Sattelmayer Karl Martin, Chevalley Odile, Kool Jan, Wiskerke Evelyne, Denkinger Lina Nilsson, Giacomino Katia, Opsommer Emmanuelle, Hilfiker Roger
School of Health Sciences, HES-SO Valais-Wallis, Leukerbad, Switzerland.
School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland.
Arch Physiother. 2021 Dec 15;11(1):29. doi: 10.1186/s40945-021-00120-3.
People with multiple sclerosis (PwMS) frequently have impaired balance from an early stage of the disease. Balance difficulties can be divided into categories; although, to date, these lack scientific foundation. Impaired balance in PwMS can be addressed using specific and challenging exercises. Such exercises should provide an optimal challenge point; however, the difficulty of balance exercises is often unknown, making it difficult to target the exercises to an individual's abilities. The aims of this study were: to develop an exercise programme for PwMS relating the exercises to the balance problem categories; to establish the order of difficulty of exercises in each category and; to evaluate the content and structural validity of the exercise programme.
A "construct map" approach was used to design and develop an exercise programme for PwMS. Potentially relevant balance exercises were identified, then a framework was set up, comprising four dimensions (subsequently reduced to three dimensions) of balance exercises. The relevance, comprehensibility, and comprehensiveness of the exercise programme were rated by 13 physiotherapists, who also linked 19 key exercises to balance categories. A total of 65 PwMS performed the 19 balance exercises, rated their difficulty and commented on the relevance and comprehensibility of each exercise. A Rasch model was used to evaluate the relative difficulty of the exercises. To assess fit of the data to the Rasch model a rating scale model was used, which is a unidimensional latent trait model for polytomous item responses.
Evaluation by the physiotherapists and PwMS indicated that the content validity of the exercise programme was adequate. Rasch analysis showed that the latent trait "balance exercises in PwMS" comprised three subdimensions ("stable BOS", "sway" and "step and walk"). The 19 balance exercises showed adequate fit to the respective dimensions. The difficulties of the balance exercises were adequate to cover the ability spectrum of the PwMS.
A balance exercise programme for PwMS comprising three dimensions of balance exercises was developed. Difficulty estimates have been established for each of the exercises, which can be used for targeted balance training. Content and structural validity of the programme was adequate.
多发性硬化症患者（PwMS）在疾病早期常出现平衡功能受损。平衡困难可分为不同类别；然而，迄今为止，这些分类缺乏科学依据。PwMS患者的平衡功能受损可通过特定且具有挑战性的运动来改善。此类运动应提供最佳挑战点；然而，平衡运动的难度往往未知，这使得难以根据个人能力来针对性地安排运动。本研究的目的是：为PwMS患者制定一个将运动与平衡问题类别相关联的运动计划；确定每个类别中运动的难度顺序；评估该运动计划的内容和结构效度。
采用“构建图”方法为PwMS患者设计和制定运动计划。确定了可能相关的平衡运动，然后建立了一个框架，该框架包含平衡运动的四个维度（随后缩减为三个维度）。13名物理治疗师对运动计划的相关性、可理解性和全面性进行了评分，他们还将19项关键运动与平衡类别相关联。共有65名PwMS患者进行了这19项平衡运动，对运动难度进行了评分，并对每项运动的相关性和可理解性发表了评论。使用Rasch模型评估运动的相对难度。为评估数据与Rasch模型的拟合度，使用了评分量表模型，这是一种用于多分类项目反应的单维潜在特质模型。
物理治疗师和PwMS患者的评估表明，运动计划的内容效度是足够的。Rasch分析表明，潜在特质“PwMS患者的平衡运动”包括三个子维度（“稳定支撑面”、“摆动”和“迈步与行走”）。这19项平衡运动与各自维度的拟合度良好。平衡运动的难度足以覆盖PwMS患者的能力范围。
为PwMS患者制定了一个包含平衡运动三个维度的平衡运动计划。已确定了每项运动的难度估计值，可用于针对性的平衡训练。该计划的内容和结构效度是足够的。
