Reliability and validity of the function in sitting test in nonambulatory individuals with multiple sclerosis

The Usability of a Smartphone-Based Fall Risk Assessment App for Adult Wheelchair Users: Observational Study

Background

Individuals who use wheelchairs and scooters rarely undergo fall risk screening. Mobile health technology is a possible avenue to provide fall risk assessment. The promise of this approach is dependent upon its usability.

Objective

We aimed to determine the usability of a fall risk mobile health app and identify key technology development insights for aging adults who use wheeled devices.

Methods

Two rounds (with 5 participants in each round) of usability testing utilizing an iterative design-evaluation process were performed. Participants completed use of the custom-designed fall risk app, Steady-Wheels. To quantify fall risk, the app led participants through 12 demographic questions and 3 progressively more challenging seated balance tasks. Once completed, participants shared insights on the app’s usability through semistructured interviews and completion of the Systematic Usability Scale. Testing sessions were recorded and transcribed. Codes were identified within the transcriptions to create themes. Average Systematic Usability Scale scores were calculated for each round.

Results

The first round of testing yielded 2 main themes: ease of use and flexibility of design. Systematic Usability Scale scores ranged from 72.5 to 97.5 with a mean score of 84.5 (SD 11.4). After modifications were made, the second round of testing yielded 2 new themes: app layout and clarity of instruction. Systematic Usability Scale scores improved in the second iteration and ranged from 87.5 to 97.5 with a mean score of 91.9 (SD 4.3).

Conclusions

The mobile health app, Steady-Wheels, has excellent usability and the potential to provide adult wheeled device users with an easy-to-use, remote fall risk assessment tool. Characteristics that promoted usability were guided navigation, large text and radio buttons, clear and brief instructions accompanied by representative illustrations, and simple error recovery. Intuitive fall risk reporting was achieved through the presentation of a single number located on a color-coordinated continuum that delineated low, medium, and high risk.

Pilot Study of a Fall Prevention and Management Intervention Program for People With Multiple Sclerosis Who Use a Wheelchair or Scooter Full-Time

Objective

To examine the efficacy of a fall prevention/management intervention among persons with multiple sclerosis (PwMS) who use a wheelchair (WC) or scooter full-time.

Design

Pre-post/follow-up trial.

Setting

Community and research laboratory.

Participants

Twenty-one PwMS who used a WC or scooter full-time, self-reported at least 1 fall/12 months, and could transfer independently or with minimal/moderate assistance (N=21).

Intervention

Six-week, group and community-based fall prevention and management intervention. The intervention included six 2-hour in-person weekly sessions led by a physical or occupational therapist featuring interactive group discussions, skill practice, and action planning opportunities.

Main Outcome Measures

Fall frequency tracked 12 weeks pre- and 24 weeks post intervention. Outcomes were assessed pre- and post intervention and 12 weeks post intervention. Measures included surveys to examine fear of falling (FOF), fall prevention/management, quality of life, community participation, and assessment of functional mobility skills. Semistructured interviews were administered post intervention to ascertain overall experiences with the program and effect on daily life. A Friedman test with signed-rank post hoc analysis was run to determine differences across the 3 study visits.

Results

After the intervention, fall incidence did not significantly change, but fall management strategies (P=.01-0.05), importance of community participation (P=.01), and transfer quality (P=.02) significantly improved. Moderate effect sizes were noted among concerns about falling, activity curtailment because of to FOF, and WC skills. Qualitative results indicate that participants found the intervention beneficial and applied intervention content in their daily lives.

Conclusions

This study is the first to describe the effect of a multicomponent fall prevention/management intervention designed specifically for PwMS who use a WC or scooter full-time. Results indicate the program has potential to reduce fall risk; however, further testing is needed to fully examine the effect of the program.

Prediction of future falls among full-time wheelchair and scooter users with multiple sclerosis: A prospective study

BACKGROUND

Seventy-five percent (75%) of full-time wheelchair or scooter users with multiple sclerosis (MS) experience at least one fall in a period of 6 months. Falls are detrimental for the independence, quality of life, and community participation. No previous prospective study has evaluated fall risk factors in this segment of MS community.

