Department of Allied Health Sciences, Division of Physical Therapy, University of North Carolina, Chapel Hill, NC 27599, USA.
J Neurol Phys Ther. 2011 Sep;35(3):116-21. doi: 10.1097/NPT.0b013e318227fe70.
Rehabilitation research for individuals with chronic stroke is increasingly addressing spatiotemporal asymmetries (STA). Understanding the reliability of STA between sessions is essential for determining whether treatment responses exceed day-to-day variation. The purpose of this study was to determine the minimal detectable change (MDC) and test-retest reliability in STA and gait speed measures for individuals with chronic stroke.
Twenty-six individuals with chronic (>6 months) stroke participated in 2 visits. At each visit, participants walked across a 14-ft (4.3-m) GAITRite mat at comfortable gait speed (CGS) and fast gait speed (FGS). Spatiotemporal asymmetries ratios (paretic/nonparetic limb) were calculated for step length, stance time, and swing time. Intraclass correlation coefficients (ICC, 2,1) were calculated to determine reliability between sessions. Minimal detectable change values were calculated to determine the smallest change that is considered "real."
Spatiotemporal asymmetry measures were consistent between sessions, with ICCs ranging from 0.93 to 0.98. Asymmetry ratio MDC values were calculated for step length (CGS: 0.15; FGS: 0.19), swing time (CGS: 0.26; FGS: 0.20), and stance time (CGS: 0.09; FGS: 0.10). Gait speed MDC was 0.20 m/s and 0.22 m/s, respectively, for the CGS and FGS walking conditions.
There were considerable differences among MDC values for the various STA measures, suggesting that larger changes will be necessary to show improvement for certain measures (eg, swing time asymmetry). These data will assist with setting clinical goals for patients with chronic stroke and will be useful for evaluating interventions designed to minimize temporal and spatial interlimb asymmetries during walking.
针对慢性脑卒中患者的康复研究越来越关注时空不对称性（STA）。了解STA 在不同治疗阶段之间的可靠性对于确定治疗反应是否超过日常变化至关重要。本研究旨在确定慢性脑卒中患者 STA 和步速测量的最小可检测变化（MDC）和测试-重测信度。
26 名患有慢性（>6 个月）脑卒中的患者参加了 2 次就诊。在每次就诊时，参与者以舒适步速（CGS）和快速步速（FGS）在 14 英尺（4.3 米）GAITRite 垫上行走。计算步长、站立时间和摆动时间的偏侧/非偏侧肢体的时空不对称比（paretic/nonparetic limb）。计算组内相关系数（ICC，2,1）以确定不同治疗阶段之间的可靠性。计算最小可检测变化值以确定被认为“真实”的最小变化。
STA 测量值在不同治疗阶段之间保持一致，ICC 范围为 0.93 至 0.98。计算了步长（CGS：0.15；FGS：0.19）、摆动时间（CGS：0.26；FGS：0.20）和站立时间（CGS：0.09；FGS：0.10）的不对称比 MDC 值。CGS 和 FGS 步行条件下的步速 MDC 值分别为 0.20 m/s 和 0.22 m/s。
各种 STA 测量的 MDC 值存在较大差异，这表明某些测量（例如摆动时间不对称）需要更大的变化才能显示出改善。这些数据将有助于为慢性脑卒中患者设定临床目标，并将有助于评估旨在最小化步行时空肢体不对称性的干预措施。
