Assessment of the measurement properties of the post stroke motor function instruments available in Brazil: a systematic review

Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke

Background

Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke.

Objective

To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke.

Methods

A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated.

Results

For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R ² = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709.

Conclusion

The TIS is a useful early predictor of gait ability in patients with acute stroke.

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.

Measurement properties of self-report physical activity assessment tools for patients with stroke: a systematic review

BACKGROUND

Individuals with stroke demonstrate low levels of physical activity. Self-report measures of physical activity are frequently used and the choice of the best one to use for each purpose and context should take into account the measurement properties of these instruments.

OBJECTIVE

To summarize the measurement properties and clinical utility of self-report measures of physical activity of post-stroke subjects and to evaluate both the methodological quality of the studies and the quality of the measurement properties.

METHODS

Searches were made in MEDLINE, EMBASE, PEDro, LILACS, and SCIELO. Two reviewers independently screened studies that investigated measurement properties or clinical utility of self-report measures of physical activity in post-stroke subjects. The studies' methodological quality, quality of the measurement properties, and clinical utility were evaluated.

RESULTS

From the 11,826 identified studies, 19 were included. Six self-report tools were evaluated: The Activity card sort, Coded activity diary, Frenchay activities index (FAI), Human activity profile (HAP), Multimedia activity recall for children and adults, and the Nottingham leisure questionnaire. The methodological quality of the studies ranged from "poor" to "good". Most of the results regarding the quality of the measurement properties were doubtful. None of the self-report tools had their content validity investigated. The FAI and HAP showed the highest clinical utility scores.

CONCLUSIONS

Content validity needs to be better investigated to determine if the instruments actually measure the physical activity domain. Further studies with good methodological quality are required to assist clinicians and researchers in selecting the best instrument to measure physical activity levels.

A Systematic Review of Translation and Cross-Cultural Adaptation of Instruments for the Selection of Assistive Technologies

This article presents a systematic review, for which research was carried out in the following electronic databases: Web of Science, Scopus, PubMed, and ERIC, in which several articles were found (n = 560). The results were analyzed based on the information obtained in the titles and abstracts, and the remaining studies were read in full for the analysis. The aim of this article was to identify the different questionnaires used for selecting items of assistive technology, describe and evaluate the translation and transcultural adaptation procedures, characterize the thematic domains of each resource, evaluate the cultural adaptation process adopted, and describe the psychometric properties. Data extraction and evaluation of the methodological quality of the eligible studies were performed in accordance with the COSMIN verification list with a checklist of 4 points. The publication of systematic review studies and others that synthesize research results is fundamental to provide support for change in the behavior of professionals in the field of health, and not only to access the available literature but also to incorporate this information into daily clinical practice. The results of this review could provide subsidies that would enable the planning, execution, identification, and choice of specific instruments for a determined study within the context of assistive technology, with a view to helping researchers and health professionals in clinical and investigatory practices.

Observational practice of incentive spirometry in stroke patients

BACKGROUND

Stroke may lead to several health problems, but positive effects can be promoted by learning to perform physical therapy techniques correctly.

OBJECTIVE

To compare two different types of observational practice (video instructions and demonstration by a physical therapist) during the use of incentive spirometry (IS).

METHOD

A total of 20 patients with diagnosis of stroke and 20 healthy individuals (56±9.7 years) were allocated into two groups: one with observational practice with video instructions for the use of IS and the other with observational practice with demonstration by a physical therapist. Ten attempts for the correct use of IS were carried out and the number of errors and the magnitude of response were evaluated. The statistic used to compare the results was the three-way ANOVA test.

RESULTS

The stroke subjects showed less precision when compared to the healthy individuals (mean difference 1.80±0.38) 95%CI [1.02-2.52], p<0.0001. When the type of practice was analyzed, the stroke subjects showed more errors with the video instructions (mean difference 1.5±0.5, 95%CI [0.43-2.56] (p=0.08)) and therapist demonstration (mean difference 2.40±0.52, 95%CI [1.29-3.50] (p=0.00)) when compared to the healthy individuals.

CONCLUSION

The stroke subjects had a worse performance in learning the use of volume-oriented incentive spirometry when compared to healthy individuals; however, there was no difference between the types of observational practice, suggesting that both may be used to encourage the use of learning IS in patients with stroke.