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Neville CE, Young IS, Kee F, Hogg RE, Scott A, Burns F, Woodside JV, McGuinness B. Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA): health assessment protocol, participant profile and patterns of participation. BMC Public Health 2023; 23:466. [PMID: 36899371 PMCID: PMC9999338 DOI: 10.1186/s12889-023-15355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 03/01/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND The Northern Ireland Cohort for the Longitudinal Study of Ageing (NICOLA) is a prospective, longitudinal study of a representative cohort of older adults living in Northern Ireland, United Kingdom. Its aim is to explore the social, behavioural, economic and biological factors of ageing and how these factors change as people age. The study has been designed to maximize comparability with other international studies of ageing thereby facilitating cross-country comparisons. This paper provides an overview of the design and methodology of the health assessment which was carried out as part of Wave 1. METHODS Three thousand, six hundred and fifty five community dwelling adults, aged 50 years and over participated in the health assessment as part of Wave 1 of NICOLA. The health assessment included a battery of measurements across various domains that addressed key indicators of ageing namely: physical function, vision and hearing, cognitive function, and cardiovascular health. This manuscript describes the scientific rationale for the choice of assessments, provides an overview of the core objective measures carried out in the health assessment and describes the differences in characteristics of participants who took part in the health assessment compared to those who did not take part. RESULTS The manuscript highlights the importance of incorporating objective measures of health in population based studies as a means of complementing subjective measures and as a way to advance our understanding of the ageing process. The findings contextualize NICOLA as a data resource within Dementias Platform UK (DPUK), the Gateway to Global Ageing (G2G) and other existing networks of population based longitudinal studies of ageing. CONCLUSION This manuscript can help inform design considerations for other population based studies of ageing and facilitate cross-country comparative analysis of key life-course factors affecting healthy ageing such as educational attainment, diet, the accumulation of chronic conditions (including Alzheimer's disease, dementia and cardiovascular disease) as well as welfare and retirement policies.
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Affiliation(s)
- Charlotte E Neville
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom.
| | - Ian S Young
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
| | - Frank Kee
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom.
| | - Ruth E Hogg
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
| | - Angela Scott
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
| | - Frances Burns
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
| | - Jayne V Woodside
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
| | - Bernadette McGuinness
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Institute of Clinical Science, Queen's University Belfast, Grosvenor Road, BT12 6BJ, Belfast, United Kingdom
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Thilarajah S, Bower KJ, Williams G, Clark RA, Tan D, Pua YH. Paretic and Nonparetic Step Tests Are Noninterchangeable in Stroke: A Prospective Cohort Study. Phys Ther 2021; 101:6134189. [PMID: 33587141 DOI: 10.1093/ptj/pzab060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 11/20/2020] [Accepted: 12/31/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The step test (ST) is a common clinical assessment of dynamic balance among survivors of stroke. The ST assesses a person's ability to place their paretic (paretic ST) or nonparetic (nonparetic ST) foot rapidly and repeatedly on and off a standardized block while standing. No study has formally explored if the 2 tests are interchangeable. Our study aimed to: (1) differentiate the correlates of paretic and nonparetic ST, and (2) compare their associations with physical function and falls. METHODS Eighty-one survivors of stroke were consecutively recruited from inpatient rehabilitation units (n = 4) and were assessed within 1 week prior to discharge. In addition to the ST, a handheld dynamometer and computerized posturography were used to measure lower limb muscle strength and standing balance, respectively. Self-selected gait speed and Timed Up and Go test were also assessed as measures of physical function. Falls data were monitored for 12 months post discharge using monthly calendars. Multivariable regression analyses were used to differentiate (1) the correlates of paretic and nonparetic STs, and (2) their associations with physical function and falls. RESULTS The median score for the paretic and nonparetic STs were 8 and 9 steps, respectively. Paretic ankle plantar-flexor and dorsiflexor strength were the strongest correlates of nonparetic ST, whereas both paretic ankle and knee extensor strength were the strongest correlates of paretic ST. In multivariable analyses adjusting for each other, both STs were independently associated with gait speed and Timed Up and Go scores. Paretic ST (odds ratio = 0.37; 95% CI = 0.22 to 0.62) was a stronger predictor than nonparetic ST (odds ratio = 0.51; 95% CI = 0.34 to 0.78) in predicting future falls. CONCLUSION This study confirmed that the paretic and nonparetic STs are noninterchangeable. ST scores should be assessed separately to achieve a more complete interpretation. IMPACT To our knowledge, this study is the first to objectively evaluate the similarities and differences between paretic and nonparetic STs. This information may refine the use and interpretation of the 2 STs for survivors of stroke.
