The Postural Assessment Scale for Stroke Patients: translation into Norwegian, cultural adaptation, and examination of reliability

Effect of innovative vs. usual care physical therapy in subacute rehabilitation after stroke. A multicenter randomized controlled trial

Background

Research on stroke rehabilitation often addresses common difficulties such as gait, balance or physical activity separately, a fragmentation contrasting the complexity in clinical practice. Interventions aiming for recovery are needed. The purpose of this study was to investigate effects of a comprehensive low-cost physical therapy intervention, I-CoreDIST, vs. usual care on postural control, balance, physical activity, gait and health related quality of life during the first 12 weeks post-stroke.

Methods

This prospective, assessor-masked randomized controlled trial included 60 participants from two stroke units in Norway. Participants, who were randomized to I-CoreDIST (n = 29) or usual care physical therapy (n = 31), received 5 sessions/week when in-patients or 3 sessions/week as out-patients. Primary outcomes were the Trunk Impairment Scale-modified Norwegian version (TISmodNV) and activity monitoring (ActiGraphsWgt3X-BT). Secondary outcomes were the Postural Assessment Scale for Stroke, MiniBesTEST, 10-meter walk test, 2-minute walk test, force-platform measurements and EQ5D-3L. Stroke specific quality of life scale was administered at 12 weeks. Linear regression and non-parametric tests were used for statistical analysis.

Results

Five participants were excluded and seven lost to follow-up, leaving 48 participants in the intention-to-treat analysis. There were no significant between-group effects for primary outcomes: TIS-modNV (p = 0,857); daily average minutes of sedative (p = 0.662), light (p = 0.544) or moderate activity (p = 0.239) and steps (p = 0.288), or secondary outcomes at 12 weeks except for significant improvements on EQ5D-3L in the usual care group. Within-group changes were significant for all outcomes in both groups except for activity levels that were low, EQ5D-3L favoring the usual care group, and force-platform data favoring the intervention group.

Conclusions

Physical therapy treatment with I-CoreDIST improved postural control, balance, physical activity and gait during the first 12 weeks after a stroke but is not superior to usual care.

Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk)

Background: There is no Turkish version of the Postural Assessment Scale for Stroke patients (PASS). Objectives: To translate and make the cross-cultural adaptation of the PASS into the Turkish language and evaluate the reliability and validity of the Turkish version (PASS-Turk). Methods: Sixty patients with stroke who had survived the three-week acute period were included in the study. The first researcher applied the scale to the participants twice with 5-day intervals. The second researcher applied the scale once at the same time with the first researcher. The reliability of PASS-Turk and its subsections was evaluated using Cronbach's alpha coefficient. In addition, item-total correlation and test-retest reliability were calculated. The interobserver agreement was assessed using the intraclass correlation coefficient. The construct validity of PASS-Turk was assessed using Pearson's product-moment correlation and principal component analyses. The Berg Balance Scale (BBS) and motor subscale of the Functional Independence Measure (FIM) were used for validity. Results: The Cronbach's alpha coefficients of the PASS-Turk scale were 0.903 for the subsection of "maintaining posture," 0.940 for the subsection of "changing a posture," and 0.953 for the total PASS-Turk scale. The first and second researcher evaluations were perfectly consistent with each other in terms of PASS-Turk total scores (ICC = 0.999, 95% CI: 0.998-0.999, and p < .001). A strong positive correlation was found between PASS-Turk and BBS and the motor subscale of FIM. Conclusion: PASS-Turk is a valid and reliable scale for the evaluation of posture and balance of patients with stroke.