were applied to determine the effects of walking devices (presence or absence), SCI levels (tetraparesis or paraparesis), and SCI stages (acute or chronic) on the ability of obstacle crossing. Results: Fifteen participants (44%) failed to adequately clear the foot or walking device over obstacles in at least one condition (range 1–3 conditions). After adjusting for covariates, the chance of failure on obstacle crossing was greatly increased with the use of walking devices (odds ratio = 8.50; 95% CI = 0.85−75.03) Conclusions: Gait safety in independent ambulatory participants with SCI remains threatened. Participants who walked with walking devices encountered a greater chance of failing to walk over obstacles as a result of inefficiently moving the foot or walking device over small obstacles. Thus, instead of training in an empty/ quiet room, rehabilitation procedures should incorporate contextual conditions that patients encounter at home and in the community in order to minimize risk of injury and prepare patients to be more independent after discharge.

Discriminative ability of the three functional tests in independent ambulatory patients with spinal cord injury who walked with and without ambulatory assistive devices

Abstract Background/objectives Many persons with spinal cord injury (SCI) require an ambulatory assistive device (AAD). An effective monitoring method enables the use of an appropriate AAD and promotes levels of independence for patients. This study investigated the discriminative ability of the three-functional tools relating to walking ability, including the 10-meter walk test (10MWT), the five times sit-to-stand test (FTSST), and the timed up and go test (TUGT), in independent ambulatory persons with SCI who walked with walker, crutches, cane, and non-AAD. Methods Eighty-five persons with SCI who could perform sit-to-stand and walk independently at least 50 m were cross-sectionally assessed for their functional ability using the 10MWT, FTSST, and TUGT. Results The findings for persons not using AADs were significantly better than the other groups for every test (P < 0.001). In addition, persons who walked with cane were significantly different from those who used walkers (P < 0.001) but there were no significant differences between persons who used walker and crutches for every test (P > 0.05). Conclusion The findings supported the discriminative validity of the tools, allowing them to indicate functional changes in persons with SCI who walk with different AADs. However, the non-significant differences between subjects who used a walker and crutches may relate to the method of subject arrangement and inclusion criteria that recruit subjects with rather good walking capability and lower limb function. The findings may also suggest the use of the sit-to-stand maneuver as a simple screening tool for walking advancement of walker users, pending further investigation.