Trautwein Sandra, Maurus Philipp, Barisch-Fritz Bettina, Hadzic Anela, Woll Alexander
1Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131 Karlsruhe, Germany.
2Faculty of Kinesiology, University of Calgary, Calgary, Alberta Canada.
Eur Rev Aging Phys Act. 2019 Nov 3;16:20. doi: 10.1186/s11556-019-0228-z. eCollection 2019.
Motor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis.
Literature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments.
This review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).
运动评估对于确定痴呆症患者（IWD）体育活动的有效性很重要。然而，人们使用了不恰当且未标准化的评估，这些评估缺乏可靠的心理测量特性。本系统评价旨在研究IWD运动评估的心理测量特性，并结合使用频率和效应大小，根据观察结果提供建议。
我们使用PubMed、Web of Science、Cochrane图书馆、ALOIS和Scopus进行了两阶段的系统文献检索（起始时间 - 2018年7月/9月，英文和德文）。第一次检索旨在识别在评估IWD体育活动有效性的随机对照试验中使用的运动评估，并展示其使用频率和效应大小。第二次检索重点关注心理测量特性，考虑痴呆症严重程度和病因以及提示对重测信度的影响。两名评审员独立提取并分析了符合条件的研究结果，并进行叙述性综合分析。
文献检索确定了46项随机对照试验和21项心理测量特性研究。虽然有效性方面的信息不足，但我们观察到大多数评估具有足够的评分者间信度和相对重测信度，但绝对重测信度不可接受。将这些结果与使用频率和效应大小相结合，我们推荐功能活动范围测试、格罗宁根曲折步行测试（时间）、伯格平衡量表、功能导向性移动评估、计时起立行走测试、仪器化步态分析（时空参数）、坐立测试（重复次数>1）和6分钟步行测试。重要的是要考虑到痴呆症的严重程度和病因以及提示会影响某些评估的重测信度。
本评价为未来的研究奠定了重要基础。足够的相对信度支持了推荐评估在群体水平上的结论性，而不可接受的绝对信度则建议在评估个体内部变化时谨慎行事。此外，对重测信度的影响表明，应根据IWD调整评估和指导，并仅在不可避免的情况下应用提示。考虑到纳入研究的异质性以及各个领域的研究不足，这些建议并不全面。进一步的研究，特别是关于有效性和对重测信度的影响，以及IWD定制评估的标准化和开发至关重要。
本系统评价已在PROSPERO（CRD42018105399）注册。
