Pooled Minimal Clinically Important Differences of the Mini-Balance Evaluation Systems Test in Patients With Early Subacute Stroke: A Multicenter Prospective Observational Study

OBJECTIVE

Balance problems are common in patients with stroke, and the Mini-Balance Evaluation Systems Test (Mini-BESTest) is a reliable and valid assessment tool for measuring balance function. Determining the minimal clinically important difference (MCID) is crucial for assessing treatment effectiveness. This study aimed to determine the MCID of the Mini-BESTest in patients with early subacute stroke.

METHODS

In this prospective multicenter study, 53 patients with early subacute stroke undergoing rehabilitation in inpatient units were included. The mean age of the patients was 72.6 (SD = 12.2) years. The Mini-BESTest, which consists of 14 items assessing various aspects of balance function, including anticipatory postural adjustments, postural responses, sensory orientation, and dynamic gait, was used as the assessment tool. The global rating of change (GRC) scales completed by the participants and physical therapists were used as external anchors to calculate the MCID. The GRC scale measured subjective improvement in balance function, ranging from -3 (very significantly worse) to +3 (very significantly better), with a GRC score of ≥+2 considered as meaningful improvement. Four methods were used to calculate the MCID: mean of participants with GRC of 2, receiver operating characteristic-based method, predictive modeling method, and adjustment of the predictive modeling method based on the rate of improvement. From the MCID values obtained using these methods, a single pooled MCID value was calculated.

RESULTS

The MCID values for the Mini-BESTest obtained through the 4 methods ranged from 3.2 to 4.5 points when using the physical therapist's GRC score as the anchor but could not be calculated using the participant's GRC score. The pooled MCID value for the Mini-BESTest was 3.8 (95% CI = 2.9-5.0).

CONCLUSIONS

The Mini-BESTest MCID obtained in this study is valuable for identifying improvements in balance function among patients with early subacute stroke.

IMPACT

Determination of the MCID is valuable for evaluating treatment effectiveness. The study findings provide clinicians with practical values that can assist in interpreting Mini-BESTest results and assessing treatment effectiveness.

Changes in physical activity level during hospitalization in patients with stroke and those with fracture: a prospective longitudinal study

[Purpose] To examine changes in physical activity levels between admission and discharge in patients hospitalized after stroke and fracture. [Participants and Methods] Patients with stroke (n=36) or fracture (n=41) wore an accelerometer during the daytime for three days after admission and before discharge. Physical activity was divided into sedentary behavior (SB), light-intensity (LIPA), and moderate-to-vigorous (MVPA), and then compared between hospital admission and discharge using the Wilcoxon signed-rank test. The characteristics of patients with or without changes in SB during hospitalization were compared using the Mann-Whitney U test. [Results] The median LIPA time in patients after stroke and fracture increased from 107.5 and 106.7 minutes on admission to 122.0 and 127.3 minutes at discharge, and the median MVPA time increased from 2.7 and 0.7 minutes on admission to 4.2 and 2.7 minutes at discharge, respectively. In particular, LIPA in non-therapy time increased for patients both after stroke and fracture. No differences in characteristics were observed between with or without changes in SB regardless of differences in diagnoses. [Conclusion] These findings indicate that while physical activity levels increased during hospitalization, they remained below World Health Organization recommendations for MVPA, and patient characteristics alone may not account for increased activity levels.

Rasch analysis of the Short Physical Performance Battery in older inpatients with heart failure

PURPOSE

The physical function of older patients with heart failure (HF) is likely to decline, and the Short Physical Performance Battery (SPPB) is widely used for its evaluation. No study has analyzed the SPPB by using Rasch model in these patients. The aim of this study was to examine the structural validity and item response of the SPPB in older inpatients with HF.

MATERIALS AND METHODS

In this multicenter cross-sectional study, we investigated 106 older inpatients with HF. We evaluated the SPPB's rating scale structure, unidimensionality, and measurement accuracy (0 = poor performance to 4 = normal performance).

RESULTS

The SPPB rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct. The SPPB demonstrated adequate reliability (person reliability = 0.81) and separated persons into four strata: those with very low, low, moderate, and high physical performance. Item-difficulty measures were -0.59 to 0.96 logits, and regarding the person ability-item difficulty matching for the SPPB, the item was somewhat easy (the mean of person ability = 0.89 logits; mean of item difficulty = 0.00).

CONCLUSION

The SPPB has strong measurement properties and is an appropriate scale for quantitatively evaluating physical function in older patients with HF.

Minimal clinically important difference in 6-minute walk distance estimated by multiple methods in inpatients with subacute cardiovascular disease

BACKGROUND

Identifying the minimal clinically important difference (MCID) contributes to the ability to determine the efficacy of physiotherapy interventions and make good clinical decisions.

PURPOSE

The purpose of this study was to estimate the MCID for 6-minute walking distance (6MWD) among inpatients with subacute cardiac disease using multiple anchor-based methods.

METHODS

This study was a secondary data analysis using only data from a multicenter longitudinal observational study in which 6MWD was measured at two time points. Based on the changes in 6MWD between baseline measurement and follow-up approximately 1 week after baseline measurement, the global rating of change scales (GRCs) of patients and physiotherapists, anchor method receiver operator operating characteristic curves, predictive models, and adjusted models were used to calculate the MCID.

RESULTS

Participants comprised 35 patients. Mean (standard deviation) 6MWD was 228.9 m (121.1 m) at baseline and 270.1 m (125.0 m) at follow-up. MCID for each GRC was 27.5-35.6 m for patients and 32.5-38.6 m for physiotherapists.

CONCLUSION

The MCID in 6MWD in patients with subacute cardiovascular disease is 27.5-38.6 m. This value may be useful in determining the effectiveness of physiotherapy interventions and for decision-making.