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Affiliation(s)
| | - Kelly J Bower
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gavin Williams
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia.,Epworth HealthCare, Richmond, Melbourne, Victoria, Australia
| | - Ross A Clark
- School of Health and Exercise Science, The University of the Sunshine Coast, Queensland, Australia
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore
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Does Exercise-Based Conventional Training Improve Reactive Balance Control among People with Chronic Stroke? Brain Sci 2020; 11:brainsci11010002. [PMID: 33374957 PMCID: PMC7821930 DOI: 10.3390/brainsci11010002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/15/2020] [Accepted: 12/17/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Exercise-based conventional training has predominantly benefited fall-associated volitional balance control domain; however, the effect on reactive balance control is under-examined. Therefore, the purpose of this study was to examine the effect of exercise-based conventional training on reactive balance control. Methods: Eleven people with chronic stroke (PwCS) underwent multi-component training for six weeks (20 sessions) in a tapering manner. Training focused on four constructs-stretching, functional strengthening, balance, and endurance. Volitional balance was measured via movement velocity on the Limits of Stability (LOS) test and reactive balance via center of mass (COM) state stability on the Stance Perturbation Test (SPT). Additionally, behavioral outcomes (fall incidence and/or number of steps taken) were recorded. Results: Movement velocity significantly increased on the LOS test (p < 0.05) post-intervention with a significant decrease in fall incidence (p < 0.05). However, no significant changes were observed in the COM state stability, fall incidence and number of recovery steps on the SPT post-intervention. Conclusion: Although volitional and reactive balance control may share some neurophysiological and biomechanical components, training based on volitional movements might not significantly improve reactive balance control for recovery from large-magnitude perturbations due to its task-specificity.
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Levinger P, Panisset M, Dunn J, Haines T, Dow B, Batchelor F, Biddle S, Duque G, Hill KD. Exercise interveNtion outdoor proJect in the cOmmunitY for older people - results from the ENJOY Seniors Exercise Park project translation research in the community. BMC Geriatr 2020; 20:446. [PMID: 33148182 PMCID: PMC7610011 DOI: 10.1186/s12877-020-01824-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 10/07/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Many research studies evaluate physical activity interventions for older people in the community, however relatively few successfully promote maintenance of physical activity beyond the completion of the intervention. This study aimed to implement and evaluate the effects of sustained engagement in physical activity on mental, social and physical health outcomes through the use of the Seniors Exercise Park physical activity program for older people (the ENJOY project). METHOD People aged ≥60 years underwent a 12-week structured supervised physical activity program using outdoor exercise park equipment followed by 6 months unstructured independent use of the exercise park. Participants were assessed at baseline, 3 months and 9 months and completed a test battery evaluating physical activity, physical function and health related quality of life measures. Repeated measures ANOVA was used to compare differences between baseline, 3 and 9 months. RESULTS Of the 95 participants, 80 (84.2%) completed the 3 months supervised program, and 58 (61%) completed the 9 month assessment (the latter impacted by COVID-19 restrictions). A significant increase in physical activity level was demonstrated following the 12 weeks intervention (p < 0.01). Significant improvements were also demonstrated in all physical function measures (p < 0.01), self-rated quality of life (p < 0.05), wellbeing (p < 0.01), fear of falls (p < 0.01), falls risk (p < 0.01), depressive symptoms (p = 0.01) and loneliness (p = 0.03) at 3 months. At the 9 months follow up, significant improvements from baseline were demonstrated in the frequency, duration and total of physical activity level (p < 0.05), and all physical function measures (p < 0.05), with no decline in these measures from 3 to 9 months. At 9 months, significant changes were observed in the health related quality of life mobility and self care domains with reductions in both fear of falls and falls risk (p < 0.05). CONCLUSION The Seniors Exercise Park may be an effective modality for improving and sustaining older people's physical function and wellbeing and can be an important public health infrastructure investment in promoting physical activity for older people. Future work should focus on wider implementation of the program and on scaling up this initiative to achieve public health benefit for the community. TRIAL REGISTRATION Trial registration number ACTRN12618001727235, Date of registration 19th October 2018, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375979.
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Affiliation(s)
- Pazit Levinger
- National Ageing Research Institute, Melbourne, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, Australia.
