Development and validation of the Function In Sitting Test in adults with acute stroke. J Neurol Phys Ther. 2010;34:150-160. [PMID: 20716989 DOI: 10.1097/npt.0b013e3181f0065f]

Functional Sitting Balance and Anthropometric Measures Are Related to Inspiratory Muscle Performance in People with Spinal Cord Injury

Background

Respiratory complications are a leading cause of mortality post spinal cord injury (SCI). Along with breathing, respiratory muscles have a role in maintaining seated balance. Postinjury breathing influences respiratory muscle function. Preliminary evidence indicates a relation between respiratory muscle function and seated balance in people with chronic SCI dwelling in the community, but the relationship between balance and body habitus has not been explored.

Objectives

To explore the relationships among inspiratory muscle function, functional seated balance (FSB), and body habitus in people with SCI.

Methods

A convenience sample of inpatients with SCI (C5-T12) aged 18 to 60 years who were using a wheelchair was recruited from November 2022 to March 2023. Those with additional neurological disorders or respiratory support were excluded. Respiratory muscle function measures included maximal inspiratory pressure (MIP), sustained MIP (SMIP), and Fatigue Index Test (FIT). FSB was scored using the Function in Sitting Test (FIST). Body habitus was assessed using the axillary: umbilical (A:U) ratio. Spearman correlations explored the relationships.

Results

Thirty-eight of 42 screened participants were eligible and participated (male, 32). Levels of injury ranged from C5 to T12. The mean (SD) age and duration of injury of the sample was 25.61 (6.68) years and 31.03 (28.69) months, respectively. SMIP and FIT correlated significantly with FSB (r s= .441, p = .01, and r s= .434, p = .006, respectively). A significant correlation between SMIP and A:U ratio (r s= -.330, p = .043) was observed.

Conclusion

We observed a significant correlation between inspiratory pressure parameters and both functional seated balance and body habitus, adding to evidence on postural role of respiratory muscles.

Investigation of the reliability and validity of the Turkish version of the Sitting Balance Scale in individuals with stroke

OBJECTIVE

The purpose of the study was to investigate the reliability and validity of the Turkish version of the Sitting Balance Scale (SBS-T).

METHODS

SBS-T was tested with 60 individuals with stroke. Test-retest reliability was calculated with the Intraclass Correlation Coefficient (ICC). The Trunk Impairment Scale (TIS), Function in Sitting Test (FIST), The Berg Balance Scale (BBS), and Barthel Index (BI) were used to test the validity of SBS-T. The internal consistency of the SBS-T items was calculated with the Cronbach Alpha Analysis. Factor analysis and hypothesis testing were used for construct validity. Ceiling and floor effects were calculated for reliability.

RESULTS

The intra-observer ICC was found to be 0.970 and the inter-observer ICC value was 0.999. The Cronbach's Alpha Coefficient was detected to be 0.955. A high correlation was detected between SBS-T and TIS, BBS, FIST, and BI (r = 0.861, p = 0.001; r = 0.849, p = 0.001; r = 0.906, p = 0.001; r = 0.848, p = 0.001, respectively).

CONCLUSION

As a result of the factor analysis, it was found that the scale was determined by one single factor. No ceiling and floor effects were detected. The Turkish version of the SBS is a valid and reliable scale for predicting mobility and functionality in stroke for use in clinical and scientific studies.

CLINICALTRIALS

GOV IDENTIFIER

NCT04801927.

Minimal Clinically Important Difference of Scales Reported in Stroke Trials: A Review

There is a growing awareness of the significance of using minimum clinically important differences (MCIDs) in stroke research. An MCID is the smallest change in an outcome measure that is considered clinically meaningful. This review is the first to provide a comprehensive summary of various scales and patient-reported outcome measures (PROMs) used in stroke research and their MCID values reported in the literature, including a concise overview of the concept of and methods for determining MCIDs in stroke research. Despite the controversies and limitations surrounding the estimation of MCIDs, their importance in modern clinical trials cannot be overstated. Anchor-based and distribution-based methods are recommended for estimating MCIDs, with patient self-evaluation being a crucial component in capturing the patient's perspective on their health. A combination of methods can provide a more comprehensive understanding of the clinical relevance of treatment effects, and incorporating the patient's perspective can enhance the care of stroke patients.

George L, Nankervis K, Sinclair J, Penhorwood G, Williams J, Clayton HM. Towards an Evidence-Based Classification System for Para Dressage: Associations between Impairment and Performance Measures

This study follows a previously defined framework to investigate the impact of impairment on performance in Para dressage athletes. Twenty-one elite Para dressage athletes (grades I to V) and eleven non-disabled dressage athletes (competing at Prix St. Georges or Grand Prix) participated. Data were collected in two phases: performing a two minute custom dressage test on a riding simulator while kinematic data were synchronously collected using inertial measurement units (2000 Hz) and optical motion capture (100 Hz), and clinically assessed using a battery of impairment assessment tools administered by qualified therapists. Impairment and performance measures were compared between Para and non-disabled athletes. Significant differences between athlete groups were found for all impairment measures and two performance measures: simulator trunk harmonics (p = 0.027) and athlete trunk dynamic symmetry (p < 0.001). Impairment assessments of sitting function and muscle tone could predict 19 to 35% of the impact of impairment on performance in Para athletes but not in non-disabled athletes. These findings provide the basis for a robust, scientific evidence base, which can be used to aid in the refinement of the current classification system for Para dressage, to ensure that it is in line with the International Paralympic Committee's mandate for evidence-based systems of classification.

Modified Recurrence Quantification Analysis for Objective Assessment of Cerebellar Ataxia

Cerebellar Ataxia (CA) is a neurological condition that affects coordination, balance and speech. Assessing its severity is important for developing effective treatment and rehabilitation plans. Traditional assessment methods involve a clinician instructing a person with ataxia to perform tests and assigning a severity score based on their performance. However, this approach is subjective as it relies on the clinician's experience, and can vary between clinicians. To address this subjectivity, some researchers have developed automated assessment methods using signal processing and data-driven approaches, such as supervised machine learning. These methods still rely on subjective ground truth and can perform poorly in real-world scenarios. This research proposed an alternative approach that uses signal processing to modify recurrence plots and compare the severity of ataxia in a person with CA to a control cohort. The highest correlation score obtained was 0.782 on the back sensor with the feet-apart and eyes-open test. The contributions of the research include modifying the recurrence plot as a measurement tool for assessing CA severity, proposing a new approach to assess severity by comparing kinematic data between people with CA and a control reference group, and identifying the best subtest and sensor position for practical use in CA assessments.