Validity of functional assessment for control of trunk in patients with subacute stroke: a multicenter, cross-sectional study

[Purpose] The purpose of this study was to clarify the criterion validity, construct validity, and feasibility of the Functional Assessment for Control of Trunk (FACT). [Participants and Methods] This study was a multicenter, cross-sectional study of patients with subacute stroke at three Japanese rehabilitation hospitals. To clarify feasibility, we examined the differences in the measurement time between FACT and the Trunk Impairment Scale (TIS). For the criterion validity of FACT, correlations between FACT, TIS, and the trunk items of the Stroke Impairment Assessment Set (SIAS) were examined using Spearman's rank correlation coefficient. For the construct validity of FACT, we examined the correlations with the other assessments. [Results] Seventy-three patients participated in this study. The measurement time was significantly shorter for FACT (212.6 ± 79.2 s) than TIS (372.4 ± 199.6 s). For criterion validity, FACT correlated significantly with TIS (r=0.896) and two SIAS trunk items (r=0.453, 0.594). For construct validity, significant correlations were found for FACT and other tests (r=0.249-0.797). Areas under the curve for FACT and TIS were 0.809 and 0.812, respectively, and the cutoff values for walking independence were 9 and 13 points, respectively. [Conclusion] For inpatients with stroke, FACT offered feasibility, criterion validity, and construct validity.

Minimal clinically important difference of the short physical performance battery and comfortable walking speed in old-old adults with acute cardiovascular disease: a multicenter, prospective, observational study

PURPOSE

The physical function of older adults age ≥ 75 years hospitalized for cardiovascular disease (CVD) often decrease. The Minimal Clinically Important Difference (MCID) is the smallest clinically meaningful difference due to therapy. The Short Physical Performance Battery (SPPB) and Comfortable Walking Speed (CWS) are physical function evaluations commonly used in people with CVD. This study aims to clarify the MCIDs of the SPPB and CWS in old-old adult with CVD.

MATERIALS AND METHODS

This was a multicenter, prospective study of 58 old-old adults with acute CVD and rehabilitation. The MCID was estimated using the participants' and physical therapists' (PT) Global Rating of Change (GRC) scales as anchors for changes in the SPPB and CWS. The area under the curve (AUC) was used to measure the discrimination accuracy.

RESULTS

The MCID of SPPB was 3 points when the GRC from PT was used as an anchor (AUC = 0.70). The MCID of CWS was 0.10 m/s when the GRC from participants and PT were used as anchors (AUC = 0.70 and 0.73, respectively).

CONCLUSIONS

The MCID of 3 SPPB points and 0.10 m/s CWS in old-old adults with acute CVD may help determine the effectiveness of therapy and improve prognosis.Implications for rehabilitationFor people with cardiovascular disease (CVD), the Short Physical Performance Battery (SPPB) and comfortable walking speed (CWS) are often used to measure physical function.The MCID of SPPB and CWS was estimated to be 3 points and 0.10 m/s, respectively, in older adults with CVD aged ≥75 years.This finding is useful for clinicians to evaluate the efficacy of cardiac rehabilitation.

Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke

[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6-0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.

Predictors of life-space mobility in patients with fracture 3 months after discharge from convalescent rehabilitation ward: a prospective longitudinal study

[Purpose] To identify predictors of life-space mobility in patients with fracture three months after discharge from convalescent rehabilitation ward. [Participants and Methods] This is a prospective longitudinal study that included patients aged 65 or older with a fracture who were scheduled for discharge home from the convalescent rehabilitation ward. Baseline measurements included sociodemographic variables (age, gender, and disease), the Falls Efficacy Scale-International, maximum walking speed, the Timed Up & Go test, the Berg Balance Scale, the modified Elderly Mobility Scale, the Functional Independence Measure, the revised version of Hasegawa's Dementia Scale, and the Vitality Index up to two weeks before discharge. As a follow-up, the life-space assessment was measured three months after discharge. In the statistical analysis, multiple linear and logistic regression analyses were performed with the life-space assessment score and the life-space level of "places outside your town" as dependent variables. [Results] The Falls Efficacy Scale-International, the modified Elderly Mobility Scale, age, and gender were selected as predictors in the multiple linear regression analysis, whereas in the multiple logistic regression analysis, the Falls Efficacy Scale-International, age, and gender were selected as predictors. [Conclusion] Our study emphasized the importance of fall-related self-efficacy and motor function for life-space mobility. The findings of this study suggest that when considering post-discharge living, therapists should conduct an appropriate assessment and adequate planning.

Relationship between the characteristics of lower extremity function and activities of daily living in hospitalized middle-aged and older adults with subacute cardiovascular disease

[Purpose] To clarify the relationship between lower extremity function and activities of daily living and characterize lower extremity function in hospitalized middle-aged and older adults with subacute cardiovascular disease. [Participants and Methods] The Short Physical Performance Battery, 6-minute walk distance, and functional independence measure tests were conducted in 79 inpatients with subacute cardiovascular disease (mean age, 76.7 ± 11.9 years; 34 females). Multiple regression analysis used the functional independence measure score as the dependent variable and the Short Physical Performance Battery and 6-minute walk distance scores as independent variables. Cross-tabulations were performed for each age group, and patients who performed the Short Physical Performance Battery and 6-minute walk distance tests were divided into two groups by their respective cutoff values. [Results] Only the Short Physical Performance Battery (β=0.568) and 6-minute walk distance (β=0.479) scores were adopted as significant independent variables in each multiple regression model. The age <75 years group had the most patients with both good lower extremity function and aerobic capacity, whereas the age ≥75 years group had the most patients with both functions impaired. [Conclusion] Although cardiovascular disease is generally associated with decreased aerobic capacity, many older patients with cardiovascular disease in this study had decreased lower extremity function, too.

Minimal clinically important difference of the Berg Balance Scale and comfortable walking speed in patients with acute stroke: A multicenter, prospective, longitudinal study

OBJECTIVE

To determine the minimal clinically important difference between the Berg Balance Scale and comfortable walking speed in acute-phase stroke patients.

DESIGN

Multicenter, prospective, longitudinal study.

SETTING

Inpatient acute stroke rehabilitation.

SUBJECTS

Seventy-five patients with acute stroke, mean (SD) age 71.7 (12.2) years.

INTERVENTION

Inpatients with acute stroke were assessed with the Berg Balance Scale and comfortable walking speed before and after rehabilitation. Physiotherapy was conducted to improve balance and gait over a 2-week period: an average of 40 min/day on weekdays and 20 min/day on weekends and holidays.