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.
| | - Maya Panisset
- National Ageing Research Institute, Melbourne, Australia
| | - Jeremy Dunn
- National Ageing Research Institute, Melbourne, Australia
| | - Terry Haines
- School of Primary and Allied Health Care, Monash University, Melbourne, Australia
| | - Briony Dow
- National Ageing Research Institute, Melbourne, Australia
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
| | - Frances Batchelor
- National Ageing Research Institute, Melbourne, Australia
- School of Nursing and Midwifery, Deakin University, Melbourne, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Australia
| | - Stuart Biddle
- Centre for Health Research, University of Southern Queensland, Brisbane, Australia
| | - Gustavo Duque
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne Medical School, Melbourne University, Melbourne, Australia
| | - Keith D Hill
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia
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Targeted Rhythmic Auditory Cueing During Treadmill and Overground Gait for Individuals With Parkinson Disease: A Case Series. J Neurol Phys Ther 2020; 44:268-274. [PMID: 32459723 DOI: 10.1097/npt.0000000000000315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Rhythmic auditory cueing and treadmill walking can improve spatiotemporal gait parameters through entrainment of movement patterns. Careful selection of cue frequencies is necessary if treadmill walking is to be employed, because cadence and step length are differentially affected by walking on a treadmill and overground. The purpose of this study was to describe the treatment of gait impairments for individuals with Parkinson disease, using strategically selected rhythmic auditory cue frequencies on both a treadmill and overground. CASE DESCRIPTION Three individuals with Hoehn & Yahr stage 2 Parkinson disease participated in this case series. INTERVENTION All participants completed 6 weeks of gait training, in which each session employed rhythmic auditory cueing during treadmill-based gait training followed by overground gait training. We provided targeted rhythmic auditory cueing with a metronome set to 85% and 115% of their self-selected cadence for treadmill and overground training, respectively. We performed clinical tests of gait and balance prior to, midway, and following training, and at a 3-month follow-up. OUTCOMES All participants improved overground gait speed (participant 1: +0.27 m/s; participant 2: +0.20 m/s; and participant 3: +0.18 m/s) and stride length (15.7 ± 4.17 cm) with small changes to cadence. Likewise, there were only small changes in balance. DISCUSSION We hypothesize that the large improvements in gait speed are due to the concomitant increases in stride length. Further research is needed to test the effect of targeted rhythmic auditory cueing during treadmill and overground gait.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A309).
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Thilarajah S, Bower KJ, Pua YH, Tan D, Williams G, Larik A, Bok CW, Koh G, Clark RA. Modifiable Factors Associated With Poststroke Physical Activity at Discharge From Rehabilitation: Prospective Cohort Study. Phys Ther 2020; 100:818-828. [PMID: 31995190 DOI: 10.1093/ptj/pzaa022] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 09/15/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND People with stroke are not meeting recommended levels of physical activity. The modifiable factors associated with poststroke physical activity levels need to be identified to develop targeted interventions. OBJECTIVE The objective of this study was to investigate the factors at discharge from inpatient rehabilitation that are associated with physical activity levels at 3 months following discharge. DESIGN This was a prospective cohort study. METHODS Sixty-four people with stroke completed baseline assessments at discharge from inpatient rehabilitation and 55 completed the follow-up 3 months later. The candidate factors (ie, gait speed, balance, strength, cognition, mood, and motivation) were measured at discharge. The primary outcome measure at follow-up was walking-related activity (measured by wrist-worn accelerometer). Secondary outcome measures were physical activity participation (Activity Card Sort) and intensity of physical activity (International Physical Activity Questionnaire-Short 7 days). Adjusted separate multivariable linear regression models or proportional odds regression models were used to evaluate the associations between candidate factors and physical activity. RESULTS Gait speed and balance were associated with all aspects of physical activity. Higher level of intrinsic motivation was also associated with higher physical activity participation. Anxiety demonstrated a significant nonlinear relationship with physical activity participation. LIMITATIONS Inclusion of fatigue and individual muscle strength could have provided further insights into associations with steps per day. CONCLUSION The results demonstrated that better physical function at discharge from inpatient rehabilitation was associated with future increased levels of physical activity. Additionally, higher levels of motivation impacted on increased physical activity participation. The influence of anxiety on physical activity participation requires further exploration. Mixed-method study designs can be utilized to further understand the factors associated with poststroke physical activity.
