Reliability and concurrent validity of the Expanded Timed Up‐and‐Go test in older people with impaired mobility

Background and Purpose . ‘Expanded Timed Up‐and‐Go’ (ETUG) was developed to assess each of the subtasks of the ‘Timed Up‐and‐Go’ (TUG). The aim of the study was to test the intrarater, interrater, test–retest reliability and internal consistency of the ETUG, and the concurrent validity with the TUG. Methods . The present study is a reliability and a validity study. Twenty‐eight subjects (80 ± 4.1 years) with balance and gait problems were included. Three raters timed the ETUG subtasks from a video, using a computer‐based scoring programme, and the total ETUG time was calculated. TUG was registered by a regular stopwatch. Results . The intrarater and interrater reliability (intraclass correlation [ICC][1,1]) ranged from 0.55 to 0.97. The test–retest reliability (ICC[1,1]) ranged from 0.54 to 0.85. The absolute measurement error of the total time (1.96 S_w) was 2.8 seconds. The internal consistency (Cronbach's alpha) was 0.74. The correlation (Pearson's r) between ETUG total time and TUG after correcting for attenuation caused by restricted reliability in each of the measures was 0.85. Conclusion . The ETUG scored from a video shows a good reliability for experienced raters and acceptable internal consistency. The ETUG showed a higher reliability than TUG when tested on the same sample of older subjects with impaired mobility, and the high concurrent validity between ETUG and TUG suggests that the two tests may have similar properties. Since ETUG also adds new information compared with TUG, we suggest that ETUG is an interesting alternative to existing clinical tests of mobility. Copyright © 2008 John Wiley & Sons, Ltd.     

Assessing advanced walking ability in people with stroke using the Groningen Meander Walking Test

Abstract

Objectives: (1) To investigate the intrarater, interrater and test–retest reliabilities of the Groningen Meander Walking Test in people with stroke; (2) to compare the performance of the Groningen Meander Walking Test between people with stroke and healthy older adults; (3) to quantify any correlations between the Groningen Meander Walking Test and other stroke-specific impairment measurements; and (4) to determine the cut off time that best discriminates between 30 people with stroke and 30 age-matched healthy elderly.

Method: Using a cross-sectional design, the Groningen Meander Walking Test was administered along with the Fugl-Meyer Motor Assessment for the lower extremities, measurement of lower limb muscle strength, Berg’s Balance Scale, comfortable walking speed, Timed up and Go test and Community Integration Measure-Cantonese version.

Results: The Groningen Meander Walking Test completion times showed excellent intrarater, interrater and test–retest reliabilities (ICC = 0.984–1.00). Our study also showed that stroke subjects took three times longer (28.8?s) than the healthy subjects (9.0?s) in completion times. Both Groningen Meander Walking Test completion times and overstep scores significantly correlated with comfortable walking speed and Timed up and Go test. The cut off time for people with stroke was 11.98 seconds (sensitivity = 0.967; specificity = 1.0) to discriminate against healthy elderly.

Conclusion: The Groningen Meander Walking Test is a highly reliable and valid tool for quantifying the advanced walking abilities of people with stroke.

• Implications for Rehabilitation

• The Groningen Meander Walking Test completion times demonstrated excellent intrarater, interrater and test–retest reliabilities.

• The Groningen Meander Walking Test completion times correlates well with Berg Balance Scale scores, comfortable walking and Timed Up and Go test times.

• The Groningen Meander Walking Test overstep scores correlates significantly to its completion times, Fugl-Myer Assessment-Lower Extremity scores, comfortable walking speed and Timed Up and Go test times.

• A cut off time of 11.98s best for Groningen Meander Walking Test completion times discriminates people with stroke from healthy elderly with sensitivity of 97% and specificity of 100%.

• The Groningen Meander Walking Test is highly reliable and easy to administer in assessing advanced walking abilities in people with stroke.