Home-based exercise using balance disc and smartphone inclinometer application improves balance and activity of daily living in individuals with stroke: A randomized controlled trial

BACKGROUND

Sitting ability is critical for daily activities in individuals who have experienced a stroke. A combination of seated balance training on an unstable surface and real-time visual feedback via a simple mobile inclinometer application may improve trunk control in stroke survivors.

OBJECTIVE

This randomized controlled trial aimed to determine the effects of home-based exercise utilizing a balance disc with input from a smartphone inclinometer application on sitting balance and activities of daily living in stroke survivors.

METHODS

This trial enrolled 32 stroke survivors aged 30 to 75 years. Participants were randomly assigned to one of two groups: intervention or control. Both groups underwent four weeks of traditional therapy. Additionally, the intervention group received four weeks of multidirectional lean training utilizing a balance disc and a smartphone application with an inclinometer. The Postural Assessment Scale for Stroke (PASS), the Function in Sitting Test (FIST), and the Barthel Index (BI) were used to assess the results. To compare between group effects, an ANCOVA analysis was performed using a baseline as a covariate.

RESULTS

The PASS changing posture and BI were considerably greater in the intervention group compared to the control group. Other metrics revealed no statistically significant differences between the groups.

CONCLUSION

Home-based training with balance discs and input from a smartphone inclinometer application may improve postural control and daily activity in stroke patients.

TRIAL REGISTRATION

Clinical trials registry number: TCTR20210617004.

Turkish translation, cross-cultural adaptation, and assessment of psychometric properties of the Ottawa sitting scale for the intensive care unit survivors

PURPOSE

To translate and cross-culturally adapt the Ottawa Sitting Scale (OSS) developed for acute care patients into Turkish and to examine its psychometric properties in intensive care unit (ICU) survivors.

METHODS

After translation process the Turkish version of the scale was adminstered to eighty-one patients aged 39-82 years after discharge from the ICU and videotape was recorded. Two physiotherapists watched the videotaped records during the evaluation and scored. Test-retest reliability was assesed by scoring the same video recordings 15 days after the initial scoring. Correlations of the OSS with Berg Balance Scale (BBS), Functional Independence Measurement (FIM), the ICU length of stay and, total mechanical ventilation duration were assessed for convergent validity.

RESULTS

The intra-class correlation coefficient for inter and intra-rater reliability was 0.989-0.994 and 0.998 respectively. The internal consistency was excellent (Cronbach's α = 0.998). The OSS score was highly correlated with the BBS total score (r = 0.716), the BBS unsupported sitting item score (r = 0.863), and moderately correlated with the total score of the FIM (r = 0.602), the number of days in ICU (r= -0.545), and total mechanical ventilation duration (r = -0.518).

CONCLUSION

The Turkish version of OSS has been found to be valid and reliable in assessment of sitting balance in patients discharged from intensive care unit.Implications For RehabilitationPhysiotherapeutic measurements are crucial and necessary to determine the functional status of the patients.Ottawa Sitting Scale was translated and culturally adapted to Turkish and showed good psychometric propertiesOttawa Sitting Scale is valid and reliable tool to evaluate sitting balance in intensive care unit survivors.Ottawa Sitting Scale can guide clinicians in establishing evaluation and rehabilitation programs for patients discharged from intensive care unit.

Adherence to and impact of home-based high-intensity IMT in people with spinal cord injury: a pilot study

Study design

The pilot study was completed in 5 phases (Control and 4 phases of IMT) incorporating assessments at Baseline 1 (BL1), BL2, Follow-up 1 (F1), F2, F3, and F4.

Objective

To assess the adherence and impact of a daily high-intensity (80% of max) inspiratory muscle training (IMT) home program with once weekly supervision for people with spinal cord injury (SCI).

Setting

Assessments: research institution or zoom. IMT: participant’s home.

Methods

Participants completed daily IMT in IMT Phase 1 and 2, once weekly in IMT Phase 3, self-selected frequency in IMT Phase 4. All phases had one weekly supervised session except IMT Phase 4. Primary outcomes included adherence and a difficulty score [DS (0- not difficult to 10- the most difficult)]. Secondary outcomes included respiratory function and seated balance.

Results

Data from 10 people with chronic SCI (>1 year) (Cervical level of injury: 6, AIS: A-B, injury duration: 10.9 years 95% CI [3.9, 18.1]) were used in the analysis. Participants completed 69% of their training days in IMT Phase 1 and 65% overall reporting an average DS of 7.4 ± 1.4. Only one participant completed training during IMT Phase 4. One participant’s training load was reduced due to suspected overtraining. Maximal inspiratory pressure (MIP), sustained MIP (SMIP), and total power (TP), improved significantly (p < 0.05) from BL2 to F1.

Conclusion

Our data suggest that people with SCI can perform high-intensity IMT at home to improve inspiratory performance. It is strongly recommended that participants be intermittently monitored for adherence and safety.

ClinicalTrials.gov Registration number: NCT04210063.

Validity and reliability of center of pressure measures to quantify trunk control ability in individuals after stroke in subacute phase during unstable sitting test

Objective

The objective of this study was to assess, for individuals with hemiparesis after a stroke in subacute phase, the validity and reliability of center of pressure (CoP) parameters measured during sitting balance on an unstable support.

Materials and methods

Thirty-two individuals after stroke were included in this observational study for validity and reliability (mean age: 64.34 ± 9.30y, 23 men, mean post-stroke duration: 55.64 ± 27days). Intra-Class Correlation (ICC) and Bland Altman plot assessed intra-rater reliability and inter-rater reliability of CoP parameters during unstable sitting balance test (anteroposterior or mediolateral imbalance). Validity was established by correlating CoP parameters with the Modified Functional Reach Test, trunk strength, Balance Assessment in Sitting and Standing and Timed Up and Go tests.