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Affiliation(s)
- Shamala Thilarajah
- School of Health and Exercise Science, University of the Sunshine Coast, Queensland, Australia; and Department of Physiotherapy, Singapore General Hospital, Outram Road, Singapore 169608 Singapore
| | - Kelly J Bower
- Physiotherapy Department, University of Melbourne, Melbourne, Australia
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital
| | - Dawn Tan
- Department of Physiotherapy, Singapore General Hospital
| | - Gavin Williams
- Physiotherapy Department, University of Melbourne; and Epworth HealthCare, Richmond, Melbourne, Australia
| | - Ashfaq Larik
- Department of Physiotherapy, Singapore General Hospital
| | - Chek-Wai Bok
- Department of Physiotherapy, Singapore General Hospital
| | - Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ross A Clark
- School of Health and Exercise Science, University of the Sunshine Coast
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Age-related changes in the capacity to select early-onset upper-limb reactions to either recover balance or protect against impact. Exp Gerontol 2019; 125:110676. [DOI: 10.1016/j.exger.2019.110676] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/21/2019] [Accepted: 07/29/2019] [Indexed: 11/18/2022]
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Ezekiel L, Collett J, Mayo NE, Pang L, Field L, Dawes H. Factors Associated With Participation in Life Situations for Adults With Stroke: A Systematic Review. Arch Phys Med Rehabil 2019; 100:945-955. [DOI: 10.1016/j.apmr.2018.06.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/09/2023]
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Engel-Yeger B, Tse T, Josman N, Baum C, Carey LM. Scoping Review: The Trajectory of Recovery of Participation Outcomes following Stroke. Behav Neurol 2018; 2018:5472018. [PMID: 30271506 PMCID: PMC6151208 DOI: 10.1155/2018/5472018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/29/2018] [Accepted: 07/26/2018] [Indexed: 12/21/2022] Open
Abstract
Participation is a central concept in health and well-being and healthcare, yet operationalizing this concept has been difficult. Its definition, uses in healthcare, and impacts on recovery require ongoing research. Our review question goes like this: from the longitudinal evidence investigating participation among stroke survivors, what are the patterns of participation recovery in stroke survivors over time, and what interventions are used to improve participation? To fully understand these questions, we also ask, how is participation defined in the stroke literature, and what are the measures of participation used in the stroke literature? A systematic scoping review was undertaken using the search terms "stroke," "longitudinal," "participation," and "outcome" in seven databases. Articles included were published until April 2017, written in English, and had at least two longitudinal assessments of participation. Fifty-nine articles met the inclusion criteria. The International Classification of Functioning, Disability and Health was the most frequent definition of participation used (34%). There were 22 different measures of participation. Eight of ten studies demonstrated significant improvements in participation up to 12 months poststroke. Efficacy of interventions and their impact on participation varied. The various definitions, measures, and intervention efficacies of participation highlight the need for further research worldwide into achieving meaningful participation and quality of life among stroke survivors. Future practice should include participation as a main outcome measure.
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Affiliation(s)
- Batya Engel-Yeger
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Tamara Tse
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
- Occupational Therapy Department, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Naomi Josman
- Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Carolyn Baum
- Program in Occupational Therapy, Washington University School of Medicine, St Louis, MO, USA
| | - Leeanne M. Carey
- Occupational Therapy, Department of Community and Clinical Allied Health, School of Allied Health, La Trobe University, Melbourne, VIC, Australia
- Neurorehabilitation and Recovery, Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
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Martins AC, Moreira J, Silva C, Silva J, Tonelo C, Baltazar D, Rocha C, Pereira T, Sousa I. Multifactorial Screening Tool for Determining Fall Risk in Community-Dwelling Adults Aged 50 Years or Over (FallSensing): Protocol for a Prospective Study. JMIR Res Protoc 2018; 7:e10304. [PMID: 30072360 PMCID: PMC6096167 DOI: 10.2196/10304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/02/2018] [Accepted: 05/05/2018] [Indexed: 12/16/2022] Open
Abstract
Background Falls are a major health problem among older adults. The risk of falling can be increased by polypharmacy, vision impairment, high blood pressure, environmental home hazards, fear of falling, and changes in the function of musculoskeletal and sensory systems that are associated with aging. Moreover, individuals who experienced previous falls are at higher risk. Nevertheless, falls can be prevented by screening for known risk factors. Objective The objective of our study was to develop a multifactorial, instrumented, screening tool for fall risk, according to the key risk factors for falls, among Portuguese community-dwelling adults aged 50 years or over and to prospectively validate a risk prediction model for the risk of falling. Methods This prospective study, following a convenience sample method, will recruit community-dwelling adults aged 50 years or over, who stand and walk independently with or without walking aids in parish councils, physical therapy clinics, senior’s universities, and other facilities in different regions of continental Portugal. The FallSensing screening tool is a technological solution for fall risk screening that includes software, a pressure platform, and 2 inertial sensors. The screening includes questions about demographic and anthropometric data, health and lifestyle behaviors, a detailed explanation about procedures to accomplish 6 functional tests (grip strength, Timed Up and Go, 30 seconds sit to stand, step test, 4-Stage Balance test “modified,” and 10-meter walking speed), 3 questionnaires concerning environmental home hazards, and an activity and participation profile related to mobility and self-efficacy for exercise. Results The enrollment began in June 2016 and we anticipate study completion by the end of 2018. Conclusions The FallSensing screening tool is a multifactorial and evidence-based assessment which identifies factors that contribute to fall risk. Establishing a risk prediction model will allow preventive strategies to be implemented, potentially decreasing fall rate. Registered Report Identifier RR1-10.2196/10304