     

Clinical Measures Related to Forward Shoulder Posture: A Reliability and Correlational Study

ObjectivesThe purpose of this study was to examine the reliability of clinical measures related to forward shoulder posture (pectoralis minor index [PMI], scapular index [SI], abduction index [AI], acromion to the wall index [AWI] acromion to the treatment table index [ATI], and thoracic curvature [TC]), and to investigate the association (redundancy) among these measures.MethodsTwenty-one asymptomatic participants participated in this study. Two physiotherapists were trained to perform the clinical measurements. Intraclass correlation coefficients (ICC_2,k) were calculated to assess intra- and interrater reliabilities. Pearson product moment correlation was used to investigate the existence of possible redundancy between the measures that showed high intra- and interrater reliabilities.ResultsThe measures showed ICCs between 0.30 and 0.97. Five measures, PMI, SI, AWI, ATI, and TC, showed appropriate values for intrarater reliability (ICCs 0.77-0.94), and 3 measures, AWI, ATI, and TC, for interrater reliability (ICCs 0.82-0.85). Among measures that showed acceptable intra- and interrater reliability values, 2 measures were redundant, showing high association (AWI vs ATI) (r = 0.80, P < .001).ConclusionFor PMI, SI, AWI, ATI, and TC measures, adequate values of intrarater reliability were observed. For AWI, ATI, and TC, adequate values of interrater reliability were found. Two pairs of measures were highly associated (PMI with SI; AWI with ATI), which indicates redundancy among them. Our results suggest that, when the same examiner performs the assessment, the combined use of the PMI, AWI, and TC measures allows a quick but comprehensive evaluation of the presence of forward shoulder posture.     

Reliability and validity of step test scores in subjects with chronic stroke

Hong S-J, Goh EY, Chua SY, Ng SS. Reliability and validity of step test scores in subjects with chronic stroke.ObjectivesTo establish (1) the intrarater and interrater reliabilities of step test (ST) scores in subjects with chronic stroke, (2) the ST's known-groups validity and cutoff scores for distinguishing subjects with chronic stroke from healthy adults older than 50 years, and (3) the convergent validity of ST scores with lower-limb muscle strength, coordination, balance performance, and walking speed.DesignCross-sectional study.SettingUniversity-based rehabilitation center.ParticipantsConvenience sample of subjects (N=30): community-dwelling subjects with chronic stroke (n=15) and healthy adults older than 50 years (n=15).InterventionsNot applicable.Main Outcome MeasuresST scores; handheld dynamometer measurements of bilateral lower-limb muscle strength; lower-extremity motor coordination test (LEMOCOT) scores; Berg Balance Scale scores; walking speed as measured by a 5-meter walk test.ResultsST scores showed excellent intrarater reliability, with intraclass correlation coefficients ranging from .981 to .995 and interrater reliability ranging from .996 to .999. A cutoff score of 13 on the paretic side was found to distinguish the healthy adults older than 50 years from subjects with stroke at a sensitivity of 87% and a specificity of 87%. A cutoff score of 11 on the nonparetic side was found to distinguish the healthy adults from subjects with stroke at a sensitivity of 100% and a specificity of 67%. ST scores of the paretic limb demonstrated a significant correlation with muscle strength, the LEMOCOT scores of the paretic leg, and walking speed. ST scores of the nonparetic limb demonstrated a significant correlation with muscle strength and the LEMOCOT scores of the paretic leg.ConclusionsThe ST is a reliable measurement tool when the number of steps is counted by either experienced or inexperienced examiners by viewing videotapes. ST scores with both the paretic limb and the nonparetic limb are sensitive in distinguishing subjects with chronic stroke from healthy adults older than 50 years.     

