The validity and reliability of the Incremental Shuttle Walk Test and Six-minute Walk Test compared to an Incremental Cycle Test for people who have had a mild-to-moderate stroke

ObjectiveTo determine the construct validity and test re-test reliability of the Six-minute Walk Test (6MWT) and Incremental Shuttle Walk Test (ISWT) in the sub-acute recovery phase following mild-to-moderate severity stroke.Participants40 stroke patients (mean age: 68.27 years, SD: 13.48) of median National Institutes of Health Stroke Scale (NIHSS) score 1.2 (range: 0 to 8) within six months of stroke.MethodEach participant completed one Incremental Cycle Test (ICT) followed by two ISWT and two 6MWT in a randomised order. Pearson’s Correlation Coefficients were used to determine the validity and Bland Altman plots were used to determine the test re-test reliability.ResultsThe Incremental Cycle Test (ICT) was positively correlated with the ISWT (r = 0.59, 95% confidence intervals 0.35 to 0.76, P = 0.001) and the 6MWT (0.55, 0.35 to 0.71, P < 0.001). The correlation of the ICT with the ISWT and 6MWT was higher for the 17 patients with no residual (ISWT: r = 0.79, P < 0.001; 6MWT: 0.826, P < 0.001) compared to mild-to-moderate neurological impairment (ISWT: r = 0.45, P = 0.03; 6MWT: r = 0.38, P = 0.08). Test–retest reliability for both the ISWT and the 6MWT showed that there was some variability between the first and second tests with a better performance on the second test.ConclusionThe ISWT and 6MWT have a significant, modest correlation with the ICT for stroke patients in the sub-acute recovery phase. The ISWT and 6MWT are not strongly correlated with ICT (VO₂ peak) in a stroke population that is disabled. The test–retest reliability of the ISWT and 6MWT indicated that two tests may be needed to accurately assess an individual’s capabilities.     

Predicting Fitness to Drive in People With Cognitive Impairments by Using DriveSafe and DriveAware

Kay LG, Bundy AC, Clemson LM. Predicting fitness to drive in people with cognitive impairments by using DriveSafe and DriveAware.

Objectives

To examine the psychometric properties of DriveSafe and DriveAware and their predictive validity.

Design

Prospective study compared screening tests with criterion standard.

Setting

Two driving rehabilitation centers affiliated with a university and a geriatric rehabilitation facility.

Participants

Consecutive sample of drivers with functional impairments (n=115) and subgroup of drivers with cognitive impairments (n=96) referred for a driving assessment.

Interventions

Not applicable.

Main Outcome Measure

Driving performance was measured by a standardized assessment in real traffic.

Results

Rasch analysis provided evidence for construct validity and internal reliability of both tests. Tests trichotomized drivers into unsafe, safe, and further testing categories. The optimal lower cutoff identified unsafe drivers with a specificity of 97% (95% confidence interval [CI], 83-100) in the test sample and 96% (95% CI, 80-100) in the validation sample. The optimal upper cutoff identified safe drivers with a sensitivity of 93% (95% CI, 77-99) and 95% (95% CI, 76-100), respectively.

Conclusions

By using DriveSafe and DriveAware, drivers with cognitive impairments referred for a driving assessment can be categorized as unsafe, safe, or requiring further testing, with only 50% needing an on-road assessment. Before clinical practice is changed, these findings should be replicated.     

Comparison of the Test-Retest Reliability of the Balance Computerized Adaptive Test and a Computerized Posturography Instrument in Patients With Stroke

Objective

To compare the test-retest reliabilities of the scores of the Balance Computerized Adaptive Test (CAT) and the Biodex Balance System in patients with stroke.

Design

A repeated-measures design (at a 1-wk interval) was used to examine the test-retest reliabilities of the scores of the Balance CAT and the Biodex Balance System.

Setting

One rehabilitation unit in a local hospital.

Participants

Patients (N=50) with stroke for more than 6 months and undergoing outpatient rehabilitation completed the Balance CAT and the eyes open (EO)/closed (EC) tests, but only 17 patients finished the Limit of Stability (LOS) test because they were unable to reach all the targets.

Interventions

Not applicable.