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Affiliation(s)
- Anabela Correia Martins
- Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Juliana Moreira
- Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Catarina Silva
- Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | | | | | - Daniela Baltazar
- Physiotherapy Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Clara Rocha
- Complementary Sciences Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal.,Institute for Systems Engineering and Computers at Coimbra, Coimbra, Portugal
| | - Telmo Pereira
- Clinical Physiology Department, Coimbra Health School, Polytechnic Institute of Coimbra, Coimbra, Portugal
| | - Inês Sousa
- Fraunhofer Portugal AICOS, Porto, Portugal
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Moore M, Barker K. The validity and reliability of the four square step test in different adult populations: a systematic review. Syst Rev 2017; 6:187. [PMID: 28893312 PMCID: PMC5594590 DOI: 10.1186/s13643-017-0577-5] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The four square step test (FSST) was first validated in healthy older adults to provide a measure of dynamic standing balance and mobility. The FSST has since been used in a variety of patient populations. The purpose of this systematic review is to determine the validity and reliability of the FSST in these different adult patient populations. METHODS The literature search was conducted to highlight all the studies that measured validity and reliability of the FSST. Six electronic databases were searched including AMED, CINAHL, MEDLINE, PEDro, Web of Science and Google Scholar. Grey literature was also searched for any documents relevant to the review. Two independent reviewers carried out study selection and quality assessment. The methodological quality was assessed using the QUADAS-2 tool, which is a validated tool for the quality assessment of diagnostic accuracy studies, and the COSMIN four-point checklist, which contains standards for evaluating reliability studies on the measurement properties of health instruments. RESULTS Fifteen studies were reviewed studying community-dwelling older adults, Parkinson's disease, Huntington's disease, multiple sclerosis, vestibular disorders, post stroke, post unilateral transtibial amputation, knee pain and hip osteoarthritis. Three of the studies were of moderate methodological quality scoring low in risk of bias and applicability for all domains in the QUADAS-2 tool. Three studies scored "fair" on the COSMIN four-point checklist for the reliability components. The concurrent validity of the FSST was measured in nine of the studies with moderate to strong correlations being found. Excellent Intraclass Correlation Coefficients were found between physiotherapists carrying out the tests (ICC = .99) with good to excellent test-retest reliability shown in nine of the studies (ICC = .73-.98). CONCLUSIONS The FSST may be an effective and valid tool for measuring dynamic balance and a participants' falls risk. It has been shown to have strong correlations with other measures of balance and mobility with good reliability shown in a number of populations. However, the quality of the papers reviewed was variable with key factors, such as sample size and test set up, needing to be addressed before the tool can be confidently used in these specified populations.
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Affiliation(s)
- Martha Moore
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK.
| | - Karen Barker
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, OX3 7HE, UK
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Bouchalová V, Houben E, Tancsik D, Schaekers L, Meuws L, Feys P. The influence of an ankle-foot orthosis on the spatiotemporal gait parameters and functional balance in chronic stroke patients. J Phys Ther Sci 2016; 28:1621-8. [PMID: 27313385 PMCID: PMC4905924 DOI: 10.1589/jpts.28.1621] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 02/06/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] Observational study investigating the influence of various ankle-foot orthoses on the spatiotemporal gait parameters and functional balance in chronic stroke patients. [Subjects and Methods] Fifteen chronic stroke patients participated in this study after providing informed consent. Two groups of patients were differentiated based on the Timed Up and Go Test. Patients were tested in three different conditions: with standard prefabricated ankle-foot orthosis (Maramed), with individualized ankle-foot orthosis (Y-tech), and without any ankle-foot orthrosis. Spatiotemporal gait parameters were obtained by walking on an instrumented walkway (GAITRite(®)) at usual and fastest speed. Balance was assessed with Timed Up and Go Test, Step Test, and Four Square Step Test. [Results] Maramed and Y-tech significantly improved the spatiotemporal parameters while walking at usual and maximal speed (single support time affected side; double support time affected side and step length unaffected side). The Y-tech in addition improved velocity and cadence. Among the balance tests, only the Timed Up and Go test showed improvements in favor of Maramed and Y-tech. [Conclusion] Patients benefited from wearing orthosis at both usual and maximal speed, irrespective of whether they wore Maramed or Y-tech. Only severe stroke patients benefited from wearing an orthoses compared to mild impaired group.