The Figure-of-Eight Walk test: reliability and associations with stroke-specific impairments

Abstract

Objectives: To investigate (1) the intra-rater, inter-rater and test–retest reliabilities of the Figure-of-Eight Walk (F8W) test times; (2) its correlation with other stroke-specific impairments; and (3) the cut-off scores best discriminating patients with stroke from the healthy elderly. Design: Cross-sectional study. Setting: University-based rehabilitation centre. Participants: A convenience sample of 64 subjects: 35 subjects with chronic stroke and 29 healthy elderly. Main Outcome Measures: F8W test times, Fugl–Meyer Motor Assessment for the lower extremities (FMA-LE), hand-held dynamometer measurements of bilateral hip abductor and knee extensor isometric muscle strength, Five times Sit to Stand Test (FTSTST) times, 10-Meter Walk Test (10MWT), Timed Up and Go Test (TUGT) times, Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) scores. Results: Excellent intra-rater, inter-rater and test–retest reliabilities (intra-class correlation coefficient (ICC) range 0.944–0.999) of F8W test times were found. The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT. No significant correlation was found between F8W test times and either leg strength or ABC results. A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%. Conclusions: The F8W test time is a reliable measurement tool, which is able to differentiate the patients with stroke and healthy elderly subjects and correlated well with stroke-specific impairments and walking tests. The F8W is a reliable measurement tool for assessing the advanced walking performance of subjects with chronic stroke.

• Implication for Rehabilitation

• The F8W test times have excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.

• The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT.

• A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%.

• The F8W test time is a reliable and valid measure in assessing the advanced walking skill in patients with stroke.

     

Effects of mental practice on mobility of individuals in the early subacute post-stroke phase: A randomized controlled clinical trial

IntroductionOnly a small number of clinical trials were designed to investigate Mental Practice (MP)'s use for gait rehabilitation in individuals in the early subacute post-stroke phase. This trial aims to investigate the effect of mental practice on mobility rehabilitation in the early subacute phase after a stroke in comparison to a control group.MethodsRandomized controlled clinical trial with 16 individuals diagnosed with a stroke between 50 and 80 years of age. Mobility was evaluated using Timed Up and Go and the Five-Minute Walk Test. In addition, lower extremity muscular strength, Timed Up and Go Assessment of Biomechanical Strategies, quality of life, and depression were evaluated.ResultsBefore and after intervention (within-subjects), mental practice group showed improved mobility in Timed Up and Go (p = 0.01,r = 0.59), muscular strength for bending the right hip (p = 0.04, r = 0.50), for right knee bending (p = 0.03,r = 0.53), and in biomechanical performance of Timed Up and Go Assessment of Biomechanical Strategies(p = 0.01,r = 0.63). Control group showed improvement in neither mobility nor in muscular strength after intervention. Comparing the scores between the groups after intervention (between-subjects), no differences were found for any of the study's outcomes. In the analysis of deltas (gains), it was observed that mental practice group volunteers had a reduction in Timed Up and Go (p = 0.27,r = 0.29) and an increase in total Timed Up and Go Assessment of Biomechanical Strategies scores (p = 0.14,r = 0.36).ConclusionMental Practice was not associated with mobility, muscular strength, mental health, and quality of life improvement for patients in the early subacute post-stroke phase as compared to a control group.     

Turning and sit-to-walk measures from the instrumented Timed Up and Go test return valid and responsive measures of dynamic balance in Parkinson's disease