Results

The findings highlighted significant correlations between CoP parameters and trunk strength for anteroposterior seated destabilization. Good to excellent intra and inter-rater reliability (0.87 ≤ ICC ≤ 0.95) was observed for all CoP length parameters and CoP mean velocity in both mediolateral and anteroposterior imbalance conditions. CoP parameters for mediolateral unstable sitting condition were more reliable than for anteroposterior instability.

Conclusion

Trunk control assessment during unstable sitting position on a seesaw is a reliable test for assessing trunk control ability in individuals after a stroke. CoP length and mean velocity are found to be the best parameters.

•

Center of pressure values during anteroposterior perturbation is related to trunk strength.

•

Center of pressure length parameters have excellent intra-rater and inter-rater reliability in individuals after a stroke in subacute phase.

•

The reliability is better when the sitting instability is in mediolateral direction.

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.

Application of a virtual reality tracker-based system to measure seated postural stability in stroke patients

Background

Postural stability while sitting is an important indicator of balance and an early predictor for future functional improvement in neurorehabilitation, but the evaluation is usually dependent on clinical balance function measures. Meanwhile, instrumental posturography has been used widely to obtain quantitative data and characterize balance abilities and underlying control mechanisms, but not as often for sitting balance. Moreover, traditional kinetic methods using a force platform to test sitting stability often require modification and are costly. We proposed a tracker-based posturography with a commercial virtual reality system, the VIVE Pro system (HTC, Inc. Taiwan), to record the trunk displacement (TD) path with a lumbar tracker for evaluation of sitting stability. The goals were to test the reliability and validity of the TD parameters among stroke patients.

Methods

Twenty-one stroke individuals and 21 healthy adults had their postural sway measured with this system under four sitting conditions, i.e., sitting on a solid surface or a soft surface, with eyes open or closed. The test–retest reliability of the TD parameters was evaluated with intraclass correlation coefficients in 22 participants. We also tested the discriminative validity of these parameters to discriminate between stroke and healthy controls, and among four sitting conditions. Furthermore, the TD parameters were correlated with the three balance function tests: the Berg Balance Scale (BBS), the Postural Assessment Scale for Stroke Patients (PASS) and the Function in Sitting Test (FIST).

Results

The results indicated that the TD parameters obtained by tracker-based posturography had mostly moderate to good reliability across the four conditions, with a few exceptions in the solid surface and eyes open tasks. The TD parameters could discriminate the postural stability between sitting on solid and soft surfaces. The stroke group had more seated postural sway than the control group, especially while sitting on a soft surface. In addition, velocity measures in the sagittal and frontal planes had moderate to high correlations with the PASS and BBS scores.

Conclusions

This tracker-based system is a cost-effective option for the clinical assessment of body stability for stroke patients in a seated position and shows acceptable reliability and validity.

Inspiratory Muscle Performance Is Related to Seated Balance Function in People With Spinal Cord Injury: An Observational Study

OBJECTIVE

To examine the relationship between inspiratory muscle performance (IMP) and functional sitting balance (FSB) in persons with chronic spinal cord injury (SCI). We hypothesized that a moderate correlation would be found between IMP and FSB and that individuals with better balance would have better IMP.

DESIGN

The SCI-specific modification of the Function in Sitting Test (FIST-SCI) measured FSB. The IMP measures included (1) maximal inspiratory pressure (MIP), (2) sustained MIP (SMIP), and (3) inspiratory duration. Upper extremity motor score (UEMS) and level of injury (LOI) were taken from International Standards for Neurological Classification of Spinal Cord Injury examinations. Spearman correlational analyses assessed relationships among these factors in the sample (N=37). Mann-Whitney U tests explored differences between 2 comparison group pairs (tetraplegia group [TG] vs paraplegia group [PG]; independent transfer group [ITG] vs assisted transfer group [ATG]). Regression analysis examined variables predictive of FSB in the TG.

SETTING

Research facility.

PARTICIPANTS

Volunteers with tetraplegia (n=21, American Spinal Injury Association Impairment Scale (AIS) A=8, B=7, C=6) and paraplegia (n=16, AIS A=9, B=4, C=3) (N=37).

INTERVENTION

Not applicable.

MAIN OUTCOME MEASURES

IMP, LOI, UEMS, FIST-SCI.

RESULTS

UEMS, MIP, SMIP, and LOI had moderate to high correlations with FIST-SCI scores (ρ=0.720 (P<.001), 0.480 (P=.003), 0.467 (P=.004), 0.527 (P=.001), respectively). UEMS, MIP, and FIST-SCI scores were higher in the PG and ITG than the TG and ATG, respectively (PG vs. TG P values=<.001, .008, .002, respectively, and ITG vs. ATG P values=<.001, .032, <.001, respectively). Further, SMIP and UEMS predicted FIST-SCI balance scores in the TG, accounting for 55% of total variance (P<.001) (FIST-SCI=11.88+0.03 [SMIP]+0.425 [UEMS]).

CONCLUSIONS

The relationship between IMP and balance appears preserved after SCI. FSB was predicted, in part, via UEMS and SMIP in the TG. Future research should focus on the effect of SCI-based breathing interventions on FSB.

