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

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.

Inter-Rater and Intra-Rater Reliability of the Kansas University Sitting Balance Scale

Kluding et al., created The Kansas University Sitting and Standing Balance Scales (KUSSBS) in 2006 to meet the need for objective documentation of balance and for a tool without a floor effect. Rater reliabilities were established by Kluding for the standing scale, but not for the sitting balance scale (KUSitBS). The aim of this study was to establish inter- and intra-rater reliability for the KUSitBS. Four occupational therapists were recruited to rate a videotaped performance of a simulated patient. Resulting inter-rater reliability inter-class coefficients (ICC) are good, ICC = .877, p < .01, suggesting that sitting balance on the KUSitBS was rated similarly across coders. Intra-rater reliability ICC are excellent, ICC = .914, indicating that each occupational therapist rated sitting balance on the KUSitBS similarly at initial assessment and then again two weeks later. In order to have confidence in using any assessment tool, intra- and inter-rater reliability must be established. This study's results advance the use of the KUSitBS with adult populations.

The relationship between sitting balance, trunk control and mobility with predictive for current mobility level in survivors of sub-acute stroke

Objective

To investigate the relationship between sitting balance, trunk control, and mobility, as well as whether the sitting balance and trunk control can predict mobility level in sub-acute stroke survivors.

Methods

This is a observational and cross-sectional study. Fifty-five hemiplegic stroke survivors were participated in this study. The Timed Up and Go Test (TUG) was used to estimate mobility, and the Sitting Balance Scale (SBS) was used to examining sitting balance. The Trunk Impairment Scale (TIS), Trunk Control Test (TCT), and Postural Assessment Scale for Stroke-trunk control (PASS-TC) were used for examining the trunk control. Spearman’s correlation was used to analyze the relationship between TUG, SBS, TIS, TCT, and PASS-TC.

Results

The TUG is significantly correlated with SBS (r = -0.78), TIS (r = -0.76), TCT (r = -0.65), and PASS-TC (r = -0.67). In addition, the receiver operation characteristic (ROC) curve showed as cut-off value of SBS as >28.5, TIS > 16.5, TCT >82, and PASS-TC >10.5. The area under the ROC curve in each of the four tests is moderately accurate for predicting the mobility of sub-acute stroke survivors (0.84 ~0.90) (0.7 < AUC ≤ 9 (moderate informative)).

Implications

The SBS showed the highest correlation for mobility using TUG in the hemiplegic stroke survivors. Also, SBS was revealed as the most dominant examination tool predicting the mobility by TUG, it can be explained the sitting postural balance is the variable predicting the mobility in survivors of sub-acute stroke.

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.