OBJECTIVE

To develop a multivariable falls risk prediction model for people with MS (PwMS) who use a wheelchair or scooter full-time.

METHODS

This prospective cohort study is a secondary data analysis that recruited PwMS from the community across the US. Forty-eight adults with MS who use a wheelchair or scooter as their main form of mobility were included. Dependent variable was fall incidence over 3-month recorded through diaries. Dependent variable was categorized as fallers (≥ 1 fall) and non-fallers (0 fall). Predictors were demographics, history of falls in the past 6 months, measures of fear of falling, Spinal Cord Injury- Falls Concern Scale, California Verbal Learning Test II, and Multiple Sclerosis Quality of Life- mental health. Multivariable logistic regression analyses were conducted to identity predictors of future falls.

RESULTS

In total, 63 falls (range 0 - 8) were reported over the 3-month period from a total of 26 fallers (54%). Multivariate logistic regression analyses indicated that the risk factor with the best predictive ability of future falls included history of falls in the past 6 months (sensitivity 77%, specificity 54%, and area under the receiving operating curve statistic = 0.76, 95% CI 0.62 to 0.89).

CONCLUSION

Findings highlight the importance of asking full-time wheelchair and scooter users with MS if they have fallen in the past 6 months to quickly identify those who are at increased fall risk and in need of follow up assessment and intervention to identify and address modifiable risk factors. More attention to fall risks among full-time wheelchair or scooter users with MS is suggested to increase the understanding among clinicians and researchers of modifiable risk factors.

Feasibility and preliminary reliability and validity of remote sitting balance assessments among wheelchair users

The aim of this study was to investigate the feasibility and preliminary validity and reliability of remote sitting balance assessment. Seven wheelchair users (mean age: 42.7 ± 19.74 years) participated in an in-person and remote sitting balance assessment. The assessments were compared to investigate the concurrent validity of the remote assessment. Reliability of remote assessment was evaluated using intraclass coefficient correlation (ICC) and the Bland-Altman. No significant differences were observed between the mean scores of in-person and remote administrations of the clinical tests (P's > 0.05). High to very high agreement was found between in-person and remote assessments (ICC = 0.88-0.982, P < 0.05). The agreement was confirmed by Bland-Altman graph analysis. Preliminary results indicate remote sitting balance assessment is feasible to perform, valid, and reliable.

Reliability and validity of the Turkish version of Function in Sitting Test (FIST-T) in stroke

Background: Trunk control in sitting position after stroke is one of the most important determinants of independence in daily living activities and there is no gold standard assessment used to measure sitting postural control.Objectives: The aim of this study is to determine the reliability and validity of the Turkish version of Function in Sitting Test (FIST-T).Methods: After translation was conducted, Function in Sitting Test, Berg Balance Scale, Functional Independent Measure and Trunk Impairment Scale were applied to 72 stroke patients (mean age was 59.26 ± 16.38 years; post-stroke time was 95.93 ± 59.64 days). For reliability and validity analysis the spearman correlation analysis was used.Results: A positive, high correlation was found between the first application and repetition of Function in Sitting Test-T (ICC = 0.97, r = 0.95, p = .001). The internal consistency was high (Cronbach Alpha = 0.97), interrater correlation was high (Cronbach Alpha = 0.98) and a positive, high correlation was found with the scores obtained from the Berg Balance Scale (r = 0.82, p = .001), Functional Independent Measure (r = 0.84, p = .001) and Trunk Impairment Scale (r = 0.80, p = .001).Conclusions: It is concluded that the Turkish version of Function in Sitting Test is a valid and reliable scale for use in stroke patients, in clinical and scientific researches.