Main Outcome Measures

The Balance CAT and 2 computerized tests of the Biodex Balance System, namely the EO/EC test and the LOS, were used to evaluate balance function.

Results

The test-retest reliabilities of the scores of the Balance CAT (Pearson r=.92, minimal detectable change [MDC] percent=12.8%) was excellent. Those of the EO/EC and LOS tests were poor to good (Pearson r=.56–.85, MDC%=50.8%–126.9%).

Conclusions

The test-retest reliabilities of the scores of the Balance CAT were sufficient for assessing balance function in patients with stroke. Moreover, the test-retest reliabilities of the scores of the Balance CAT, one of the functional balance measures, were superior to those of the Biodex Balance System, 1 type of computerized posturography instrument. Therefore, the Balance CAT may be a more reliable measure for clinicians and researchers to use in assessing the balance function of patients with stroke for more than 6 months.     

Maximal Cardiorespiratory Fitness Testing in Individuals With Chronic Stroke With Cognitive Impairment: Practice Test Effects and Test-Retest Reliability

Objectives

To evaluate, for individuals with chronic stroke with cognitive impairment, (1) the effects of a practice test on peak cardiorespiratory fitness test results; (2) cardiorespiratory fitness test-retest reliability; and (3) the relationship between individual practice test effects and cognitive impairment.

Design

Cross-sectional.

Setting

Rehabilitation center.

Participants

A convenience sample of 21 persons (men [n=12] and women [n=9]; age range, 48–81y; 44.9±36.2mo poststroke) with cognitive impairments who had sufficient lower limb function to perform the test.

Interventions

Not applicable.

Main Outcome Measure

Peak oxygen consumption (Vo₂peak, ml·kg⁻¹·min⁻¹).

Results

Test-retest reliability of Vo₂peak was excellent (intraclass correlation coefficient model 2,1 [ICC_2,1]=.94; 95% confidence interval [CI], .86–.98). A paired t test showed that there was no significant difference for the group for Vo₂peak obtained from 2 symptom-limited cardiorespiratory fitness tests performed 1 week apart on a semirecumbent cycle ergometer (test 2–test 1 difference, −.32ml·kg⁻¹·min⁻¹; 95% CI, −.69 to 1.33ml·kg⁻¹·min⁻¹; P=.512). Individual test-retest differences in Vo₂peak were, however, positively related to general cognitive function as measured by the Mini-Mental State Examination (ρ=.485; P<.026).

Conclusions

Vo₂peak can be reliably measured in this group without a practice test. General cognitive function, however, may influence the effect of a practice test in that those with lower general cognitive function appear to respond differently to a practice test than those with higher cognitive function.     

Psychometric Evaluation of the Rasch-Based Depression Screening in Patients With Neurologic Disorders

Forkmann T, Norra C, Wirtz M, Gauggel S, Boecker M. Psychometric evaluation of the Rasch-based depression screening in patients with neurologic disorders.

Objectives

To provide a first evaluation of the Rasch-Based Depression Screening (DESC) in consecutive patients with neurologic disorders.

Design

Cross-sectional study.

Setting

Hospital specializing in neurologic disorders.

Participants

Eligible patients (N=323; mean age ± SD, 53.4±17.2y; 49.3% women) age 18 years and older.

Interventions

Not applicable.

Main outcome Measures

DESC with 2 parallel versions.

Results

Both versions of the DESC showed good item separation (DESC-I=4.96; DESC-II=4.94) and person separation (DESC-I=2.01; DESC-II=2.14) as well as item separation reliability (DESC-I=.96; DESC-II=.96) and person separation reliability (DESC-I=.80; DESC-II=.82). All items fit the Rasch model (infit and outfit mean squares ≤1.3). There were no signs of violation of unidimensionality. One item of DESC-I showed differential item functioning because of age and 1 item because of sex. Parallel test reliability of the 2 DESC forms was r equal to .92.

Conclusions

The DESC shows good psychometric characteristics that suggest high psychometric quality of the instrument in patients with neurologic disorders. Differential item functioning on single items needs further examination but should not substantially interfere with the valid interpretation of DESC sum scores.     