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Affiliation(s)
- Vendula Bouchalová
- Department of Public Health and Preventive Medicine, Faculty of Medicine in Pilsen, Charles University in Prague, Czech Republic
| | - Els Houben
- Rehabilitation Department of Ziekenhuis Oost-Limburg, Belgium
| | - Dorine Tancsik
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Lotte Schaekers
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Leni Meuws
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
| | - Peter Feys
- University of Hasselt, BIOMED/REVAL, Faculty of Medicine and Life Sciences, Belgium
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Clark RA, Vernon S, Mentiplay BF, Miller KJ, McGinley JL, Pua YH, Paterson K, Bower KJ. Instrumenting gait assessment using the Kinect in people living with stroke: reliability and association with balance tests. J Neuroeng Rehabil 2015; 12:15. [PMID: 25884838 PMCID: PMC4333881 DOI: 10.1186/s12984-015-0006-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 01/28/2015] [Indexed: 11/15/2022] Open
Abstract
Background The Microsoft Kinect has been used previously to assess spatiotemporal aspects of gait; however the reliability of this system for the assessment of people following stroke has not been established. This study examined the reliability and additional information that the Kinect provides when instrumenting a gait assessment in people living with stroke. Methods The spatiotemporal variables of step length, step length asymmetry, foot swing velocity, foot swing velocity asymmetry, peak and mean gait speed and the percentage difference between the peak and mean gait speed were assessed during gait trials in 30 outpatients more than three months post-stroke and able to stand unsupported. Additional clinical assessments of functional reach (FR), step test (ST), 10 m walk test (10MWT) and the timed up and go (TUG) were performed, along with force platform instrumented assessments of center of pressure path length velocity during double-legged standing balance with eyes closed (DLEC), weight bearing asymmetry (WBA) and dynamic medial-lateral weight-shifting ability (MLWS). These tests were performed on two separate occasions, seven days apart for reliability assessment. Separate adjusted multiple regressions models for predicting scores on the clinical and force platform assessments were created using 1) the easily assessed clinically-derived gait variables 10MWT time and total number of steps; and 2) the Kinect-derived variables which were found to be reliable (ICC > 0.75) and not strongly correlated (Spearman’s ρ < 0.80) with each other (i.e. non-redundant). Results Kinect-derived variables were found to be highly reliable (all ICCs > 0.80), but many were redundant. The final regression model using Kinect-derived variables consisted of the asymmetry scores, mean gait velocity, affected limb foot swing velocity and the difference between peak and mean gait velocity. In comparison with the clinically-derived regression model, the Kinect-derived model accounted for >15% more variance on the MLWS, ST and FR tests and scored similarly on all other measures. Conclusions In conclusion, instrumenting gait using the Kinect is reliable and provides insight into the dynamic balance capacity of people living with stroke. This system provides a minimally intrusive method of examining potentially important gait characteristics in people living with stroke.
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Affiliation(s)
- Ross A Clark
- School of Exercise Science, Australian Catholic University, Melbourne, Australia.
| | - Stephanie Vernon
- School of Exercise Science, Australian Catholic University, Melbourne, Australia.
| | - Benjamin F Mentiplay
- School of Exercise Science, Australian Catholic University, Melbourne, Australia.
| | - Kimberly J Miller
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada.
| | | | - Yong Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.
| | - Kade Paterson
- School of Physiotherapy, University of Melbourne, Melbourne, Australia.
| | - Kelly J Bower
- School of Exercise Science, Australian Catholic University, Melbourne, Australia. .,Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Australia.