Influence of Core-Stability Exercises Guided by a Telerehabilitation App on Trunk Performance, Balance and Gait Performance in Chronic Stroke Survivors: A Preliminary Randomized Controlled Trial

Stroke is one of the main causes of disability. Telerehabilitation could face the growing demand and a good strategy for post-stroke rehabilitation. The aim of this study is to examine the possible effects of therapeutic exercises performed by an App on trunk control, balance, and gait in stroke survivors. A preliminary 12-week randomized controlled trial was developed. Thirty chronic stroke survivors were randomly allocated into two groups. Both groups performed conventional physiotherapy, in addition to, the experimental group (EG) had access to a telerehabilitation App to guide home-based core-stability exercises (CSE). Trunk performance was measured with the Spanish-Trunk Impairment Scale (S-TIS 2.0) and Spanish-Function in Sitting Test. Balance and gait were measured with Spanish-Postural Assessment Scale for Stroke patient, Berg Balance Scale and an accelerometer system. In EG was observed an improvement of 2.76 points in S-TIS 2.0 (p = 0.001). Small differences were observed in balance and gait. Adherence to the use of the App was low. CSE guided by a telerehabilitation App, combined with conventional physiotherapy, seem to improve trunk function and sitting balance in chronic post-stroke. Active participation in the rehabilitation process should be increased among stroke survivors. Further confirmatory studies are necessary with a large sample size.

Trunk Impairment as a Predictor of Activities of Daily Living in Acute Stroke

Background and purpose: Trunk function plays a key role in performing activities of daily living (ADL) including locomotion and sitting. Sitting and ADL should be performed as early as possible especially during the acute phase of stroke rehabilitation. Therefore, this study aimed to assess trunk function among patients with acute stroke using the Trunk Impairment Scale (TIS) and to predict its functional outcomes.

Methods: Overall, 67 patients with acute stroke (i.e., within 2 days of occurrence of the stroke) were included. The following clinical assessment items were obtained within 48 h after stroke onset and on the day before discharge from the hospital. Trunk function was examined using TIS and Trunk Control Test (TCT). The motor function of the upper and lower extremities was assessed using the stroke impairment assessment set motor (SIAS-M) score, and ADL was assessed using functional independence measure motor (FIM-M) items.

Results: Multiple regression analysis was performed using the stepwise regression method, using the total FIM-M score following discharge as the dependent variable and age, TIS, TCT, SIAS-M, and FIM-M within 48 h after stroke onset as the independent variables. Age, TIS, and FIM-M within 48 h after stroke onset were selected as the input variables and showed a high-adjusted determination coefficient (R² = 0.79; P < 0.001).

Conclusion: TIS is a reliable method for evaluating trunk control function and is an early predictor of ADL among patients with acute stroke.

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.

A Mobility Measure for Inpatient Rehabilitation Using Multigroup, Multidimensional Methods

BACKGROUND AND PURPOSE

Inpatient rehabilitation facilities (IRFs) report patient functional status to Medicare and other payers using Quality Indicators (QI). While the QI is useful for payment purposes, its measurement properties are limited for monitoring patient progress. A mobility measure based on QI items and additional standardized assessments may enhance clinicians' ability to track patient improvement. Thus, we developed the Mobility Ability Quotient (Mobility AQ) to assess mobility during inpatient rehabilitation.

METHODS

For 10 036 IRF inpatients, we extracted assessments from electronic health records, used confirmatory factor analysis to define subdimensions of mobility, and then applied multidimensional item response theory (MIRT) methods to develop a unidimensional construct. Assessments included the QI items and standardized measures of mobility, motor performance, and wheelchair and transfer skills.

RESULTS

Confirmatory factor analysis resulted in good-fitting models (root-mean-square errors of approximation ≤0.08, comparative fit indices, and nonnormed fit indices ≥0.95) for 3 groups defined by anticipated primary mode of locomotion at discharge-walking, wheelchair propulsion, or both. Reestimation as a multigroup, MIRT model yielded scores more sensitive to change compared with QI mobility items (dlast-first = 1.08 vs 0.60 for the QI; dmax-min = 1.16 vs 1.05 for the QI). True score equating analysis demonstrated a higher ceiling and lower floor for the Mobility AQ than the QI.

DISCUSSION AND CONCLUSIONS

The Mobility AQ demonstrates improved sensitivity over the QI mobility items. This MIRT-based mobility measure describes patient function and progress for patients served by IRFs and has the potential to reduce assessment burden and improve communication regarding patient functional status.Video Abstract available for more insights from authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A341).

Psychometric properties of the Chinese version of the Trunk Impairment Scale in people with a stroke

Background

The Trunk Impairment Scale (TIS) has been translated into Chinese, but the psychometric properties of the Chinese version of the TIS (TIS-C) have not yet been established. We aimed to examine the reliability and validity of the TIS-C for assessing sitting balance among Chinese people with a stroke.

Methods

A descriptive, cross-sectional design was used. We recruited a convenience sample of 170 subacute stroke patients aged 18 years or over from the neurology departments of four traditional Chinese medicine hospitals in China. Patients completed the TIS-C, the Berg Balance Scale and the Modified Barthel Index. The psychometric properties of the TIS-C were examined to establish test–retest reliability, internal consistency, equivalence, and content, criterion, and construct validity.

Results

Intraclass correlation coefficients for inter-rater and intra-rater reliability ranged from 0.75 to 0.89 and from 0.90 to 0.97, respectively. The TIS-C Cronbach α was 0.86. The strong correlation between the total score of the TIS-C and the Berg Balance Scale (r_s = 0.81, p < 0.001) or Modified Barthel Index (r_s = 0.84, p < 0.001) suggested good concurrent and convergent validity, respectively. Known-group validity was supported by the significant difference (p < 0.001) in TIS-C scores between participants with mild and moderate stroke.

Conclusions

The TIS-C is a valid and reliable tool for assessing static and dynamic sitting balance as well as coordination of trunk movement among stroke survivors with mild and moderate stroke.

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.

Portable neuromodulation induces neuroplasticity to re-activate motor function recovery from brain injury: a high-density MEG case study

BACKGROUND

In a recent high-profile case study, we used functional magnetic resonance imaging (fMRI) to monitor improvements in motor function related to neuroplasticity following rehabilitation for severe traumatic brain injury (TBI). The findings demonstrated that motor function improvements can occur years beyond current established limits. The current study extends the functional imaging investigation to characterize neuromodulation effects on neuroplasticity to further push the limits.

METHODS

Canadian Soldier Captain (retired) Trevor Greene (TG) survived a severe open-TBI when attacked with an axe during a 2006 combat tour in Afghanistan. TG has since continued intensive daily rehabilitation to recover motor function, experiencing an extended plateau using conventional physical therapy. To overcome this plateau, we paired translingual neurostimulation (TLNS) with the continuing rehabilitation program.