Comparison of scoring methods for the participation assessment with recombined tools-objective

Bogner JA, Whiteneck GG, Corrigan JD, Lai J-S, Dijkers MP, Heinemann AW. Comparison of scoring methods for the Participation Assessment with Recombined Tools–Objective.

Objective

To develop and compare 2 scoring algorithms for a measure of participation, the Participation Assessment with Recombined Tools–Objective (PART-O) based on the assumption that more participation is better versus an alternative that reflects balance in domains of participation.

Design

Survey.

Setting

Community settings.

Participants

Three groups of participants under the age of 65 years were included: (1) persons with spinal cord injury, traumatic brain injury, stroke, and other disorders who are commonly treated in acute rehabilitation settings (n=220), and (2) participants from the general population who did (n=366) or (3) did not (n=284) self-report limitations indicative of a disability who participated in the 2006 Colorado Behavioral Risk Factor Surveillance System (N=870).

Interventions

Not applicable.

Main Outcome Measure

PART-O.

Results

We developed PART-O subscores using a consensus process and then evaluated them empirically. We combined subscores using 2 contrasting algorithms, one using average scores and the other reflecting the amount of participation and variation in participation across 3 domains. The algorithms for the total scores yielded normal distributions in all 3 samples and were equally sensitive to the impact of disability. While strongly correlated, about 30% of the variance of the 2 total scores was not shared.

Conclusions

Two scoring algorithms for the PART-O illustrate contrasting perspectives of the construct of participation. The 2 algorithms may be used in future studies to expand our understanding of the construct of participation.     

Suggestions for Refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): A Factor Analysis and Rasch Validation Study

Franchignoni F, Giordano A, Sartorio F, Vercelli S, Pascariello B, Ferriero G. Suggestions for refinement of the Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH): a factor analysis and Rasch validation study.

Objective

To perform a comprehensive psychometric analysis of Disabilities of the Arm, Shoulder and Hand (DASH) to examine its properties and provide insights for an improved version.

Design

Methodologic research on cross-sectional data from a convenience sample.

Setting

A free-standing rehabilitation center.

Participants

Outpatients and inpatients (N=238; 56% men; mean age, 52.2y) with upper-extremity musculoskeletal disorders.

Main Outcome Measure

The official Italian version of DASH was analyzed by factor (both explorative and confirmatory) and Rasch analysis for evaluating dimensionality, functioning of rating scale categories, item fit, hierarchy of item difficulties, and reliability indices.

Interventions

Not applicable.

Results

Factor analysis established the presence of 3 underlying constructs related to manual functioning (items 1-5, 7-11, 16-18, 20, 21), shoulder range of motion (items 6, 12-15, 19), and symptoms and consequences (items 22-30). Rating scale diagnostics showed category malfunctioning. The fit to the Rasch model was good for all items except 4 (items 20, 21, 25, 26). Ten item pairs had high residual correlations after subtraction of the Rasch dimension (local dependency). A test model based on the 3 subscales suggested by factor analysis and corrected categories still showed misfitting in items 21 (“Sexual Activities”) and 26 (“Tingling”) and the presence of some dependent items.

Conclusions

Unidimensionality and the key domains identified by the original developers as the theoretic framework of DASH were not confirmed by our analyses. The response categories showed misfunctioning. “Sexual Activities” and “Tingling” misfit the Rasch model. Further detailed investigations of DASH are warranted, both to confirm these results in different health conditions and cultures, and to reanalyze in-depth content validity issues regarding the questionnaire.     

Psychometric Properties of 2-Minute Walk Test: A Systematic Review

Objective

To systematically review the psychometric evidence on the 2-minute walk test (2MWT).

Data Sources

Electronic searches of databases including MEDLINE, CINAHL, Academic Search Premier, SPORTDiscus, PsycINFO, EMBASE, the Cochrane Library, and DARE were done until February 2014 using a combination of subject headings and free texts.

Study Selection

Studies were included if psychometric properties of the 2MWT were (1) evaluated; (2) written as full reports; and (3) published in English language peer-reviewed journals.

Data Extraction

A modified consensus-based standard for the selection of health measurement instruments checklist was used to rate the methodological quality of the included studies. A quality assessment for statistical outcomes was used to assess the measurement properties of the 2MWT.