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Boonsinsukh R, Panichareon L, Saengsirisuwan V, Phansuwan-Pujito P. Clinical Identification for the Use of Light Touch Cues with a Cane in Gait Rehabilitation Poststroke. Top Stroke Rehabil 2015; 18 Suppl 1:633-42. [DOI: 10.1310/tsr18s01-633] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Jung JH, Ko SE, Lee SW. Immediate effects of single-leg stance exercise on dynamic balance, weight bearing and gait cycle in stroke patients. ACTA ACUST UNITED AC 2014. [DOI: 10.14474/ptrs.2014.3.1.49] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ji-Hye Jung
- Physical Therapy Team, Hangeoleum Rehabilitation Hospital, Seoul, Republic of Korea
| | - Si-Eun Ko
- Physical Therapy Team, Ilsan Hi Hospital, Goyang, Republic of Korea
| | - Seung-Won Lee
- Department of Physical Therapy, College of Health and Welfare, Sahmyook University, Seoul, Republic of Korea
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Mercer VS, Freburger JK, Yin Z, Preisser JS. Recovery of paretic lower extremity loading ability and physical function in the first six months after stroke. Arch Phys Med Rehabil 2014; 95:1547-55.e4. [PMID: 24755045 DOI: 10.1016/j.apmr.2014.03.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 03/17/2014] [Accepted: 03/21/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To evaluate poststroke recovery of paretic lower extremity loading, walking ability, and self-reported physical function; and to identify subject characteristics associated with recovery. DESIGN Inception cohort study, with testing at monthly intervals from 1 to 6 months poststroke. SETTING Medical center and research laboratory. PARTICIPANTS Volunteer sample of individuals with first-ever, unilateral, noncerebellar stroke (N=33). A total of 78 individuals underwent screening, and 45 were found to be eligible. Of these, 8 declined participation, 2 were excluded because of deteriorating cognitive status, and 2 were lost to follow-up. The remaining 33 individuals enrolled in the study, and 30 (91%) completed the study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Outcomes were loading of the paretic lower extremity when standing up from a chair, self-selected gait speed (GS), and Physical Functioning Index. RESULTS Data analyses using linear mixed models indicated that subjects improved over time for all outcomes. Baseline Fugl-Meyer (FM) lower extremity motor scale score was a predictor of immediate poststroke performance for paretic lower extremity loading and self-selected GS, and a predictor of recovery rate for paretic lower extremity loading. Factors identified as having significant effects on performance at 6 months poststroke were baseline FM lower extremity motor scale score for paretic lower extremity loading and self-selected GS and baseline star cancellation score (from the Behavioral Inattention Test) for paretic lower extremity loading. CONCLUSIONS Individuals with better baseline paretic lower extremity motor function have better ability to load that extremity during functional activities and faster walking speeds, and these advantages are still present at 6 months poststroke. Individuals with severe visuospatial neglect demonstrate less ability to load the paretic leg during functional activities at 6 months poststroke.
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Affiliation(s)
- Vicki Stemmons Mercer
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Janet Kues Freburger
- Center for Human Movement Science and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, NC; Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Zhaoyu Yin
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John S Preisser
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Vernon S, Paterson K, Bower K, McGinley J, Miller K, Pua YH, Clark RA. Quantifying Individual Components of the Timed Up and Go Using the Kinect in People Living With Stroke. Neurorehabil Neural Repair 2014; 29:48-53. [DOI: 10.1177/1545968314529475] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The Microsoft Kinect presents a simple, inexpensive, and portable method of examining the independent components of the Timed Up and Go (TUG) without any intrusion on the patient. Objective. This study examined the reliability of these measures, and whether they improved prediction of performance on common clinical tests. Methods. Thirty individuals with stroke completed 4 clinical assessments, including the TUG, 10-m walk test (10MWT), Step Test, and Functional Reach test on 2 testing occasions. The TUG was assessed using the Kinect to determine 7 different functional components. Test–retest reliability was assessed using intraclass correlation coefficient (ICC), redundancy using Spearman’s correlation, and score prediction on the clinical tests using multiple regression. Results. All Kinect-TUG variables possessed excellent reliability (ICC(2,k) > 0.90) except trunk flexion angle (ICC = 0.73). Trunk flexion angle and first step length were nonredundant with total TUG time. When predicting 10MWT and Step Test scores, adding step length into regression models comprising age and total TUG time improved model performance by 7% ( P <.01) and 6% ( P =.03), respectively. Specifically, an interquartile range increase in first step length (0.19 m) was associated with a 0.15 m/s faster gait speed and 1.8 more repetitions on the Step Test. These effect sizes were comparable to our minimal detectable change scores of 0.17 m/s for gait speed and 1.71 repetitions for the Step Test. Conclusions. Using the Kinect to independently assess the multiple components of the TUG may provide reliable and clinically useful information. This could enable efficient and information-rich large-scale assessments of physical deficits following stroke.
