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Cramer E, Weber F, Faro G, Klein M, Willeke D, Hering T, Zietz D. Cross-cultural adaption and validation of the German version of the Mini-BESTest in individuals after stroke: an observational study. Neurol Res Pract 2020; 2:27. [PMID: 33324929 PMCID: PMC7650133 DOI: 10.1186/s42466-020-00078-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/30/2020] [Indexed: 01/15/2023] Open
Abstract
Background Postural control is a very important function in everyday life. However, assessing postural control with commonly used measurement instruments (MIs) is limited due to deficits in their psychometric properties. The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a comprehensive and multidimensional MI for assessing postural control in persons with limited balance function, such as individuals after stroke. Despite the increasing use of the Mini-BESTest worldwide, no German version is available. Research question Is the German version of the Mini-BESTest (GVMBT) comprehensible and valid for measuring postural control in individuals after stroke? Methods The Mini-BESTest was translated and cross-culturally adapted, following established guidelines. It was pilot-tested with ten participants. This observational measurement and validation study was conducted at one point and included 50 participants with subacute and chronic stroke (mean age: 64.58 ± 13.34 years/ 34 men/ 16 women). Convergent validity was investigated using 1) the Berg Balance Scale (BBS) and 2) the Timed “Up & Go” (TUG). The MIs were evaluated for normal distribution with the calculation of skewness, kurtosis and Q-Q-Plots. Spearman correlation coefficients and Bland Altman analysis were used to examine the relationship between the MIs. The internal consistency was assessed using Cronbach’s alpha. Results Comprehension of the GVMBT was confirmed. The GVMBT correlated significantly with the BBS (rs = 0.93) and the TUG (rs = − 0.85). Bland Altman analysis revealed low absolute differences. The GVMBT demonstrated no significant floor or ceiling effects and showed excellent internal consistency (Cronbach’s α = 0.90). Significance The GVMBT has excellent validity and internal consistency. Due to this and its specific subcategories, the GVMBT is recommended for the use in research and clinical practice. Further psychometric properties should be evaluated.
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Affiliation(s)
- Elena Cramer
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Franziska Weber
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
| | - Gilian Faro
- Rehabilitation Center for Neurology, Neurosurgery and Neuropaediatrics, VAMED Klinik Hattingen GmbH, Am Hagen 20, 45527 Hattingen, Germany
| | - Michael Klein
- Rehabilitation Center for Neurology, Neurosurgery and Neuropaediatrics, VAMED Klinik Hattingen GmbH, Am Hagen 20, 45527 Hattingen, Germany
| | - Dennis Willeke
- Rehabilitation Center for Neurology and Orthopaedics, Johanniter-Klinik am Rombergpark, Am Rombergpark 42, 44225 Dortmund, Germany
| | - Thomas Hering
- Department of Applied Human Sciences, Hochschule Magdeburg-Stendal (University of Applied Sciences), Osterburger Str. 25, 39576 Stendal, Germany
| | - Dörte Zietz
- Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801 Bochum, Germany
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Raab D, Diószeghy-Léránt B, Wünnemann M, Zumfelde C, Cramer E, Rühlemann A, Wagener J, Gegenbauer S, Geu Flores F, Jäger M, Zietz D, Hefter H, Kecskemethy A, Siebler M. A Novel Multiple-Cue Observational Clinical Scale for Functional Evaluation of Gait After Stroke - The Stroke Mobility Score (SMS). Med Sci Monit 2020; 26:e923147. [PMID: 32930152 PMCID: PMC7518021 DOI: 10.12659/msm.923147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background For future development of machine learning tools for gait impairment assessment after stroke, simple observational whole-body clinical scales are required. Current observational scales regard either only leg movement or discrete overall parameters, neglecting dysfunctions in the trunk and arms. The purpose of this study was to introduce a new multiple-cue observational scale, called the stroke mobility score (SMS). Material/Methods In a group of 131 patients, we developed a 1-page manual involving 6 subscores by Delphi method using the video-based SMS: trunk posture, leg movement of the most affected side, arm movement of the most affected side, walking speed, gait fluency and stability/risk of falling. Six medical raters then validated the SMS on a sample of 60 additional stroke patients. Conventional scales (NIHSS, Timed-Up-And-Go-Test, 10-Meter-Walk-Test, Berg Balance Scale, FIM-Item L, Barthel Index) were also applied. Results (1) High consistency and excellent inter-rater reliability of the SMS were verified (Cronbach’s alpha >0.9). (2) The SMS subscores are non-redundant and reveal much more nuanced whole-body dysfunction details than conventional scores, although evident correlations as e.g. between 10-Meter-Walk-Test and subscore “gait speed” are verified. (3) The analysis of cross-correlations between SMS subscores unveils new functional interrelationships for stroke profiling. Conclusions The SMS proves to be an easy-to-use, tele-applicable, robust, consistent, reliable, and nuanced functional scale of gait impairments after stroke. Due to its sensitivity to whole-body motion criteria, it is ideally suited for machine learning algorithms and for development of new therapy strategies based on instrumented gait analysis.
