Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed "Up & Go" Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone.

OBJECTIVE To determine test-retest reliability and absolute and relative minimal detectable changes at the 95% confidence level (MDC(95)) of measures to detect postural balance and lower limb movements in individuals with chronic stroke who were able to walk and had differences in ankle plantarflexor tone. DESIGN Test-retest study. Data were collected on 2 occasions, about 6 days apart. SETTING Outpatient physical therapy clinics. PARTICIPANTS Volunteers (N=61) with chronic stroke who were able to walk and had differences in ankle plantarflexor tone: no increase in ankle plantarflexor tone (n=12), a slight increase in ankle plantarflexor tone (n=32), and a marked increase in ankle plantarflexor tone (n=17). INTERVENTION Not applicable. MAIN OUTCOME MEASURES Reliability and absolute and relative MDC(95) of the Berg Balance Scale (BBS), the lower limb subscale of Fugl-Meyer Assessment (FMA-LE), the Timed "Up & Go" test (TUG), the comfortable gait speed (CGS), the fast gait speed (FGS), and the 2-minute walk test (2MWT). RESULTS Excellent reliability of the BBS, FMA-LE, TUG, CGS, FGS, and 2MWT for all the participants combined and for the subgroups was shown. All the participants combined showed the absolute and relative MDC(95) in the BBS of 5 points and 10%, FMA-LE of 4 points and 16%, TUG of 8 seconds and 28%, CGS of 0.2m/s and 34%, FGS of 0.1m/s and 21%, and 2MWT of 13m and 23%. The absolute and relative MDC(95) of the subgroups were varied based on ankle plantarflexor tone. CONCLUSIONS The BBS, FMA-LE, TUG, CGS, FGS, and 2MWT are reliable measures to detect postural balance and lower limb movements in individuals with chronic stroke who have differences in ankle plantarflexor tone. The absolute and relative MDC(95) of each measure are dissimilar in those with differences in ankle plantarflexor tone. The relative MDC(95) seems more useful than the absolute MDC(95) because the relative value can be used for a single individual.

[1]  A. Copay,et al.  Understanding the minimum clinically important difference: a review of concepts and methods. , 2007, The spine journal : official journal of the North American Spine Society.

[2]  D. Bourbonnais,et al.  Weakness in patients with hemiparesis. , 1989, The American journal of occupational therapy : official publication of the American Occupational Therapy Association.

[3]  Richard W. Bohannon,et al.  Interrater reliability of a modified Ashworth scale of muscle spasticity. , 1987, Physical therapy.

[4]  D. Connelly,et al.  Clinical utility of the 2-minute walk test for older adults living in long-term care. , 2009, Physiotherapy Canada. Physiotherapie Canada.

[5]  M. V. von Arbin,et al.  Spasticity After Stroke: Its Occurrence and Association With Motor Impairments and Activity Limitations , 2003, Stroke.

[6]  P. Goldie,et al.  Systematic and random error in repeated measurements of temporal and distance parameters of gait after stroke. , 1997, Archives of physical medicine and rehabilitation.

[7]  R A Liston,et al.  Reliability and validity of measures obtained from stroke patients using the Balance Master. , 1996, Archives of physical medicine and rehabilitation.

[8]  Chia-Ling Lee,et al.  Effect on Spasticity After Performance of Dynamic‐Repeated‐Passive Ankle Joint Motion Exercise in Chronic Stroke Patients , 2006, The Kaohsiung journal of medical sciences.

[9]  Robertw . Mann,et al.  Whole-body movements during rising to standing from sitting. , 1990, Physical therapy.

[10]  Dina Brooks,et al.  Reliability of the two-minute walk test in individuals with transtibial amputation. , 2002, Archives of physical medicine and rehabilitation.

[11]  C. Richards,et al.  Locomotor-specific measure of spasticity of plantarflexor muscles after stroke. , 2001, Archives of physical medicine and rehabilitation.

[12]  S. Nadeau,et al.  Muscular utilization of the plantarflexors, hip flexors and extensors in persons with hemiparesis walking at self-selected and maximal speeds. , 2007, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[13]  Anne Forster,et al.  Reliability of gait speed measured by a timed walking test in patients one year after stroke , 2002, Clinical rehabilitation.

[14]  A. Verbeek,et al.  A criterion for stability of the motor function of the lower extremity in stroke patients using the Fugl-Meyer Assessment Scale. , 1996, Scandinavian journal of rehabilitation medicine.

[15]  A R Upton,et al.  Functional changes in motoneurones of hemiparetic patients , 1973, Journal of neurology, neurosurgery, and psychiatry.

[16]  G. Guyatt,et al.  Measurement of health status. Ascertaining the minimal clinically important difference. , 1989, Controlled clinical trials.

[17]  J. Weir.  Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. , 2005, Journal of strength and conditioning research.

[18]  Steven Y Cen,et al.  Meaningful Gait Speed Improvement During the First 60 Days Poststroke: Minimal Clinically Important Difference , 2010, Physical Therapy.