MAIN MEASURES

The patients' Berg Balance Scale, comfortable walking speed, Global Rating of Change scale (patient-rated and physiotherapist-rated), and motor score of the Functional Independence Measure were obtained. Minimal clinically important differences were estimated using both anchor- (receiver operating characteristic curves and change difference) and distribution-based approaches (minimal detectable change and 0.5× the change score [SD]).

RESULTS

The baseline scores were 31.2 (18.9) for the Berg Balance Scale and 0.79 (0.35) m/s for comfortable walking speed. The minimal clinically important difference in the Berg Balance Scale was 6.5-12.5 points by the anchor-based approach and 2.3-4.9 points by the distribution-based approach. The minimal clinically important difference in comfortable walking speed was 0.18-0.25 m/s by the anchor-based and 0.13-0.15 m/s by the distribution-based approach.

CONCLUSIONS

A change of 6.5-12.5 points in the Berg Balance Scale and 0.18-0.25 m/s in the comfortable walking speed is required in these measurements' anchor-based minimal clinically important differences to be beyond measurement error, and to be perceptible by both patients and clinicians.

Rasch Validation and Comparison of the Mini-BESTest and S-BESTest in Individuals With Stroke

OBJECTIVE

The purpose of this study was to compare the psychometric properties of the Mini-Balance Evaluation Systems Test (Mini-BESTest) and S-BESTest and to evaluate which is more suitable for use in clinical settings for individuals with stroke.

METHODS

This multicenter retrospective cross-sectional study investigated 115 individuals with stroke (mean age, 70.8 y [SD = 11.2 y]) who were able to stand without physical assistance. All individuals were examined with the BESTest and with the Mini-BESTest and S-BESTest scored based on the BESTest results. The data were analyzed using a Rasch analysis (partial credit model).

RESULTS

The Mini-BESTest results revealed a correctly functioning rating scale, good fit of the data to the model (apart from 1 overfit item), good reliability for both persons and items (6 statistically detectable levels of balance ability), local dependence between 1 item pair, and essential unidimensionality. The S-BESTest results demonstrated disordered rating scale thresholds (1 response option required collapsing), good fit of the data to the model (apart from 1 underfit item), good reliability for both persons and items (5 statistically detectable levels of balance ability), local dependence between 2 item pairs, and essential unidimensionality.

CONCLUSION

The analyses confirmed that the reliability of the S-BESTest was good and unidimensional and that the test provides several improved points, such as item redundancy and local independence of items. Nevertheless, the Mini-BESTest results supported previous findings as a whole and were better than those from the S-BESTest.

IMPACT

Rasch analysis demonstrated that the Mini-BESTest was a better balance assessment scale than the S-BESTest for individuals with stroke based on its psychometric properties. The Mini-BESTest may serve as a useful scale for assessing balance in individuals with stroke, and a keyform plot and strata may help clinical decision-making in terms of interpreting scores and goal setting.

Association between self-perceived activity performance and upper limb functioning in subacute stroke

BACKGROUND AND PURPOSE

This study aimed to investigate to what extent upper limb (UL) motor impairment, trunk compensation, and activity performance are related to self-perception of UL activity performance in subacute stroke.

METHODS

This was a prospective observational study. Twenty-four adults with subacute stroke (age: 65.4 ± 10.8 years) underwent clinical and kinematic assessments at baseline (33.9 ± 5.2 days after stroke onset) and 4 weeks after the baseline. The clinical assessment included the UL Fugl-Meyer motor assessment (FMA), Simple Test for Evaluating hand Function (STEF), and the performance and satisfaction scores of the Canadian Occupational Performance Measure (COPM). The kinematic measurement was performed using a motion capture system during a standardized reach-to-grasp task. Endpoint performance variables and trunk displacement were calculated as kinematic outcomes. An inpatient rehabilitation program of 3 h/day was provided every day for 4 weeks between the two measurement points. The relationships between COPM scores and clinical/kinematic outcomes were examined by multiple regression analysis. Significance levels of p < 0.05 were used.

RESULTS

The results of the multiple regression analysis showed that the changes in STEF (β = 0.520, p = 0.005) and trunk compensation (β = -0.398, p = 0.024) were moderately related to the change in the COPM satisfaction (R² _adj  = 0.426, p = 0.001), while the change in UL FMA was not.

DISCUSSION

The changes in activity performance and trunk compensation were related to improved self-perception of UL activity performance. Therapeutic management for activity performance and trunk compensation may be important for improving self-perception of UL activity performance after stroke.

Sections of the Brief-Balance Evaluation Systems Test Relevant for Discriminating Fast Versus Slow Walking Speeds in Community-Dwelling Older Women

BACKGROUND AND PURPOSE

Walking speed can be used to identify characteristics of frailty in older adults. It has a strong positive correlation with balance abilities. The Brief-Balance Evaluation Systems Test (Brief-BESTest) was developed to assess functions of the 6 balance control systems in a short time. However, for community-dwelling older adults, the relationship between walking speed and the Brief-BESTest needs to be clarified. Even the cutoff scores for each Brief-BESTest section should be indicated for physical therapists to effectively evaluate balance deficits. Our objective was to establish cutoff scores for individual Brief-BESTest sections, determine fast or slow walkers in community-dwelling older adults, and investigate the relationship between balance control systems and walking speed.

METHODS

In a cross-sectional study involving 55 participants 77 years and older, the Brief-BESTest was evaluated after grouping the participants based on their walking speeds in public community centers. We compared the age, history of falls, handgrip strength, quadriceps strength, appendicular skeletal muscle mass index, comfortable walking speeds, and the Brief-BESTest scores between the fast- and slow-walking groups by using the independent t test, Fisher exact test, or Mann-Whitney U test. We also determined the receiver operating characteristic curves, and calculated the cutoff, area under the curve (AUC), sensitivity, and specificity of each section.

RESULTS

All sections of the Brief-BESTest, except Section 1 (Biomechanical Constraints) were able to differentiate between fast and slow walkers in community-dwelling older women. Section VI (Stability in Gait) showed the highest AUC (0.83) and the cutoff score for the fast- and slow-walker groups was 3.0 points (sensitivity = 0.85, specificity = 0.81). Sections III, IV, and V (Anticipatory, Reactive, and Sensory Orientation, respectively) had moderate AUC (0.71-0.72). Sections I and II (Stability Limits) showed weak correlations with the walking speed.

