Suzanne Shanelle Kuys

Test-retest reliability of the GAITRite system in people with stroke undergoing rehabilitation

Purpose. To determine the test-retest reliability of the GAITRite system in measuring spatio-temporal gait parameters in people with stroke undergoing inpatient rehabilitation and to investigate whether walking ability influences test-retest reliability. Method. A within-subject repeated measures study was conducted. Twenty-one individuals with first stroke undergoing inpatient rehabilitation participated. The Motor Assessment Scale Item 5 score was used to categorise participants into poorer (score 3 or 4) or better walkers (score 5 or 6). Participants made two passes at a self-selected gait speed over the GAITRite mat on two separate occasions. Intra-class correlation coefficients (ICC(2,1)) and 95%% limits of agreement for spatio-temporal gait parameters between the two occasions and groups were determined. Results. No differences in gait parameters between the two sessions (p  >  0.15) were found. Test-retest reliability for the whole group was good to excellent, ICC(2,1) ranging from 0.72 to 0.94. Walking ability did influence these findings with fair to good reliability demonstrated for both poorer (ICC(2,1)  >  0.57) and better walkers (ICC(2,1)  >  0.41). Conclusions. It appears that the GAITRite has good test-retest reliability in this group of people with first stroke undergoing rehabilitation. Test reliability seems to be slightly higher for poorer walkers than better walkers.

Higher-intensity treadmill walking during rehabilitation after stroke in feasible and not detrimental to walking pattern or quality: a pilot randomized trial:

Objective: To determine whether higher-intensity treadmill walking during rehabilitation in those newly able to walk after stroke is feasible, is detrimental to walking or is beneficial. Design: A single-blind, randomized trial. Setting: Two rehabilitation units. Participants: Thirty people with first stroke. Interventions: Experimental group received 30 minutes of higher-intensity treadmill walking, three times per week for six weeks, in addition to usual physiotherapy. Control group received usual physiotherapy only. Main outcome measures: Feasibility was measured by examining compliance and adverse events. Detriment to walking was measured by examining pattern and quality. Benefit to walking was measured as capacity using six-minute walk test and speed, at baseline (Week 0), immediately after (Week 6) and at three months (Week 18). Results: Overall compliance was 89%, with no adverse events reported. There was no between-group difference in walking pattern and quality. By Week 6, the experimental group improved walking capacity by 62 m (95% confidence interval (CI) 10 to 114), comfortable walking speed by 0.18 m/s (95% CI 0.07 to 0.29) and fast walking speed by 0.18 m/s (95% CI 0.03 to 0.35) more than the control group. By Week 18, the experimental group was still walking 0.26 m/s (95% CI 0.12 to 0.41) faster than the control group. Conclusions: Higher-intensity treadmill walking during rehabilitation after stroke is feasible and not detrimental to walking pattern and quality in those newly able to walk. 94 participants are required to detect a between-group difference of 75 m on six-minute walk test (α 0.05, β 0.90) in future trials. Trial registration: ACTRN12607000412437

Prediction of Discharge Destination After Stroke Using the Motor Assessment Scale on Admission: A Prospective, Multisite Study

OBJECTIVE To determine if admission functional status, measured with the Motor Assessment Scale (MAS), was predictive of discharge destination to home or residential aged care in patients with stroke undergoing rehabilitation. DESIGN Cohort study. SETTING Inpatient rehabilitation units. PARTICIPANTS Adults (N=566) diagnosed with stroke undergoing inpatient physiotherapy at one of 15 units in Australia. INTERVENTION Multidisciplinary rehabilitation. MAIN OUTCOME MEASURE Discharge home versus residential aged care. RESULTS Prestroke residential status, gait ability measured with the MAS (MAS-5), rolling ability (MAS-1), and age were able to correctly predict 99% of patients with stroke discharged home and 33.3% discharged to residential aged care facilities, producing an accuracy of 87.3%. Odds ratios indicate that for every 1-point increase in MAS-5 (gait), subjects were 1.66 times more likely to go home (95% confidence interval [CI], 1.28-2.27; P<.001). Similarly, for every 1-point increase in MAS-1 (rolling), subjects were 1.28 times more likely to go home (95% CI, 1.11-1.49; P<.01). CONCLUSIONS Two items of the MAS assessed on admission to rehabilitation-gait and rolling-in conjunction with basic demographic information of age and prestroke residential status, were highly predictive of discharge from rehabilitation to home.

