Reliability and validity of the Activities-specific Balance Confidence scale-Japanese (ABC-J) in community-dwelling stroke survivors

Yoga in the Rehabilitation of Post-Stroke Sequelae: A Non-Inferiority Randomized Controlled Trial

Introduction: Stroke survivors can experience various consequences that affect their physical and psychological balance. Yoga seems to be relevant for this population as it allows to work on both the body and the mind. The first objective of this study was to investigate the non-inferiority of yoga compared with conventional physical activity in improving physical function in patients with chronic post-stroke sequelae. The secondary objective was to investigate the superiority of yoga in improving the mental health of these patients. Methods: A randomized controlled trial was conducted. Thirty-six patients were randomized into two groups to practice a yoga program (YOG'AVC) or the Fitness and Mobility Exercise (FAME) program. Patients were assessed in a blinding mode pre- (T0) and post-program (T1) and 3-4 months after completion (T2). The physical assessments were the Berg Balance Scale, timed up and go test, 6-minute walk test, and quadriceps strength measured by hand-held dynamometer. Questionnaire assessments were: Activities-specific Balance Confidence Scale-Simplified, State-Trait Anxiety Inventory, Beck's Depression Inventory, and the Reintegration to Normal Living Index. Results: The YOG'AVC program was not inferior to the FAME program in improving balance, functional mobility and muscle strength. Both groups showed significant improvement (p < 0.05) between T0 and T1 in their anxiety, depression, and reintegration to normal life scores, with no significant difference between groups. Discussion: Both programs seem to be valuable in improving the physical abilities and psychological well-being of chronic post-stroke patients. However, further studies are required to confirm the difference between these programs.

The Chinese Short Version of the Activities-Specific Balance Confidence Scale: Its Validity, Reliability, and Predictive Value for Future Falls in Community-Dwelling Older Adults

Purpose

To examine the reliability and validity of the Chinese short version of the Activities-specific Balance Confidence scale (ABC-6), and its predictive value for prospective falls in community-dwelling older adults.

Patients and Methods

A total of 391 community older adults completed the prospective study. Internal consistency reliability, test-retest reliability, structural validity and discriminant validity were analyzed. To determine the accuracy of ABC-6 total score in predicting falls, a receiver operating characteristic curve analysis was performed, and comparisons with the Activities-specific Balance Confidence scale (ABC-16) and Berg Balance Scale (BBS) were made.

Results

Excellent internal consistency (Cronbach’s α = 0.938) and test-retest reliability (ICC=0.964, 95% CI: 0.947–0.977) were found for the ABC-6. Exploratory factor analysis suggested that ABC-6 had a one-factor structure (explained variance, 68.30%). The optimal cutoff value, sensitivity and specificity of ABC-6 to distinguish fallers from non-fallers was ≤ 60.00%, 70.83% and 84.26%, respectively, and there was no significant difference in the predictive value among the ABC-6, ABC-16, and BBS.

Conclusion

The Chinese version of the ABC-6 scale was a valid and reliable tool for measuring self-perceived balance confidence in community-dwelling older adults, and can be used as an effective assessment tool to predict future falls.

Walking while talking: validation in older adults with lower-limb amputation

BACKGROUND

Walking while talking (WWT) is a dual-task (cognitive and motor) performance test that has not yet been validated in older adults with lower-limb amputation (LLA). WWT is composed of two sections: WWT-simple (walking while reciting every letter of the alphabet) and WWT-complex (walking while reciting every other letter of the alphabet).

OBJECTIVE

To determine the validity, and provide normative data and a new scoring system for the WWT test in older adults with LLA.

STUDY DESIGN

Baseline cross-sectional data were collected from 56 community-living older adults (≥50 years old) with LLA at rehabilitation hospitals in Vancouver, BC, London, ON, and Edmonton, AB, Canada.