Rehabilitation for ataxia study: protocol for a randomised controlled trial of an outpatient and supported home-based physiotherapy programme for people with hereditary cerebellar ataxia

INTRODUCTION

Emerging evidence indicates that rehabilitation can improve ataxia, mobility and independence in everyday activities in individuals with hereditary cerebellar ataxia. However, with the rarity of the genetic ataxias and known recruitment challenges in rehabilitation trials, most studies have been underpowered, non-randomised or non-controlled. This study will be the first, appropriately powered randomised controlled trial to examine the efficacy of an outpatient and home-based rehabilitation programme on improving motor function for individuals with hereditary cerebellar ataxia.

METHODS AND ANALYSIS

This randomised, single-blind, parallel group trial will compare a 30-week rehabilitation programme to standard care in individuals with hereditary cerebellar ataxia. Eighty individuals with a hereditary cerebellar ataxia, aged 15 years and above, will be recruited. The rehabilitation programme will include 6 weeks of outpatient land and aquatic physiotherapy followed immediately by a 24- week home exercise programme supported with fortnightly physiotherapy sessions. Participants in the standard care group will be asked to continue their usual physical activity. The primary outcome will be the motor domain of the Functional Independence Measure. Secondary outcomes will measure the motor impairment related to ataxia, balance, quality of life and cost-effectiveness. Outcomes will be administered at baseline, 7 weeks, 18 weeks and 30 weeks by a physiotherapist blinded to group allocation. A repeated measures mixed-effects linear regression model will be used to analyse the effect of the treatment group for each of the dependent continuous variables. The primary efficacy analysis will follow the intention-to-treat principle.

ETHICS AND DISSEMINATION

The study has been approved by the Monash Health Human Research Ethics Committee (HREC/18/MonH/418) and the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research (2019/3503). Results will be published in peer-reviewed journals, presented at national and/or international conferences and disseminated to Australian ataxia support groups.

TRIAL REGISTRATION NUMBER

ACTRN12618000908235.

The Validity, Reliability, and Sensitivity of a Smartphone-Based Seated Postural Control Assessment in Wheelchair Users: A Pilot Study

Seated postural control is essential for wheelchair users to maintain proper position while performing activities of daily living. Clinical tests are commonly used to measure seated postural control, yet they are subjective and lack sensitivity. Lab-based measures are highly sensitive but are limited in scope and restricted to research settings. Establishing a valid, reliable, and accessible measurement tool of seated postural control is necessary for remote, objective assessments. Therefore, the purpose of this study was to examine the validity, reliability, and sensitivity of smartphone-based postural control assessments in wheelchair users. Eleven participants (age: 35.4 ± 17.9) completed two experimental visits 1-week apart consisting of three clinical tests: Trunk Control Test (TCT), Function in Sitting Test (FIST), and Tee-shirt Test, as well as, standardized instrumented balance tasks that manipulated vision (eyes open and closed), and trunk movement (functional reach and stability boundary). During these tasks, participants held a smartphone instrumented with a research-grade accelerometer to their chest. Maximum and root mean square (RMS) acceleration in the medial-lateral (ML) and anterior-posterior (AP) axes were derived. Participants were grouped into non-impaired and impaired postural groups based on FIST scores. Spearman rank-order correlations were conducted between the two devices' outcome measurements and between these measures and those of the clinical tests. Receiver operating characteristic (ROC) curves and the area under the curves (AUC) were determined to distinguish participants with and without impaired postural control. The reliability of outcome variables was assessed using inter-class correlations. Strong correlations between outputs derived from the smartphone and research-grade accelerometer were seen across balance tasks (ρ = −0.75–1.00; p ≤ 0.01). Numerous significant moderate correlations between clinical test outcomes and smartphone and research-grade RMS ML accelerometry were seen (ρ = −0.62 to 0.83 (p ≤ 0.044)]. On both devices, the AUC for ROC plots were significant for RMS ML sway during the eyes open task and functional stability boundary (p < 0.05). Reliability of smartphone accelerometry was comparable to the research-grade accelerometer and clinical tests. This pilot study illustrated that smartphone-based accelerometry may be able to provide a valid and reliable assessment of seated postural control and have the ability to distinguish between those with and without impaired postural control.

