Validity,reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-BESTest and brief-BESTest in patients with end-stage renal disease

Abstract

Purpose: This study determined the validity, test–retest reliability and minimal detectable change of the balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) in patients with end-stage renal disease.

Methods: A cross-sectional study with 74 patients with end-stage renal disease (male 66.2%; 63.9?±?15.1?years old) was conducted. Participants were asked to report the number of falls during the previous 12?months and to complete the activity-specific balance confidence (ABC) scale. The BESTest was administered, and the Mini-BESTest and Brief-BESTest scores were computed based on the BESTest performance. Validity was assessed by correlating balance tests with each other and with the ABC scale. Test–retest relative reliability and agreement were explored with the intraclass correlation coefficient (ICC) equation (2,1) and the Bland and Altman method. Minimal detectable changes at the 95% confidence level were established.

Results: Balance test scores were significantly correlated with each other (spearman’s correlation?=?0.89–0.92) and with the ABC scale (spearman’s correlation?=?0.49–0.59). Balance tests presented high test–retest reliability (ICC?=?0.84–0.94), with no evidence of bias. Minimal detectable change values were 10.8 (expressed as a percentage 13.5%), 5.3 (23.7%) and 5.6 (34%) points for the BESTest, Mini-BESTest and Brief-BESTest, respectively.

Conclusions: All tests are valid and reliable to assess balance in patients with end-stage renal disease. Nevertheless, based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended tests for this specific population.

• Implications for Rehabilitation

• Balance evaluation systems test (BESTest), mini-balance evaluation systems test (Mini-BESTest) and brief-balance evaluation systems test (Brief-BESTest) are reliable and valid in patients with end stage renal disease (ESRD).

• The minimal detectable changes of 10.8 for the BESTest, 5.3 for the Mini-BESTest and 5.6 for the Brief-BESTest can be used by clinicians to identify a true change in balance over time or in response to interventions.

• Based on the minimal detectable changes found, BESTest and Mini-BESTest may be the most recommended; and the selection of one of them may be based on time and equipment availability.

     

Psychometric properties of functional postural control tests in children: A systematic review

BackgroundPostural control deficits are one of the most common impairments treated in pediatric physiotherapeutic practice. Adequate evaluation of these deficits is imperative to identify postural control deficits, plan treatment and assess efficacy. Currently, there is no gold standard evaluation for postural control deficits. However, the number of studies investigating the psychometric properties of functional pediatric postural control tests has increased significantly.ObjectiveTo facilitate the selection of an appropriate pediatric functional postural control test in research and clinical practice.MethodsSystematic review following the PRISMA guidelines. PubMed, Web of Science and Scopus were systematically searched (last update: June 2022; PROSPERO: CRD42021246995). Studies were selected using the PICOs-method (pediatric populations (P), functional assessment tools for postural control (I) and psychometric properties (O). The risk of bias was rated with the COSMIN checklist and the level of evidence was determined with GRADE. For each test, the postural control systems were mapped, and the psychometric properties were extracted.ResultsSeventy studies investigating 26 different postural control tests were included. Most children were healthy or had cerebral palsy. Overall, the evidence for all measurement properties was low to very low. Most tests (95%) showed good reliability (ICC>0.70), but inconsistent validity results. Structural validity, internal consistency and responsiveness were only available for 3 tests. Only the Kids-BESTest and FAB covered all postural control systems.ConclusionCurrently, 2 functional tests encompass the entire construct of postural control. Although reliability is overall good, validity results depend on task, age and pathology. Future research should focus on test batteries and should particularly explore structural validity and responsiveness in different populations with methodologically strong study designs.     

Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: A systematic review

BackgroundA wide array of instruments are available for non-invasive thoracic kyphosis measurement. Guidelines for selecting outcome measures for use in clinical and research practice recommend that properties such as validity and reliability are considered. This systematic review reports on the reliability and validity of non-invasive methods for measuring thoracic kyphosis.MethodsA systematic search of 11 electronic databases located studies assessing reliability and/or validity of non-invasive thoracic kyphosis measurement techniques. Two independent reviewers used a critical appraisal tool to assess the quality of retrieved studies. Data was extracted by the primary reviewer. The results were synthesized qualitatively using a level of evidence approach.Results27 studies satisfied the eligibility criteria and were included in the review. The reliability, validity and both reliability and validity were investigated by sixteen, two and nine studies respectively. 17/27 studies were deemed to be of high quality. In total, 15 methods of thoracic kyphosis were evaluated in retrieved studies. All investigated methods showed high (ICC ≥ .7) to very high (ICC ≥ .9) levels of reliability. The validity of the methods ranged from low to very high.ConclusionThe strongest levels of evidence for reliability exists in support of the Debrunner kyphometer, Spinal Mouse and Flexicurve index, and for validity supports the arcometer and Flexicurve index. Further reliability and validity studies are required to strengthen the level of evidence for the remaining methods of measurement. This should be addressed by future research.     

Influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment

IntroductionBreast cancer affects women of different ages, and comorbidities resulting from treatment can affect postural stability. The study aimed to evaluate the influence of age and lymphedema on the postural balance of women undergoing breast cancer treatment.MethodsThe study included 77 women undergoing breast cancer treatment, divided into different groups: 37 young adult women divided into 17 with lymphedema (GYL) and 20 young adults without lymphedema (GY); 40 elderly women, 20 elderly women with lymphedema (GEL) and 20 elderly women without lymphedema (GE). Mini Balance Evaluation Systems Test (Mini BESTest) and Falls Efficacy Scale - International (FES-I) were used.ResultsMini BESTest and FES-I between the groups showed that GE and GEL had a significant difference to GY. Mini BESTest Total and Time Up and Go TUG-Double Task showed that GE has a significant difference to GYL, with GE and GEL having lower scores. Moderate negative correlation in the GEL between FES-I and Mini BESTest. In the age correlation between the Mini BESTest, FES-I, TUG, and double task TUG, a moderate positive correlation was observed for TUG. GEL showed a moderate positive correlation for FES-I and double-task TUG, strong for TUG, and moderate negative correlation with Mini BESTest. Correlation of the volume difference between the limb affected and not affected by lymphedema and the FES-I, Mini BESTest, TUG, and TUG double task, GYL showed moderate negative correlation for TUG.ConclusionAge and lymphedema influenced the dynamic postural balance of women undergoing breast cancer treatment.     

WHICH BALANCE EVALUATION SYSTEMS TEST SECTIONS BEST DISTINGUISH LEVELS OF POST-STROKE FUNCTIONAL WALKING STATUS?

ObjectiveTo determine which sections of the Balance Evaluation Systems Test (BESTest) distinguish levels of post-stroke functional walking status and to establish their cut-off scores.DesignA retrospective cross-sectional study.Subjects and methodsThe BESTest was administered to 87 stroke patients who were able to walk without physical assistance upon discharge from the hospital. Subjects were divided into 3 functional walking status groups: namely, household ambulators, limited community ambulators, and unlimited community ambulators. The receiver operating characteristic curve was determined and the cut-off score and area under the receiver operating characteristic curve (AUROC) of each section calculated.ResultsIn the comparison of household and limited community ambulators, the accuracies of all BESTest sections were moderate (AUROC>0.7), and the cut-off scores were 36.1–78.6%. In the comparison of limited and unlimited community ambulators, one section (stability in gait) had high accuracy (AUROC=0.908, cut-off scores=73.8%) and 3 sections (biomechanical constraints, anticipatory postural adjustments, and postural response) had moderate accuracy (AUROC=0.812–0.834, cut-off scores=75.0–83.4%).ConclusionThis study demonstrated that different sections of the BESTest had different abilities to discriminate levels of post-stroke functional walking status, and identified cut-off values for targeted improvement.LAY ABSTRACTThe Balance Evaluation Systems Test (BESTest), a clinical postural control measure, categorizes postural control systems in 6 different sections. This study investigated which sections of the BESTest distinguish levels of post-stroke functional walking status, which, in turn, is based on walking speed. Among the slower walkers, all sections of the BESTest showed moderate relationships to categories of walking status. Among the faster walkers, 4 sections showed moderate to strong relationships and 2 sections showed weak relationships. This study may have clinical implications for rehabilitation aimed at improving functional walking status in individuals with stroke. These findings will help rehabilitation professionals assess postural control in relation to stroke patients’ ability to walk in different settings (e.g. their household or the community) and determine which postural control systems should be prioritized in therapeutic interventions.Key words: stroke, walking speed, postural balance, BESTest

