Reliability and validity of trunk assessment for people with multiple sclerosis

Psychometric properties of the modified reaching performance scale in persons with multiple sclerosis

BACKGROUND

A valid and reliable assessment tool to describe the quality of the movement pattern of reaching can provide valuable insights into motor performance deficits in persons with MS (pwMS). The Reaching Performance Scale, developed for stroke, is a promising scale to assess movement patterns in pwMS. However, psychometric properties of the scale are lacking in pwMS.

OBJECTIVES

Firstly, to investigate the content validity of the modified Reaching Performance Scale for application in patients with MS (mRPS). Secondly, to investigate the psychometric properties (within- and between-session reliability and concurrent validity) of the mRPS for pwMS.

METHODS

Forty-five pwMS (mean EDSS 6.6 pt, IQR 6-7.5) executed the mRPS that rates the quality of movement patterns and compensations during reach to grasp tasks. The content validity was determined by an expert panel based on observations of subjects performing the RPS. The reliability was based on five repetitions within one day, and between two days. For the concurrent validity, outcome measures at two levels of the International Classification of Functioning were correlated with the mRPS: Body Structure and Function level: Fugl-Meyer Assessment of the Upper Limb (FMA-UL), maximal isometric hand grip strength (HGS; Activity level: Action Research Arm Test (ARAT), Box and Blocks Test (BBT), Nine Hole Peg Test (NHPT) and Trunk Impairment Scale 2.0 (TIS 2.0) as well as perceived performance by the Manual Ability Measure-36 (MAM-36).

RESULTS

Scale modifications were made only on the ratings of the trunk displacement subscale. The mRPS had excellent agreement scores for within-session reliability (range of Kappa between 0.85 and 0.98) and moderate-to-excellent agreement scores for between-session reliability (K: 0.66-1.00). Regarding validity, the mRPS was highly correlated with the ARAT (rho=0.74, p < 0.001), followed by moderate correlations with trunk performance (TIS 2.0, rho= 0.61, p < 0.001), hand function (BBT: rho=0.64, p < 0.001; NHPT: rho=-0.61, p < 0.001) and perceived performance (MAM36 rho= 0.53, p < 0.001).

CONCLUSION

The mRPS is a reliable measurement tool to describe the movement pattern quality and motor compensations used during reaching in pwMS. Concerning concurrent validity, the mRPS is partially related to other measures of upper limb and trunk performance.

Effects of robot-assisted walking training on balance, motor function, and ADL depending on severity levels in stroke patients

BACKGROUND

Despite the explosive increase in interest regarding Robot-Assisted Walking Training (RAWT) for stroke patients, very few studies have divided groups according to the severity levels of patients and conducted studies on the effects of RAWT.

OBJECTIVE

The purpose of this study was to present a definite basis for physical therapy using the robot-assisted walking device through a more detailed comparison and analysis and to select the optimal target of RAWT.

METHODS

This study was designed as a prospective and randomized controlled trial to investigate the effect of RAWT on balance, motor function, and Activities of Daily Living (ADL) depending on severity levels in stroke patients. 100 participants were randomly divided into study and control groups in equal numbers. The study group was 49 and the control group was 47. One from the study group and three from the control group were eliminated. The study period is four weeks in total, and RAWT is performed five times a week for 40 minutes only for study group. During the same period, all group members had 30 minutes of Conventional Physiotherapy (CP) five times a week.

RESULTS

The results of this study clearly confirmed that RAWT combined with CP produces more significant improvement in patients with stroke than the CP alone. And they indicated that RAWT had a more considerable effect in the poor or fair trunk control group for trunk balance and in the high fall risk group for balance. In motor function, RAWT showed its value in the severe and marked motor impairment group. The total or severe dependence group in ADL experienced more improvements for RAWT.

CONCLUSION

This study can be concluded that the lower the level of physical functions, the more effective it responds to RAWT. As demonstrated in the results of this study, the potential of current robotic technology appears to be greatest at very low functional levels of stroke patients. Patients with low functional levels among stroke patients may benefit from robot rehabilitation.

Associations between respiratory function, balance, postural control, and fatigue in persons with multiple sclerosis: an observational study

Introduction

Fatigue, postural control impairments, and reduced respiratory capacities are common symptoms in persons diagnosed with Multiple Sclerosis (MS). However, there is a paucity of evidence establishing correlations among these factors. The aim of this study is to analyze respiratory function in persons with MS compared to the control group as well as to analyze the relationship between fatigue, respiratory function and postural control in persons with MS.

Materials and methods

A total of 17 persons with MS and 17 healthy individuals were enrolled for this cross-sectional study. The evaluated parameters included fatigue assessed using the Visual Analog Scale-fatigue (VAS-F) and the Borg Dyspnea Scale, postural control assessed through the Mini Balance Evaluation System Test (Mini-BESTest), Berg Balance Scale (BBS), Timed Up and Go (TUG) test, and Trunk Impairment Scale (TIS); and respiratory capacities measured by Maximum Inspiratory Pressure (MIP), Maximum Expiratory Pressure (MEP), Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), FEV1/FVC ratio, Diaphragmatic excursion and diaphragmatic thickness.

Results

A very high correlation was observed between the Borg Dyspnoea Scale and the BBS (r = -0.768), TUG (0.867), and Mini-BESTest (r = -0.775). The VAS-F exhibited an almost perfect correlation solely with the TUG (0.927). However, none of the variables related to fatigue exhibited any correlation with the respiratory variables under study. Balance-related variables such as BBS and Mini-BESTest demonstrated a very high and high correlation. Respectively, with respiratory function variables MEP (r = 0.783; r = 0.686), FVC (r = 0.709; r = 0.596), FEV1 (r = 0.615; r = 0.518). BBS exhibited a high correlation with diaphragmatic excursion (r = 0.591). Statistically significant differences were noted between the persons with MS group and the control group in all respiratory and ultrasound parameters except for diaphragmatic thickness.

Conclusion

The findings suggest that decreased postural control and balance are associated with both respiratory capacity impairments and the presence of fatigue in persons with MS. However, it is important to note that the alterations in respiratory capacities and fatigue are not mutually related, as indicated by the data obtained in this study. Discrepancies were identified in abdominal wall thickness, diaphragmatic excursion, and respiratory capacities between persons with MS and their healthy counterparts.

Validity and reliability of the Persian version of the trunk impairment scale in people with multiple sclerosis

BACKGROUND

In order to provide an important measuring tool for the assessment, prognosis of recovery, and treatment of people with multiple sclerosis (PWMS), the aim of this research is to examine the validity and reliability of the Trunk Impairment Scale (TIS) in Persian.