CONCLUSIONS

Three sections (III, anticipatory postural adjustments; IV, reactive postural responses; and VI, stability in gait) could differentiate between fast and slow walkers. Section VI was a particularly important balance function measurement that differentiated the walking speed with the highest accuracy. Therefore, it should be a primary focus when physical therapists treat community-dwelling older adults.

Which Balance Evaluation Systems Test sections best distinguish levels of post-stroke functional walking status?

Objective

To determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores.

Design

A retrospective cross-sectional study.

Subjects and methods

The BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated.

Results

In the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1–78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.812–0.834, cut-off scores=75.0–83.4%).

Conclusion

This study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.

Section of the Balance Evaluation Systems Test (BESTest) Cutoff Values for Walking Speed Level in Older Women With Hip Fracture

BACKGROUND AND PURPOSE

Hip fracture is a common injury in older adults, with a high proportion of hip fractures affecting women. After a hip fracture, the recovery of the patient's walking speed is very important; one of the key determinants of walking speed is balance. The Balance Evaluation Systems Test (BESTest), a clinical balance measure, categorizes balance into 6 postural control systems. However, the relationship between the walking speed level and the sections of the BESTest has not been explored for older women with hip fracture. Our objective was to establish section scores for the BESTest cutoff values for walking speed in older women with hip fracture.

METHODS

This was an observational study involving 46 older women 65 years or older with hip fracture. The BESTest was administered to all participants upon their discharge from the hospital. Participants were divided into groups on the basis of their walking speed levels, and receiver operating characteristic curves were determined for each section of the BESTest. We calculated the cutoff value, area under the curve (AUC), sensitivity, and specificity of each.

RESULTS

Section IV-Stability in Gait showed the highest AUC (0.92) compared with the other sections, and the cutoff value determined for the fast and slow walker groups was 64.3% (sensitivity = 0.82, specificity = 0.83). The sections with moderate AUC (0.7-0.9) were I-Biomechanical Constraints (cutoff = 70.0%), III-Anticipatory Postural Adjustments (cutoff = 66.5%), IV-Postural Responses (cutoff = 69.4%), and V-Sensory Orientation (cutoff = 83.4%). The sections with the highest sensitivity (0.82) were I-Biomechanical Constraints and VI-Stability in Gait, and that with the highest specificity (0.88) was II-Stability Limits and Verticality.

CONCLUSIONS

Five of the BESTest sections (I-Biomechanical Constraints, III-Anticipatory Postural Adjustments, IV-Postural Responses, V-Sensory Orientation, and IV-Stability in Gait) were able to differentiate between fast and slow walkers among older women with hip fracture. Balance during gait and anticipatory postural adjustments were shown to be important components of balance, and their cutoff values were indicators of the balance required to reach fast walking levels.

Accuracy of wrist-worn heart rate monitors during physical therapy sessions among hemiparetic inpatients with stroke

[Purpose] We aimed to examine the accuracy of heart rate monitors worn on the wrist by patients with stroke. The wrist worn heart rate monitor could improve the quality of rehabilitation by monitoring exercise intensity during physical therapy. [Participants and Methods] Thirty inpatients with subacute hemiparetic stroke wore heart rate monitors on both (non-paretic and paretic) wrists, as well as a chest heart rate monitor. We recorded the heart rate values measured at the wrist and chest every minute during physical therapy sessions. The wrist monitors were an optical heart rate measurement device based on photoplethysmography, and the chest monitor was a traditional chest device based on electrocardiography. The relative and absolute reliabilities between the heart rate measurements from the wrist and chest monitors were calculated. [Results] The intraclass correlation coefficients for model 2.1 ranged from 0.75 to 0.79. Bland-Altman analysis revealed a very slight fixed bias; however, no significant proportional bias was observed. For the non-paretic and paretic sides, the lower and upper limits of agreement ranged from −21.8 to 23.8 beats/min and from −20.8 to 21.6 beats/min, and the mean absolute percentage errors were 6.7% and 5.9%, respectively. The Cohen’s d value was small. [Conclusion] The relative reliability of the wrist heart rate monitors was substantial. The absolute reliability as bias in wrist heart rate and chest heart rate was small, but heart rates estimated from wrist monitors were not particularly accurate.

Sensitivity to change and responsiveness of the Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Brief-BESTest in patients with subacute cerebral infarction

[Purpose] To compare the sensitivity to change and responsiveness of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in patients with subacute cerebral infarction. [Participants and Methods] Thirty patients with subacute cerebral infarction participated in this study. The Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, Brief-Balance Evaluation Systems Test, Berg Balance Scale, and ambulatory ability were assessed on admission and discharge. Sensitivity to change was calculated using the effect size, standardized response mean, and relative efficiency. Responsiveness was analyzed by comparing the ability of the difference between the scores of the balance assessments at admission and discharge in classifying the participants’ ambulatory independence. [Results] All assessments showed significant improvement from admission to discharge. The effect size of the three versions of the Balance Evaluation Systems Test ranged from 0.41 to 0.69. The standardized response mean ranged from 0.75 to 1.28. The cutoff score was 16.7% for the Balance Evaluation Systems Test, 5.5 points for the Mini-Balance Evaluation Systems Test, 1.5 points for the Brief-Balance Evaluation Systems Test, and 3.5 points for the Berg Balance Scale. [Conclusion] The sensitivity to change of the three versions of the Balance Evaluation Systems Test was high or moderate. However, the Mini-Balance Evaluation Systems Test had the highest responsiveness, as determined with the extent of ambulatory independence.

Fall prediction using decision tree analysis in acute care units

[Purpose] To present an accurate and straight-forward system of fall prediction by performing decision tree analysis using both the fall assessment sheet and Berg balance scale (BBS). [Participants and Methods] The participants in this retrospective study were inpatients from acute care units. We extracted the risk factors for falls from the fall assessment and performed a decision tree analysis using the extracted fall risk factors and BBS score. [Results] "History of more than one fall in the last 1 year", "Muscle weakness", "Use of a walking aid or wheelchair", "Requires assistance for transfer", "Use of Narcotics", "Dangerous behavior", and "High degree of self-reliance" were fall risk factors. The decision tree analysis extracted five fall risk factors, with an area under the curve of 0.7919. Patients with no history of falls and who did not require assistance for transfer or those with a BBS score ≥51 did not fall. [Conclusion] Decision tree-based fall prediction was useful and straightforward and revealed that patients with no history of falling and those who did not require assistance for transfer or had a BBS score ≥51 had a low risk of falling.