[19]  W Z Rymer,et al.  Abnormal force--EMG relations in paretic limbs of hemiparetic human subjects. , 1981, Journal of neurology, neurosurgery, and psychiatry.

[20]  Thomas Bauermann,et al.  Occurence and Clinical Predictors of Spasticity After Ischemic Stroke , 2010, Stroke.

[21]  T. Steffen,et al.  Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism , 2008, Physical Therapy.

[22]  L. Lundin-Olsson,et al.  Timed "Up & Go" test: reliability in older people dependent in activities of daily living--focus on cognitive state. , 2006, Physical therapy.

[23]  Carolynn Patten,et al.  Reliability of gait performance tests in men and women with hemiparesis after stroke. , 2005, Journal of rehabilitation medicine.

[24]  A. Fugl-Meyer,et al.  The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. , 1975, Scandinavian journal of rehabilitation medicine.

[25]  G. Lankhorst,et al.  Reproducibility of walking at self-preferred and maximal speed in patients with postpoliomyelitis syndrome. , 2004, Archives of physical medicine and rehabilitation.

[26]  S. Haley,et al.  Interpreting change scores of tests and measures used in physical therapy. , 2006, Physical therapy.

[27]  J Quintern,et al.  Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contribute to hypertonia. , 1981, Brain : a journal of neurology.

[28]  Roberta B. Shepherd,et al.  Stroke rehabilitation : guidelines for exercise and training to optimize motor skill , 2003 .

[29]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[30]  Ching-Fan Sheu,et al.  Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients , 2002, Stroke.

[31]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[32]  Heleen Beckerman,et al.  Smallest real difference, a link between reproducibility and responsiveness , 2001, Quality of Life Research.

[33]  D. Wade,et al.  Validity and reliability comparison of 4 mobility measures in patients presenting with neurologic impairment. , 2001, Archives of physical medicine and rehabilitation.

[34]  Teresa Smith,et al.  Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke. , 2005, Journal of rehabilitation research and development.

[35]  J. Stein.  Stroke Recovery and Rehabilitation , 2008 .

[36]  D. Corcos,et al.  Movement deficits caused by hyperexcitable stretch reflexes in spastic humans. , 1986, Brain : a journal of neurology.

[37]  Ruud W Selles,et al.  Feedback-controlled and programmed stretching of the ankle plantarflexors and dorsiflexors in stroke: effects of a 4-week intervention program. , 2005, Archives of physical medicine and rehabilitation.

[38]  Hui Chen,et al.  The relative and absolute reliability of two balance performance measures in chronic stroke patients , 2008, Disability and rehabilitation.

[39]  P. Goldie,et al.  Walking speed on parquetry and carpet after stroke: effect of surface and retest reliability , 1999, Clinical Rehabilitation.

[40]  Henk J Stam,et al.  Measurement error in grip and pinch force measurements in patients with hand injuries. , 2003, Physical therapy.

[41]  Eadric Bressel,et al.  The effect of prolonged static and cyclic stretching on ankle joint stiffness, torque relaxation, and gait in people with stroke. , 2002, Physical therapy.

[42]  D. Wade,et al.  Walking after stroke. Measurement and recovery over the first 3 months. , 2020, Scandinavian journal of rehabilitation medicine.

[43]  David A. Winter,et al.  Human balance and posture control during standing and walking , 1995 .

[44]  C. Hui-Chan,et al.  The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke. , 2005, Archives of physical medicine and rehabilitation.

[45]  Miao-Ju Hsu,et al.  Psychometric Comparisons of 2 Versions of the Fugl-Meyer Motor Scale and 2 Versions of the Stroke Rehabilitation Assessment of Movement , 2008, Neurorehabilitation and neural repair.

[46]  S. Wood-Dauphinée,et al.  The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke. , 1995, Scandinavian journal of rehabilitation medicine.

[47]  T. Stevenson.  Detecting change in patients with stroke using the Berg Balance Scale. , 2001, The Australian journal of physiotherapy.

[48]  S. Black,et al.  The Fugl-Meyer Assessment of Motor Recovery after Stroke: A Critical Review of Its Measurement Properties , 2002, Neurorehabilitation and neural repair.

[49]  M. Leathley,et al.  Prevalence of spasticity post stroke , 2002, Clinical rehabilitation.

[50]  K. M. Gill,et al.  Clinical Gait Assessment in the Neurologically Impaired , 1984 .

[51]  G. Fulk,et al.  Test-Retest Reliability and Minimal Detectable Change of Gait Speed in Individuals Undergoing Rehabilitation After Stroke , 2006, Journal of neurologic physical therapy : JNPT.

[52]  J. Echternach,et al.  Test-Retest Reliability and Minimal Detectable Change Scores for the Timed " Up & Go " Test , the Six-Minute Walk Test , and Gait Speed in People With Alzheimer Disease , 2018 .

[53]  P. Stratford,et al.  Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. , 1993, Physical therapy.