BackgroundBalance impairment is a hallmark of Parkinson's disease with dramatic effects for patients (e.g. falls). Its assessment is thus of paramount importance. The aim of this work is to assess which measures from the instrumented Timed Up and Go test (recorded with inertial sensors) are valid balance measures in Parkinson's disease and evaluate their responsiveness to rehabilitation.MethodsThe Mini-BESTest (a criterion-standard balance measure) and the instrumented Timed Up and Go test (with inertial sensors secured to the trunk) were administered to 20 Parkinson's disease patients before and after inpatient rehabilitation (median [IQR]; 76.5 [8.25] years; 5 females; Hoehn and Yahr stage: 2.5 [0.5]). 81 parameters from the instrumented Timed Up and Go test were evaluated. Multiple factor analysis (a variant of principal component analysis for repeated measurements) and effect sizes were used to assess validity and responsiveness, respectively.FindingsOnly the first component of the multiple factor analysis correlated with the Mini-BESTest, and 21 measures from the instrumented Timed Up and Go test had large loadings on this component. However, only three of these 21 measures also directly correlated with the Mini-BESTest (trunk angular velocities from sit-to-walk and turning; r = 0.46 to 0.50, P = 0.021 to 0.038). Sit-to-walk angular velocity showed greater responsiveness than the Mini-BESTest, while turning showed slightly less.InterpretationAngular velocities from the turning and sit-to-walk phases of the Timed Up and Go test are valid balance measures in Parkinson's disease and are also responsive to rehabilitation.     

Immediate Effects of Ankle Non-elastic Taping on Balance and Gait Ability in Patients With Chronic Stroke: A Randomized,Controlled Trial

ObjectiveThe purpose of this study was to determine the immediate effects of ankle non-elastic taping on balance and gait ability in patients with chronic stroke.MethodsThirty patients (inpatients and outpatients) with stroke were randomly assigned to 2 groups: the non-elastic taping group (n = 15) and the placebo-taping group (n = 15). Patients in the non-elastic taping group received Endura sports taping for their ankle joint, and patients in the placebo-taping group received Endura fix tape for their ankle joint. The Balance System SD assessed balance, and the GAITRite system assessed gait ability. We recorded measurements before and after intervention.ResultsThe non-elastic taping group showed a significant improvement in static and dynamic standing balance (P ≤ .001) after intervention; in addition, this group showed significant increases in the velocity, cadence, step length, and stride length of gait (P ≤ .001) after intervention. However, the placebo-taping group showed no significant improvements in standing balance and gait ability after intervention (P >.05). Furthermore, significant differences in static and dynamic standing balance, cadence, and velocity were observed between the 2 groups after intervention (P ≤ .001).ConclusionsOur results demonstrate that the application of ankle non-elastic taping is effective at improving balance and gait abilities in patients with stroke. Ankle non-elastic taping appears to be an effective method to facilitate active rehabilitation in patients with hemiplegia.     

Reliability of the Craniocervical Posture Assessment: Visual and Angular Measurements Using Photographs and Radiographs

ObjectiveThe purposes of this study were to determine the intrarater and interrater reliability of the craniocervical posture in a sagittal view using quantitative measurements on photographs and radiographs and to determine the agreement of the visual assessment of posture between raters.MethodsOne photograph and 1 radiograph of the sagittal craniocervical posture were simultaneously taken from 39 healthy female subjects. Three angles were measured on the photographs and 10 angles on the radiographs of 22 subjects using Alcimage software (Alcimage; Uberlândia, MG, Brazil). Two repeated measurements were performed by 2 raters. The measurements were compared within and between raters to test the intrarater and interrater reliability, respectively. Intraclass correlation coefficient and SEM were used. κ Agreement was calculated for the visual assessment of 39 subjects using photographs and radiographs between 2 raters.ResultsGood to excellent intrarater and interrater intraclass correlation coefficient values were found on both photographs and radiographs. Interrater SEM was large and clinically significant for cervical lordosis photogrammetry and for 1 angle measuring cervical lordosis on radiographs. Interrater κ agreement for the visual assessment using photographs was poor (κ = 0.37).ConclusionThe raters were reliable to measure angles in photographs and radiographs to quantify craniocervical posture with exception of 2 angles measuring lordosis of the cervical spine when compared between raters. The visual assessment of posture between raters was not reliable.     