Comparison of the structural validity of three Balance Evaluation Systems Test in older adults with femoral or vertebral fracture

OBJECTIVE

To clarify and compare the structural validity of 3 Balance Evaluation Systems Tests (BESTest, Mini-BESTest, and Brief-BESTest) in older adults with femoral or vertebral fractures.

DESIGN

Cross-sectional study.

SUBJECTS

Ninety-four older adults (age ?65 years) with femoral or vertebral fractures, who could walk without physical assistance.

METHODS

Four BESTest models (BESTest, one-factor Mini-BESTest, four-factor Mini-BESTest, and Brief-BESTest) were examined using confirmatory factor analysis, and the models goodness-of-fit was assessed. Unidimensionality of the best-fitting model was confirmed by Rasch principal component analysis on the residuals.

RESULTS

Confirmatory factor analysis showed that the four-factor Mini-BESTest model (comparative fit index?=?0.952; Tucker-Lewis index?=?0.937; root-mean square error of approximation?=?0.060; standardized root-mean-square residual?=?0.062) has a better structure than other models. The principal component analysis of standardized residuals showed that the variance attributable to Rasch factor was good, with eigenvalues <2, confirming the factors unidimensionality.

CONCLUSION

The four-factor Mini-BESTest model shows good structural validity in older adults with femoral or vertebral fracture. Evaluating dynamic balance by focusing on 4 components (anticipatory postural adjustments, postural responses, sensory orientation, and stability in gait) may help therapists in making clinical decisions.

Comparing the measurement properties and relationship to gait speed recovery of the Mini-Balance Evaluation Systems Test and the Berg Balance Scale in ambulatory individuals with subacute stroke

OBJECTIVES

Although the Mini-Balance Evaluation Systems Test (Mini-BESTest) is known to be a reliable and valid measure of balance in individuals with stroke, the utility of this tool in relation to subacute stroke walking speed and the recovery of gait ability has not been explored. Here, we compared the measurement properties and their relationship to gait speed on the Mini-BESTest and the Berg Balance Scale (BBS) in middle and older ambulatory individuals with subacute stroke, and we investigated which balance assessment tool is more likely to capture the status of the recovery of gait speed.

METHODS

We retrospectively analyzed the cases of 88 individuals 50 years or older with stroke who had been evaluated using the Mini-BESTest by using the BBS and by assessing their comfortable walking speed (CWS). The proportion of subjects who showed improvement was calculated for 34 stroke survivors from data obtained at admission to and discharge from the hospital.

RESULTS

Compared with the BBS, the Mini-BESTest showed a better distribution of total scores without a ceiling effect. The two scales showed correlations with gait speed (Mini-BESTest: r=0.702; BBS: r=0.592) and discrimination between fast and slow walkers. The responsiveness of the Mini-BESTest was excellent, with an area under the curve of 0.894, thus discriminating between gait speed improvement versus non-improvement.

CONCLUSIONS

These results indicate that the Mini-BESTest is more useful than the BBS in terms of its measurement properties and ability to measure gait recovery in middle and older ambulatory individuals with subacute stroke.

Cognitive-motor interference in post-stroke individuals and healthy adults under different cognitive load and task prioritization conditions

[Purpose] We aimed to compare the effects of cognitive load and task prioritization on dual task strategies in patients with stroke and healthy adults in order to clarify the characteristics of cognitive-motor interference. [Participants and Methods] In total, 26 patients with stroke and 26 age-matched healthy adults (controls) performed the Timed Up and Go Test while performing a serial subtraction task from random numbers between 90 and 100. Dual task was measured under four conditions in which two difficulty levels of "3 subtraction" and "7 subtraction" were multiplied by two prioritizing tasks that involved "paying equal attention to both walking and subtraction tasks" (no priority) and "paying attention while mainly focusing on subtraction tasks" (cognitive priority). [Results] Increasing cognitive load and prioritizing cognitive tasks affected motor performance in terms of the amount of time and number of steps required to complete the Timed Up and Go Test in both the patients and controls. However, cognitive load and task prioritization did not affect cognitive performance. [Conclusion] When cognitive load increases and instructions are given to prioritize increases in cognitive load, patients with stroke use the "posture first" strategy to stabilize their gait as effectively as healthy adults do.

Structural validity of Balance Evaluation Systems Test assessed using factor and Rasch analyses in patients with stroke

[Purpose] The Balance Evaluation Systems Test (BESTest) is a comprehensive assessment tool, although it is not confined for use in stroke patients. This study aimed to determine the structural validity of the BESTest in self-ambulatory patients with stroke using both factor and Rasch analyses. [Participants and Methods] This retrospective study included 140 self-ambulatory patients with stroke. The structural validity of the BESTest was analyzed according to principal component, exploratory factor, Rasch, confirmatory factor, and correlation analyses. [Results] The analytical results supported a four-factor model comprising 25 items. The four factors included dynamic postural control with gait, static postural control, stepping reaction, and stability limits in sitting. Evidence of high structural validity and reliable internal consistency suggested that the 25-item BESTest is valid and reliable. Each factor was significantly correlated with lower extremity motor function and walking ability. [Conclusion] Eleven items in the BESTest were poorly correlated, and the remaining 25 items were grouped into four factors that demonstrated good structural validity for patients with stroke. Further studies should validate the applicability of the 25-item BESTest four-factor model in a larger sample of patients with stroke in a clinical setting.

