Reliability and validity of the L test in participants with chronic stroke

The effect of rectus femoris transfer on kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait

BACKGROUND

Stiff knee gait is characterized by a reduced peak knee flexion during swing. Overactivity of the rectus femoris is often cited as a main cause for stiff knee gait. Little is known about the effect of an isolated rectus femoris transfer treatment on kinematic and functional outcomes in a group of stroke survivors.

OBJECTIVE

To perform an experimental study to evaluate the effect of an isolated rectus femoris transfer on knee and hip kinematics and functional outcomes in adult stroke patients walking with a stiff knee gait.

METHOD

In this experimental study, 10 stroke survivors were included. During the surgical procedure, the distal rectus femoris tendon of the affected side was transferred to the medial knee flexors to improve knee flexion during swing. Knee and hip kinematics and a variety of functional outcomes were measured within 3 weeks before surgery and between 6 and 7 months after the surgery.

RESULTS

We found a statistically significant improvements in peak knee flexion during swing and knee range of motion of 10.6° (sd 4.7, p=0.000) and 10.5° (sd 6.2, p=0.001) post-surgery, respectively. Hip kinematics showed no significant differences. In addition, we found statistically significant improvements on the 6-minute walk test (42.5, sd 36.7, p=0.008), 10-meter walk test (1.26, sd 1.4, p=0.030), Timed up-and-go test (1.34, sd 1.18, p=0.009), L-test (2.97 sd 2.85, p=0.014) and on a subjective BORG scoring of foot clearance (1.8, sd 0.6, p=0.006). No significant differences were found on other measured functional outcomes.

CONCLUSIONS

Rectus femoris transfer is a valuable treatment option for stroke patients walking with a stiff knee gait to improve knee kinematics and a selection of functional outcomes. There are no detrimental side effects on hip kinematics.

Assessing the Turning Ability during Walking in People with Stroke Using L Test

BACKGROUND

The L Test of Functional Mobility (L Test) was developed to assess the advanced mobility, which includes both turning and walking ability. This study aimed to evaluate (1) the intra-rater reliability of the L Test in four turning conditions, (2) the correlation with other stroke-specific impairment for community-dwelling older adults with stroke, and (3) the optimal cut-off completion time of the L Test to distinguish the difference of performance between healthy older adults and people with stroke.

METHODS

This is a cross-sectional design. Thirty older adults with stroke and healthy older adults were included. The subjects were assessed by L Test along with other stroke-specific outcomes.

RESULTS

The L Test showed excellent intra-rater reliability (ICC = 0.945-0.978) for the four turning conditions. There were significant correlations between L Test completion times and Fugl-Meyer Assessment-Lower Extremity (FMA-LE) scores, Fugl-Meyer Assessment-Upper Extremity (FMA-UE) scores, Berg Balance Scale (BBS) score, and Timed Up and Go (TUG) Test scores. The cut-off of the L Test was established as 23.41-24.13 s.

CONCLUSION

The L Test is an easy-to-administer clinical test for assessing the turning ability of people with stroke.

Test-retest reliability of the L-Test in patients with advanced knee osteoarthritis

BACKGROUND

The reliability of tests to be used in research or clinical practice should be established for each population specific to their intended use. Reliability is important because it allows correct evaluations to be made about treatment effects or about the amount of changes.

OBJECTIVES

To evaluate the test-retest reliability and minimal detectable change of the L-test in patients with advanced knee osteoarthritis (OA).

METHODS

The intraclass correlation coefficient (ICC2,1) was used to assess the test-retest reliability of the L-test. The minimal detectable change with 95% confidence interval (MDC95) was calculated to determine the true change. The inclusion criteria were diagnosis of knee OA, had Kellgren Lawrence Grade IV and age of ≥40 years.

RESULTS

Twenty-five participants who met the inclusion criteria were included. Five were male and the mean age was 62.32±9.77 years. All of the participants had radiographic findings indicative of Kellgren-Lawrence Grade IV. The L-test showed excellent test-retest reliability. The ICC was 0.99, the SEM and the MDC95 was 1,90 and 5.28 seconds, respectively.

