Physical Therapy Rehabilitation Science

korean Academy of Physical Therapy Rehabilitation Science (물리치료재활과학회)
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Evaluating the Reliability of Short-Form Berg Balance Scales and Short-Form Postural Assessment Scales in Chronic Stroke Survivors

  • Seung-Heon An (Department of Gait Lab of National Rehabilitation Center) ;
  • Dae-Sung Park (Department of Physical Therapy, Konyang University)
  • Received : 2024.03.19
  • Accepted : 2024.04.29
  • Published : 2024.06.30
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Abstract

Objective: This study aims to assess the test-retest reproducibility of the Short Form Berg Balance Scale (SF-BBS) and the Short Form Postural Assessment Scale for Stroke (SF-PASS) among chronic stroke survivors, focusing on their reliability for consistent measurements over time. Design: A cross-sectional study design Methods: Thirty chronic stroke survivors participated in this study, undergoing evaluations with SF-BBS and SF-PASS scales at two different points, separated by a seven-day interval. The analysis focused on test-retest reliability, employing statistical measures such as the Intra-Class Coefficient (ICC2,1), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and MDC%, the Bland-Altman plot to assess the limits of agreement and the extent of random measurement error. Results: The study found notable test-retest reproducibility for both SF-BBS and SF-PASS, with ICC values demonstrating strong reliability (0.932 to 0.941, with a confidence interval of 0.889 to 0.973). SEM values for SF-BBS and SF-PASS were reported as 1.34 and 0.61, respectively, indicating low measurement error. MDC values of 3.71 for SF-BBS and 1.69 for SF-PASS suggest that the scales have an acceptable level of sensitivity to change, with reliability metrics falling below 20% of the maximum possible score. Conclusions: The findings suggest that both SF-BBS and SF-PASS exhibit high intra-class correlation coefficients, indicating strong test-retest reliability. The SEM and MDC values further support the scales' reproducibility and reliability as tools for evaluating mobility and dynamic balance in chronic stroke survivors. Therefore, these scales are recommended for clinical use in this population, providing reliable measures for assessing progress in rehabilitation.