Prediction of falling risk after discharge in ambulatory stroke or history of fracture patients using Balance Evaluation Systems Test (BESTest)

[Purpose] The purpose of this study was to clarify the relationships between falls and sections of the Balance Evaluation Systems Test (BESTest) in patients with stroke or those with a history of fracture. [Subjects and Methods] This longitudinal study included 51 self-ambulatory inpatients. Balance was assessed 1 week prior to discharge using the BESTest, and the incidence of falls within 6 months after discharge was investigated. Relationships between falling and balance components were analyzed using the t-test or the Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis. [Results] Five subjects were dropped out before follow-up at 6 months. Falls were reported by 10 of the remaining 46 participants. Scores for two sections (Anticipatory Postural Adjustments and Sensory Orientation) were significantly lower in fallers than in non-fallers with stroke. Four of the six sections (Biomechanical Constraints, Anticipatory Postural Adjustments, Sensory Orientation, and Stability in Gait) showed areas under the ROC curves >0.8 (0.82, 0.83, 0.84, and 0.81, respectively). In patients with a history of fractures, all sections were not significantly different between fallers and non-fallers. [Conclusion] Anticipatory Postural Adjustments and Sensory Orientation sections of the BESTest were related to future occurrence of fall after discharge in self-ambulatory stroke patients.

Effects of high-intensity pulse irradiation with linear polarized near-infrared rays and stretching on muscle tone in patients with cerebrovascular disease: a randomized controlled trial

[Purpose] The purpose of this study was to clarify the influence of high-intensity pulse irradiation with linear polarized near-infrared rays (HI-LPNR) and stretching on hypertonia in cerebrovascular disease patients. [Subjects and Methods] The subjects were 40 cerebrovascular disease patients with hypertonia of the ankle joint plantar flexor muscle. The subjects were randomly allocated to groups undergoing treatment with HI-LPNR irradiation (HI-LPNR group), stretching (stretching group), HI-LPNR irradiation followed by stretching (combination group), and control group (10 subjects each). In all groups, the passive range of motion of ankle dorsiflexion and passive resistive joint torque of ankle dorsiflexion were measured before and after the specified intervention. [Results] The changes in passive range of motion, significant increase in the stretching and combination groups compared with that in the control group. The changes in passive resistive joint torque, significant decrease in HI-LPNR, stretching, and combination groups compared with that in the control group. [Conclusion] HI-LPNR irradiation and stretching has effect of decrease muscle tone. However, combination of HI-LPNR irradiation and stretching has no multiplier effect.

The validity of an accelerometer-based method for estimating fluidity in the sit-to-walk task in a community setting

[Purpose] Fluidity in the sit-to-walk task has been quantitatively measured with three-dimensional motion analysis system. The purpose of this study was to determine the validity of an accelerometer-based method for estimating fluidity in community-dwelling elderly individuals. [Subjects and Methods] Seventeen community-dwelling elderly females performed a sit-to-walk task. The motion was recorded by an accelerometer, a three-dimensional motion analysis system and a foot pressure sensor simultaneously. The timings of events determined from the acceleration waveform were compared to the timings determined from the three-dimensional motion analysis data (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index from the duration between events. [Results] The characteristics of the acceleration waveform were similar to those previously reported in younger adults. Comparisons of event timings from accelerometer and motion analysis system data indicated no systematic bias. Regression analysis showed that the duration from maximum trunk inclination to the first heel strike was the best predictor of fluidity index. [Conclusion] An accelerometer-based method using the duration between characteristic events may be used to precisely and conveniently assess fluidity in a sit-to-walk task in a community setting.

Development of a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and investigation of its reliability and validity

[Purpose] To develop a clinical assessment test of 180-degree standing turn strategy (CAT-STS) and quantify its reliability and construct validity. [Subjects] Outpatients with stroke that occurred at least 6 months previously (N = 27) who could walk 10 m without physical assistance were included. [Methods] The CAT-STS was based on the literature and discussion with four physical therapists. The final version of the CAT-STS includes seven items: direction, use of space, foot movement, initiation, termination, instability, and non-fluidity. Patients were videotaped performing a 180-degree turn while standing. The Motricity Index, gait speed and Functional Ambulation Category were also evaluated. Two raters evaluated the turn on two occasions, and inter- and intra-rater reliability were calculated. Construct validity was also calculated. [Results] Inter-rater reliability was fair or moderate for many items (kappa = 0.221-0.746). Intra-rater reliability was good-to-excellent for all items (kappa = 0.681-0.846) except direction and termination. Inter- and intra-rater reliability of the total CAT-STS score were substantial and excellent, respectively (intraclass correlation coefficient = 0.725 and 0.865, respectively). The total CAT-STS score was associated with walking ability and the time and number of steps taken to turn. [Conclusion] The total CAT-STS score is a reliable and valid measure.

Effect of high-intensity pulse irradiation with linear polarized near-infrared rays on muscle tone in patients with cerebrovascular disease: a randomized controlled trial

[Purpose] This study evaluated effects of a high-intensity linear polarized near-infrared ray irradiation for mitigation of muscle hypertonia. [Subjects] The subjects were 20 patients with cerebrovascular disease. [Methods] Subjects were randomly allocated to an intervention or control group. The intervention group received irradiation of the triceps surae. Passive range of motion and passive resistive joint torque of ankle dorsiflexion were measured before and after the intervention in knee extended and flexed positions. [Results] In the knee extended position, the mean changes in passive range of motion were 2.70° and -0.50° in the intervention and control groups, respectively, and the mean changes in passive resistive joint torque were -1.42 and -0.26 N·m in the intervention and control groups, respectively. In the knee flexed position, the mean changes in passive range of motion were 3.70° and 0.70° in the intervention and control groups, respectively, and the mean changes in passive resistive joint torque were -2.38 and -0.31 N·m in the intervention and control groups, respectively. In both knee positions, the mean changes in the two indices were greater in the intervention group than in the control group. [Conclusion] High-intensity linear polarized near-infrared ray irradiation increases passive range of motion and decreases passive resistive joint torque.

An accelerometer-based method for estimating fluidity in the sit-to-walk task

[Purpose] The purpose of this study was to clarify the validity of accelerometer data for quantifying fluidity during the sit-to-walk task. [Subjects] The participants were 16 healthy young males. [Methods] The timing of events (task onset, maximum trunk inclination, and first heel strike) was determined from the acceleration waveform and compared to the timing determined from a three-dimensional motion analysis (task onset, maximum trunk inclination) or foot pressure sensor data (first heel strike). Regression analysis was used to estimate the fluidity index (FI) from the duration between events and the magnitude of the acceleration peak. The task was performed at two speeds (comfortable and maximum). [Results] A comparison of the timings from two different systems indicated no systematic bias. Specific events could be identified from acceleration data using regression analysis under both speed conditions. In addition, significant regression equations predictive of FI were constructed using the duration between events under both speed conditions. The duration from the maximum trunk inclination to the first heel strike was the best predictor of FI. [Conclusion] Accelerometer data may be used to precisely and conveniently evaluate fluidity. The clinical utility of these data should be tested in elderly individuals or patient populations.