Postural control quantification in minimally and moderately impaired persons with multiple sclerosis: The reliability of a posturographic test and its relationships with functional ability

BACKGROUND

Postural control has been associated with the functional impairment in persons with multiple sclerosis (pwMS). However, there is a need for reliable methods to assess postural control in early stages of the disease, when subtle changes can be difficult to detect. The aims of this study were to assess the absolute and relative reliability of a standing and a sitting posturographic protocol in minimally (Expanded Disability Status Scale ≤ 2) and moderately (2.5 ≤ Expanded Disability Status Scale ≤ 4) impaired pwMS, and to analyze relationships among postural control and functional mobility and gait performance.

METHODS

To assess postural control in an upright stance, 14 minimally and 16 moderately impaired pwMS performed six 70 s trials in tandem stance, 3 with their weaker leg behind (TS_WL) and 3 with their stronger leg behind (TS_SL). Additionally, participants completed five 70 s trials using an unstable sitting protocol (US) to assess trunk stability. The mean radial errors of TS_WL, TS_SL, and US trials were calculated as postural control indexes. Furthermore, participants performed the Timed Up and Go test (TUG) and the Timed 25-foot Walk test (T25FW) to measure their functional mobility and gait speed, respectively. Reliability was evaluated using the intraclass correlation coefficient (ICC_3,1) and the standard error of measurement (SEM). Analyses of variances were carried out to assess between-group differences. Hedges' g index (d_g) was used to estimate the effect size of differences. Pearson correlation analyses (r) were performed to examine the relationships among the postural control and the functional tests.

RESULTS

Posturographic tests showed a high reliability in both minimally (0.87 ≤ ICC ≤ 0.92; 9.32% ≤ SEM ≤ 11.76%) and moderately (0.80 ≤ ICC ≤ 0.92; 10.33% ≤ SEM ≤ 15.33%) impaired pwMS. Similarly, T25FW and TUG displayed a high consistency in minimally (0.89 ≤ ICC ≤ 0.94; 3.43% ≤ SEM ≤ 5.17%) and moderately (0.85 ≤ ICC ≤ 0.93; 5.57% ≤ SEM ≤ 6.56%) impaired individuals. Minimally impaired pwMS showed a better performance on the TUG, T25FW, and TS_WL than moderately impaired individuals (p < 0.05; d_g ≥ 0.8). The TS_WL, TS_SL, and US variables correlated with TUG scores (0.419 ≤ r ≤ 0.604; p < 0.05), but TS_WL also correlated with T25FW scores (r = 0.53; p < 0.01). Furthermore, US scores correlated with both tandem stance parameters (TS_WL: r = 0.54, p < 0.01; TS_SL: r = 0.43, p < 0.05).

CONCLUSION

Tandem and sitting posturographic tests provide reliable measures of postural control in pwMS, even in individuals with a homogeneous disease profile. Gait speed, functional mobility, and weaker leg status seem decisive in assessing the degree of physical activity limitation in pwMS. Finally, although trunk stability does not seem to be so affected by the course of the disease, it remains relevant for postural control and functional capacity.

Analysis of Postural Control in Sitting by Pressure Mapping in Patients with Multiple Sclerosis, Spinal Cord Injury and Friedreich's Ataxia: A Case Series Study