Data Synthesis

Best-evidence synthesis was collated from 25 studies of 14 patient groups. Only 1 study was found that examined the 2MWT in the pediatric population. The testing procedures of the 2MWT varied across the included studies. Reliability, validity (construct and criterion), and responsiveness of the 2MWT also varied across different patient groups. Moderate to strong evidence was found for reliability, convergent validity, discriminative validity, and responsiveness of the 2MWT in frail elderly patients. Moderate to strong evidence for reliability, convergent validity, and responsiveness was found in adults with lower limb amputations. Moderate to strong evidence for validity (convergent and discriminative) was found in adults who received rehabilitation after hip fractures or cardiac surgery. Limited evidence for the psychometric properties of the 2MWT was found in other population groups because of methodological flaws.

Conclusions

There is inadequate breadth and depth of psychometric evidence of the 2MWT for clinical and research purposes—specifically, minimal clinically important changes and responsiveness. More good-quality studies are needed, especially in the pediatric population. Consensus on standardized testing procedures of the 2MWT is also required.     

Rasch Analysis of the Executive Interview (The EXIT-25) and Introduction of an Abridged Version (The Quick EXIT)

Larson EB, Heinemann AW. Rasch analysis of the Executive Interview (The EXIT-25) and introduction of an abridged version (The Quick Exit).

Objectives

To evaluate the psychometric properties of the Executive Interview (EXIT-25) and to propose modifications that will improve those properties.

Design

Rasch analysis of existing datasets contributed by 3 prior projects, all of which examined criterion-related validity of the EXIT-25.

Setting

A large, urban, academic free-standing rehabilitation facility.

Participants

The sample of 147 was comprised of 109 adults diagnosed with stroke evaluated during inpatient rehabilitation and 38 adults with traumatic brain injury evaluated during inpatient (n=11) or outpatient rehabilitation (n=27).

Interventions

Not applicable.

Main Outcome Measures

The EXIT-25, Repeatable Battery for the Assessment of Neuropsychological Status, and Trails A and B.

Results

Eleven of the 25 items correlated weakly with the total measure and misfit the rating scale model. Deleting these 11 items improved the internal consistency of the remaining 14 items and enhanced the measure's criterion-related validity.

Conclusions

The EXIT-25 can be reduced from 25 to 14 items without reducing internal consistency. Convergent validity of the abbreviated measure is supported by moderate-size correlations with standard measures of cognitive deficits.     

A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke

OBJECTIVE: To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. DESIGN: One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients' comprehensive activities of daily living (ADL) function. SETTING: Three rehabilitation units in Taiwan. PARTICIPANTS: Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. RESULTS: For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78-.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [d], .63) and small (d range, .27-.33), respectively, whereas the responsiveness of the weight-shifting tests was limited (d range, .04-.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function (r2 range, .15-.17). The PASS showed high reliability (ICC=.84) and small responsiveness (d=.41), and the PASS in the second evaluation had acceptable predictive validity (r2=.24). CONCLUSIONS: The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.     

Longitudinal invariance and construct validity of the abbreviated late-life function and disability instrument in healthy older adults

Szabo AN, Mullen SP, White SM, Wojcicki TR, Mailey EL, Gothe N, Olson EA, Fanning J, Kramer AF, McAuley E. Longitudinal invariance and construct validity of the abbreviated Late-Life Function and Disability Instrument in healthy older adults.

Objective

To cross-validate the psychometric properties of the abbreviated Late-Life Function and Disability Instrument (LL-FDI), a measure of perceived functional limitations and disability.

Design

Baseline and 12-month follow-up assessments conducted across the course of a 12-month exercise program.

Setting

University research community.

Participants

Older healthy adults (N=179; mean ± SD age, 66.43±5.67y) at baseline; 145 were retained at follow-up.

Interventions

Not applicable.

Main Outcome Measures

LL-FDI and functional performance measures.

Results

Factor analyses confirmed the factor structure of the abbreviated LL-FDI, and all subscales met minimal criteria for temporal invariance. Significant correlations also were found between functional limitations subscales and an array of physical function performance measures, supporting the scale's construct validity.