Changes in corticospinal excitability with short-duration high-frequency electrical muscle stimulation: a transcranial magnetic stimulation study

[Purpose] Afferent input caused by electrical stimulation of a peripheral nerve or a muscle modulates corticospinal excitability. However, a long duration of stimulation is required to induce these effects. The purpose of this study was to investigate the effect of short-duration high-frequency electrical muscle stimulation (EMS) on corticospinal excitability through the measurement of motor evoked potentials (MEP) in young healthy subjects. [Subjects] Eleven healthy right-handed subjects participated in this study. [Methods] EMS was applied to the abductor pollicis brevis (APB) muscle at 100 Hz with a pulse width of 100 μs for 120 s. The intensity of stimulation was just below the motor threshold. Transcranial magnetic stimulation was applied over the motor cortex, and MEP were recorded from the APB before, and immediately, 10, and 20 min after EMS. [Results] In the APB muscle, the MEP amplitude significantly decreased after EMS, and this effect lasted for 20 min. [Conclusion] The excitability of the corticospinal tract decreased after short-duration high-frequency EMS, and the effect lasted for 20 min. These results suggest that even short duration EMS can change the excitability of the corticospinal tract.

The characteristics of multi-directional step distance and the association between stepping laterality and walking ability of patients with stroke

[Purpose] The purpose of this study was to determine the effect of stepping limb and step direction on step distance and the association of step distance and stepping laterality in step difference with walking ability and motor dysfunction. [Subjects and Methods] The subjects were thirty-nine patients with chronic hemiparesis as a result of stroke, who performed the MSL (Maximum Step Length) test along with tests of motor impairment, gait speed and Functional Ambulation Category. The MSL test is a clinical test of stepping distance in which participants step to the front, side, and back. The subjects were classified into three groups according to the stepping laterality in front step distance. [Results] Step distance did not differ across stepping limbs but did differ across step directions. Front step distance was significantly longer than side and back step distance. Participants with forward paretic step length shorter than forward non-paretic step length had significantly higher walking ability than participants with symmetric forward step length or forward paretic step length longer than forward non-paretic step length [Conclusion] Patients with stroke have characteristic step distances in each direction. Adequate weight shift toward the paretic limb when stepping with the non-paretic limb is associated with walking ability.

Influences of visual and supporting surface conditions on standing postural control and correlation with walking ability in patients with post-stroke hemiplegia

[Purpose] To quantify the influence of visual and under-foot-surface conditions on standing balance in patients with post stroke hemiplegia and examine associations of this ordinal score with somatosensory disturbance and walking ability. [Subjects] Sixty-six patients with post-stroke hemiplegia. [Methods] Standing balance was tested in 4 conditions (firm floor or foam rubber surface with eyes open or eyes closed) for 30 s per condition and scored using a 5-category ordinal scale. The accuracy of the standing balance score to distinguish patients above/below cut-offs for the timed up-and-go test (14 s) and functional ambulation category (4) was determined. [Results] Standing balance score was correlated with sensory impairments (tactile and vibration perception) and walking ability (up-and-go and functional ambulation category). The standing balance score distinguished patients with up-and-go times ≤14 and >14 s with moderate sensitivity and specificity, and distinguished patients with functional ambulation category <4 and ≥4 with high sensitivity and specificity. [Conclusion] Patients with post-stroke hemiplegia may be unable to adapt to changing visual or surface conditions. Therapists should perform comprehensive balance tests. The standing balance ordinal scale score was moderately correlate with walking ability, distinguishing patients according to walking ability. This scale's validity and reliability must be assessed in clinical settings.

Accelerometry-based gait characteristics evaluated using a smartphone and their association with fall risk in people with chronic stroke

BACKGROUND

The smartphone, which contains inertial sensors, is currently available and affordable device and has the potential to provide a self-assessment tool for health management. The aims of this study were to use a smartphone to record trunk acceleration during walking and to compare accelerometry variables between poststroke subjects with and without a history of falling.

METHODS

This cross-sectional study was conducted in 2 day care centers for elderly adults. Twenty-four community-dwelling adults with chronic stroke (mean age, 71.6 ± 9.7 years; mean time since stroke, 68.5 ± 38.7 months) were enrolled. Acceleration of the trunk during walking was recorded in the anteroposterior and mediolateral directions and quantified using the autocorrelation coefficient, harmonic ratio, and interstride variability (coefficient of variation of root mean square acceleration). Fall history in the past 12 months was obtained by self-report.

RESULTS

Eleven participants (45.8%) reported at least one fall in the past 12 months and were classified as fallers. Fallers exhibited significantly higher interstride variability of mediolateral trunk acceleration than nonfallers. In the logistic regression analysis, interstride variability of mediolateral trunk acceleration was significantly associated with fall history (adjusted odds ratio, 1.462; 95% confidence interval, 1.009-2.120). The area under the receiver operating characteristic curve for interstride variability of mediolateral trunk acceleration to discriminate fallers from nonfallers was .745 (95% confidence interval, .527-.963).

CONCLUSIONS

The results suggest that quantitative gait assessment using a smartphone can provide detailed and objective information about subtle changes in the gait pattern of stroke subjects at risk of falling.

Association of performance of standing turns with physical impairments and walking ability in patients with hemiparetic stroke

[Purpose] The effect of turn direction and relation between turn performance and walking ability in patients with hemiparetic stroke is not clear. The purpose of this study was to determine the effect of turn direction on the performance of standing turns and to examine the relations between turn performance and walking ability in patients with hemiparetic stroke. [Subject and Methods] The participants were 38 outpatients with chronic hemiparesis due to stroke. Turn performance was evaluated using the time and number of steps required to complete a 360° standing turn, and was evaluated for turns toward the paretic side and the non-paretic side. Walking ability was assessed using gait speed in the 10-m walk test, the Timed Up and Go test, and the Functional Ambulation Category. [Results] Thirty-six participants were analyzed, and the time needed for turns and number of steps were similar for turns to the paretic and non-paretic sides. The time needed for turns was correlated walking ability. A turn time of 10.0 s distinguished FAC 5 (independent ambulation in the community) from FAC ≤4 with a sensitivity of 0.94 and specificity of 0.85. [Conclusion] The performance of standing turns was not affected by the turning direction and was closely correlated with walking ability.