Decline in mobility is one of the major sequelae after a stroke (1). Approximately 30–40% of patients with stroke can engage in only limited community walking (2). Walking speed has been shown to be a valid and reliable measure of functional walking status across the continuum of recovery after stroke (3), which, in turn, is important for enabling the patient to safely perform activities of daily living (ADL). In previous studies, researchers have categorized post-stroke individuals as household ambulators, limited community ambulators, and unlimited community ambulators, based on cut-off scores for comfortable walking speed (4, 5). Recovery of walking speed after stroke is tantamount to recovery of walking ability and is critical to maintaining quality of life.In patients with stroke, walking speed is related to various functions; however, one of its key determinants is postural control. Postural control is a complex ability that involves several sub-systems (6), an observation reinforced by biomechanical studies (7–9). However, a systematic review of the literature did not provide sufficient evidence that postural control training per se improved walking speed in individuals with stroke (10). Postural control training is complex and not specific to individual postural control systems. For efficient assessment and intervention by a physiotherapist, it is recommended that postural control systems more directly related to walking speed, and hence walking function, be identified.The Balance Evaluation Systems Test (BESTest) is a clinical assessment tool that evaluates the examinee’s performance across 6 postural control systems (sections) (11). Therefore, the BESTest assessment results can be used to select interventions that focus on the specific deficits identified in each patient. Reports about the sections of the BESTest are increasing; for instance, each section of the BESTest is reported to have low to moderate accuracy as a fall prediction tool, and the relationships of scores with falls vary among the BESTest sections (12, 13). Effective rehabilitation of postural control to improve walking ability and prevent falls requires a better understanding of the relationship of walking to postural control.Although previous research has demonstrated that specific sections of the BESTest are able to differentiate between slow and fast walking speeds in older adults with hip fractures (14), studies have not yet examined which section(s) of the BESTest can best identify functional walking status in individuals with stroke. A better understanding of the relationship between functional walking status and the sections of the BESTest can guide the selection of interventions that address problems in specific aspects of postural control to improve the walking ability of individuals with stroke. We thus conducted the present cross-sectional study, first, to determine which of the sections of the BESTest can distinguish levels of functional walking status using the 3 walking status groups recently updated by Fulk et al. (5), and secondly, to establish cut-off scores for these sections in post-stroke individuals.     

Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis

BackgroundImprovement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation.ObjectiveA systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy.MethodsSearches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval.ResultsSeven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p = 0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency.ConclusionCombining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.     

A Systematic Review and Meta-analysis of the Effect of Active Video Games on Postural Balance

ObjectiveTo conduct a comprehensive systematic review and meta-analysis of the effects of active video game (AVG) interventions on postural balance across all ages in populations with and without neurologic impairments, using all types of platforms.Data SourceSix databases (PubMed, PsycINFO, Sport Discus, MEDLINE, Web of Science, and Google Scholar) were reviewed by December 31, 2020.Study SelectionThe protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO: CRD42020204191). For inclusion, a study must be original, published in English peer-reviewed venues and employed AVGs as the sole or primary intervention to enhance, maintain, or regain postural balance. At least 2 within- or between-subjects conditions must be included with ≥10 participants per condition.Data ExtractionThree reviewers independently performed data extraction and assessed the risk of bias.Data Synthesis129 studies were identified, with 102 eligible for meta-analysis. The total number of tested participants was 6407 (60.0% women, M_age=55.1 years, range=3-99 years, SD=22.6). The average intervention duration was 35.6 min/session with 3.1 sessions/week for 7.6 weeks. The overall effect favored AVG interventions (Hedges’ g=0.469; 95% confidence interval [CI]=0.407-0.531). Although the overall study quality was relatively low, the analysis expectedly indicated significantly larger effects (P<.001) for AVG-interventions over passive controls (Hedges’ g=0.627; 95% CI=0.466-0.788), but importantly also favored AVG-interventions over conventional treatment (Hedges’ g=0.389; 95% CI=0.311-0.468). All clinical populations responded positively, although with different effect sizes (P=.023). Children experienced larger treatment effects (Hedges’ g=0.550; 95% CI=0.336-0.764), closely followed by seniors (Hedges’ g=0.529; 95% CI=0.402-0.656). The largest intervention effect on balance improvements was seen in healthy people without a medical condition (Hedges’ g=0.609; 95% CI=0.465-0.753).ConclusionsAVGs can produce postural balance improvements and better postural maintenance. All populations could benefit from AVG interventions.     