Cost-Effectiveness Analysis of Screening for Risk of In-Hospital Falls Using Physiotherapist Clinical Judgement

Introduction:Screening hospital patients for falls risk is now a contentious component of geriatric care despite its widespread clinical use. The economic implications of using a falls risk screening approach to deliver an effective falls prevention intervention have not previously been examined. Methods:This was a multicenter prospective longitudinal cohort and incremental cost-effectiveness analysis. Participants/Setting:One thousand one hundred twenty-three geriatric inpatients from 17 rehabilitation units across Australia. Measures:Physiotherapist accuracy in predicting patient who will fall was captured with the question “Will this patient experience one or more falls during their rehabilitation period?” Falls were measured using hospital incident reporting systems. Procedure:The multicenter longitudinal cohort was undertaken to establish the predictive accuracy of physiotherapist clinical judgement. This data was used in the incremental cost-effectiveness analysis where estimates of the cost of falls and effectiveness of an intervention program were taken from previous research. Results:The accuracy of physiotherapist clinical judgement in predicting falls was high relative to previous research (sensitivity = 0.61, specificity = 0.82, Youden index = 0.43). Selectively providing patient falls-prevention education using physiotherapist clinical judgement would reduce falls [2.2 (SD: 0.19) fallers per 100 inpatients reduction] and reduce resources spent on trying to prevent and treat injuries from in-hospital falls [

Measurement of functional ability following traumatic brain injury using the Clinical Outcomes Variable Scale: A reliability study

2704 AUD (SD:

Changes in falls risk factors for geriatric diagnostic groups across inpatient, outpatient and domiciliary rehabilitation settings

432) per 100 inpatients reduction] compared with doing nothing. However, there was greater uncertainty as to whether the patient education intervention modeled should be provided selectively or universally. Conclusions:Preventing in-hospital falls using a targeted falls prevention intervention approach utilizing physiotherapist clinical judgement was more cost-effective than a “no intervention” approach.

Validation and reliability of the Modified Elderly Mobility Scale

This study determined the inter-tester and intra-tester reliability of physiotherapists measuring functional motor ability of traumatic brain injury clients using the Clinical Outcomes Variable Scale (COVS). To test inter-tester reliability, 14 physiotherapists scored the ability of 16 videotaped patients to execute the items that comprise the COVS. Intra-tester reliability was determined by four physiotherapists repeating their assessments after one week, and three months later. The intra-class correlation coefficients (ICC) were very high for both inter-tester reliability (ICC > 0.97 for total COVS scores, ICC > 0.93 for individual COVS items) and intra-tester reliability (ICC > 0 97). This study demonstrates that physiotherapists are reliable in the administration of the COVS.

Immediate effect of treadmill walking practice versus overground walking practice on overground walking pattern in ambulatory stroke patients: an experimental study:

Purpose. To compare falls event rates and risk factors for falls across three rehabilitation settings. Methods. A multi-centre prospective longitudinal cohort study was conducted of 1682 participants referred for rehabilitation from 18 sites (across two Australian states) and receiving physiotherapy treatment. Falls risk factors across multiple domains (rehabilitation settings, medical diagnoses, age, gender, standing balance, functional capacity, cognition, prior living arrangements, pre-admission use of gait aid and past history of falls) were collected by treating physiotherapists on admission to rehabilitation. Falls were measured by incident reporting and review of medical histories in the inpatient settings and by weekly interviews in the outpatient and domiciliary settings. Results. Overall, outpatient and domiciliary settings demonstrated lower falls event rates compared to inpatient [IRR (95%% CI): 0.58 (0.36–0.93) and 0.35 (0.24–0.51)], respectively. Cognitive status, functional ability and past history of falls were consistent risk factors across settings. However medical diagnoses of stroke, other neurological conditions, elective orthopaedic and other orthopaedic together with standing balance were inconsistent as risk factors or protective factors across settings. Conclusions. Risk factors for falls, including medical diagnosis, are not necessarily universal across settings. Balance performance was a significant risk factor for outpatient and domiciliary settings but was not a risk factor for inpatients. Cognitive status and a previous history of falls were, however, consistent risk factors across all settings. This suggests that different approaches for the prevention of falls may be required for the same diagnostic group of patients depending on the location of the rehabilitation setting.

Dose-response relationship between physiotherapy resource provision with function and balance improvements in patients following stroke : A multi-centre observational study

Objective:  To establish concurrent validity, interrater and test–retest reliability of the Modified Elderly Mobility Scale (MEMS).

Measures of activity limitation on admission to rehabilitation after stroke predict walking speed at discharge: an observational study

Objective: To determine whether 10 minutes of treadmill walking had a different effect on overground walking pattern compared with 10 minutes of overground walking in newly ambulatory stroke patients. Are any changes influenced by walking ability? Design: A within-participant, repeated measures experimental study was conducted. Each participant carried out 10 minutes of overground walking practice followed by 10 minutes of treadmill walking practice at matched heart rate on separate days. Setting: An inpatient rehabilitation facility. Subjects: Twenty-one participants receiving inpatient rehabilitation following stroke. Measures: Overground walking pattern was measured as linear and angular kinematics using GAITRite and a two-dimensional webcam application respectively. Results: Following treadmill walking practice, there was 6 degrees (95% confidence interval (CI) 2 to 10) more knee extension at heel strike during overground walking than following overground walking practice. Poorer walkers increased non-paretic limb step length following treadmill walking practice more than those with better walking ability (mean difference 2.2 cm, 95% CI 0 to 5). Conclusions: Ten minutes of treadmill walking practice resulted in a similar overground walking pattern compared with overground walking practice in newly ambulatory stroke patients undergoing rehabilitation, regardless of walking ability.