Injuries and disorders among young ice skaters: relationship with generalized joint laxity and tightness

This study retrospectively investigated 192 teenage speed and figure skaters with prior injuries documented by an athletes’ questionnaire, who underwent a physical examination to assess their muscle tightness and generalized joint laxity. In all athletes, the degree of muscle tightness and joint laxity were measured by a standardized physical examination. A descriptive report of the types of injuries showed a predominance of fractures, ligament injuries, enthesitis, and lower back pain. Approximately 5% of all skaters tested positive for tightness, while 25.8% of figure skaters and 15.2% of speed skaters had generalized ligamentous laxity. Statistical testing showed an association between ankle sprains and muscle tightness, and an association between knee enthesitis and muscle tightness in skating athletes. There was also an association between lower back pain and generalized joint laxity, which held true only for the male skaters.

Effects of Directional Change on Postural Adjustments during the Sit-to-walk Task

[Purpose] The purpose of this study was to clarify the effects of directional change on postural adjustments during the sit-to-walk (STW) task. [Subjects] Fifteen healthy young men participated in this study. [Methods] Subjects were required to stand up from a chair and walk toward a target. The first step was limited to the right limb only. Three conditions of target direction (straight, ipsilateral and contralateral) were set. For the ipsilateral and contralateral conditions, the target was placed at an angle 45° clockwise and 45° counterclockwise from straight ahead, respectively. Trials were recorded by a motion capture system and force plates. The forward momentum of the body, time of events, center of pressure (COP) and center of gravity (COG) displacement were measured and compared between conditions. [Results] In the contralateral condition, the fluidity index was significantly lower than that in the straight condition. In the contralateral condition, COP displacement toward the swing limb was larger than in the other conditions. [Conclusion] The present results indicate that a directional change during the STW task affects fluidity and postural adjustments. When the STW direction was changed to diagonal, the lateral component of postural control became more important.

The reliability and validity of the clinical competence evaluation scale in physical therapy

[Purpose] To examine the internal consistency, criterion-related validity, factorial validity, and content validity of the Clinical Competence Evaluation Scale in Physical Therapy (CEPT). [Subjects] The subjects were 278 novice physical therapy trainees and 119 tutors from 21 medical facilities. [Methods] The trainees self-evaluated their clinical competences and the tutors evaluated trainee competences using the CEPT. Overall trainee autonomy was evaluated using a visual analog scale (VAS) for self-evaluation and the trainees were also evaluated by their tutors. The content validity of the CEPT was examined by asking if the CEPT could evaluate the competence of novice physical therapists on a four-point scale. [Results] Cronbach's alpha of the CEPT was 0.96 for the trainees and 0.97 for the tutors. The correlation coefficient between the total score of the CEPT and whole competence by VAS was 0.83 for the trainees and 0.87 for the tutors. Factor analysis identified two factors, "the specialty of the physical therapist" and "the essential competence of a health professional". Ninety percent or more of the trainees and the tutors answered that the CEPT could sufficiently evaluate the competence of novice physical therapists. [Conclusion] The CEPT is a reliable and valid scale for clinical competence evaluation of novice physical therapists.

Temporal motor coordination in the ankle joint following upper motor neuron lesions

[Purpose] We compared ankle temporal motor coordination between stroke, spinal disease and healthy elderly groups, and investigated the relationship between motor impairments and gait speed. [Subjects] Twenty-four patients with stroke, 19 post-operative spinal disease patients and 17 healthy elderly subjects participated. [Methods] Ankle temporal motor coordination of the three groups was assessed using the simple reaction time, the foot-tapping test, and a rhythm task. Rhythm error and rhythm variation were analyzed using the results of the rhythm task. Isometric muscle strength, spasticity, muscle stiffness, somatosensory and 10-m gait speed of the stroke and spinal disease subjects were also measured. [Results] Only the stroke group showed significant reductions in temporal accuracy and consistency in the rhythm task. Simple reaction time and the rhythm task were significantly poorer in the stroke group, whereas the foot-tapping test was not. Stepwise multiple regression analysis indicated gait speed was explained by rhythm error and plantarflexor strength in the stroke group, and rhythm error and simple reaction time in the spinal disease group. [Conclusion] Poor performance in simple reaction time and the rhythm task in the stroke group suggest these tasks are controlled by the supraspinal central nervous system. Negative features, particularly motor coordination, are more associated with gait speed than positive features.

Are contents of physical therapy in nine Japanese hospitals for inpatients with stroke related to inpatients' and physical therapists' characteristics?

[Purpose] This study investigated the factors that influence activities provided during physical therapy for stroke. [Subjects] Data were collected from 85 physical therapists and 216 inpatients with stroke. [Methods] Time spent on specific functional activities provided to inpatients with stroke was recorded at nine rehabilitation facilities. These were used as dependent variables. Physical therapists’ characteristics, including years since acquiring a license, gender, and treatment concepts influencing physical therapy for stroke, were recorded. Inpatients’ characteristics, including age, gender, affected side, days post stroke, score on the Modified Rankin Scale (mRS), and gait ability measured by the Functional Independence Measure (FIM gait), were also recorded. Physical therapists’ and inpatients’ characteristics were used as independent variables. The t-test, correlation coefficients, and analysis of covariance were used to investigate which independent variables correlated with which dependent variables. [Results] Pre-gait, advanced gait, and community mobility were significantly correlated with mRS and FIM gait (|r_s| = 0.32–0.62). Time spent on other functional activities had a weak correlation with inpatients’ characteristics. Time spent on functional activities had no or few correlations with physical therapists’ characteristics. [Conclusion] Relationships between time spent on specific functional activities and physical therapists’ characteristics were weaker than those for inpatients’ characteristics. Physical therapy for stroke includes many factors.