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.     

Within-Day Test-Retest Reliability of the Timed Up & Go Test in Patients With Advanced Chronic Organ Failure

Objective

To investigate the within-day test-retest reliability of the Timed Up & Go (TUG) test in patients with advanced chronic obstructive pulmonary disease (COPD), chronic heart failure (CHF), and chronic renal failure (CRF).

Design

Cross-sectional.

Setting

Patients' home environment.

Participants

Subjects (N=235, 64% men; median age, 70y [interquartile range, 61–77y]; median body mass index, 25.6kg/m² [interquartile range, 22.8–29.4kg/m²]) with advanced COPD (n=95), CHF (n=68), or CRF (n=72).

Interventions

Not applicable.

Main Outcome Measure

Time to complete the TUG test. Three trials were performed on the same day and by the same assessors. The intraclass correlation coefficient (ICC), kappa coefficient, standard error of measurement, and absolute and relative minimal detectable change (MDC) values were calculated.

Results

Good agreement was observed, in general, for both the total sample and subgroups (COPD, CHF, CRF), with ICC values ranging from .85 to .98, and kappa coefficients from .49 to 1.00. However, statistical improvement occurred in the total sample from the first to the second trial with large limits of agreement (mean difference, −.97s; 95% confidence interval, 3.00 to −4.94s; P<.01). The third trial added little or no information to the first 2 trials. For the total sample, a standard error of measurement value of approximately 1.6 seconds, an absolute value of MDC at the 95% confidence level (MDC_95%) of approximately 4.5 seconds, and a relative value of MDC at the 95% confidence level (MDC_95%%) of approximately 35% were found between the first 2 trials, with similar values found for the subgroups.

Conclusions

The TUG test is reliable in patients with advanced COPD, CHF, or CRF after 2 trials. Values of standard error of measurement and MDC may be used in daily clinical practice with these populations to define what is expected and what represents true change in repeated measures.     

Timed Up & Go Test Score in Patients With Hip Fracture Is Related to the Type of Walking Aid

Kristensen MT, Bandholm T, Holm B, Ekdahl C, Kehlet H. Timed Up & Go test score in patients with hip fracture is related to the type of walking aid.

Objective

To determine the relationship between Timed Up & Go (TUG) test scores and type of walking aid used during the test, and to determine the feasibility of using the rollator as a standardized walking aid during the TUG in patients with hip fracture who were allowed full weight-bearing (FWB).

Design

Prospective methodological study.

Setting

An acute orthopedic hip fracture unit at a university hospital.

Participants

Patients (N=126; 90 women, 36 men) with hip fracture with a mean age ± SD of 74.8±12.7 years performed the TUG the day before discharge from the orthopedic ward.

Interventions

Not applicable.

Main Outcome Measures

The TUG was performed with the walking aid the patient was to be discharged with: a walker (n=88) or elbow crutches (n=38). In addition, all patients also performed the TUG using a rollator.

Results

Patients who performed the TUG with a walker were on average 13.6 (95% confidence interval [CI], 11.2–16.1) seconds faster using a rollator compared with the walker (P<.001). Correspondingly, patients who performed the TUG with crutches were on average 3.5 (95% CI, 1.5–5.4) seconds faster using a rollator compared with elbow crutches (P=.001). In both patient groups, the between walking-aid scores were strongly correlated (r>.833, P<.001).

Conclusions

TUG scores are significantly related to the type of walking aid used during the test in patients with hip fracture who are allowed FWB when discharged from the hospital, but all patients were able to perform the TUG using the rollator as a standardized walking aid. Our findings indicate the importance of using a standardized walking aid when evaluating changes or comparing TUG scores in patients with hip fracture.     

The hemiplegic arm: Interrater reliability and concurrent validity of passive range of motion measurements

Purpose. To assess whether our measurement protocol using two raters simultaneously yielded reliable passive range of motion measurements of the hemiplegic arm. Additionally, motion ranges were correlated to several factors to examine the concurrent validity of these measurements.