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.     

Endotracheal suction interventions in mechanically ventilated children: An integrative review to inform evidence-based practice

ObjectiveThe objective of this study was to review and critically appraise the evidence for paediatric endotracheal suction interventions.Data sourcesA systematic search for studies was undertaken in the electronic databases CENTRAL, Medline, EMBASE, and EBSCO CINAHL from 2003.Study selectionIncluded studies assessed suction interventions in children (≤18 ys old) receiving mechanical ventilation. The primary outcome was defined a priori as duration of mechanical ventilation. Secondary outcomes included adverse events and measures of gas exchange and lung mechanics.Data extractionData extraction were performed independently by two reviewers. Study methodological quality was assessed using Cochrane's risk of bias tool for randomised trials or the Newcastle–Ottawa Scale for observational studies. Overall assessment of the certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations criteria.ResultsOverall 17 studies involving 1618 children and more than 21,834 suction episodes were included in the review. The most common intervention theme was suction system (five studies; 29%). All included trials were at unclear or high risk of performance bias due to the inability to blind interventionists. Current evidence suggests that closed suction may maintain arterial saturations, normal saline leads to significant transient desaturation, and lung recruitment applied after suction offers short-term oxygenation benefit.LimitationsLack of randomised controlled trials, inconsistencies in populations and interventions across studies, and imprecision and risk of bias in included studies precluded data pooling to provide an estimate of interventions effect.ConclusionsBased on the results of this integrative review, there is insufficient high-quality evidence to guide practice around suction interventions in mechanically ventilated children.     

Effect of Resistance Exercise on Body Structure and Function,Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review

ObjectiveTo investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson Disease (PD) in the mild to moderate stages.Data SourcesMedline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms “Parkinson Disease,” “Exercise,” “Resistance Training,” “Muscle Strength,” “Cardiorespiratory Fitness,” “Postural Balance,” “Gait,” and “Quality of Life.”Study SelectionWe included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies.Data extractionTwo reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach.Data SynthesisThe level of evidence for body structure and function was low and without effect for lower limb muscle strength; very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, quality of life) the evidence was very low and without effect.ConclusionsAlthough the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait). In contrast, RE did not significantly improve participation (quality of life). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.     

Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis

BACKGROUND:

The Balance Evaluation Systems Test (BESTest) was recently created to allow the development of treatments according to the specific balance system affected in each patient. The Brazilian version of the BESTest has not been specifically tested after stroke.

OBJECTIVE:

To evaluate the intra- and inter-rater reliability and concurrent and convergent validity of the total score of the BESTest and BESTest sections for adults with hemiparesis after stroke.

METHOD:

The study included 16 subjects (61.1±7.5 years) with chronic hemiparesis (54.5±43.5 months after stroke). The BESTest was administered by two raters in the same week and one of the raters repeated the test after a one-week interval. Intraclass correlation coefficient (ICC) was calculated to assess intra- and interrater reliability. Concurrent validity with the Berg Balance Scale (BBS) and convergent validity with the Activities-specific Balance Confidence scale (ABC-Brazil) were assessed using Pearson''s correlation coefficient.