RESULTS

Combining TLNS with rehabilitation resulted in demonstrable clinical improvements along with corresponding changes in movement evoked electro-encephalography (EEG) activity. High-density magneto-encephalography (MEG) characterized cortical activation changes in corresponding beta frequency range (27 Hz). MEG activation changes corresponded with reduced interhemispheric inhibition in the post-central gyri regions together with increased right superior/middle frontal activation suggesting large scale network level changes.

CONCLUSIONS

The findings provide valuable insight into the potential importance of non-invasive neuromodulation to enhance neuroplasticity mechanisms for recovery beyond the perceived limits of rehabilitation.

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.

Development of a Multidimensional, Multigroup Measure of Self-Care for Inpatient Rehabilitation

OBJECTIVE

To develop and evaluate a measure of clinician-observed and patient-performed self-care function for use during inpatient rehabilitation.

DESIGN

Retrospective analysis of self-care assessments collected by therapists using confirmatory factor analysis (CFA) followed by multidimensional item response theory (MIRT).

SETTING

Freestanding inpatient rehabilitation hospital in the Midwestern United States.

PARTICIPANTS

Inpatients (N=7719) with stroke, traumatic brain injury, spinal cord injury, neurologic disorders, and musculoskeletal conditions.

INTERVENTIONS

Not applicable MAIN OUTCOME MEASURES: A total of 19 clinician-selected self-care measures including the FIM and patient-performed, clinician-rated measures of balance, upper extremity function, strength, changing body position, and swallowing. Clinicians completed assessments on admission and at least 1 interim assessment.

RESULTS

CFA was completed for 3 patient groups defined by their highest level of balance (sitting, standing, walking). We reduced the number of items by 47.5% while maintaining acceptable internal consistency; unidimensionality within each item set required development of testlets. A recursive analysis defined a self-care measure with sensitivity (Cohen d_max-min =1.13; Cohen d_last-first.=0.91) greater than the FIM self-care items (d_max-min.=0.94; d_last-first .=0.83). The CFA models provided good to acceptable fit (root mean square error of approximations 0.03-0.06). Most patients with admission FIM self-care ratings of total assistance (88%, 297 of 338) made improvements on the MIRT self-care measure that were undetected by the FIM; the FIM detected no change for 26% of these patients (78 of 297). The remaining 74% (219 of 297) improved on the MIRT-based measure an average of 14 days earlier than was detected by the FIM.

CONCLUSIONS

This MIRT self-care measure possesses measurement properties that are superior to the FIM, particularly for patients near its floor or ceiling. Methods assure accommodation for multidimensionality and high levels of sensitivity. This self-care measure has the potential to improve monitoring of self-care and manage therapy effectively during inpatient rehabilitation.

A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time. Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment. Setting: Research laboratory and community. Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78 ± 13.89 years, lived with SCI for 17.06 ± 14.6 years; 61.1% were female. Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control. Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life - short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST). Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P = 0.047, d_z= 0.507) and FIST scores improved (P = 0.035, d_z = 0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P = 0.05, d_z= 1.566) and Psychological (P = 0.040, d_z= 0.760) domains. Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.

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.

Responsiveness, minimal detectable change, and minimal clinically important difference of the sitting balance scale and function in sitting test in people with stroke

Background: Limited studies have examined the responsiveness of the Sitting Balance Scale (SBS) and Function in Sitting Test (FIST). No studies have investigated the psychometric properties of these tools in skilled nursing facilities.Objective: The purposes of the study were (1) to examine responsiveness of the SBS and FIST, in people with stroke, receiving rehabilitation in skilled nursing facilities; and (2) to estimate the MDC and MCID of these scales.Methods: Forty participants completed the FIST, SBS, and Barthel Index (BI) at admission and discharge. Internal responsiveness of the FIST and SBS was measured using Effect Size (ES) and Standardized Response Mean (SRM). Examining the association between the difference in scores on the SBS or FIST and the difference in scores on the BI determined external responsiveness. MDC and MCID were estimated for both measures.Results: The ES and the SRM for both scales were large (1.01-2.30) indicating excellent internal responsiveness. Both scales demonstrated satisfactory external responsiveness, showing good association with change in BI scores (p < .01). MDC₉₀ of the SBS and the FIST were 2.3 and 3.9, respectively. Anchor-based MCID estimates were 4.5 and 3.5, and distribution-based were 3.5 and 4.8 for the SBS and FIST, respectively.Conclusions: Both scales demonstrate sufficient responsiveness in the skilled nursing setting. Our findings suggest a change of 5 on the SBS and 4 on the FIST are clinically important, and clinicians may use these values to assess patient progress.

Sitting Balance Exercise Performed Using Virtual Reality Training on a Stroke Rehabilitation Inpatient Service: A Randomized Controlled Study

BACKGROUND

Virtual reality training (VRT) is engaging and may enhance rehabilitation intensity. Only one previous study has looked at its use to improve sitting balance after stroke.

OBJECTIVE

To determine if supplemental sitting balance exercises, administered via VRT, improve control of sitting balance and upper extremity function in stroke rehabilitation inpatients.

DESIGN

Assessor-blinded, placebo-controlled randomized controlled trial.

SETTING

Stroke inpatient rehabilitation unit.

PARTICIPANTS

Seventy-six participants (out of 130 approached) with subacute stroke who could not stand independently were randomized to experimental and control groups. Sixty-nine completed the study.

INTERVENTIONS

The experimental group did VRT that required leaning and reaching, whereas the control group had their trunk restrained and performed VRT that involved only small upper extremity movements to minimize trunk movement. Both groups performed 10-12 sessions of 30-45 minutes. Participants were assessed pre, post, and 1 month after the sessions by a blinded examiner.

OUTCOME MEASURES

Function in Sitting Test (FIST, primary outcome measure); Ottawa Sitting Scale; Reaching Performance Scale; Wolf Motor Function Test (WMFT).

