Toomey Elaine, Coote Susan
Department of Physiotherapy, University of Limerick, Limerick, Ireland.
Int J MS Care. 2013 Spring;15(1):1-6. doi: 10.7224/1537-2073.2011-036.
This study investigated the between-rater reliability of the Berg Balance Scale (BBS), 6-Minute Walk test (6MW), and handheld dynamometry (HHD) in people with multiple sclerosis (MS). Previous studies that examined BBS and 6MW reliability in people with MS have not used more than two raters, or analyzed different mobility levels separately. The reliability of HHD has not been previously reported for people with MS. In this study, five physical therapists assessed eight people with MS using the BBS, 6MW, and HHD, resulting in 12 pairs of data. Data were analyzed using intraclass correlation coefficients (ICCs), Spearman correlation coefficients (SCCs), and Bland and Altman methods. The results suggest excellent agreement for the BBS (SCC = 0.95, mean difference between raters [d̄] = 2.08, standard error of measurement [SEM] = 1.77) and 6MW (ICC = 0.98, d̄ = 5.22 m, SEM = 24.76 m) when all mobility levels are analyzed together. Reliability is lower in less mobile people with MS (BBS SCC = 0.6, d̄ = -1.83; 6MW ICC = 0.95, d̄ = 20.04 m). Although the ICC and SCC results for HHD suggest good-to-excellent reliability (0.65-0.85), d̄ ranges up to 17.83 N, with SEM values as high as 40.95 N. While the small sample size is a limitation of this study, the preliminary evidence suggests strong agreement between raters for the BBS and 6MW and decreased agreement between raters for people with greater mobility problems. The mean differences between raters for HHD are probably too high for it to be applied in clinical practice.
本研究调查了伯格平衡量表（BBS）、6分钟步行试验（6MW）和手持测力计（HHD）在多发性硬化症（MS）患者中的评分者间信度。之前检测MS患者BBS和6MW信度的研究中，评分者不超过两人，或未分别分析不同的活动水平。此前尚未报道过MS患者HHD的信度。在本研究中，五名物理治疗师使用BBS、6MW和HHD对八名MS患者进行评估，得到12组配对数据。使用组内相关系数（ICC）、斯皮尔曼相关系数（SCC）以及布兰德和奥特曼方法对数据进行分析。结果表明，当对所有活动水平一起分析时，BBS（SCC = 0.95，评分者间平均差异[d̄] = 2.08，测量标准误[SEM] = 1.77）和6MW（ICC = 0.98，d̄ = 5.22 m，SEM = 24.76 m）具有极佳的一致性。MS患者中活动能力较差者的信度较低（BBS的SCC = 0.6，d̄ = -1.83；6MW的ICC = 0.95，d̄ = 20.04 m）。尽管HHD的ICC和SCC结果表明其信度良好至极佳（0.65 - 0.85），但d̄范围高达17.83 N，SEM值高达40.95 N。虽然样本量小是本研究的一个局限，但初步证据表明评分者之间对BBS和6MW的一致性较强，而对于活动能力问题较大的患者，评分者之间的一致性降低。HHD评分者间的平均差异可能过高，以至于无法应用于临床实践。