The postural control assessments in patients with neurological diseases lack reliability and sensitivity to small changes in patient functionality. The appearance of pressure mapping has allowed quantitative evaluation of postural control in sitting. This study was carried out to determine the evaluations in pressure mapping and verifying whether they are different between the three sample groups (multiple sclerosis, spinal cord injury and Friedreich’s ataxia), and to determine whether the variables extracted from the pressure mapping analysis are more sensitive than functional tests to evaluate the postural trunk control. A case series study was carried out in a sample of 10 adult patients with multiple sclerosis (n = 2), spinal cord injury (n = 4) and Friedreich’s ataxia (n = 4). The tests applied were: pressure mapping, seated Lateral Reach Test, seated Functional Reach Test, Berg Balance Scale, Posture and Postural Ability Scale, Function in Sitting Test, and Trunk Control Test. The participants with Friedreich’s ataxia showed a tendency to present a higher mean pressure on the seat of subject’s wheelchair compared to other groups. In parallel, users with spinal cord injury showed a tendency to present the highest values of maximum pressure and area of contact. People with different neurological pathologies and similar results in functional tests have very different results in the pressure mapping. Although it is not possible to establish a strong statistical correlation, the relationships between the pressure mapping variables and the functional tests seem to be numerous, especially in the multiple sclerosis group.

Reliability and validity of the function in sitting test among non-ambulatory individuals with spinal cord injury

Context: Trunk impairment among non-ambulatory individuals with spinal cord injury (SCI) reduces the ability to maintain a functional sitting position and perform activities of daily living. Measuring functional sitting balance is complex and difficult in a clinical setting. The function in sitting test (FIST) is a clinical measure that includes the assessment of all the components of sitting balance. The purpose of this study is to assess the reliability and validity of the 14-item FIST among non-ambulatory individuals with SCI. Participants: Twenty-six individuals with chronic SCI. Outcome measures: Participants were evaluated with the FIST, the modified Functional Reach Test (lateral and forward mFRT) and a posturography assessment (virtual time to contact - VTC). The FIST was re-assessed during a second study visit 12 weeks later. Test-retest reliability was evaluated using intraclass coefficient correlation (ICC), the minimal detectable change (MDC) was calculated and the internal consistency reliability was assessed using Cronbach's coefficient-α. Concurrent validity of the FIST was also tested with the mFRT and the VTC. Results: Test-retest reliability was found to be excellent (ICC = 0.95) with a MDC of 4. The internal consistency was satisfactory (0.81). Moreover, the FIST correlates with the lateral mFRT (r = 0.64, P = 0.001) but not with the forward mFRT and the VTC. Conclusion: These observations provide evidence that the FIST is a reliable clinical measure with partially established validity for non-ambulatory individuals with SCI. Further studies are needed to strengthen the validity of the FIST and explore this measure in a larger sample.

A systematic review of adults` sitting balance assessments in neurological and neuromuscular condition

Objectives:

To find out new assessment tools for sitting, in patients with neurological and neuromuscular conditions, to be recommended for rehabilitation practice locally in Saudi Arabia and internationally.

Methods:

Four databases were used: PubMed, Web of Science, Ovid Medline, and Cochrane. Inclusion criteria were articles published between the years 2009–2019; sitting, not standing or walking; assessment not intervention; published in English and studies on adults only. Exclusion criteria were any assessment that measures the standing/walking ability or has items for that, and studies that include pediatric or adolescent or both.

Results:

Ten articles met our criteria including 464 patients and divided into 3 main neurological conditions (stroke, SCI, and MS). One assessment (Function in Sitting Test) showed promising potential being implemented with both stroke and multiple sclerosis, Cronbach’s alpha, α were 0.91 and 0.98 indicating high internal consistency. It was used with SCI patients, however, no access was available to include this study in this review.

Conclusion:

This review indicates an extension of what was carried out by previous systematic reviews with neurological conditions. It seems that Function in Sitting Test is the most frequent assessment in this review with multiple neurological conditions (stroke, MS and SCI) with high internal consistency and high quality studies according to available data. However, this review showed that there is an absence of evidence for individuals with brain injury. Further work needs to be carried out to address such groups of patients to extend the choices that clinicians can use in rehabilitation sittings.

Psychometric Testing and Clinical Utility of a Modified Version of the Function in Sitting Test for Individuals With Chronic Spinal Cord Injury

OBJECTIVES

Seated balance (SB) is substantially compromised and greatly impacts the function of individuals living with a spinal cord injury (SCI). A clinically applicable criterion standard measure for SB does not exist for this population. Initial validation and reliability analysis of the Function in Sitting Test (FIST) in SCI has been published, but the authors of this study report that modifications to the tool may be necessary. This study aimed to explore the psychometrics and clinical utility of a modified version of the FIST to better measure SCI-specific functional tasks in sitting.