METHODS

Time and number of recited letters and errors during both sections were recorded. A new score was developed based on all these variables. Correlations of the recorded times with the Activities-specific Balance Confidence (ABC) scale and the 2-Minute Walk Test (2MWT) score were used to evaluate the validity of the WWT test.

RESULTS

As hypothesized, the times for both sections of the WWT were negatively correlated with both the ABC and 2MWT scores. Positive correlations were observed between the scores developed for both WWT sections with the 2MWT score.

CONCLUSION

Times taken to complete each section of the WWT test were correlated with the 2MWT and the ABC scale scores, providing evidence for the validity of the WWT test. We also provided a scoring method that is more objective and in line with the dual-task nature of the test.

Effect of Multisession Progressive Gait-Slip Training on Fall-Resisting Skills of People with Chronic Stroke: Examining Motor Adaptation in Reactive Stability

Background: This study examined whether a multisession gait-slip training could enhance reactive balance control and fall-resisting skills of people with chronic stroke (PwCS). Methods: A total of 11 PwCS underwent a four-week treadmill-based gait-slip training (four sessions). Pre- and post-training assessment was performed on six intensities of gait-slips (levels 1–6). Training consisted of 10 blocks of each progressively increasing intensity (four trials per block) until participants fell at >2 trials per block (fall threshold). In the next session, training began at a sub-fall threshold and progressed further. Fall outcome and threshold, number of compensatory steps, multiple stepping threshold, progression to higher intensities, pre- and post-slip center of mass (CoM), state stability, clinical measures, and treadmill walking speed were analyzed. Results: Post-training, PwCS demonstrated a reduction in falls and compensatory steps on levels 5 and 6 (p < 0.05) compared to pre-training. While an increase in pre-slip stability was limited to level 6 (p < 0.05), improvement in post-slip stability at lift-off was noted on levels 2, 3, and 5 (p < 0.05) along with improved post-slip minimum stability on levels 5 and 6 (p < 0.05). Post-training demonstrated improved fall (p < 0.05) and multiple stepping thresholds (p = 0.05). While most participants could progress to level 4 between the first and last training sessions, more participants progressed to level 6 (p < 0.05). Participants’ treadmill walking speed increased (p < 0.05); however, clinical measures remained unchanged (p > 0.05). Conclusions: Multisession, progressively increasing intensity of treadmill-based gait-slip training appears to induce significant adaptive improvement in falls, compensatory stepping, and postural stability among PwCS.

Psychometric properties of a short version of the Activities-specific Balance Confidence scale-Japanese (Short ABC-J) in community-dwelling people with stroke

Background and Purpose: The Activities-specific Balance Confidence (ABC) scale has been widely used as patient-reported outcome measures for community stroke rehabilitation and its short version is beginning to be used. This study aimed to assess the psychometric properties of the short version of the ABC scale-Japanese (Short ABC-J).Methods: Eighty-four participants with chronic stroke (mean age was 66.4 ± 9.7 years, mean time post stroke was 4.7 ± 3.5 years) including 66 test-retest samples were analyzed. The Short ABC-J was assessed with the ABC-J, the Falls Efficacy Scale-International (FES-I), the Berg Balance Scale (BBS), and the Timed Up and Go Test (TUG-T). Results: The internal consistency was good (Cronbach's alpha 0.90), reproducibility was excellent [intra-class correlation coefficient (ICC2,1) 0.92], and levels of absolute reliability were acceptable (standard error of measurement and minimal detectable change 8.32 and 23.07, respectively). Concurrent, convergent, and discriminative validity were supported for the FES-I, ABC-J, BBS, and TUG-T (all |rho| > 0.60, p < .001), and identifying balance and mobility (the area under the curve estimates ≥ 0.80) and discriminative power of the Short ABC-J were better than those of the FES-I and equal to or better than those of ABC-J. Conclusion: The Short ABC-J has good psychometric properties and is a valid and reliable measure of balance self-efficacy in Japanese community-dwelling people with chronic stroke. Further replication studies as well as other psychometric studies are needed.