METHODS

The research included 105 PWMS. The TIS questionnaire was translated and culturally equivalent according to the IQOLA approach. The Intra Class Correlations (ICC) and Cronbach's alpha were used to assess the internal consistency of the questionnaire. Barthel Index (BI), Time Up and Go (TUG), Multiple Sclerosis Walking Scale-12 (MSWS-12), and Trunk Control Test (TCT) scores were correlated with the TIS score in order to assess validity.

RESULTS

86 of 105 participants in this study were female. For several subscales, the ICC correlation coefficient ranged from 0.89 to 0.98. The Cronbach's alpha value of the TIS total score indicates that the TIS questionnaire has quite good internal consistency. (Cronbach's alpha=0.97). The TIS and the MSWS-12, BI, TUG, and TCT questionnaires have correlation coefficients of 0.78, 0.72, 0.60, and 0.71, respectively, indicating strong construct and concurrent validity.

CONCLUSION

The results of the research showed that the TIS in Persian is a relevant and reliable tool for assessing trunk abnormalities in Persian-speaking PWMS.

Core stability-based balance training and kinesio taping for balance, trunk control, fear of falling and walking capacity in patients with multiple sclerosis: A randomized single-blinded study

BACKGROUND

Trunk performance-based therapies are important in the Multiple Sclerosis (MS) rehabilitation process since they have been associated with balance, trunk performance, fall prevention, and walking capacity. Kinesio taping (KT) is a popular approach that has recently been used to treat a variety of musculoskeletal and neuromuscular impairments. Therefore, the aim of this single-blind, randomized controlled study was to investigate the effects of KT combined trunk stabilization-based balance training on balance, trunk control, walking capacity, and fear of falling in patients with MS.

MATERIAL AND METHODS

Thirty patients diagnosed with MS were randomly assigned to the KT group or the control group. The control group received core stability-based balance training and the KT group was treated with KT applied on global trunk muscles in addition to core stability-based balance training. Balance was measured with the Mini BESTest, trunk control with the Trunk Impairment Scale, fear of falling with the Falls Efficacy Scale and walking capacity with the 2-minute walk test.

RESULTS

Balance, trunk control, fear of falling, and walking capacity of all the patients improved after treatment (p < 0.05). No superiority was found between the groups in terms of treatment efficacy (p > 0.05).

CONCLUSION

In conclusion, core stability-based balance training was effective in patients with MS, and the addition of KT had no additional effect in terms of balance, trunk control, fear of falling, and walking capacity.

Neurorehabilitation in Multiple Sclerosis-A Review of Present Approaches and Future Considerations

Multiple sclerosis is an increasingly prevalent disease, representing the leading cause of non-traumatic neurological disease in Europe and North America. The most common symptoms include gait deficits, balance and coordination impairments, fatigue, spasticity, dysphagia and an overactive bladder. Neurorehabilitation therapeutic approaches aim to alleviate symptoms and improve the quality of life through promoting positive immunological transformations and neuroplasticity. The purpose of this study is to evaluate the current treatments for the most debilitating symptoms in multiple sclerosis, identify areas for future improvement, and provide a reference guide for practitioners in the field. It analyzes the most cited procedures currently in use for the management of a number of symptoms affecting the majority of patients with multiple sclerosis, from different training routines to cognitive rehabilitation and therapies using physical agents, such as electrostimulation, hydrotherapy, cryotherapy and electromagnetic fields. Furthermore, it investigates the quality of evidence for the aforementioned therapies and the different tests applied in practice to assess their utility. Lastly, the study looks at potential future candidates for the treatment and evaluation of patients with multiple sclerosis and the supposed benefits they could bring in clinical settings.

The effects of Baduanjin and yoga exercise programs on physical and mental health in patients with Multiple Sclerosis: A randomized controlled trial

OBJECTIVE

To discuss whether Baduanjin and yoga exercise interventions improve motor function, posture control, and relieving fatigue and depression in MS patients. And to explore whether practicing Baduanjin benefits MS patients more than yoga.

DESIGN

A prospective, randomized, controlled, three-arm trial comparing BDJ (n = 30), yoga (n = 30) and control group (n = 20).

SETTING

Jiangsu Provincial Corps Hospital.

INTERVENTION

Eligible participants were randomized to a 24-week Baduanjin or yoga intervention, or a usual activity control group. Balance, posture control and trunk movement were measured with the Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS). Fatigue was measured using the Fatigue Severity Scale (FSS) and depressive symptoms via the Zung Self-Rating Depression Scale (SDS).

RESULTS

For BBS and TIS, there were significant changes pre- to post- exercise in two exercise groups (P < 0.05), with greater increases in the Baduanjin exercise group (BDJ group). For the FSS, there were significant changes pre- to post- exercise in both the BDJ (P = 0.0292) and yoga groups (P = 0.0150). For the SDS, the pre- and post-exercise difference of the BDJ group was larger than the yoga group (P < 0.0001). On the other hand, we could not find any changes of the BBS, TIS, FSS, and SDS scores in the control group (p > 0.05).

CONCLUSION

The results suggest that practicing Baduanjin was more effective than yoga and that it is suitable for the MS patients.

Effect of dynamic neuromuscular stabilization on balance and trunk function in people with multiple sclerosis: protocol for a randomized control trial

Background

Multiple sclerosis is a chronic and disabling neurological disease among young people. One of the major complaints in patients with multiple sclerosis (PWMS) is falling. There are a number of factors that risk factors for falling, including balance disorder and spasticity. Core stability (CS) exercises such as trunk muscle strengthening exercises can improve balance and mobility and reduce falling. Dynamic neuromuscular stabilization (DNS) exercise is a new functional rehabilitation strategy that optimizes motor function based on the principles of developmental kinesiology. This trial will evaluate the effectiveness of DNS in comparison to CS on balance, spasticity, and falling in PWMS.

Methods

A total of 64 PWMS, between 30 and 50 years old and expanded disability status scale (EDSS) between 2 to 5, will be recruited from neurophysiotherapy clinic, Faculty of Rehabilitation Sciences, Iran University of Medical Sciences to participate in this 2-armed parallel study. Participants will be randomly divided into two groups to receive CS exercise or DNS exercise. All participants will receive exercise treatment for 15 sessions during a period of 5 weeks (3 sessions per week). Primary outcome measures will be balance. Falling rate, fear of falling, patient mobility, as well as spasticity, will be measured as secondary outcomes. All outcome measures will be measured at baseline, the day after the completion of the 15th session, and after 17 weeks.

Discussion

Dynamic neurostabilization exercises utilize the subconscious stimulation of special zones to reflexively mediate the diaphragm and other core stabilization muscles, which is extremely effective for individuals with reduced somatosensory or movement awareness. Findings from the proposed study are expected to benefit the knowledge base of the physiotherapist, and it can be a good alternative for the rehabilitation program and even reduce medication use in patients with multiple sclerosis. These exercises are easy to understand and applicable for these patients and their partners as well.