RESULTS

Thirty-three participants completed the experimental intervention and 36 the control. Pre/post differences for FIST were 3.4 (confidence interval [CI] 0.5;6.3) for the experimental group and 5.3 (2.9;7.7) for the control group. There was a significant improvement over time (adjusted for multiple comparisons, P < .006) on most outcome measures except the WMFT Performance Time Scale (control group; P = .007) and grip strength (P = .008); there were no differences between groups (P > .006).

CONCLUSIONS

Siting balance outcomes were similar for both groups; therefore, this study does not support the use of sitting balance exercises provided via VRT for the rehabilitation of sitting balance after stroke. However, because it is only the second study to investigate VRT for sitting balance and upper extremity function, more research, using more challenging exercises and a greater treatment intensity, is required before definitive conclusions are made.

Effects of diagonally aligned sitting training with a tilted surface on sitting balance for low sitting performance in the early phase after stroke: a randomised controlled trial

PURPOSE

To clarify the effects of diagonally aligned sitting training using a tilted surface on sitting balance for patients with low sitting performance in the early phase after stroke.

MATERIALS AND METHODS

This was an assessor-blinded randomised controlled trial. The experimental group used a surface tilted 10° backward and down toward the most affected side; the control group trained on a horizontal surface. Both groups were asked to move their trunk diagonally forward toward the least affected side. Participants performed the activity 40 times/session for seven sessions over 8 days. Sitting performances were assessed using the function in sitting test (FIST), subjective postural vertical (SPV) on the diagonal plane, and trunk impairment scale (TIS).

RESULTS

Thirty-three stroke patients were randomly allocated into two groups. Treatment effects differed significantly: mean differences between groups for FIST (total score, static, dynamic, scooting, and reactive) were 8.96, 2.35, 3.01, 1.27, and 1.72 points, for the mean SPV value was 1.82°, and for the TIS (total score and static) were 1.87 and 1.58 points, respectively. These results were more favourable in the experimental group.

CONCLUSIONS

Diagonally aligned sitting training on a tilted surface improves sitting balance and modulates the SPV compared with a horizontal surface.

Assessing quality of life using the brief cancer-related worry inventory for gynecological surgery

BACKGROUND

The mental status of gynecologic patients has an important influence on their quality of life (QOL). Although high-quality QOL studies into breast cancer patients have been performed internationally, few QOL studies have examined patients with gynecological cancer.

AIM

To investigate the brief cancer-related worry inventory (BCWI) could evaluate the mental status of gynecological patients.

METHODS

Between July 2018 and December 2018, 19 consecutive gynecological cancer patients were prospectively recruited for this study. The BCWI is a 15-item self-reported questionnaire that assesses cancer-related worries on a numeric scale (0–100).

RESULTS

The high BCWI group was significantly younger than the low BCWI group. Regarding social status, the absence of a spouse and children was significantly more common in the high BCWI group than in the low BCWI group. The operation time was longer in the worsening BCWI group than in the stable BCWI group (305.3 ± 140.5 min vs 171.1 ± 97.2 min; P = 0.026).

CONCLUSION

Being young, having no family, and a long operation time were found to be risk factors for increased anxiety. Therefore, gynecological cancer patients should be assessed using the BCWI, and specific perioperative mental care should be considered for highly anxious patients.

Diagnostic test evaluation methodology: A systematic review of methods employed to evaluate diagnostic tests in the absence of gold standard - An update

OBJECTIVE

To systematically review methods developed and employed to evaluate the diagnostic accuracy of medical test when there is a missing or no gold standard.

STUDY DESIGN AND SETTINGS

Articles that proposed or applied any methods to evaluate the diagnostic accuracy of medical test(s) in the absence of gold standard were reviewed. The protocol for this review was registered in PROSPERO (CRD42018089349).

RESULTS

Identified methods were classified into four main groups: methods employed when there is a missing gold standard; correction methods (which make adjustment for an imperfect reference standard with known diagnostic accuracy measures); methods employed to evaluate a medical test using multiple imperfect reference standards; and other methods, like agreement studies, and a mixed group of alternative study designs. Fifty-one statistical methods were identified from the review that were developed to evaluate medical test(s) when the true disease status of some participants is unverified with the gold standard. Seven correction methods were identified and four methods were identified to evaluate medical test(s) using multiple imperfect reference standards. Flow-diagrams were developed to guide the selection of appropriate methods.

CONCLUSION

Various methods have been proposed to evaluate medical test(s) in the absence of a gold standard for some or all participants in a diagnostic accuracy study. These methods depend on the availability of the gold standard, its' application to the participants in the study and the availability of alternative reference standard(s). The clinical application of some of these methods, especially methods developed when there is missing gold standard is however limited. This may be due to the complexity of these methods and/or a disconnection between the fields of expertise of those who develop (e.g. mathematicians) and those who employ the methods (e.g. clinical researchers). This review aims to help close this gap with our classification and guidance tools.

A pilot investigation of anterior tilt use among power wheelchair users

PURPOSE

To examine the influence of use of the anterior tilt-in-space power seat function on performance of functional activities, physical health, and user satisfaction on among power wheelchair users.

MATERIALS AND METHODS

Ten full-time power wheelchair users with a seat elevator on their current chair participated in a mixed-methods, repeated measures study. At Visit 1 participants completed the Wheelchair Outcome Measure, Functional Mobility Assessment, Wheelchair Users Shoulder Pain Index, Fatigue Severity Scale, and the Spinal Cord Injury Secondary Conditions Scale. Physical assessments were performed to examine transfer quality (transfer assessment instrument), functional reach, activities of daily living (performance assessment of self-care skills), seated balance (function in sitting test), spasticity, respiratory function, and speech production. Approximately 3 days later (Visit 2), participants were trained on use and provided a power wheelchair with anterior tilt to trial for two weeks. After two weeks (Visit 3), the Visit 1 protocol was repeated and a semistructured interview conducted.