CONCLUSIONS

The L-test is a reliable outcome measurement for the assessment of walking ability in patients with advanced knee OA, and it showed very high test-retest reliability in these patients. This test may assist clinicians and researchers in assessing the functional mobility of patients and planning rehabilitation in patients with advanced knee OA.

Questionnaire development on measuring parents’ anxiety about their children’s education: Empirical evidence of parental perceived anxiety data for primary and secondary school students in China

Background

With the implementation of the “double reduction” policy in China, parents of primary and secondary school students are experiencing a growing trend of educational anxiety that needs to be alleviated.

Objective

To manage the education anxiety risk of parents of primary and secondary school students, a measurement questionnaire of parents’ anxiety about their children’s education (MQPAE) was developed and its reliability and validity were evaluated.

Methods

A self-administered MQPAE was developed. An online crowdsourcing questionnaire platform was used to collect data on parents’ anxiety about their children’s education (PAE), and parents of primary and secondary school students in Hefei, China, were selected as the study population. The randomly extracted 5,747 questionnaires were gradually screened by discrete trend method, t-test, and Pearson’s correlation coefficient method for the initial screening of PAE items, based on which exploratory factor analysis (EFA) was conducted for the final screening of questionnaire items and the reliability of the questionnaire. The reliability of the questionnaire was assessed by internal consistency and Pearson’s correlation coefficient analysis. Confirmatory factor analysis (CFA) was conducted using 639 pre-selected data to investigate the validity of the questionnaire. Structural equation modeling was used to investigate the structural validity of the questionnaire, and average variance extracted (AVE), combined reliability (CR), and maximum of shared squared variance (MSV) were used to test for convergent and discriminant validity.

Results

Exploratory factor analysis extracted five factors with a cumulative variance contribution of 65.66%. The CFA showed that χ²/df = 4.306, CFI = 0.920, NFI = 0.898, RMSEA = 0.072<0.08, AGFI = 0.839>0.80, PNFI = 0.793 and PGFI = 0.708. The overall Cronbach’s α coefficient of the questionnaire was 0.956, and the factors’ Cronbach’s α coefficients were 0.926, 0.857, 0.913, 0.901, and 0.768, respectively. Repeated measurements of Pearson’s correlation coefficients were 0.908, 0.911, 0.873, 0.891, 0.907 and 0.885 (all p < 0.001). The AVE was greater than 0.5 and the CR was greater than 0.7, and the value of the MSV was less than the corresponding AVE.

Conclusion

The MQPAE has good reliability and validity and can be used in studies related to PAE of primary and secondary school students.

Reliability, concurrent validity and minimal detectable change of the L test in patients with total knee arthroplasty

PURPOSE

The L test is a modified version of the timed up and go test (TUG), extending the walking distance from 6 to 20 meters and also requiring participants to make four turns in both (right/left) direction. It could be a useful measurement method in assessment of functional mobility for patients with Total Knee Arthroplasty (TKA). The aim of the study was to determine reliability, concurrent validity, and minimal detectable change (MDC) of L test in patients with TKA.

MATERIALS AND METHODS

The study included 43 patients with TKA. The Intraclass Correlation Coefficient (ICC) was used to assess the intra-rater reliability of the L test. The correlations of the L test with TUG were assessed for concurrent validity.

RESULTS

Intra-rater (ICC 0.97) reliability of the L test was determined to be excellent. The SEM and MDC₉₅ values of intra-rater reliability were 1.03 and 2.84, respectively. A high correlation was found between the L test and TUG (r: 0.75).

CONCLUSION

The L test is a valid and reliable method in the assessment of functional mobility in patients with TKA. The L test can be used to quantify changes in functional mobility level in patients with TKA.Implications for rehabilitationThe L test is a reliable and valid measurement tool that can be used to assess functional mobility in patients with TKA.Clinicians and researchers can use a greater change than 2.84 seconds for the L test as a meaningful change in patients with TKA.