DESIGN

The FIST was modified (FIST-SCI) by an expert panel and used by 2 graders to evaluate the SB of individuals with chronic SCI (cSCI) on 2 separate days. The Motor Assessment Scale item 3 (MAS-SCI) was included as a comparison measure.

SETTING

Research facility.

PARTICIPANTS

Individuals with cSCI longer than 1 year (N=38) participated in the study. Injury levels of individuals participating in this study spanned C1 to T10 (American Spinal Injury Association Impairment Scale A, 17 subjects; B, 12 subjects; and C, 9 subjects). Thirteen individuals required assistance to transfer.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Validity, reliability, internal consistency, sensitivity, specificity, and responsiveness.

RESULTS

Validity testing found a moderate relationship between the MAS-SCI and the FIST-SCI (ρ, .522; P<.05). FIST-SCI scores distinguished individuals requiring assistance to transfer from those who were independent (t=4.51; P<.05). Inter- and intra-rater reliability were excellent (intraclass correlation coefficient (2,k)=.985 and .983, respectively) and internal consistency was excellent (α=.94). A FIST-SCI cutoff score of 45 or greater was 92% sensitive and specific in characterizing transfer ability. Standard error of the measure (1.3) and minimal detectable change (3.5) were similar to previous work.

CONCLUSIONS

Initial validity of the FIST-SCI is reported, but further assessment is required. Reliability is excellent in the cSCI population. FIST-SCI scores provide clinical insight into the seated functional ability of individuals with cSCI.

Validation of an individualized reduction of falls intervention program among wheelchair and scooter users with multiple sclerosis

INTRODUCTION

Falls are a serious concern for wheelchair and scooter users with multiple sclerosis (MS). Approximately, 75% of the population reports at least one fall in a 6-month period and nearly half report frequent falls. Falls can result in physical injuries and contribute to activity curtailment. Despite the negative consequences, limited evidenced-based fall prevention programs designed specifically for wheelchair and scooter users with MS exist.

PURPOSE

Recognizing the threat falls pose to health and well-being and the dearth of fall prevention programs, the purpose of this study is to perform a structured process evaluation and examine the feasibility and efficacy of a community-based intervention specifically designed to reduce fall incidence among wheelchair and scooter users with MS. Secondary aims of the intervention are to improve functional mobility skills associated with fall risk (e.g., transfer and wheelchair skills, balance), increase knowledge of fall risk factors, decrease fear of falling, and enhance quality of life and community participation.

METHODS

To evaluate our specific aims, a clinical trial will be performed with 160 wheelchair and scooter users with MS. (ClinicalTrials.gov Identifier: NCT03705364). Participants will be recruited to participate in a small group-style community-based program. The content of the program will be based on factors found to be associated with falls among wheelchair and scooter users with MS. These factors include but are not limited to, wheelchair/scooter related characteristics, transfer activities, impaired seated balance, and environmental factors. A physical or occupational therapist, will implement the intervention, which is comprised of 6 sessions that occur once weekly. The incidence of falls, along with an examination of wheelchair/scooter and transfer skills, seated postural control and knowledge of fall related risk factors will be compared between intervention and control participants, with assessment periods occurring prior to the intervention, 1 to 2 weeks after completion of the 6-week intervention session, and 12 weeks after the intervention period is complete.

CONCLUSION

Results from this study will guide the refinement of the intervention program and inform future research among a large and diverse group of wheelchair and scooter users living with MS.

Investigation of the Feasibility of an Intervention to Manage Fall Risk in Wheeled Mobility Device Users with Multiple Sclerosis

Background

Falls are a common concern for wheeled mobility device users with multiple sclerosis (MS); however, no evidence-based fall prevention programs have been developed to meet the specific needs of the population. We examine the preliminary feasibility of a fall management intervention in wheeled mobility device users with MS.