Absolute and Relative Reliability of Pressure Pain Threshold Assessments in the Shoulder Muscles of Participants With and Without Unilateral Subacromial Impingement Syndrome

ObjectiveThe purpose of this study was to determine the relative and absolute reliability of the pressure pain threshold (PPT) in the shoulder muscles of participants with and without unilateral subacromial impingement syndrome.MethodsStudy of intraday intra- and interrater and interday intrarater reliability. Fifty-two participants symptomatic for unilateral subacromial impingement syndrome were divided into 2 groups (SG1 and SG2) of 26 participants each, and 26 participants asymptomatic for shoulder pain took part in the study. Two raters assessed the PPT in 4 shoulder muscles. Each rater assessed symptomatic (SG1) and asymptomatic participants twice on the same day, and one of the raters on 2 different days (SG2). The intraclass correlation coefficient, standard error of measurement (SEM_95% and SEM%), and minimum detectable change (MDC_95% and MDC%) were calculated.ResultsRelative reliability was good or excellent for all assessments, as well as for both groups and raters (intraclass correlation coefficient: 0.87-0.98). The SEM_95% values for intra- and interday intrarater measures were between 0.43 and 1.50 kgf/cm² and SEM% between 6.76 and 12.86%, whereas MDC_95% values ranged from 0.60 to 2.12 kgf/cm² and MDC% from 9.56 to 18.18%. In interrater measures, SEM_95% was between 0.58 and 0.77 kgf/cm² and SEM% between 10.10% and 13.71%, whereas MDC_95% varied from 0.82 to 1.08 kgf/cm² and MDC% from 14.29% to 19.39%.ConclusionRelative reliability was good or excellent. This study presents absolute reliability values that could be used as a reference in the clinical use of PPT.     

Effect of Unstable Surface Training on Walking Ability in Stroke Patients

[Purpose] The purpose of this study was to determine the effects of unstable surface training (UST) on walking ability in chronic stroke patients. [Subjects] The subjects were 12 stroke patients who were randomly divided into experimental (n₁=6) and control (n₂=6) groups. [Methods] The Subjects in both groups performed treadmill training for 30 minutes. The Subjects in the experimental group also performed UST after treadmill training, with the UST being performed for 10 minutes, five times per week, for four weeks. All subjects were evaluated with a 10-meter walk test, Timed Up and Go test and 6-minute walk test. The pared t-test was performed to test the significant differences between before and after the intervention. The independent t-test was conducted to test the significant differences between groups. [Results] Following the intervention, the experimental group showed significant differences in the Timed Up and Go test and 6-minute walk test. [Conclusion] The results of the study suggest that UST is an effective method for improvement of walking ability in chronic stroke patients.Key words: Stroke, Unstable surface training, Walking ability     

Reliability,Concurrent Validity,and Minimal Detectable Change of Timed Up and Go Obstacle Test in People With Stroke

ObjectiveThe aims of this study were to investigate the psychometric property of the timed Up and Go Obstacle (TUGO) test in people with stroke.DesignCross-sectional design.SettingUniversity based neurorehabilitation laboratory.ParticipantsTwenty-eight people with stroke and 30 healthy older adults.InterventionNot Applicable.Outcome MeasuresThe TUGO (obstacle heights: 0, 5, 17 cm) test completion times, Fugl-Meyer Assessment (FMA) score, ankle dorsiflexor and plantarflexor muscle strength, Berg Balance Scale (BBS) score, Narrow Corridor Walking Test (NCWT) completion time, timed Up and Go (TUG) test completion time, and Community Integrated Measure.ResultsExcellent inter-rater (intraclass correlation coefficient [ICC]=0.999-1.000) and test-retest reliabilities (ICC=0.917-0.975) were found for TUGO test completion times for all obstacle heights. The TUGO test completion times for all obstacle heights were significantly correlated with NCWT and TUG test completion times (r=0.817-0.912). Only TUGO test completion times for 0 and 5 cm obstacle heights showed significant correlations with BBS scores (r=-0.518 to -0.534), while the TUGO test completion time for the 17 cm obstacle height correlated significantly with FMA scores. The minimal detectable change and optimal cut-off values for TUGO test completion times for the 0, 5, and 17 cm obstacle heights were 2.54, 3.60, and 3.07 s, and 14.69, 14.76, and 16.10 s, respectively.ConclusionThe TUGO test is a reliable, valid, and easy-to-administer clinical measure to discriminate between people with stroke and healthy older adults.     