Trial registration

The trial was registered in the Iran registry organization with code IRCT20140222016680N5 and was approved on April 7^th, 2020. Address: IRCT administration team, Central Library Building, Iran University Campus, Hemmat Freeway, next to Milad tower, Tehran, Iran. postal code:14496-14535.

What is the distribution of trunk impairments and its relationship with disability level in individuals with multiple sclerosis?

BACKGROUND

Trunk control is essential for movement, balance and walking and is ignored in the regular medical follow-up.

OBJECTIVE

First, to describe the distribution of trunk impairments in the full range of disability levels in individuals with MS. Second, to identify the relationship between trunk control, measured by the Trunk Impairment Scale (TIS 2.0.), and general disability measured by the Expanded Disability Status Scale (EDSS).

METHODS

154 individuals with MS were included (mean age 53.6; SD 11.06), EDSS ranging from 1.0- 8.5 (mean 4.47; SD 2.55). The relationship between EDSS and TIS 2.0. was calculated by Spearman correlation coefficient for the total sample and subgroups, EDSS ≤ 4 versus EDSS ≥ 4.5.

RESULTS

Trunk impairments were detected throughout the full range of disability, including individuals with low disability. Pelvic elevation and lower trunk rotation appeared most difficult to perform. In the total sample, a moderate correlation was found (rho= -0.608**) between disability (EDSS) and trunk performance (TIS 2.0.). Sub-analyses revealed a poor correlation (rho= -0.193) for the EDSS ≤ 4 subgroup and a strong correlation for the EDSS ≥ 4.5 subgroup (rho= -0.712**).

CONCLUSION

The results advocate for including trunk assessment already at early disease stages of MS, particularly of pelvic elevation and trunk rotation, and dedicated rehabilitation strategies.

Psychometric properties of trunk impairment scale in children with spastic diplegia

The Trunk Impairment Scale (TIS) is a valid and reliable tool to assess trunk impairment in children with heterogeneous cerebral palsy. The purpose of this study was to determine the reliability and validity of the TIS in assessing children with spastic diplegic cerebral palsy. The sample was a total of 30 subjects (15 = boys, 15 = girls). All subjects underwent an assessment of the sitting component of the Gross Motor Function Measure-88 and TIS by rater 1. Rater one observed video recordings within 24 h and scored TIS for intra-rater reliability, while rater two did likewise after 48 h for inter-rater reliability. The mean and standard deviation of the TIS and sitting components of the Gross Motor Function Measure-88 were 15.66 ± 4.20 and 52.36 ± 6.26, respectively. We established intra-rater and inter-rater reliability of the TIS with Intra Class Correlation Coefficient 0.991 and 0.972, respectively. The concurrent validity of the TIS with the sitting component of the Gross Motor Function Measure-88 was good, with an r-value of 0.844 (p < 0.001). This study showed the excellent intra-rater and inter-rater reliability and high concurrent validity of the TIS in assessing children with spastic diplegic cerebral palsy.

Movement compensations during a step ascent task are associated with stair climbing performance in people with multiple sclerosis

BACKGROUND

The biomechanical mechanisms underlying stair climbing limitations are poorly understood in people with multiple sclerosis (MS).

RESEARCH QUESTIONS

Are trunk and pelvis motion and lower extremity joint moments during step ascent different between MS and control groups? Are step ascent biomechanics and stair climbing performance associated in people with MS?

METHODS

20 people with MS (49 ± 12 years, EDSS range: 1.5-5.5) and ten control participants (48 ± 12 years) underwent three-dimensional motion analysis while ascending a 15.2-cm step and also completed a timed Functional Stair Test. Main effects of group (MS vs Control) and limb (Stronger/Dominant vs Weaker/Non-dominant) and interactions were assessed using two-way analyses of variance. Associations between movement patterns during the step ascent and Functional Stair Test performance were performed using Pearson's correlations and backward stepwise linear regression.

RESULTS

Significant group main effects were observed in greater sagittal pelvis excursion (p < 0.001), greater sagittal (p = 0.013) and frontal (p = 0.001) trunk excursion, and lower trail limb peak ankle plantar flexion moment (p < 0.001) of the MS group. Significant limb main effects were observed with greater sagittal trunk excursion (p = 0.037) and peak trail limb ankle plantar flexion moment (p = 0.037) in the stronger/dominant limb. A significant interaction was observed in peak knee extensor moment (p = .002). Stair climbing performance in the MS group correlated with sagittal (r = .607, p=<0.001) and frontal pelvis excursions (r = 0.385, p = 0.014), sagittal trunk excursion (r = .411, p = 0.008), and ankle plantar flexion moments (r=-0.415, p = 0.008). Sagittal and frontal pelvis excursion and bilateral handrail use explained a significant amount of variability in stair climbing performance (Adj R² = 0.775).

SIGNIFICANCE

In conclusion, despite the presence of proximal and distal lower extremity movement pattern compensations during a step ascent task, larger pelvis angular excursions are associated with impaired stair climbing performance in people with MS and may serve as targets for future rehabilitation interventions.

Test-Retest Reliability and Known-Groups Validity of Trunk Muscle Tests in People With Multiple Sclerosis: A Cross-Sectional, Case-Control Study

OBJECTIVE

Research on muscle performance testing reliability in people with multiple sclerosis (MS) has focused on limb performance while less is known about trunk strength and endurance. This work aims to 1) establish test-retest reliability of trunk flexion, lateral flexion, and extension strength tests, and plank, side bridge, and Biering-Sørensen endurance tests in people with MS and matched healthy controls (HCs); 2) analyze known-groups validity of these tests in people with MS and HCs; 3) to compare groups for side-to-side differences; and 4) to describe the relationships between trunk performance and functional mobility tests.

METHODS

Fifteen people with MS (median Expanded Disability Status Scale = 3) and 15 HCs underwent 2 trunk isometric strength and endurance testing sessions. Mobility was evaluated by Timed Up-and-Go test. Intraclass correlation coefficient, SEM, and minimal detectable change (MDC) were calculated. Between-group differences in trunk performance were tested using the t test for independent measures. Between-group differences in an asymmetry index were analyzed by independent t test. Bivariate correlations between trunk tests and mobility were also examined.

