Brouwer Rafaël, Kal Elmar, van der Kamp John, Houdijk Han
Research and Development, Heliomare Rehabilitation Center, Relweg 51, 1949 EC, Wijk aan Zee, the Netherlands; Royal Dutch Society for Physical Therapy (KNGF), PO Box 248, 3800 AE, Amersfoort, the Netherlands.
Research and Development, Heliomare Rehabilitation Center, Relweg 51, 1949 EC, Wijk aan Zee, the Netherlands; Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands; Department of Clinical Neuropsychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, De Boelelaan 1105, 1081 HV, Amsterdam, the Netherlands.
Gait Posture. 2019 Jan;67:77-84. doi: 10.1016/j.gaitpost.2018.09.025. Epub 2018 Sep 29.
A pronounced discrepancy exists between balance assessments for stroke survivors that are used for clinical purposes and those used for research. Clinical assessments like the Berg Balance Scale generally have stronger ecological validity, whereas research-based assessments like posturography are generally more reliable and precise. We developed a stabilometer balance test (SBT) that aims to couple measurement reliability and precision to clinical meaningfulness by means of a personalized and adaptive test procedure.
To examine the validity, reliability, and measurement error of the stabilometer balance test in inpatient stroke patients.
In this cross-sectional study, inpatient stroke patients (FAC > 2) were tested on a stabilometer with adjustable resistance to mediolateral movement. A modified staircase procedure was used to adapt task difficulty (i.e., rotational stiffness) on a trial-by-trial basis. The main outcome was the threshold stiffness at which a patient could just stay balanced. Threshold stiffness was correlated with the Berg Balance Scale and posturography measurements to determine concurrent validity (N = 86). Test-retest reliability (N = 23) was analyzed with the Intraclass Correlation Coefficient (ICC). Floor and ceiling effects were assessed. The minimal detectable change was determined at individual and group level.
Threshold rotational stiffness moderately correlated with the Berg Balance Scale (r=-0.559, p < 0.001), and the absolute path length of the center of pressure during posturography (r=0.348, p = 0.006). Test-retest reliability was good to excellent (ICC=0.869; 95%CI=0.696-0.944). There were no floor or ceiling effects. The minimal detectable change was sufficiently small to detect relevant changes in balance control both on individual and group level.
The SBT is both a valid and reliable balance assessment in stroke patients. It is at least as precise as current clinically preferred measures and does not suffer from ceiling effects. Therefore, it is suitable for use in clinical practice as well as research.
用于临床目的的中风幸存者平衡评估与用于研究的平衡评估之间存在明显差异。像伯格平衡量表这样的临床评估通常具有更强的生态效度，而像姿势描记法这样基于研究的评估通常更可靠、更精确。我们开发了一种稳定计平衡测试（SBT），旨在通过个性化和自适应测试程序将测量的可靠性和精确性与临床意义相结合。
检验稳定计平衡测试在住院中风患者中的效度、可靠性和测量误差。
在这项横断面研究中，对住院中风患者（功能独立性评定量表得分>2）在具有可调节内外侧运动阻力的稳定计上进行测试。采用改良的阶梯程序在每次试验的基础上调整任务难度（即旋转刚度）。主要结果是患者刚好能够保持平衡的阈值刚度。将阈值刚度与伯格平衡量表和姿势描记法测量结果进行相关性分析，以确定同时效度（N = 86）。使用组内相关系数（ICC）分析重测信度（N = 23）。评估地板效应和天花板效应。在个体和组水平上确定最小可检测变化。
阈值旋转刚度与伯格平衡量表呈中度相关（r = -0.559，p < 0.001），与姿势描记法期间压力中心的绝对路径长度呈中度相关（r = 0.348，p = 0.006）。重测信度良好至优秀（ICC = 0.869；95%置信区间 = 0.696 - 0.944）。没有地板效应或天花板效应。最小可检测变化足够小，能够在个体和组水平上检测到平衡控制的相关变化。
SBT是一种对中风患者有效的、可靠的平衡评估方法。它至少与当前临床上首选的测量方法一样精确，并且不存在天花板效应。因此，它适用于临床实践以及研究。
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