Method. Two raters simultaneously assessed five arm motions at baseline, after five and ten weeks in respectively 18, 13 and 12 stroke patients. One tester made the passive movement and the other read the hydrogoniometer. Raters then switched roles.

Results. Intraclass correlation coefficients revealed high agreement between the raters with intraclass correlation coefficients (ICCs) ranging between 0.84 and 0.99. Standard errors of measurement and smallest detectable differences were large for shoulder abduction. Significant correlations were found between shoulder external rotation and flexion. All arm motions correlated negatively to pain at the end range of these motions. Shoulder external rotation and flexion were significantly correlated to the time post stroke. Concurrent validity with Ashworth Scale, Fugl-Meyer Assessment and Barthel Index was limited.

Conclusions. The current measurement protocol yielded high reliability indices and seems useful for further use. However, standard error of measurement and smallest detectable difference for shoulder abduction were high, implying the neccesity to include a large sample size in future studies. Correlations revealed that restricted range of arm motions relate to the time post-stroke and coincide with pain.     

Interrater and intrarater reliability of the wheelchair skills test version 4.2 for power wheelchair users

Purpose: The purpose of this study is to estimate the interrater and intrarater reliability of the Wheelchair Skills Test (WST) Version 4.2 for powered wheelchairs operated by adult users.

Materials and methods: Cohort study with a convenience sample of occupational therapists (n?=?10). For the main outcome measure, participants viewed and scored eight videos of adult power wheelchair users completing the 30 skills of the WST Version 4.2 on two occasions, a minimum of two weeks apart. Using these scores, we calculated intraclass correlation coefficients to estimate interrater and intrarater reliability.

Results: The interrater reliability intraclass correlation coefficient was 0.940 (95%CI 0.862–0.985). Intrarater reliability intraclass correlation coefficients ranged from 0.923 to 0.998.

Conclusions: The WST Version 4.2 has excellent interrater and intrarater reliability and is a reliable tool for use in clinical and research practice to evaluate a power wheelchair user’s skill capacity.

• Implications for Rehabilitation

• The Wheelchair Skills Test for Powered Wheelchair Users (WST-P 4.2) is a useful addition to the clinical tools available for clinicians who assess and train for powered wheelchair use.

• The WST-P 4.2 has excellent reliability and potential for clinical use as a pre-post measure of powered wheelchair skills.

• Clinicians using the WST-P 4.2 should attempt to maintain consistent scoring procedures, particularly for those skills that may require subjective assessment of skill safety.

     

Sedative load and functional outcomes in community‐dwelling older Australian men: the CHAMP study

The aim of this cross‐sectional study was to investigate the association between sedative load and functional outcomes in community‐dwelling older Australian men. A total of 1696 males aged ≥ 70 years, enrolled in the Concord Health and Ageing in Men Project, were studied. Participants underwent assessments during 2005–2007. Sedative load was computed using a published model. Outcomes included activities of daily living (ADL), instrumental activities of daily living (IADL), physical performance measures and a clinical diagnosis of cognitive impairment. Of the participants, 15.3% took medications with sedative properties. After adjusting for age, education, depressive symptoms and comorbidities, participants who took one medication with sedation as a prominent side effect (sedative load = 1) had odds ratio (OR) of 2.15 (95% confidence interval, CI: 1.20–3.85) for ADL disability, compared with participants with sedative load = 0. Participants who took at least one primary sedative or two medications with sedation as a prominent side effect (sedative load ≥ 2) had an OR of 1.55 (95% CI: 1.02–2.35) for IADL disability, compared with participants with sedative load = 0. The mean 6‐m walking speed (P = 0.001) and grip strength (P = 0.003) were significantly different between sedative load groups in unadjusted models only. No association between sedative load and poorer performance on balance and chair stands tests or cognitive impairment was observed. Participants with sedative load of one were more likely to report ADL disability, whereas participants with sedative load of ≥2 were more likely to report IADL disability. Higher sedative load was not associated with poorer physical performance or cognitive impairment in older Australian men.