RESULTS

All trunk tests showed good-to-excellent relative reliability in both groups (intraclass correlation coefficient > 0.71). Regarding absolute reliability, strength tests were associated with low intersession variability in both groups (MDC: MS, 11.23%-36.45%; HCs, 26.60%-31.98%). Conversely, endurance tests showed higher variability scores in people with MS (MDC: MS, 69.55%-116.50%; HCs, 29.57%-54.40%). People with MS displayed significantly lower trunk performance. Likewise, the asymmetry index showed significantly higher scores in people with MS for endurance assessment but not in strength tests. Significant correlations were detected in people with MS between Timed Up-and-Go and several trunk tests (r = 0.63-0.70).

CONCLUSIONS

SEM and MDC scores revealed similar consistency and variability between groups for strength tests, whereas higher variability was observed for endurance tests in people with MS. Trunk strength tests are reliable and present discriminant validity to distinguish mildly disabled people with MS from HCs. Conversely, the high measurement error and variability of the endurance tests may hinder their application in intervention programs.

IMPACT

Determining the reliability and validity of the tests currently used to assess trunk function is of the greatest importance for people with MS (who show not only impaired trunk function but also wide fluctuations in performance), as it requires consistent and accurate measurements that are sensitive enough to detect minimal changes induced by rehabilitation.

Reliability of measurement of active trunk movement in wheelchair basketball players

The study aim was to assess the reliability to active trunk movements measurement in four sitting positions in wheelchair basketball players and to check their trunk movements in these positions. Eighteen volunteer wheelchair basketball athletes, with a minimum of five years’ training experience, were asked to perform the maximum range of active trunk movement in three planes in four sitting positions (in a sports wheelchair with straps, without straps, on a table with feet on the floor, on a table without foot support). The range of movement was measured by the Kinect for Windows V2 sensor twice (with one-week interval). To assess the reliability, different statistical methods were used for each movement: significance of differences between the results (p-value), interclass correlation coefficient (ICC) and minimal detectable change (MDC). The limits of agreement analysis (LOA) were calculated. Differences between trunk movements in four positions were checked by the MANOVA (Wilk’s Lambda and ETA² were calculated if data were normally distributed). The significance level was set at α < .05. Friedman ANOVA and non-parametric Wilcoxon test with the Bonferroni correction were applied when data were not normally distributed. The significance level after Bonferroni correction was set at α < .013 (α = p/k, where p = .05, k–number of positions = 4). The measurement of active trunk movement in each plane was reliable (p > .05, no differences between the results, “very good”ICC, between .96-.99). In the position with straps, the trunk movement was significantly bigger than in other positions (p < .05), except for the position without straps (p > .05). The Kinect for Windows V2 sensor measured active trunk movement in a reliable manner and it can be recommended as a reliable tool for measuring trunk function. Utilizing straps by wheelchair basketball players increases their trunk movement.

A Core Set of Outcome Measures for Adults With Neurologic Conditions Undergoing Rehabilitation: A CLINICAL PRACTICE GUIDELINE

Supplemental Digital Content is Available in the Text.

Background:

Use of outcome measures (OMs) in adult neurologic physical therapy is essential for monitoring changes in a patient's status over time, quantifying observations and patient-reported function, enhancing communication, and increasing the efficiency of patient care. OMs also provide a mechanism to compare patient and organizational outcomes, examine intervention effectiveness, and generate new knowledge. This clinical practice guideline (CPG) examined the literature related to OMs of balance, gait, transfers, and patient-stated goals to identify a core set of OMs for use across adults with neurologic conditions and practice settings.

Methods:

To determine the scope of this CPG, surveys were conducted to assess the needs and priorities of consumers and physical therapists. OMs were identified through recommendations of the Academy of Neurologic Physical Therapy's Evidence Database to Guide Effectiveness task forces. A systematic review of the literature on the OMs was conducted and additional OMs were identified; the literature search was repeated on these measures. Articles meeting the inclusion criteria were critically appraised by 2 reviewers using a modified version of the COnsensus-based Standards for the selection of health Measurement INstruments. (COSMIN) checklist. Methodological quality and the strength of statistical results were determined. To be recommended for the core set, the OMs needed to demonstrate excellent psychometric properties in high-quality studies across neurologic conditions.

Results/Discussion:

Based on survey results, the CPG focuses on OMs that have acceptable clinical utility and can be used to assess change over time in a patient's balance, gait, transfers, and patient-stated goals. Strong, level I evidence supports the use of the Berg Balance Scale to assess changes in static and dynamic sitting and standing balance and the Activities-specific Balance Confidence Scale to assess changes in balance confidence. Strong to moderate evidence supports the use of the Functional Gait Assessment to assess changes in dynamic balance while walking, the 10 meter Walk Test to assess changes in gait speed, and the 6-Minute Walk Test to assess changes in walking distance. Best practice evidence supports the use of the 5 Times Sit-to-Stand to assess sit to standing transfers. Evidence was insufficient to support use of a specific OM to assess patient-stated goals across adult neurologic conditions. Physical therapists should discuss the OM results with patients and collaboratively decide how the results should inform the plan of care.

Disclaimer:

The recommendations included in this CPG are intended as a guide for clinicians, patients, educators, and researchers to improve rehabilitation care and its impact on adults with neurologic conditions. The contents of this CPG were developed with support from the APTA and the Academy of Neurologic Physical Therapy (ANPT). The Guideline Development Group (GDG) used a rigorous review process and was able to freely express its findings and recommendations without influence from the APTA or the ANPT. The authors declare no competing interest.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A214.

Assessing the validity and reliability of the Turkish version of the Trunk Impairment Scale in stroke patients

OBJECTIVE:

To determine the validity and reliability of the Turkish version of the Trunk impairment scale (TIS), used in the evaluation of somatic, motor, and coordination disturbances in stroke patients, and provide a culturally adapted version for use in the Turkish population.

METHODS:

A total of 80 patients who were either hospitalized at our facility and rehabilitated for stroke or admitted at our outpatient clinics were included in this study. Reliability was evaluated by the internal consistency (Cronbach α) and test reproducibility [intra-class correlation coefficient (ICCC)] methods, and validity was evaluated by the correlation between subgroups and the total scores of the TIS and Berg Balance Scale (BBS), Brunnstrom phases, Barthel index (BI), Rivermead mobility index (RMI), and Short Form-36 (SF-36) scores.

RESULTS:

The mean age of the patients was 63.00±12.1 years. Out of a total of 80 subjects, 34 were female and 46 were male. The reliability of the scale was evaluated by the internal consistency, inter- and intra-observer reliability, and test reproducibility. The findings showed that the Turkish form of the scale was reliable at a good level. The test values were as follows; Cronbach α: >0.70, ICCC: 0.969–1, subgroups and total score comparison: 0. The correlation between TIS and BBS was considerably high in the validity analysis (p<0.001). Further, significant associations among the BI, RMI, KF-36, Brunnstrom, and TIS scores were found (p<0.001), which indicate the structural validity of this scale.