Conclusions

The abbreviated LL-FDI with some modifications appears to be temporally invariant in community-dwelling older adults. Additionally, moderate relationships between functional limitations and functional performance provide further support for these being conceptually distinct constructs.     

Measuring participation enfranchisement

Heinemann AW, Lai J-S, Magasi S, Hammel J, Corrigan JD, Bogner JA, Whiteneck GG. Measuring participation enfranchisement.

Objective

To reflect the perspectives of rehabilitation stakeholders in a measure of participation enfranchisement that can be used by people with and without disabilities.

Design

Survey.

Setting

Community settings.

Participants

We pilot-tested a draft instrument with 326 adults who had sustained stroke, spinal cord injury, traumatic brain injury, or other disabling condition, as well as a general population sample. We administered a revised version of the instrument to a statewide sample drawn from the 2006 Colorado Behavioral Risk Factors Surveillance System that included persons with (N=461) and without (N=451) self-identified activity limitations.

Interventions

None.

Main Outcome Measure

Participation enfranchisement.

Results

We used multidimensional scaling, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), followed by rating scale analysis to evaluate the psychometric properties of the instrument. EFA identified 3 participation enfranchisement factors that describe perceived choice and control, contributing to one's community, and feeling valued; the factors were supported marginally by CFA. Rating scale analysis revealed marginal person separation and no misfitting items.

Conclusions

Participation enfranchisement constitutes a new, previously unmeasured aspect of participation—one that addresses subjective perceptions rather than objective performance—with items that are clearly distinct from more generalized satisfaction with participation. The 19 enfranchisement items describe aspects of participation that may prove useful in characterizing longer-term rehabilitation outcomes.     

Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke

Wang T, Lin K, Wu C, Chung C, Pei Y, Teng Y. Validity, responsiveness, and clinically important difference of the ABILHAND questionnaire in patients with stroke.

Objective

To investigate the criterion-related validity, responsiveness, and clinically important differences of the ABILHAND questionnaire in patients with stroke.

Design

Validation and clinimetric study.

Setting

Three medical centers.

Participants

Patients with stroke (N=51).

Interventions

A total of 51 patients with stroke received 1 of 3 upper extremity rehabilitation programs for 4 weeks.

Main Outcome Measures

The ABILHAND and the criterion measures, including the Stroke Impact Scale (SIS), FIM, Nottingham Extended Activities of Daily Living (NEADL), and accelerometers, were administered at pretreatment and posttreatment. The score of the ABILHAND, given in logits, was based on the conversion of the ordinal score into a linear measure of ability.

Results

Correlation coefficients (Pearson r) were moderate to large between the ABILHAND and SIS physical domains (.54–.66), fair to moderate between the ABILHAND and FIM-motor and NEADL (.28–.48), and moderate between the ABILHAND and accelerometer data (.45–.54). The responsiveness of the ABILHAND was large (standardized response mean=1.27). The minimal clinically important difference range for the ABILHAND was .26 to .35, and 51.0% of the patients showed a positive change that exceeded the lower bound of a clinically important difference after intervention.

Conclusions

The results support that the ABILHAND is an appropriate outcome measure for assessing upper extremity performance in daily activities in patients with stroke and is sensitive to detect change after rehabilitative interventions. The change score of a patient with stroke on the ABILHAND should reach .26 to .35 logits points to be regarded as a clinically important change.     

The Hopkins Rehabilitation Engagement Rating Scale: development and psychometric properties

OBJECTIVE: To conduct an initial investigation of the psychometric properties of the Hopkins Rehabilitation Engagement Rating Scale (HRERS), a 5-item, clinician-rated measure developed to quantify engagement in acute rehabilitation services. DESIGN: We used a cross-sectional design to conduct correlational and multivariate analyses to establish the measure's internal consistency, interrater reliability, construct validity, and criterion validity. SETTING: Acute inpatient rehabilitation in 3 metropolitan hospitals. PARTICIPANTS: A total of 206 subjects with spinal cord injury, ischemic or hemorrhagic stroke, amputation, or hip or knee replacement. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The HRERS, Positive and Negative Affect Schedule, Brief Symptom Inventory, Levine's Denial of Illness Scale, Craig Handicap Assessment and Reporting Technique, and FIM instrument. RESULTS: The HRERS has good internal consistency (alpha=.91) and interrater reliability (intraclass correlation coefficient, .73) and represents a unidimensional construct. It correlated negatively with symptoms of depression (r=-.24, P<.01), higher ratings of denial of illness (r=-.30, P<.001), and self-rated negative affect (r=-.23, P<.01), and correlated positively with self-rated positive affect (r=.36, P<.001) and level of functioning 3 months postdischarge (r=.22, P<.01). CONCLUSIONS: The HRERS is a valid and reliable measure of rehabilitation engagement that relates to intermediate-term functional outcomes.     