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References

  1. Berg K, Norman KE. Functional assessment of balance and gait. Clin Geriatr Med. 1996;12(4):705-723. https://doi.org/10.1016/S0749-0690(18)30197-6
  2. Tyson SF, Hanley M, Chillala J, Selley A, Tallis RC. Balance disability after stroke. Phys Ther. 2006;86(1):30-38. https://doi.org/10.1093/ptj/86.1.30
  3. Carr J, Shepherd R. Stroke Rehabilitation: guidelines for exercise and training to optimize motor skill. London; Butterworth Heinemann; 2003.
  4. De Vet HC, Terwee CB, Knol DL, Bouter LM. When to use agreement versus reliability measures. J Clin Epidemiol. 2006;59(10):1033-1039. https://doi.org/10.1016/j.jclinepi.2005.10.015
  5. De Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM. Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes. 2006; 4:54.
  6. Atkinson G, Nevill AM. Statistical methods for assessing measurement error(reliability) in variables relevant to sports medicine. Sports Med. 1998;26(4):217-238. https://doi.org/10.2165/00007256-199826040-00002
  7. Statistical methods for assessing measurement error(reliability) in variables relevant to sports medicine. Sports Med. 1998;26(4):217-238. https://doi.org/10.2165/00007256-199826040-00002
  8. Bland JM, Altman DG. A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement. Comput Biol Med. 1990;20(5):337-340. https://doi.org/10.1016/0010-4825(90)90013-F
  9. Kovacs FM, Abraira V, Royuela A, Corcoll J, Alegre L, Tomas M, et al. Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain. BMC Musculoskelet Disord. 2008;9:43.
  10. Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res 2001;10(7):571-578. https://doi.org/10.1023/A:1013138911638
  11. Flansbjer UB, Blom J, Brogardh C. The reproducibility of berg balance scale and the single-leg stance in chronic stroke and the relationship between the two tests. PM R 2012;4(3):165-170. https://doi.org/10.1016/j.pmrj.2011.11.004
  12. Schuck P, Zwingmann C. The'smallest real difference'as a measure of sensitivity to change: a critical analysis. Int J Rehabil Res. 2003;26(2):85-91.
  13. Berg K, Wood-Dauphinee S, Williams JI. The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. Scand J Rehabil Med. 1995;27(1):27-36. https://doi.org/10.2340/1650197719952736
  14. Brennan P, Silman A. Statistical methods for assessing observer variability in clinical measures. BMJ. 1992;304(6840):1491-1494. https://doi.org/10.1136/bmj.304.6840.1491
  15. Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002; 33(4):1022-1027. https://doi.org/10.1161/01.STR.0000012516.63191.C5
  16. Blum L, Korner-Bitensky N. Usefulness of the Berg Balance Scale in stroke rehabilitation: a systematic review. Phys Ther. 2008;88(5):559-566. https://doi.org/10.2522/ptj.20070205
  17. Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9):656-661. https://doi.org/10.1080/09638280701400698
  18. Liaw LJ, Hsieh CL, Hsu MJ, Chen HM, Lin JH, Lo SK. Test-retest reproducibility of two short-form balance measures used in individuals with stroke. Int J Rehabil Res. 2012;35(3):256-262. https://doi.org/10.1097/MRR.0b013e3283544d20
  19. Hobart JC, & Thompson AJ. The five item Barthel index. Journal of Neurology Neurosurgery, and Psychiatry. 2001;71(2):225-230. https://doi.org/10.1136/jnnp.71.2.225
  20. Chien CW, Lin JH, Wang CH, Hsueh IP, Sheu CF, Hsieh CL. Developing a Short Form of the Postural Assessment Scale for People With Stroke. Neurorehabil Neural Repair. 2007;21(1):81-90. https://doi.org/10.1177/1545968306289297
  21. Chou CY, Chien CW, Hsueh IP, Sheu CF, Wang CH, Hsieh CL. Developing a short form of the Berg Balance Scale for people with stroke. Phys Ther. 2006;86(2):195-204. https://doi.org/10.1093/ptj/86.2.195
  22. Wang CH, Hsueh IP, Sheu CF, Yao G, Hsieh CL. Psycometric Properties of 2 Simplified 3-Level Balance Scales Used for Patients With Stroke. Phys Ther, 2004;84(5):430-438.
  23. An SH, Kim JH, Song CH. The Comparison of Postural Assesment Scale for Stroke. (PASS : 5items-3Level) and Berg Balance Scale(BBS : 7items-3Level) Used for Patients with Stroke. Journal of the Korean Society of Physical Medicine. 2010;5(1):89-99.
  24. Park CS, Choi YI, An SH. The Comparison of Simplified Postural Assessment Scale for Stroke and Berg Balance Scale Used for Stroke Patients. The Journal of Korean Society of Occupational Therapy. 2010;18(1):65-77.
  25. Chen HM, Hsieh CL, Lo SK, Liaw LJ, Chen SM, Lin JH. The test-retest reliability of 2 mobility performance tests in patients with chronic stroke. Neurorehabil Neural Repair. 2007;21(4):347-352. https://doi.org/10.1177/1545968306297864
  26. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61-65.
  27. Prince B, Makrides L, Richman J. Research methodology and applied statistics. Part 2: The literature search. Physiother Can. 1980;32(4):201-206.
  28. Beckerman H, Roebroeck ME, Lankhorst GJ, Becher JG, Bezemer PD, Verbeek AL. Smallest real difference, a link between reproducibility and responsiveness. Qual Life Res. 2001;10(7):571-578. https://doi.org/10.1023/A:1013138911638
  29. Smidt N, van der Windt DA, Assendelft WJ, Mourits AJ, Deville WL, de Winter AF, et al. nterobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil. 2002;83(8):1145-1150. https://doi.org/10.1053/apmr.2002.33728
  30. Schuck P, Zwingmann C. The 'smallest real difference' as a measure of sensitivity to change: a critical analysis. Int J Rehabil Res. 2003;26(2):85-91.