CONCLUSION:

TIS is a scale used in measuring the motor derangement that develops after a stroke. It has sufficient reliability, internal consistency, and validity for use in clinical practice and stroke investigations. Our study has shown that TIS used for the evaluation of body balance is valid and reliable for the Turkish population.

Changes in trunk sway and impairment during sitting and standing in children with cerebral palsy

BACKGROUND

Poor postural control constitutes a major impairment in children with cerebral palsy (CP), compromising everyday activities such as sitting- and standing-position.

PURPOSE

In this study, we measured trunk sway during sitting- and standing-position. Additionally, we assessed trunk control ability using the trunk impairment scale (TIS), trunk control measurement scale (TCMS), and sitting assessment test for children with neuromotor dysfunction (SACND), in children with CP.

METHODS

Fifteen children (10 boys and 5 girls) were recruited for this study. Trunk sway was measured using a triaxial accelerometer that recorded variation in movement acceleration during quiet sitting- and standing-position.

RESULTS

Anterior-posterior (AP) acceleration was significantly greater in the standing position than the sitting position (p= 0.001). Medio-lateral (ML) acceleration was significantly greater in the standing position than in the sitting position (p= 0.012). The TIS total score showed a moderate negative relationship with AP acceleration (r=-0.635, p= 0.011). The TCMS total score moderately and negatively correlated with AP acceleration (r=-0.582, p= 0.023). The SACND total score moderately and positively correlated with AP acceleration (r= 0.670, p= 0.006).

CONCLUSION

Measurement of trunk sway using a triaxial accelerometer revealed a moderate correlation with trunk control test data and excellent reliability. Our findings suggest that measurement of trunk sway using a triaxial accelerometer is not time-consuming, and is simple and easy. Our approach can be applied in clinical settings to gain information on trunk control in children with CP.

Performance on Balance Evaluation Systems Test (BESTest) Impacts Health-Related Quality of Life in Adult Spinal Deformity Patients

STUDY DESIGN

Prospective single-center study.

OBJECTIVE

Study investigates how dynamic balance performance complements 2D static radiographic measurements and demographics in terms of understanding health-related quality of life in adult spinal deformity (ASD) patients.

SUMMARY OF BACKGROUND DATA

Recent insights suggest that demographic variables have a stronger impact on health-related quality of life than 2D radiographic spinopelvic parameters in ASD patients.

METHODS

Nine healthy volunteers and 36 ASD patients following inclusion criteria were recruited. Demographics, Scoliosis Research Society Score-22r (SRS-22r), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), 2D radiographic spinopelvic measurements, and performance on Balance Evaluation Systems Test (BESTest), and Trunk Control Measurement Scale (TCMS) were determined for each subject. Nonparametric tests, Spearman correlations, univariate, and stepwise-like linear multivariate regression analysis were performed.

RESULTS

BESTest and TCMS had significant lower values in the ASD group versus the control group (P = 0.000). In the ASD group, Cumulative Illness Rating Scale (CIRS) correlated fair to ODI, COMI (0.441 ≥ r ≥ 0.383, P < 0.021) and to SRS-22-r (r = -0.335, P = 0.046), Mini Mental State Examination correlated fair to COMI (r = -0.352, P = 0.035), "Pelvic Incidence minus Lumbar Lordosis" correlated fair to ODI (r = 0.361, P = 0.031), BESTest correlated moderate to ODI and COMI (r ≤ -0.505; P ≤ 0.002), TCMS correlated fair to ODI (r = -0.356; P = 0.033). CIRS and BESTest were significant predictive variables for COMI based on univariate analysis in ASD patients. Multivariate regression analysis including demographics, 2D static radiographic parameters, and dynamic balance scales identified BESTest as single independent variable (P = 0.000) to predict COMI (adjusted R = 0.285) in ASD patients.

CONCLUSION

BESTest has a higher potential than demographic and 2D radiographic spinopelvic parameters to predict quality of life in ASD patients. Further research is necessary to identify the impact of ASD on quality of life.

LEVEL OF EVIDENCE

3.

Comparison of trunk impairment scale versions 1.0 and 2.0 in people with multiple sclerosis: A validation study

BACKGROUND

Trunk control impairment often accompanies multiple sclerosis (MS). Trunk stability is necessary for movements of extremities, as are selective trunk movements for normal gait. Measuring trunk function is thus of interest.

METHODS

We examined the relationships between the Trunk Impairment Scale (TIS1.0 and TIS2.0) and the Berg Balance Scale (BBS), 5 sit-to-stand test (5STS), Timed Up and Go test (TUG), 10-m timed walk test (10TW), 2-min walk test (2MWT), Falls Efficacy Scale - International, and 12-item MS Walking Scale (MSWS-12) in 47 outpatients. We determined construct validity by calculating the degree to which the TIS versions produced different scores between known groups: use or nonuse of walking aid, MS disability status, and whether participants experienced a fall or not during 14 weeks.

RESULTS

TIS correlated moderately with BBS and 5STS; moderately (TIS1.0) or weakly (TIS2.0) with TUG, 10TW, and 2MWT; and weakly to moderately with MSWS-12 in subgroups with Expanded Disability Status Scale (EDSS) >6.0. No other clear correlation patterns were found. TIS did not discriminate between known groups.

CONCLUSIONS

TIS1.0 is recommended for individuals with MS (EDSS score 4.0-7.5). Better trunk function correlates with better balance and walking ability. TIS has limited value in fall risk screening.

CoDuSe group exercise programme improves balance and reduces falls in people with multiple sclerosis: A multi-centre, randomized, controlled pilot study

Background:

Imbalance leading to falls is common in people with multiple sclerosis (PwMS).

Objective:

To evaluate the effects of a balance group exercise programme (CoDuSe) on balance and walking in PwMS (Expanded Disability Status Scale, 4.0–7.5).

Methods:

A multi-centre, randomized, controlled single-blinded pilot study with random allocation to early or late start of exercise, with the latter group serving as control group for the physical function measures. In total, 14 supervised 60-minute exercise sessions were delivered over 7 weeks. Pretest–posttest analyses were conducted for self-reported near falls and falls in the group starting late. Primary outcome was Berg Balance Scale (BBS). A total of 51 participants were initially enrolled; three were lost to follow-up.

Results:

Post-intervention, the exercise group showed statistically significant improvement (p = 0.015) in BBS and borderline significant improvement in MS Walking Scale (p = 0.051), both with large effect sizes (3.66; −2.89). No other significant differences were found between groups. In the group starting late, numbers of falls and near falls were statistically significantly reduced after exercise compared to before (p < 0.001; p < 0.004).