Gait assessment in shaped pathways: The test-retest reliability and concurrent validity of the figure of eight test and L test in multiple sclerosis patients without mobility aids

PURPOSE

To our knowledge, no other studies have demonstrated the reliability and validity of the Figure of Eight Walking Test (F8WT) and L Test in patients with multiple sclerosis (MS). The aim of the study was to prove the test-retest reliability and concurrent validity of the F8WT and L Test in patients with MS.

METHODS

A cross-sectional study was conducted with 52 patients with MS. A clinical neurologist evaluated patients by Expanded Disability Status Scale (EDSS). Participants completed the F8WT, L Test, Timed Up and Go Test (TUG), and Timed 25-Foot Walk Test (T25FW) in the first assessment session. Then, the F8WT and L Test was retested one hour later. The same evaluator completed all of the assessments.

RESULTS

The ICC of both tests were excellent (ICC_F8WT: 0.972, ICC_{L Test}: 0.986). F8WT and L test measurement did not show a systematic bias and were within the agreement limits. The Standard Error of Measurement (SEM₉₅) and Minimal Detectable Change (MDC₉₅) values of the F8WT was 0.58 and 1.60, respectively. Besides, L Test's SEM₉₅ and MDC₉₅ were 0.59 and 1.63. The correlation between F8WT with TUG, T25FW and EDSS was 0.849, 0.810 and 0.453. On the other hand, the L test's correlation coefficient with TUG, T25FW and EDSS 0.682, 0.706 and 0.535, respectively (p < 0.01). Individuals with "EDSS ≤ 1″ had statistically significantly better L-test and F8WT scores than those with "EDSS: 1 to 4.5″ (p < 0.01).

CONCLUSION

F8WT and L Test is a valid and reliable physical performance test in MS patients without mobility aids. Both tests demonstrate advanced gait assessment in L and 8 shaped pathways to provide more comprehensive evaluation than horizontal pathways.

Subhealth Risk Perception Scale: Development and Validation of a New Measure

Background

To develop an individual's physical subhealth risk perception scale and evaluate its reliability and validity, so as to provide a measurement tool for individual physical health risk.

Methods

A questionnaire on the perception risk of physical subhealth was developed. Using a random sampling method, 785 people in the Anhui provincial physical examination centre were selected as the research participants. Of the questionnaires returned, 770 were valid, giving an effective rate of 98%. Firstly, the Pearson correlation coefficient method was used to study the correlation of 35 items in the initial scale, and then, polychoric factor structure analysis was carried out by using the Pratt D matrix to optimize the item structure. The Cronbach'α coefficient method was used to test the internal consistency reliability, and a structural equation model was used to explore the construct validity of the scale. The discriminant validity of the scale was obtained by factor analysis. A general linear model was used to analyse the relationship between the clinical manifestations of physical subhealth and the level of risk perception, and the convergent validity of the scale was evaluated.

Results

All the data of 35 items were significantly correlated at the 0.01 level. The correlation coefficients between a1 and a2, a3 and a4, b1 and b2, b2 and b3, c4 and c5, c5 and c6, c6 and c7, c8 and c9, d1 and d2, d2 and d3, e5 and e6, g1 and g2, g2 and g3, and g2 and g4 were greater than 0.6. The items with correlation coefficients greater than 0.6 were reduced by a Pratt D matrix. The resulting physical subhealth risk perception scale covers five factors with a total of 18 items. The Cronbach'α coefficient of the scale was 0.889, and the Cronbach'α coefficients of the five factors F1-F5 were 0.780, 0.825, 0.801, 0.736, and 0.704, respectively. Structural equation model analysis showed that χ²/df = 3.43, p < 0.001, RMSEA = 0.08, GFI = 0.88, NFI = 0.84, AGFI = 0.84, and CFI = 0.88. Factor analysis showed that factors F1–F5 had significant correlations (p < 0.01), and the correlation coefficients were less than the corresponding square root value of AVE. Based on the subhealth clinical manifestations of the participants, the general linear model was used to explore the convergent validity of the scale, and the results indicated that the scale passed the convergent validity test.