Reference Values for 7 Different Protocols of Simple Functional Tests: A Multicenter Study

ObjectivesTo establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study.DesignCross-sectional data collection in 4 research centers across different regions of a continental dimension country.SettingHealthy subjects from general community were assessed in different research laboratories.ParticipantsData collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m²) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers.InterventionsNot applicable.Main Outcome MeasuresAll participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all.ResultsParticipants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34<r<0.53) and body mass index (0.24<r< 0.31; P<.05 for all). Reference values with limits of normality were provided by each 10-year age group and regression models identified reference equations for all tests. Reliability of the reference equations were confirmed in an independent sample.ConclusionsReference values and equations for 7 widely used simple functional tests were provided in this study and might help researchers and clinicians to identify and quantify functional impairments using easy-to-perform assessments.     

Berg平衡量表在脑卒中患者中的内在信度和同时效度

目的：探讨Berg平衡量表在脑卒中患者中的内在信度和同时效度。方法：40例符合入选标准的脑卒中偏瘫患者参与本研究。对患者进行Berg平衡量表、计时起立-步行测验和Barthel指数的评价。结果：Berg平衡量表的Cronbach α系数为0.864,14项目的Cronbach α系数范围为0.844—0.869,Berg平衡量表折半信度系数为0.915。Berg平衡量表与效标工具计时起立-步行测验和Barthel指数之间显著相关。结论：Berg平衡量表在脑卒中患者中具有良好的内在信度和同时效度。     

Reference values for the Modified Timed Up and Go Test in Saudi children aged 4–12 years old in Riyadh city: cross-sectional study

PurposeThe study aimed to report within-session reliability, estimate the reference values for the Modified Timed Up and Go (mTUG) test in typically developing (TD) Saudi children aged 4–12 years old, develop a reference equation for the estimated mTUG, and compare the measured mTUG in the present study with the predicted mTUG obtained from the previous regression equation.MethodsIn this cross-sectional observational study, anthropometric measurements and mTUG test were investigated in 805 child. The association between the mTUG test and predictive variables was studied.ResultsAverage mTUG speed was 4.63 ± 0.68 s. Within-session reliability was excellent with intraclass correlation coefficient of 0.90. The test was significantly and negatively correlated with age, height, and weight (r = −0.66, p = .00), (r = −0.54, p = .01), and (r = −0.33, p = .01) respectively. According to the stepwise regression analysis, age and weight were the predictors and explained 47% of total variance of mTUG scores.ConclusionThis study provided the mTUG reference values that can be used clinically to evaluate functional mobility and dynamic balance in TD Saudi children aged 4–12 years. The mTUG scores can be predicted as a function of age and weight.

KEY MESSAGES

• Modified Timed Up and Go test used to assess the functional mobility and dynamic balance for children with or without developmental abnormalities.
• Availability of reference values according to age is helpful to compare the performance of children at same ages.

     

Myotonometer intra- and interrater reliabilities

OBJECTIVES: To assess the intra- and interrater reliabilities of the Myotonometer, a hand-held, computerized, electronic device that quantifies muscle stiffness (tone/compliance). DESIGN: Reliability study. SETTING: Research laboratory. PARTICIPANTS: Thirty-five healthy, nondisabled adults (age range, 22-42 y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Two raters used the Myotonometer to evaluate subjects' lateral gastrocnemius and biceps brachii muscles. Muscles were measured in a relaxed state and during a voluntary isometric contraction. Coefficients were calculated for each muscle and each condition (relaxed, contracted). Results were analyzed by using Design II intraclass correlation coefficients. RESULTS: Reliability coefficients were highest when the instrument exerted moderate to strong forces against the muscle (range, 0.50-2.00 kg; intrarater reliability R range, .84 - .99; interrater reliability R range, .75 - .96). CONCLUSIONS: Myotonometer measurements had high to very high intra- and interrater reliabilities for measurements of the lateral gastrocnemius and biceps brachii muscles.     