RESULTS

Participants lived with disabilities of cerebral palsy, spinal muscular atrophy and multiple sclerosis. With use of anterior tilt, significant improvements were seen among safety of meal preparation, p = 0.033, d_z = 0.91 and functional reach in the vertical direction, p = 0.000, d_z = 2.62. Subjectively, participants found anterior tilt helpful in performance of reaching tasks in but found the safety equipment restrictive.

CONCLUSION

Preliminary results indicate that use of the anterior tilt may help to improve performance of functional activities. Additional research is needed to examine the long-term influence of the technology.Implications for rehabilitationThe anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position.Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive.Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users.

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.

Tracking and Comparing Self-Determined Motivation in Elite Youth Soccer: Influence of Developmental Activities, Age, and Skill

Purpose: Our aim was to determine if self-determined motivation (SDM) in elite, men's soccer changes over time and differs as a function of age, skill-grouping, and engagement in soccer play and practice. We tested predictions from the Developmental Model of Sport Participation (DMSP) regarding relations between practice and play and SDM among both elite and non-elite samples. Methods: Elite youth soccer players in the United Kingdom (n = 31; from the Under 13/U13 and U15 years age groups) completed practice history and motivation questionnaires at time 1 (T1) and ∼2 years later (T2: now U15 and U17 years). Non-elite players (n = 32; from U15 and U17 years) completed the same questionnaires at T2 only. Results: For the elite groups, global SDM decreased over time for the current U17 group (from U15), but no change was seen for the current U15 group (from U13). Age group differences at T2 mirrored these data, with U17 players showing lower global SDM and higher controlled motivation than U15 elites. The non-elite players did not show age group differences, but elites scored higher for global SDM and autonomous motivation than non-elites. The recent hours accumulated in practice negatively correlated with global SDM in elite and non-elite groups, but play was unrelated to measures of motivation. Conclusion: Differences in SDM as a function of age and skill point toward the dynamic nature of these motivations over time, likely a result of proximity to external rewards related to professional status. Although high volumes of practice are related to lower global SDM in both skill groups, the absence of any relations between SDM and soccer play does not support a key prediction related to the DMSP.

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.

Clinical measurement tools to assess trunk performance after stroke: a systematic review

INTRODUCTION

Stroke may result in decreased trunk muscle strength and limited trunk coordination, frequently determining loss of autonomy due to the trunk impairment. Furthermore, sitting balance has been repeatedly identified as an important predictor of motor and functional recovery after stroke. Given the importance of the trunk, it is therefore mandatory that validated tools be available to assess its performance. A systematic review of the currently available clinical measurement tools to assess trunk performance after stroke has been carried out.

EVIDENCE ACQUISITION

We searched the PubMed database from January 2006 to April 2017 to select articles which reported or included a clinical measure of trunk performance used in an adult stroke population. The data collected were integrated with the results of a previous review published in 2006. A total of 302 articles were identified, of which 19 were eligible for inclusion.

EVIDENCE SYNTHESIS

Numerous clinical tools have been validated to assess trunk performance after stroke, including the Trunk Control Test, the Trunk Impairment Scale, the Postural Assessment Scale for Stroke, the Ottawa Sitting Scale, the Modified Functional Reach Test, the Function In Sitting Test, the Physical Ability Scale, the Trunk Recovery Scale, the Balance Assessment in Sitting and Standing Positions, and the and Sitting-Rising Test.

CONCLUSIONS

Several scales and tests have been demonstrated to be valid for assessing trunk performance in stroke. Some of these have already been refined by Rasch analysis to increase their psychometric characteristics. Further psychometric analysis of these tools in large and different samples is, however, still needed.

Outcome Measures for Persons With Moderate to Severe Traumatic Brain Injury: Recommendations From the American Physical Therapy Association Academy of Neurologic Physical Therapy TBI EDGE Task Force

BACKGROUND AND PURPOSE

The use of standardized outcome measures (OMs) is essential in assessing the effectiveness of physical therapy (PT) interventions. The purposes of this article are (1) to describe the process used by the TBI EDGE task force to assess the psychometrics and clinical utility of OMs used with individuals with moderate to severe traumatic brain injury (TBI); (2) to describe the consensus recommendations for OM use in clinical practice, research, and professional (entry-level) PT education; and (3) to make recommendations for future work.

METHODS

An 8-member task force used a modified Delphi process to develop recommendations on the selection of OMs for individuals with TBI. A 4-point rating scale was used to make recommendations based on practice setting and level of ambulation. Recommendations for appropriateness for research use and inclusion in entry-level education were also provided.

RESULTS

The TBI EDGE task force reviewed 88 OMs across the International Classification of Functioning, Disability, and Health (ICF) domains: 15 measured body functions/structure only, 21 measured activity only, 23 measured participation only, and 29 OMs covered more than 1 ICF domain.

DISCUSSION AND CONCLUSIONS

Recommendations made by the TBI EDGE task force provide clinicians, researchers, and educators with guidance for the selection of OMs. The use of these recommendations may facilitate identification of appropriate OMs in the population with moderate to severe TBI. TBI EDGE task force recommendations can be used by clinicians, researchers, and educators when selecting OMs for their respective needs. Future efforts to update the recommendations are warranted in order to ensure that recommendations remain current and applicable.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A140).

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.

Long-term follow-up of a randomized controlled trial on additional core stability exercises training for improving dynamic sitting balance and trunk control in stroke patients

OBJECTIVE

Analyse the effect of core stability exercises in addition to conventional physiotherapy training three months after the intervention ended.

DESIGN

A randomized controlled trial.

SETTING

Outpatient services.

SUBJECTS

Seventy-nine stroke survivors.

INTERVENTIONS

In the intervention period, both groups underwent conventional physiotherapy performed five days/week for five weeks, and in addition the experimental group performed core stability exercises for 15 minutes/day. Afterwards, during a three-month follow-up period, both groups underwent usual care that could eventually include conventional physiotherapy or physical exercise but not in a controlled condition.

MAIN MEASURES

Primary outcome was trunk control and dynamic sitting balance assessed by the Spanish-Version of Trunk Impairment Scale 2.0 and Function in Sitting Test. Secondary outcomes were standing balance and gait evaluated by the Berg Balance Scale, Tinetti Test, Brunel Balance Assessment, Spanish-Version of Postural Assessment Scale for Stroke and activities of daily living using the Barthel Index.