Conclusion:

This pilot study suggests that the CoDuSe exercise improved balance and reduced perceived walking limitations, compared to no exercise. The intervention reduced falls and near falls frequency.

Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial

BACKGROUND

Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties.

OBJECTIVES

The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises.

METHODS

A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]).

RESULTS

One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=-0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure.

LIMITATIONS

In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome.

CONCLUSION

Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation.

Clinical tools to measure trunk performance after stroke: a systematic review of the literature

Objective : To give a systematic review of clinical measurement scales used to assess trunk performance after stroke.

Data sources : The databases CINAHL, Cochrane, Pedro and PubMed were searched with the terms `sitting balance' plus `stroke' and `trunk' plus `stroke' mentioned in the title or abstract. Databases were searched from inception to January 2006.

Review methods : All articles were selected which reported or included a clinical measure of trunk performance used in an adult stroke population. Reference lists were searched as secondary sources of articles.

Results : A total of 458 articles resulted from the database search. Thirty-two articles were eligible for inclusion. Earlier studies mentioned ordinal single items or a combination of items which are part of a larger scale used to assess sitting balance as a derived measure of trunk performance. Three clinical tools were available which specifically evaluated trunk performance after stroke; the Trunk Control Test and two Trunk Impairment Scales.

Conclusion : Ordinal single items or subscales of existing larger scales lack a systematic evaluation of psychometric characteristics. Both Trunk Impairment Scales have been extensively examined. A comparative study assessing psychometric properties of the Trunk Control Test and two Trunk Impairment Scales could determine which should be the measure of choice when assessing trunk performance after stroke.

Effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and maintain balance in chronic stroke patients

[Purpose] The aim of this study was to investigate the effects of proprioceptive neuromuscular facilitation neck pattern exercise on the ability to control the trunk and balance in chronic stroke patients. [Subjects and Methods] A total of 30 study subjects were selected and randomly divided into an experimental group of 15 subjects, who received the proprioceptive neuromuscular facilitation neck pattern exercise, and a control group of 15 subjects, who received a traditional rehabilitation treatment. [Results] Statistically significant changes in all the items of the Trunk Impairment Scale, the Trunk Impairment Scale total score, and the Berg Balance Scale were observed in both the experimental group and the control group. significant between-group differences were found in all items among the subitems of the Trunk Impairment Scale except the static sitting balance. [Conclusion] Proprioceptive neuromuscular facilitation neck pattern exercise was shown to have a positive effect on increasing the ability to control the trunk and maintain balance in chronic stroke patients.

Validation of the Spanish version of the Trunk Impairment Scale Version 2.0 (TIS 2.0) to assess dynamic sitting balance and coordination in post-stroke adult patients

BACKGROUND

In recent years the Trunk Impairment Scale version 2.0 (TIS 2.0) has been a frequently used scale to assess dynamic sitting balance and trunk control for stroke patients.

OBJECTIVE

To translate the TIS 2.0 into Spanish and validate it as an instrument to evaluate dynamic sitting balance and trunk control and coordination for post-stroke adult patients.

METHODS

The original version was translated into Spanish and was agreed by a team of experts. A back-translation into English was subsequently performed and sent to the original author, who approved this version. 58 post-stroke patients' performance was recorded on a videotape. These videos were then used to carry out four measurements to assess the intra-rater and inter-rater reliability, two of these were performed by the same rater and the third and fourth by a second and third rater.

RESULTS

The reliability was calculated by the Kappa index, and was superior to 0.80 for intra-rater reliability, while inter-rater reliability varied from 0.487 to 1. Cronbach's alpha for internal consistency was 0.896 and to subscales dynamic sitting balance and coordination were 0.899 and 0.613 respectively. Intra-class correlations (ICC) for the summed scores of the different subscales were above 0.90 for all of them.

CONCLUSION

The Spanish version of the TIS 2.0 is valid and reliable, and can be recommended for use in the evaluation of dynamic sitting balance and trunk control and coordination in future research on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.

Improvements in cognition, quality of life, and physical performance with clinical Pilates in multiple sclerosis: a randomized controlled trial

[Purpose] The aim of this study was to determine the effects of clinical Pilates in multiple sclerosis patients. [Subjects and Methods] Twenty multiple sclerosis patients were enrolled in this study. The participants were divided into two groups as the clinical Pilates and control groups. Cognition (Multiple Sclerosis Functional Composite), balance (Berg Balance Scale), physical performance (timed performance tests, Timed up and go test), tiredness (Modified Fatigue Impact scale), depression (Beck Depression Inventory), and quality of life (Multiple Sclerosis International Quality of Life Questionnaire) were measured before and after treatment in all participants. [Results] There were statistically significant differences in balance, timed performance, tiredness and Multiple Sclerosis Functional Composite tests between before and after treatment in the clinical Pilates group. We also found significant differences in timed performance tests, the Timed up and go test and the Multiple Sclerosis Functional Composite between before and after treatment in the control group. According to the difference analyses, there were significant differences in Multiple Sclerosis Functional Composite and Multiple Sclerosis International Quality of Life Questionnaire scores between the two groups in favor of the clinical Pilates group. There were statistically significant clinical differences in favor of the clinical Pilates group in comparison of measurements between the groups. Clinical Pilates improved cognitive functions and quality of life compared with traditional exercise. [Conclusion] In Multiple Sclerosis treatment, clinical Pilates should be used as a holistic approach by physical therapists.

The effects of horse riding simulation training on stroke patients' balance ability and abdominal muscle thickness changes

[Purpose] The purpose of this study was to assess the effects of horse riding simulation training on changes in balance ability and abdominal muscle thicknesses of stroke patients. [Subjects] Thirty stroke patients with hemiplegia were recruited, and they were randomly assigned to a control or experimental group. [Methods] The experimental group performed horse riding simulation training, whereas the control group performed trunk exercises for 8 weeks. Balance ability was measured using a BioRescue system. The thicknesses of subjects' external oblique, internal oblique, and transversus abdominis muscles were measured by ultrasonic imaging. [Results] In the experimental group, balance ability was significantly improved after training. Similarly, the thickness of the abdominal muscles on the affected side changed after training in the experimental group, whereas the control group showed no statistically significant changes. [Conclusion] We suggest that horse riding simulation training is more effective than trunk exercises at reducing the center of pressure path length and travel speed and improving the asymmetry of the abdominal muscles of stroke patients.

Reliability of the revised wheelchair rugby trunk impairment classification system

STUDY DESIGN

Observational, cross-sectional.

OBJECTIVES

A new classification system for trunk impairment in wheelchair rugby was introduced in 2010. It consists of 10 tests, arranged in an algorithm, to assign four different trunk scores (0, 0.5, 1.0 or 1.5) to athletes. The purpose of this study was to assess the inter-rater reliability of this classification system.

