Department of Physical Medicine and Rehabilitation, Oslo University Hospital, PO Box 4956, Nydalen N-0424, Oslo, Norway.
Phys Ther. 2013 Jul;93(7):900-10. doi: 10.2522/ptj.20120381. Epub 2013 Mar 15.
The High-Level Mobility Assessment Tool (HiMAT) was developed to quantify balance and mobility problems after traumatic brain injury (TBI). Measurement properties of the HiMAT have not been tested in the mild TBI (MTBI) population.
The aim of this study was to examine the reliability, validity, and responsiveness of the HiMAT in a sample of the MTBI population.
A cohort, pretest-posttest, comparison study was conducted.
Ninety-two patients (69% men, 31% women) with a mean age of 37.1 years (SD=13.8) and a mean Glasgow Coma Scale score of 14.7 (SD=0.7) were recruited from Oslo University Hospital. All patients were tested with the HiMAT (range of scores=0 [worst] to 54 [best]) at 3 months postinjury. Fifty-one patients were retested at 6 months. A subgroup of 25 patients was selected for the reliability testing. Balance function reported on the Rivermead Post Concussion Symptoms Questionnaire was chosen as a criterion and anchor. Criterion-related validity was studied with correlation analysis. Intraclass correlation coefficients (ICCs) were used for assessing interrater and intrarater reliability. Minimal detectable change (MDC) for the HiMAT was estimated. Responsiveness was assessed with receiver operating characteristic curve analyses.
The mean HiMAT sum score was 46.2 (95% confidence interval=44.4 to 48.1). The HiMAT had a ceiling effect of 22.8%. The correlation between HiMAT scores and self-reported balance problems was large (r=-.63, P<.001). Interrater and intrarater reliability of the HiMAT sum score was high (interrater ICC=.99, intrarater ICC=.95). The MDC was -3 to +4 points. Responsiveness was good, and the HiMAT discriminated well between patients with self-perceived improved balance function versus unchanged balance function (area under the curve=0.86).
The small sample size, a ceiling effect, and lack of a gold standard were limitations of the study.
The HiMAT demonstrated satisfactory measurement properties for patients with MTBI. The HiMAT can be used as an outcome measure of balance and mobility problems in patients with MTBI.
高移动性评估工具（HiMAT）旨在量化创伤性脑损伤（TBI）后平衡和移动问题。HiMAT 的测量特性尚未在轻度 TBI（mTBI）人群中进行测试。
本研究旨在检查 HiMAT 在 mTBI 人群样本中的可靠性、有效性和反应性。
这是一项前瞻性队列研究。
92 名患者（69%为男性，31%为女性），平均年龄为 37.1 岁（标准差=13.8），格拉斯哥昏迷量表评分为 14.7（标准差=0.7），均来自奥斯陆大学医院。所有患者在受伤后 3 个月时接受 HiMAT（得分范围为 0 [最差]至 54 [最佳]）测试。51 名患者在 6 个月时进行了重复测试。选择了 25 名患者进行可靠性测试。选择 Rivermead 脑震荡后症状问卷中的平衡功能作为标准和锚定物。用相关性分析研究效标关联效度。组内相关系数（ICC）用于评估评分者间和评分者内的可靠性。估计 HiMAT 的最小可检测变化（MDC）。用受试者工作特征曲线分析评估反应性。
平均 HiMAT 总分 46.2（95%置信区间=44.4 至 48.1）。HiMAT 的天花板效应为 22.8%。HiMAT 评分与自我报告的平衡问题之间的相关性较大（r=-.63，P<.001）。HiMAT 总分的评分者间和评分者内可靠性较高（评分者间 ICC=.99，评分者内 ICC=.95）。MDC 为-3 至+4 分。反应性良好，HiMAT 能很好地区分自我感知平衡功能改善的患者和平衡功能无变化的患者（曲线下面积=0.86）。
样本量小、天花板效应和缺乏金标准是本研究的局限性。
HiMAT 对 mTBI 患者具有令人满意的测量特性。HiMAT 可作为 mTBI 患者平衡和移动问题的结局测量工具。