Bipedal hopping timed to a metronome to detect impairments in anticipatory motor control in people with mild multiple sclerosis

BackgroundPeople with mild multiple sclerosis (MS) often report subtle deficits in balance and cognition but display no measurable impairment on clinical assessments. We examined whether hopping to a metronome beat had the potential to detect anticipatory motor control deficits among people with mild MS (Expanded Disability Status Scale ≤ 3.5).MethodsParticipants with MS (n = 13), matched controls (n = 9), and elderly subjects (n = 13) completed tests of cognition (Montreal Cognitive Assessment (MoCA)) and motor performance (Timed 25 Foot Walk Test (T25FWT)). Participants performed two bipedal hopping tasks: at 40 beats/min (bpm) and 60-bpm in random order. Hop characteristics (length, symmetry, variability) and delay from the metronome beat were extracted from an instrumented walkway and compared between groups.ResultsThe MS group became more delayed from the metronome beat over time whereas elderly subjects tended to hop closer to the beat (F = 4.52, p = 0.02). Delay of the first hop during 60-bpm predicted cognition in people with MS (R = 0.55, β = 4.64 (SD 4.63), F = 4.85, p = 0.05) but not among control (R = 0.07, p = 0.86) or elderly subjects (R = 0.17, p = 0.57). In terms of hopping characteristics, at 60-bpm, people with MS and matched controls were significantly different from the elderly group. However, at 40-bpm, the MS group was no longer significantly different from the elderly group, even though matched controls and elderly still differed significantly.ConclusionsThis new timed hopping test may be able to detect both physical ability, and feed-forward anticipatory control impairments in people with mild MS. Hopping at a frequency of 40-bpm seemed more challenging. Several aspects of anticipatory motor control can be measured: including reaction time to the first metronome cue and the ability to adapt and anticipate the beat over time.     

Reliability and Accuracy of 2-Minute Step Test in Active and Sedentary Lean Adults

ObjectiveThe purpose of this study was to evaluate the intrarater and interrater reliability of the 2-minute step test (2MST) in active and sedentary lean adults and to identify the test cutoff point to differentiate active from sedentary individuals.MethodsThis observational study involved 4 mixed-sex groups (each with 50 lean participants): group 1, sedentary and aged 18 to 24 years; group 2, active and aged 18 to 24 years; group 3, sedentary and aged 25 to 44 years; and group 4, active and aged 25 to 44 years. The 2MST was administered independently by 2 examiners (with 3 months’ training) at 2 different times, with a 7-day interval. Habitual physical activity was evaluated by means of the Baecke Questionnaire (BQ). In statistical analysis, the Pearson correlation coefficient was used to verify the correlation between the 2MST and BQ; intraclass correlation coefficients (ICC_2,3) were used to determine the intrarater and interrater reliability of the 2MST; and the receiver operating characteristic curve was used to identify the accuracy of the 2MST.ResultsExcellent intrarater and interrater reliability were found for all 4 groups (intraclass correlation coefficients ≥ 0.83). Correlating the 2MST score with the BQ score, a significant, positive, weak correlation was observed (r = 0.344, P < .001). For differentiating active from sedentary individuals, the 2MST showed low accuracy (area under the curve = 0.671), with 61% sensitivity and 67% specificity.ConclusionThis study showed that the 2MST is a reliable test with a low amount of inherent error. There was a significant correlation between the 2MST and usual physical activity measured, and slight accuracy in differentiating active from sedentary individuals.     

The Wheelchair Skills Test: a pilot study of a new outcome measure.