SETTING

National competition for wheelchair rugby and wheelchair basketball in the Netherlands and Belgium.

METHODS

Three experienced wheelchair rugby classifiers independently assigned trunk scores to wheelchair rugby and wheelchair basketball athletes in two sessions. After each session, test descriptions were adjusted. The inter-rater reliability was evaluated by determining the agreement and Fleiss Kappa.

RESULTS

In the first session, all classifiers agreed on the trunk score in 13 out of 16 athletes; the overall Kappa was 0.76 (P<0.001). The Kappa per trunk score ranged from 0.29 to 1. Four test descriptions were adjusted after the first session. In the second session, there was an agreement in trunk score between the classifiers in 15 out of 21 athletes. The overall Kappa was 0.75 (P<0.0001), and the Kappa per trunk scores ranged from 0.58 to 0.92. After the second session, two test descriptions were improved.

CONCLUSION

The revised classification system for trunk impairment in wheelchair rugby showed a adequate inter-rater reliability for the allocation of trunk scores.

Reliability and validity of the Trunk Impairment Scale in children and adolescents with cerebral palsy

Standardized clinical tools are useful for treatment planning and evaluation, however clinical tools to assess quality in trunk movements in children with cerebral palsy (CP) are sparse. We have recently reported good intra- and inter-observer reliability of the Trunk Impairment Scale (TIS) in 5-12 year old children with CP. The aim of this study was to assess reliability in adolescents (13-19 years old), and to assess the construct validity in children and adolescents in the whole age spectrum from 5 to 19 years. Video recordings of 17 children with CP with Gross Motor Function Classification (GMFCS) level I-IV were analyzed by three observers on two occasions. For construct validity the TIS was compared with Gross Motor Function Measure (GMFM), in 37 children with GMFCS levels I-IV. Intraclass correlation coefficients varied between 0.82 and 0.98, and 86% of the kappa values varied between 0.61 and 1.00, suggesting high inter- and intra-observer reliability. The smallest detectable difference (SDD) of the TIS (scale range 0-23) varied between 2.55 and 3.82 for intra- and 4.07-8.23 for inter-observer observations. The high inter-observer SDD was partly due to consistently lower TIS scores by one observer. The correlation between the TIS total score and the dimension scores of the GMFM was high (Spearman's rho: 0.80-0.87), while decreasing GMFCS levels were associated with increasing total TIS score; both findings indicating good construct validity of the TIS. This study suggests that the TIS is a reliable and valid measure of trunk control for both children and adolescents with cerebral palsy.

Validity of the Sitting Balance Scale in older adults who are non-ambulatory or have limited functional mobility

OBJECTIVE

To determine whether the Sitting Balance Scale is an acceptable alternative to the Trunk Impairment Scale for measuring the construct of sitting balance, to examine relationships with other clinical outcomes and to establish discriminative validity.

DESIGN

Prospective descriptive methodological study.

SETTING

Acute care, inpatient rehabilitation, skilled nursing facility and home health.

PARTICIPANTS

Patients receiving physical therapy (N = 98; n = 20 acute care, n = 18 inpatient rehabilitation, n = 30 skilled nursing facility, n = 30 home setting) mean (SD) age, 80.5 (7.9) years. Nineteen were non-ambulatory and 79 had limited functional mobility with Timed Up and Go scores ≥20 seconds.

MAIN MEASURES

Sitting Balance Scale, Trunk Impairment Scale, Timed Up and Go, length of stay and setting specific clinical measures of sitting balance (OASIS-C M1850; MDS G-3b).

RESULTS

Moderate association between ambulatory status and sitting balance measures (Sitting Balance Scale r = 0.67, Trunk Impairment Scale r = 0.61; P = 0.0001). Moderate to strong relationships between Sitting Balance Scale, Trunk Impairment Scale and clinical outcomes varying by setting. MANOVA results revealed differences between ambulators and non-ambulators and among diagnostic categories for both instruments (P < 0.001).

CONCLUSIONS

The Sitting Balance Scale is comparable to the Trunk Impairment Scale for measuring sitting balance in older adults who are non-ambulatory or have limited mobility.

The Trunk Impairment Scale - modified to ordinal scales in the Norwegian version

PURPOSE

To translate the Trunk Impairment Scale (TIS), a measure of trunk control in patients after stroke, into Norwegian (TIS-NV), and to explore its construct validity, internal consistency, intertester and test-retest reliability.

METHOD

TIS was translated according to international guidelines. The validity study was performed on data from 201 patients with acute stroke. Fifty patients with stroke and acquired brain injury were recruited to examine intertester and test-retest reliability. Construct validity was analyzed with exploratory and confirmatory factor analysis and item response theory, internal consistency with Cronbach's alpha test, and intertester and test-retest reliability with kappa and intraclass correlation coefficient tests.

RESULTS

The back-translated version of TIS-NV was validated by the original developer. The subscale Static sitting balance was removed. By combining items from the subscales Dynamic sitting balance and Coordination, six ordinal superitems (testlets) were constructed. The TIS-NV was renamed the modified TIS-NV (TIS-modNV). After modifications the TIS-modNV fitted well to a locally dependent unidimensional item response theory model. It demonstrated good construct validity, excellent internal consistency, and high intertester and test-retest reliability for the total score.

CONCLUSIONS

This study supports that the TIS-modNV is a valid and reliable scale for use in clinical practice and research.

Validation of the Brazilian version in Portuguese of the Thoracic-Lumbar Control Scale for spinal cord injury

STUDY DESIGN

Prospective clinical study.

OBJECTIVES

This study aimed to translate, adapting to Brazilian version in Portuguese, validate and measure inter and intra-examinator reliability and internal consistency of the Thoracic-Lumbar Control Scale instrument.

SETTING

State University of Campinas, São Paulo, Brazil.

METHODS

This instrument was translated to Brazilian Portuguese by a bilingual translator, and it was retranslated to English for conflict correction and cultural adaptation. Two physiotherapists were previously trained to standardize the scale administration. In all, 22 patients were selected and initially assessed through FIM and American Spinal Injury Association (ASIA) instruments. Furthermore, they were evaluated through the Thoracic-Lumbar Control Scale by two examiners and revaluated 1 week after by only one examinator.

RESULTS

The Brazilian Portuguese version of Thoracic-Lumbar Control Scale showed excellent intra and inter-examinator reliability (0.961 and 0.986), high value of internal consistence (0.934) and significant correlation with ASIA sensory score (r=0.83, P=0.001).

CONCLUSIONS

The Brazilian Portuguese version of Thoracic-Lumbar Control Scale is a valid and efficient instrument to assess trunk control of after-spinal cord injury patients, which certifies its replicability by other neurology professionals.