Conclusions

We propose a physical subhealth risk perception scale amounting to 18 items, which includes five dimensions: health knowledge (2 items), risk perception (5 items), trust selection (4 items), information channel (4 items), and social groups (3 items). The reliability and validity of the physical subhealth risk perception scale are acceptable. Applying the scale into practice has potential to improve the overall public health level.

The test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty

Background

The L test is a modified version of the timed up and go test (TUG) with an L-shaped walking path. The L test is more extensive than other performance tests, especially in turn direction and specific tasks. The study aimed to evaluate the test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty (THA). A cross-sectional study was conducted with 33 unilateral and primary THA patients. The L test was performed twice with an interval of an hour on the same day for the test-retest reliability. Timed up and go test (TUG), five times sit to stand test (FTST), and Harris hip score (HHS) were carried out for the analysis of the concurrent validity of the L test.

Results

The mean age of the participants was 74.6 ± 10.3 years. The ICC score of the L test was 0.992. Test-retest reliability was excellent. SEM95 and MDC95 values were 3.39 and 9.39, respectively. Both TUG and HHS were strongly correlated with the L test (r1 = 0.889, r2 = −0.568, p < 0.001). However, there was no significant correlation between FTST and L test (r = 0.024, p > 0.05).

Conclusions

The L test is valid and reliable performance measurement in patients with primary unilateral THA. MDC95 of the L test is an essential reference for clinicians in the rehabilitation follow-up process of THA patients.

Measurement properties of the L Test with fast walking speed in patients after lower limb amputation in initial prosthetic training phase

The L Test is a clinical mobility test used in patients after lower limb amputation. To assess dynamic balance, it should be performed with fast walking speed. Its measurement properties in the initial prosthetic training phase are not known yet. The objective of the study was to establish intra- and interrater reliability, concurrent and discriminant validity, minimal detectable change, effect size between the rehabilitation time points and ceiling effect of the L Test with fast walking speed in patients after lower limb amputation in initial prosthetic training phase. The study included 36 inpatients aged 19-86 years who were provided with a prosthesis for the first time. They were assessed repeatedly with the L Test, Ten-meter Walk Test and 6-min Walk Test. The intra- (ICC3, k = 0.94) and interrater reliability (ICC2, k = 0.96) of the L Test were excellent. Correlations with the walking tests were very good (r = 0.75-0.86). Regression analysis with respect to the level of lower limb amputation showed a linear relationship with other variables (R2 = 0.55). Influences of age, cause of lower limb amputation and walking aid were statistically significant. The L Test was responsive to change after two weeks of prosthetic training (Cohen's d = 1.21). No ceiling effect was identified. The L Test with fast walking speed is a feasible, reliable, valid, and responsive measure of basic mobility skills in patients after lower limb amputation in the initial prosthetic training phase.

The reliability and validity of the Timed Up and Go as a clinical tool in individuals with and without disabilities across a lifespan: a systematic review

PURPOSE

To summarize the available literature related to reliability and validity of the Timed Up and Go in typical adults and children, and individuals diagnosed with the following pathologies: Huntington's disease, stroke, multiple sclerosis, Parkinson's disease, spinal cord injury, Down syndrome, or cerebral palsy.

MATERIALS AND METHODS

A search was conducted using MeSH terms and keywords through a variety of databases. Data regarding reliability and validity were synthesized.

RESULTS

This review included 77 articles. Results were variable depending on the studied population. The Timed Up and Go showed excellent reliability in typical adults, in individuals with cerebral palsy, in individuals with multiple sclerosis, in individuals with Huntington's disease, individuals with a stroke, and individuals with a spinal cord injury. The TUG demonstrated strong concurrent validity for individuals with stroke and spinal cord injury. Predictive validity data was limited.