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Affiliation(s)
- Dominik Raab
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Duisburg, Germany
| | | | - Meret Wünnemann
- Neurology Rehabilitation Unit, MediClin Fachklinik Rhein/Ruhr, Essen, Germany
| | - Christina Zumfelde
- Neurology Rehabilitation Unit, MediClin Fachklinik Rhein/Ruhr, Essen, Germany
| | - Elena Cramer
- Department of Applied Health Sciences - Physiotherapy, University of Applied Sciences Bochum, Bochum, Germany
| | - Alina Rühlemann
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany
| | - Johanna Wagener
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany.,Department of Orthopedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim, Mülheim, Germany
| | | | - Francisco Geu Flores
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Duisburg, Germany
| | - Marcus Jäger
- Department of Orthopedics and Trauma Surgery, University of Duisburg-Essen, Essen, Germany.,Department of Orthopedics, Trauma and Reconstructive Surgery, St. Marien Hospital Mülheim, Mülheim, Germany
| | - Dörte Zietz
- Department of Applied Health Sciences - Physiotherapy, University of Applied Sciences Bochum, Bochum, Germany
| | - Harald Hefter
- Department of Neurology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Andres Kecskemethy
- Chair of Mechanics and Robotics, University of Duisburg-Essen, Duisburg, Germany
| | - Mario Siebler
- Neurology Rehabilitation Unit, MediClin Fachklinik Rhein/Ruhr, Essen, Germany
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Braun T, Marks D, Thiel C, Zietz D, Zutter D, Grüneberg C. Effects of additional, dynamic supported standing practice on functional recovery in patients with sub-acute stroke: a randomized pilot and feasibility trial. Clin Rehabil 2015; 30:374-82. [PMID: 25952591 DOI: 10.1177/0269215515584801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/06/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary effectiveness of additional dynamic versus static passive standing performed by patients with sub-acute stroke supervised by trained helpers. DESIGN Assessor blinded, randomized pilot and feasibility trial. SETTING Neurological rehabilitation centre. PARTICIPANTS Non-ambulatory participants in the sub-acute phase after stroke. INTERVENTION Usual care plus additional standing training, consisting of either dynamic standing practice in a modified standing frame (intervention group, n=14) or static standing practice in a conventional standing frame (control group, n=14) for 5 weeks. MAIN MEASURES Feasibility was assessed through occurrence of adverse events, patient satisfaction and operability of the technical device handled by trained helpers. Preliminary effectiveness was assessed with the Berg Balance Scale (primary outcome) and other measures of physical functioning. RESULTS Trained helpers were capable to apply the intervention, and no adverse events occurred. Both groups were comparable at baseline. Within-group changes tended to be higher for the intervention group, but did not reach a significant level except for the Functional Ambulation Categories. Specifically, median pre-post improvements in the Berg Balance Scale tended to be higher in the dynamic (20, inter quartile range (IQR): 2-33 points) than in the static standing group (4.5, IQR: 0-16 points; U=62; P=0.052; effect size=0.478). CONCLUSIONS In severely affected individuals after stroke, dynamic supported standing practice can be performed safely by trained helpers. In a larger-scale phase III study, a total of 116 patients would be needed to prove the preliminary effectiveness found in this study.
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Affiliation(s)
- Tobias Braun
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Detlef Marks
- Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Christian Thiel
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Dörte Zietz
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
| | - Daniel Zutter
- Rehaklinik Zihlschlacht, Neurorehabilitation Centre, Zihlschlacht, Switzerland
| | - Christian Grüneberg
- Hochschule für Gesundheit, Department of Applied Health Sciences, Physiotherapy Program, Bochum, Germany
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