OBJECTIVE: To evaluate the practicality, safety, reliability, validity, and usefulness of a new Wheelchair Skills Test (WST). DESIGN: A pilot study with within-subject comparisons. SETTING: Rehabilitation center. PATIENTS: Twenty-four wheelchair users (11 with amputations, 4 with stroke, 3 with musculoskeletal disorders, 3 with spinal cord injury, 3 with neuromuscular disorders). INTERVENTION: The WST. MAIN OUTCOME MEASURES: Subjects were videotaped while performing 33 skills twice (>10d apart). Their ability to perform each skill was rated on a 3-point ordinal scale. The test-retest, intra-, and interrater reliabilities were determined. Each subject's occupational therapist completed a visual analog scale (VAS), reflecting a global rating of the subject's manual wheelchair skills. We assessed validity by evaluating whether the WST detected expected changes (construct validity) and how well the total WST scores correlated with the occupational therapists' global ratings (concurrent validity). Each occupational therapist also used a VAS to quantify the usefulness of the WST. RESULTS: The mean time required to administer the WST was 29 minutes. There were no adverse incidents. For the test-retest, intra-, and interrater reliabilities, the correlations for the total scores were .65 (P =.001), .96 (P <.001), and .95 (P <.001), respectively. The 9 therapists unanimously endorsed 30 (91%) of the 33 WST skills. The correlation between the mean changes in the WST and global rating scores was .45 (P <.05). There was a slight negative relationship between total WST score and age (P <.05). There were no significant differences related to the diagnoses accounting for wheelchair use. Wheelchair users with more than 3 weeks of experience with their wheelchairs scored higher than those with less experience (P =.0085). The correlations between the WST and global rating scores ranged from .40 to .54 (P <.05). Through Rasch analysis, we eliminated 6 skills, with the remaining skills comprising a unidimensional screening test of wheelchair ability. The mean VAS score for perceived usefulness was 59%. CONCLUSIONS: The WST is practical, safe, well tolerated, exhibits good to excellent reliability, excellent content validity, fair construct and concurrent validity, and moderate usefulness. This pilot study makes an important contribution toward meeting the need for a well-validated outcome measure of manual wheelchair ability.     

Clinical utility of the modified trunk impairment scale for stroke survivors

Objective: The present study aimed to determine the discriminant power of the modified Trunk Impairment Scale (mTIS) in stroke survivors versus healthy adults.

Design: Cross-sectional.

Setting: Inpatient rehabilitation center.

Participants: Fifty-five subjects with stroke and 29 healthy adults.

Methods: Subjects were examined using the mTIS, Berg Balance Scale, and Timed Up and Go test for balance; 5-m Walk Test and Functional Ambulation Category for gait; Fugl-Meyer Assessment for motor function; Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test for trunk control; and Modified Barthel Index for activities of daily living performance.

Results: The mTIS results differed significantly between stroke survivors and healthy adults (p?r?=?0.82), Timed Up and Go test (r?=?–0.70), 5-m Walk Test (r?=?0.73), Functional Ambulation Category (r?=?0.54), Fugl-Meyer Assessment (r?=?0.37–0.80), Postural Assessment Scale for Stroke-Trunk Control and Trunk Control Test (r?=?0.55–0.63), and Modified Barthel Index score (r?=?0.56) results (p?10.5 points, while the area under the curve had a moderate accuracy of 73%.

Conclusion: The mTIS can be used to examine the degree of trunk control or the level of trunk impairment, which is seen as a prerequisite for balance, gait, motor function, and activities of daily living performance in stroke survivors.

• Implications for Rehabilitation

• The modified Trunk Impairment Scale can be used as an assessment tool to classify the degree of trunk control or its level of impairment in stroke survivors.

• The modified Trunk Impairment Scale may have a favorable correlation with assessing physical functions such as balance, gait, motor function, and ADL in stroke survivors.