Reliability, validity, and responsiveness of three scales for measuring balance in patients with chronic stroke

Abstract

BackgroundVarious outcome measures are used for the assessment of balance and mobility in patients with stroke. The purpose of the present study was to examine test-retest reliability, construct validity, and responsiveness of the Timed Up and Go Test (TUG), Berg Balance Scale (BBS), and Dynamic Gait Index (DGI) for measuring balance in patients with chronic stroke.MethodsFifty-six patients (39 male and 17 female) with chronic stroke participated in this study. A senior physical therapist assessed the test-retest reliability and validity of three scales, including the DGI, TUG, and BBS over two testing sessions. In addition, the third assessment of each scale was taken at the time of discharge to determine the responsiveness of the three outcome measures.ResultsThe reliability of the TUG (intraclass correlation coefficient [ICC2,1] = 0.98), DGI (ICC2,1 = 0.98) and BBS (ICC2,1 = 0.99) were excellent. The standard error of measurement (SEM) of the TUG, DGI, and BBS were 1.16, 0.71, and 0.98, respectively. The minimal detectable change (MDC) of the TUG, DGI, and BBS were 3.2, 1.9, and 2.7, respectively. There was a significant correlation found between the DGI and BBS (first reading [r] = 0.75; second reading [r] = 0.77), TUG and BBS (first reading [r] = −.52; second reading [r] = −.53), and the TUG and DGI (first reading [r] = 0.45; second reading [r] = 0.48), respectively.ConclusionsThe test-retest reliability of the TUG, BBS, and DGI was excellent. The DGI demonstrated slightly better responsiveness than TUG and BBS. However, the small sample size of this study limits the validity of the results.

Evaluating the effectiveness of aquatic therapy on mobility, balance, and level of functional independence in stroke rehabilitation: a systematic review and meta-analysis

“…43,44 For Timed Up and Go, our calculated point estimate (MD = 2.229 ± 0.513) was below the range of reported minimal clinically important difference values (3.2-3.6 s) within a population who had undergone surgery for lumbar degenerative disk disease and also below reported minimal detectable change values (2.9-3.2 s) within a chronic stroke population. 41,45,46 Finally, while there was insufficient information related to minimal clinically important difference values on the Functional Reach Test, our calculated point estimate (MD = 3.511 ± 1.597) was below the range of reported minimal detectable change values (3.7-6.79 cm) within a stroke population. 47,48 Therefore, this meta-analysis has found that based on the current evidence, despite statistically significant improvements, aquatic therapy may not be clinically superior to land therapy based on the measures of balance and mobility assessed.…”

“…One could interpret these results as reaching the threshold for possible to probable clinical importance, based on the systematic method outlined by Man-Son-Hing et al 37 However, reported minimal detectable change values for this measure range from 2.5 to 4.66 points within a chronic stroke population. [38][39][40][41] As our point estimate is below this range, the difference found may be attributed to measurement error. 42 A similar trend was observed for gait speed, where our calculated point estimate (MD = 0.049 ± 0.023) falls within the range of a small meaningful change within a population of older adults and stroke patients (0.04-0.06 m/s), but was much below the reported minimal detectable change values (0.10-0.18 m/s) in a chronic stroke population.…”

Feasibility and effect of interactive telerehabilitation on balance in individuals with chronic stroke: a pilot study

“…In the present study, BBS scores improved significantly in the conventional physiotherapy and telerehabilitation groups, increasing by 4 and 5 points, respectively (Table 2 ); however, whether the magnitudes of increase in BBS scores are clinically meaningful warrants further investigation. Moreover, TUG test times were also improved significantly in the experimental group after participants completed the telerehabilitation program, although the change between before and after intervention was 2.35s less than the MDC for TUG (approximate 3–8s) [ 47 , 48 ]. In contrast, TUG times were not significantly different between pre- and post-intervention in the control group, but the difference (4.61s) was with the range of the corresponding MDC.…”

Mobile Computing Technologies for Health and Mobility Assessment: Research Design and Results of the Timed Up and Go Test in Older Adults

“…To ensure that these data collection methodologies can be used to assess physical and functional performance in the clinic, this data should be valid, reliable, and with proper responsiveness, as has been demonstrated by the Timed-Up and Go test in a variety of conditions [ 64 , 65 ].…”