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Affiliation(s)
| | - Kade Paterson
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Kelly Bower
- The University of Melbourne, Melbourne, Victoria, Australia
| | | | | | | | - Ross A. Clark
- Australian Catholic University, Melbourne, Victoria, Australia
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da Silva TD, Raimundo RD, Ferreira C, Torriani-Pasin C, Monteiro CBDM, Theodoro Júnior OA, Valenti VE, Adami F, de Oliveira EP, Barnabé V, de Abreu LC. Comparison between the six-minute walk test and the six-minute step test in post stroke patients. Int Arch Med 2013; 6:31. [PMID: 23924407 PMCID: PMC3750617 DOI: 10.1186/1755-7682-6-31] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 08/05/2013] [Indexed: 01/18/2023] Open
Abstract
Background The Stroke remains one of the major chronic diseases worldwide, and is considered a major cause of disability, which results not only in persistent neurological deficits, but also in the high physical deconditioning, nevertheless there are not many forms of assessing functional capacity in this population. We aimed to investigate the feasibility of the Six Minute Walk Teste and the Six-Minute Step Test (6MST) in post-stroke patients and compare the behavior of physiological variables during the 6MST and the Six-Minute Walk Test (6MWT), by correlating the functional performance obtained in both tests. Method The 6MWT was carried out according to the American Thoracic Society (ATS) and the 6MST was performed in six minutes in order to compare it to the 6MWT in a 20 cm step. Was included post-stroke individuals able to walk without aid. All of them did the 6MWT and the 6MST. Results 12 patients participated in the study. There was no statistical difference in the parameters analyzed when tests were compared. There was poor correlation between the functional performance in both tests. Conclusion The 6MWT and the 6MST is feasible for post-stroke patients and physiological responses are equal during the performance of both tests. However, there was no correlation with respect to functional performance, which was assessed by the distance walked in the 6MWT and by the number of steps climbed in the 6MST.
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Affiliation(s)
- Talita Dias da Silva
- Universidade Federal de São Paulo, UNIFESP, R. Botucatu, SP 740, 03828-000, Brazil
| | - Rodrigo Daminello Raimundo
- Escola de Artes, Ciências e Humanidades da Universidade de São Paulo EACH/USP, Rua Arlindo Béttio, SP 1000,03828-00 SP, Brasil
| | - Celso Ferreira
- Universidade Federal de São Paulo, UNIFESP, R. Botucatu, SP 740, 03828-000, Brazil
| | - Camila Torriani-Pasin
- Escola de Educação Física e Esporte da Universidade de São Paulo, EEFE/USP, Av. Prof. Mello de Morais, 65, 05508-030 SP, Brasil
| | | | | | - Vitor E Valenti
- Programa de Pós-Graduação em Fisioterapia, Faculdade de Ciências e Tecnologia, Universidade Estadual Paulista, UNESP, Rua Roberto Simonsen, 305,19060-900 Presidente Prudente, SP, Brasil
| | - Fernando Adami
- Departamento de Saúde da Coletividade, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821, Santo André, SP, Brasil
| | | | - Viviani Barnabé
- Faculdade Mario Schenberg, Estrada do Espigão, SP, 06710540 Cotia, Brasil
| | - Luiz Carlos de Abreu
- Departamento de Morfologia e Fisiologia, Faculdade de Medicina do ABC, Av. Príncipe de Gales, 821 09060-650 Santo André, SP, Brasil
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Tse T, Douglas J, Lentin P, Carey L. Measuring participation after stroke: a review of frequently used tools. Arch Phys Med Rehabil 2012; 94:177-92. [PMID: 22982555 DOI: 10.1016/j.apmr.2012.09.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 08/29/2012] [Accepted: 09/02/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To identify and critique the measures currently used to assess participation in clinical stroke studies. DATA SOURCES Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases. STUDY SELECTION Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included. DATA EXTRACTION The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories. DATA SYNTHESIS Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered. CONCLUSIONS This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.
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Affiliation(s)
- Tamara Tse
- The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia.
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Hong SJ, Goh EY, Chua SY, Ng SS. Reliability and Validity of Step Test Scores in Subjects With Chronic Stroke. Arch Phys Med Rehabil 2012; 93:1065-71. [DOI: 10.1016/j.apmr.2011.12.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 12/21/2011] [Accepted: 12/22/2011] [Indexed: 10/28/2022]
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van Bloemendaal M, van de Water ATM, van de Port IGL. Walking tests for stroke survivors: a systematic review of their measurement properties. Disabil Rehabil 2012; 34:2207-21. [PMID: 22583082 DOI: 10.3109/09638288.2012.680649] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid.
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