CONCLUSIONS

Based on the literature assessed, the Timed Up and Go is clinically applicable and reliable across multiple populations. The Timed Up and Go has a wide variety of clinical use making it a diverse measure that should be considered when choosing an outcome an activity based outcome measure. However, there are some limitations in the validity of the utilization of the Timed Up and Go to some populations due to a lack of data and/or poor choice of comparison outcome measures when assessing validity. Additional research is needed for young to middle aged adults.IMPLICATIONS FOR REHABILITATIONOutcome measures are a vital component of clinical practice across all populations.The Timed Up and Go is a highly studied outcome measure in the geriatric population, but lacks research of its applicability to other populations.This study was able to highlight the clinical utility of the Timed Up and Go in populations that under utilize this outcome measure.

Intra- and inter-rater reliability of the 10-meter ambulation test in hemiparesis is better barefoot at maximal speed

Objectives Reliability of clinical tests to evaluate ambulation in chronic hemiparesis may vary according to the testing condition. The 10-meter ambulation test (AT10) assesses walking speed and step length over 10 m, starting and ending in seated position. In the present study, we compared the intra- and inter-reliability of AT10 in chronic hemiparesis in four different conditions: with shoes and barefoot, at free and maximal safe speed. Methods Ten patients with hemiparesis, >1 year post-stroke (age 45 ± 12, time since stroke 16 ± 9 months, mean ± SD) participated in the reliability study (registration, ID-RCB-2017-A00090-53). All patients performed the AT10 twice, one week apart, in each of the four conditions. The number of steps and time to complete the task were manually recorded by four independent raters. The main outcome measurements were the intraclass correlation coefficients (ICC), coefficients of variation (CV), and mean raw differences (DIFF) of the three parameters of AT10 (speed, step length, and cadence) in each of the four conditions. Effects of wearing shoes and speed condition were explored using ANOVA. Results Across all conditions, mean intra- and inter-rater ICCs were, respectively, 98.5 ± 0.1 and 99.9 ± 0.1% for speed, 98.3 ± 0.1 and 99.7 ± 0.2% for step length, and 96.5 ± 0.1 and 98.9 ± 0.6% for cadence. Mean intra- and inter-rater CV for speed were 0.051 ± 0.016 and 0.022 ± 0.002, respectively. Intra-rater reliability of speed assessments was higher at maximal than at free speed (ICC, CV, DIFF, p < 0.05). At free speed, intra-rater ICCs were higher barefoot than with shoes (p < 0.05). Discussion Performing the 10-meter ambulation test barefoot at maximal speed optimizes its reliability.

The reliability and validity of the L-test in people with Parkinson's disease

OBJECTIVE

To evaluate the test-retest and concurrent validity of the L-test in a group of participants with mild to moderate Parkinson's disease. The L-test is an extended version of the Timed up and Go test, incorporating a longer walking distance and turns in two directions.

DESIGN

Cross-sectional.

SETTING

Community.

PARTICIPANTS

16 participants (13 male), mean age 75 (SD 6.7) mean duration since diagnosis 7.1 years (±2.8). Disease severity was mild to moderate on the Hoehn and Yahr scale (mean 2.1; mode 2; range 1-3). 14 participants (12 male) completed the study.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A Bland and Altman plot examined the agreement between first and second testing occasion of the L-test. Intra-class correlation coefficients (ICC) assessed the test-retest reliability. Concurrent validity was established by correlating the L-test with the Timed up and Go test (TUG). The Minimal Detectable Change with 95% confidence interval (MDC95) was calculated to determine the true change not due to chance.

RESULTS

The L-test showed excellent test-retest reliability on the Bland & Altman plot and the ICC. There was a high degree of agreement between measurements taken on days 1 and 2. The L-test correlated strongly with the Timed up and Go test on both measurement days with r=0.97 (p<0.001) and r=0.96 (p<0.001). The MDC95 was 5.31seconds.

CONCLUSIONS

The L-test is a reliable and valid outcome measurement for the assessment of walking ability in participants with mild to moderate Parkinson's disease.