The influence of warm versus cold climate on the effect of physiotherapy in multiple sclerosis

OBJECTIVE

To compare the effect of inpatient physiotherapy in a warm versus cold climate in short- and long-term perspectives.

METHODS

Sixty multiple sclerosis (MS) patients with gait problems, without heat intolerance, were included in a randomized cross-over study of 4-week inpatient physiotherapy in warm (Spain) and cold (Norway) climate. The primary outcome, 6-min walk test (6MWT), and secondary physical performance and self-reported measures were scored at screening, baseline, after treatment and at 3 and 6 months of follow-up. Treatment effects were analysed by mixed models.

RESULTS

After treatment, the mean walking distance had increased by 70 m in Spain and 49 m in Norway (P = 0.060). Improvement in favour of warm climate was demonstrated at 6 months of follow-up, 43 m (Spain) compared to 20 m (Norway) (P = 0.048). The patients reported less exertion after walking (6MWT) in favour of treatment in Spain at all time points (P < 0.05). No significant differences in change were detected for the other physical performance measures. Most self-reported measures showed more improvement after treatment in Spain, but these improvements were not sustained at follow-up.

CONCLUSION

The results indicate that MS patients without heat intolerance have additional benefits from physiotherapy in a warm climate.

Intra- and inter-observer reliability of the Trunk Impairment Scale for children with cerebral palsy

Standardized scales to evaluate qualities of trunk movements in children with dysfunction are sparse. An examination of the reliability of scales that may be useful in the clinic is important. The aim of this study was to examine the reliability of the Trunk Impairment Scale (TIS) for children with cerebral palsy (CP). Standardized scales are useful for treatment planning and evaluation. This was an intra- and inter-observer reliability study. Video recordings of 25 children, 20 with CP and 5 with no motor impairment, in the age group 5-12 years of age, were analyzed by three observers on two occasions. Intraclass correlation coefficients (ICC [1,1] and [3,1]) with 95% confidence intervals, standard error of measurement, kappa values and percent agreement, and Bland-Altman Plots were calculated. The relative reliability (intra- and inter-observer reliability) was very high for the total score and subscale score of the TIS: ICC [1,1] and [3,1] varied between .94 and 1.00. Kappa values for the items ranged from .45 to 1.00. The absolute reliability values for the parameters are reported. The Bland-Altman analysis showed consistency of scores. This study indicates that TIS is a reliable measure of trunk control for children, 5-12 years of age, with CP.

How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions

OBJECTIVE

To identify psychometrically robust and clinically feasible measurement tools of balance activity in people with neurological conditions to recommend for use in clinical practice.

DATA SOURCES

MEDLINE, CINAHL, EMBASE, PEDro and AMED.

REVIEW METHODS

Independent reviewers selected and extracted data from articles that assessed the reliability, validity, sensitivity to change and clinical utility of measures of balance activity in adult neurological conditions. Quality assessment was based on Jorstad et al. Measures with 'good' psychometrics and > or =9/10 clinical utility scores were recommended.

RESULTS

Nineteen measurement tools were selected. Of these, the Brunel Balance Assessment, Berg Balance Scale, Trunk Impairment Scale, arm raise and forward reach tests in sitting and standing, weight shift, step/tap and step-up tests reached the required standards and are usable in clinical practice. The Brunel Balance Assessment and its associated functional performance tests have the additional advantages of being a hierarchical scale with established lack of redundancy.

CONCLUSION

The measurement tools identified above are psychometrically robust and feasible to use in clinical practice. Future objective measure development should consider the theoretical construct of the measure, the minimal detectable change and use in clinical populations other than stroke.

The Physical Activity and Disability Survey -- Revised (PADS-R): an evaluation of a measure of physical activity in people with chronic neurological conditions

OBJECTIVE

To revise the Physical Activity Disability Scale (PADS) and to explore the acceptability and test-retest reliability of the revised measure, the PADS-R, in people with multiple sclerosis.

DESIGN

This study was conducted over three phases: (1) PADS-R questionnaire development including modification to the original PADS, field testing and refinement; (2) PADS-R scoring; (3) PADS-R acceptability and reliability assessment, where participants completed the PADS-R twice over the telephone, three days apart, and then answered a series of semi-structured questions on the instrument's acceptability.

SUBJECTS

Participants were recruited from the local Multiple Sclerosis Society, Stroke Foundation and Auckland District Health Board depending on the purpose of each phase: (1) PADS-R questionnaire development (n = 30, multiple sclerosis); (2) PADS-R scoring (n = 293, multiple sclerosis; and n = 83, stroke); and (3) PADS-R acceptability and reliability assessment (n = 29, multiple sclerosis).

MAIN MEASURES

Physical Activity Disability Scale-Revised (PADS-R) RESULTS: The PADS-R took approximately 20 minutes to administer and most (n = 25; 86%) participants reported it to be easy to understand and complete. All participants reported that it enabled them to give an accurate picture of their physical activities. In terms of test-retest reliability, the intraclass correlation coefficient was high (0.87 (95% confidence intervals (CI) 0.78, 0.96)), but the 95% limits of agreement were wide (+/-1.13). When observations which potentially represented important changes in activity were excluded, these limits narrowed considerably (+/-0.89).

CONCLUSIONS

The PADS-R appears to be a conceptually and psychometrically sound measure of physical activity for people with chronic neurological conditions.

Validity of the Trunk Impairment Scale as a Measure of Trunk Performance in People With Parkinson’s Disease

OBJECTIVE

To evaluate construct validity of the Trunk Impairment Scale (TIS) as a measure of trunk performance in Parkinson's disease (PD).

DESIGN

A cross-sectional study of PD patients and healthy subjects.

SETTING

University rehabilitation research unit.

PARTICIPANTS

Twenty-six PD patients (Hoehn and Yahr stages 2-4) and 26 healthy subjects.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The TIS and its subscales; static and dynamic sitting balance and trunk coordination.

RESULTS

Compared with healthy controls, PD patients showed significantly lower scores on the total TIS, static sitting balance, and coordination subscale. Healthy subjects scored significantly better on the total TIS and coordination subscale compared with patients in the early stage of PD. Patients with PD in the early stage scored significantly higher for the total TIS as well as static and dynamic sitting balance in comparison with PD patients in a later stage. Forward stepwise multiple linear regression analysis showed that trunk impairment in PD patients was significantly related to a combination of older age and a higher score on part III of the Unified Parkinson's Disease Rating Scale, which assesses motor impairments.

CONCLUSIONS

Early detection of trunk deficits and the significant relation with PD severity advocates further evaluation and use of the TIS in PD.