Methods

Study participants were exposed to an intervention program targeting risk factors for falls, including transfer skills and seated postural control. The feasibility of the program was evaluated by assessing participant perspectives, cost, recruitment rates, study adherence, participant retention, safety, and the ability to collect primary and secondary outcomes, including fall frequency, concerns about falling, transfer quality, and seated postural control.

Results

16 wheeled mobility device users completed the program, which was found to be feasible and was positively evaluated by participants. No adverse events were experienced. After exposure to the intervention, fall frequency significantly decreased (P < .001) and transfer quality (P = .001) and seated postural control (P = .002) significantly improved. No significant differences were found regarding concerns about falling (P = .728).

Conclusions

This study examined the feasibility of an intervention program to manage fall risk in wheeled mobility device users with MS. The program was found to be feasible, and preliminary results showed the intervention to be effective in decreasing fall frequency. Additional testing is needed to further examine the efficacy and long-term impact of the intervention.

Recommended outcome measures for inpatient rehabilitation of multiple sclerosis are not appropriate for the patients with substantially impaired mobility

BACKGROUND

In multiple sclerosis (MS) rehabilitation, most currently used outcome measures were validated in patients with a relapsing remitting MS and mild to moderate impairments. We aimed to assess whether these measures were also adequate in more impaired patients, frequently encountered in those with progressive MS (PMS).

METHODS

Outcome measurements were extracted from medical records of 229 patients with PMS undergoing 3 weeks of routine inpatient rehabilitation between 2011 and 2015. We assessed the acceptability of Nine-Hole Peg Test (9HPT), Timed 25-Foot Walk (T25FW), 2-Minute Walk Test (2MWT), Rivermead Mobility Index (RMI) and the Functional Independence Measure (FIM) by analysing their statistical distributions, concurrent validity by comparing Spearman correlations with pre-specified hypotheses, and responsiveness across impairment status by calculating standardized response means.

RESULTS

Our concurrent validity hypotheses were mainly satisfied. However, all outcome measures had skewed distributions, showed low variability, and thus were inadequately discriminative. Moreover, 9HPT was never responsive across the impairment states, whereas the T25FW was responsive for mildly impaired patients, and the 2MWT for mild to moderate MS, respectively. Generic multi-items measures such as RMI and FIM-motor were adequately responsive for all severity levels.

CONCLUSIONS

Currently used outcome measures are inadequate for patients with impaired mobility, and there is a dire need of specifically designed outcome measures for routine care that are less burdensome and short-term responsive.

Validation and reliability of the Spanish version of the Function in Sitting Test (S-FIST) to assess sitting balance in subacute post-stroke adult patients

BACKGROUND

Function in Sitting Test (FIST) is a clinical functional assessment of sitting balance validated in adults with stroke. For a major use of this, the test is recommended to be translated in Spanish-speaking countries.

OBJECTIVES

Translate to Spanish the FIST and determine its intra-rater and inter-rater reliabilities and concurrent validity as a measure of sitting balance in adult individuals with stroke.

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 named from now Spanish version of Function in Sitting Test (S-FIST). Sixty 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 reliabilities; two of these were performed by the same rater and the third and fourth by a second and third rater.

RESULTS

The S-FIST meets the following requirements: good construct validity and high correlation with Spanish version of Trunk Impairment Scale 2.0 (S-TIS 2.0) scores (r = 0.791) Spearman's rank, high internal consistency (Cronbach's α-coefficient = 0.97), and high intra-rater and inter-rater reliabilities for the summed scores assessed by intra-class correlation coefficient were 0.999 and 0.997, respectively.

CONCLUSIONS

The S-FIST is valid and reliable and can be recommended for use in the evaluation of dynamic and sitting balance and trunk control in future research and clinical practice on post-stroke patients. Guidelines for treatment and level of quality of trunk activity can be derived from its use.