Psychometric Properties of the Brief Fatigue Inventory in Community-Dwelling Older Adults

Objective

To investigate the psychometric properties of the Brief Fatigue Inventory (BFI) in community-dwelling older adults.

Design

Cross-sectional validation study.

Setting

Community based.

Participants

Subjects (N=302) were nondemented older adults (mean age, 76.44y; 54% women).

Interventions

Not applicable.

Main Outcome Measures

BFI total, severity, and interference summation scores.

Results

A principal component analysis (PCA) yielded 2 factors, fatigue severity and interference, explaining 65.94% of the variance. Both factors had good reliability, with Cronbach alpha values of .867 for fatigue interference and .818 for fatigue severity. Higher fatigue scores were associated with older age and worse physical and cognitive functions.

Conclusions

Fatigue is a common and debilitating symptom in the aging population. The current study provides novel findings in validating and establishing a bidimensional factor structure for the BFI in older adults. Severity and interference were differentially related to important health outcomes; therefore, using these subscales in addition to the total BFI score is recommended with older adults. Because of its relatively short administration time and established psychometric properties, the BFI can be successfully incorporated into longitudinal studies and clinical trials.     

Rasch Analysis of the Community Integration Measure in Persons With Traumatic Brain Injury

Objective

To examine the measurement properties of the Community Integration Measure (CIM) in persons with traumatic brain injury (TBI).

Design

Rasch analysis was used to retrospectively evaluate the CIM.

Setting

Rehabilitation hospital.

Participants

Persons (N=279) 1 to 15 years after a TBI.

Interventions

None.

Main Outcome Measure

CIM.

Results

The CIM met Rasch expectations of unidimensionality and reliability (person separation ratio=2.01, item separation ratio=4.52). However, item endorsibility was poorly targeted to the participants' level of community integration. A ceiling effect was found with this sample.

Conclusions

The CIM is a relatively reliable and unidimensional scale. Future iterations might benefit from the addition of items that are more difficult to endorse (ie, improved targeting).     

Development of a set of functional hierarchical balance short forms for patients with stroke

Hou W-H, Chen J-H, Wang Y-H, Wang C-H, Lin J-H, Hsueh I-P, Ou Y-C, Hsieh C-L. Development of a set of functional hierarchical balance short forms for patients with stroke.

Objective

To develop a set of 3 hierarchical balance short forms (HBSF; containing sitting, standing, and stepping forms) to measure balance function in patients with stroke.

Design

First, we developed the HBSF, based on a previous data set, with each short form containing 6 items. Second, we examined the psychometric properties and efficiency of the HBSF.

Setting

Six teaching hospitals.

Participants

Patients with stroke (n=764) for the first part of this study; inpatients and outpatients (n=85) for the second part of this study.

Interventions

Not applicable.

Main Outcome Measures

We used the item bank (9 sitting-related, 14 standing-related, and 13 stepping-related items) from the Balance Computerized Adaptive Test to develop the HBSF. Both the HBSF and the Berg Balance Scale (BBS) were administered to patients, to determine the concurrent validity and time needed for administration of both measures. Each patient was assessed by 1 of the 3 short forms selected by a rater.

Results

The reliability of the HBSF was relatively high (reliability coefficients, .94–.95). The scores of the HBSF were highly correlated with those of the BBS (Spearman ρ=.80–.91), supporting the concurrent validity of the HBSF. The average time needed to administer the HBSF was 122 seconds (ie, about 40% of that for the BBS).

Conclusions

Our results provide sufficient evidence that the HBSF is an efficient, reliable, valid, and practical way to measure balance function in patients with stroke.