RESULTS

A total of 68 subjects out of 79 completed the three-month follow-up period. The mean difference (SD) between groups was 0.78 (1.51) points ( p = 0.003) for total score on the Spanish-Version of Trunk Impairment Scale 2.0, 2.52 (6.46) points ( p = 0.009) for Function in Sitting Test, dynamic standing balance was 3.30 (9.21) points ( p= 0.009) on the Berg Balance Scale, gait was 0.82 (1.88) points ( p = 0.002) by Brunel Balance Assessment (stepping), and 1.11 (2.94) points ( p = 0.044) by Tinetti Test (gait), all in favour of core stability exercises.

CONCLUSIONS

Core stability exercises plus conventional physiotherapy have a positive long-term effect on improving dynamic sitting and standing balance and gait in post-stroke patients.

Comprehensive clinical sitting balance measures for individuals following stroke: a systematic review on the methodological quality

PURPOSE

The aim of this systematic review was to examine the psychometric properties of published clinical sitting measurement scales containing dynamic tasks in individuals following stroke.

METHOD

Databases, including Cumulative Index of Nursing and Allied Health Literature (CINAHL), MEDLINE, EMBASE, Cochrane, PubMed and Allied and Complementary Medicine Database (AMED) were searched from inception to December 2015. The search strategy included terms relating to sitting, balance and postural control. Two reviewers independently selected and extracted data from the identified articles and assessed the methodological quality of the papers using the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist.

RESULTS

Fourteen clinical sitting measurement scales (39 papers) containing dynamic tasks met the inclusion criteria and various measurement properties were evaluated. The methodological quality of the majority of the included studies was rated as poor to fair using the COSMIN checklist, with common limitations including small sample size and inappropriate use of statistical methods.

CONCLUSIONS

This review was unable to identify measures with sufficient psychometric properties to enable recommendation as preferred tools. However, measures were identified that warrant further specific psychometric investigations to fulfil requirements for a high quality measure. Implications for Rehabilitation Fourteen clinical sitting balance scales containing dynamic tasks are available to measure sitting balance with individuals following stroke. No single scale has sufficient psychometric properties to enable recommendation as a preferred tool for measuring sitting balance with stroke survivors. Use of a balance scale or dedicated sitting balance measure containing static and dynamic sitting items should be utilised to monitor progress for individuals following stroke with more severe deficits.

Does the addition of virtual reality training to a standard program of inpatient rehabilitation improve sitting balance ability and function after stroke? Protocol for a single-blind randomized controlled trial

Background

Sitting ability and function are commonly impaired after stroke. Balance training has been shown to be helpful, but abundant repetitions are required for optimal recovery and patients must be motivated to perform rehabilitation exercises repeatedly to maximize treatment intensity. Virtual reality training (VRT), which allows patients to interact with a virtual environment using computer software and hardware, is enjoyable and may encourage greater repetition of therapeutic exercises. However, the potential for VRT to promote sitting balance has not yet been explored. The objective of this study is to determine if supplemental VRT-based sitting balance exercises improve sitting balance ability and function in stroke rehabilitation inpatients.

Methods/Design

This is a single-site, single-blind, parallel-group randomized control trial. Seventy six stroke rehabilitation inpatients who cannot stand independently for greater than one minute but can sit for at least 20 minutes (including at least one minute without support) are being recruited from a tertiary-care dedicated stroke rehabilitation unit. Participants are randomly allocated to experimental or control groups. Both participate in 10–12 sessions of 30–45 minutes of VRT performed in sitting administered by a single physiotherapist, in addition to their traditional therapy. The experimental group plays five games which challenge sitting balance while the control group plays five games which minimize trunk lean. Outcome measures of sitting balance ability (Function in Sitting Test, Ottawa Sitting Scale, quantitative measures of postural sway) and function (Reaching Performance Scale, Wolf Motor Function Test, quantitative measures of the limits of stability) are administered prior to, immediately following, and one month following the intervention by a second physiotherapist blind to the participant’s group allocation.

Discussion

The treatment of sitting balance post-stroke with VRT has not yet been explored. Results from the current study will provide important evidence for the use of low-cost, accessible VRT as an adjunct intervention to increase sitting balance in lower-functioning patients receiving inpatient rehabilitation. The motivating and enjoyable attributes of VRT may increase exercise dosage, leading to improved function and optimal results from rehabilitation.

Trial Registration

https://clinicaltrials.gov/; Identifier: NCT02285933. Registered 06 November 2014.

Funded by the Heart & Stroke Foundation of Canada and a generous donation from Tony & Elizabeth Graham.

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.

Mechanisms underlying alcohol-approach action tendencies: the role of emotional primes and drinking motives

The tendency to approach alcohol-related stimuli is known as the alcohol-approach bias and has been related to heavy alcohol use. It is currently unknown whether the alcohol-approach bias is more pronounced after emotional priming. The main aim of this study was to investigate whether positive and negative emotional primes would modulate the alcohol-approach bias. For this purpose, a new contextual emotional prime-approach avoidance task was developed, containing both negative and positive emotional primes. Explicit coping drinking motives were expected to be related to an increased alcohol-approach bias after negative primes. Results of 65 heavy and 50 occasional drinkers showed that the alcohol-approach bias was increased in both groups during negative emotional priming. This appeared to be due to slower alcohol avoidance rather than faster alcohol approach. This change in alcohol-approach bias was positively related to explicit enhancement drinking motives and negatively related to alcohol use-related problems. A stronger alcohol-approach bias in heavy compared to occasional drinkers could not be replicated here, and coping drinking motives were not related to the alcohol-approach bias in any of the emotional contexts. The current findings suggest that both occasional and heavy drinkers have a selective difficulty to avoid alcohol-related cues in a negative emotional context. Negative reinforcement may therefore be involved in different types of drinking patterns. The influence of emotional primes on alcohol-related action tendencies may become smaller when alcohol use becomes more problematic, which is in line with habit accounts of addiction.