RESULTS:

Both the BESTest total score (ICC=0.98) and the BESTest sections (ICC between 0.85 and 0.96) have excellent intrarater reliability. Interrater reliability for the total score was excellent (ICC=0.93) and, for the sections, it ranged between 0.71 and 0.94. The correlation coefficient between the BESTest and the BBS and ABC-Brazil were 0.78 and 0.59, respectively.

CONCLUSIONS:

The Brazilian version of the BESTest demonstrated adequate reliability when measured by sections and could identify what balance system was affected in patients after stroke. Concurrent validity was excellent with the BBS total score and good to excellent with the sections. The total scores but not the sections present adequate convergent validity with the ABC-Brazil. However, other psychometric properties should be further investigated.     

Measurement Properties of the Mayo-Portland Adaptability Inventory (MPAI-4) and Related Measures: A Systematic Review

ObjectiveTo assess the Mayo-Portland Adaptability Inventory—version 4 (MPAI-4) and related measures’ measurement properties and the quality of evidence supporting these results; and identify the interpretability and feasibility of the MPAI-4 and related measures.Data SourcesWe conducted a systematic review according to COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. We searched 9 electronic databases and registries, and hand searched reference lists of included articles.Study SelectionTwo independent reviewers screened and selected all articles. From 605 retrieved articles, 48 were included.Data ExtractionTwo independent reviewers appraised the evidence quality and rated the extracted classical test theory and Rasch results from each study.Data SynthesisWe used meta-analysis and COSMIN's approach to synthesize measurement properties evidence (insufficient, sufficient), and the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to synthesize evidence quality (very low, low, moderate, high) by diagnosis (traumatic brain injury [TBI], stroke), and setting (inpatient, outpatient). The MPAI-4 and its subscales are sufficiently comprehensible (GRADE: very low), but there is currently no other content validity evidence (relevance, comprehensiveness). The MPAI-4 and its participation index (M2PI) have sufficient interrater reliability for stroke and TBI outpatients (GRADE: moderate), whereas interrater reliability between TBI inpatients and clinicians is currently insufficient (GRADE: moderate). There is no evidence for measurement error. For stroke and TBI outpatients, the MPAI-4 and M2PI have sufficient construct validity (GRADE: high) and responsiveness (GRADE: moderate-high). For TBI inpatients, the MPAI-4 and M2PI have mixed indeterminant/sufficient construct validity and responsiveness evidence (GRADE: moderate-high). There is 1 study with mixed insufficient/sufficient evidence for each MPAI-4 adaptation (21- and 22-item MPAI, 9-item M2PI) (GRADE: low-high).ConclusionUsers can be most confident in using the MPAI-4 and M2PI in TBI and stroke outpatient settings. Future research is needed on reliability, measurement error, predictive validity, and content validity of the MPAI-4 and its related measures across populations and settings.     

Measurement Properties of Clinical Instruments for Assessing Manual Wheelchair Mobility in Individuals With Spinal Cord Injury: Systematic Review

ObjectiveTo evaluate the measurement properties of clinical instruments used to assess manual wheelchair mobility in individuals with spinal cord injury (SCI).Data SourcesThis systematic review was conducted according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidance and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search was conducted up to December 2021 on MEDLINE/PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Biblioteca Regional de Medicina, and Cumulative Index to Nursing and Allied Health databases without time restriction.Study SelectionPeer-reviewed original research articles that examined any clinical wheelchair mobility and/or skill assessment instrument among adults with SCI and reported data on at least one measurement property or described the development procedure were evaluated independently by two reviewers.Data ExtractionData were independently extracted according to Consensus-Based Standards for the Selection of Health Measurement Instruments methodology. Measurement property results from each study were independently rated by two reviewers as sufficient, insufficient, indeterminate, or inconsistent. The evidence for each measurement property was rated as high, moderate, low, or very low (Grading of Recommendations, Assessment, Development, and Evaluation). Recommendations for highly-rated instruments were performed.Data SynthesisTwenty-nine studies with 21 instruments were identified. The methodological quality of studies ranged from insufficient to sufficient, and the quality of evidence ranged from very low to high. Six instruments reported content validity. Reliability and construct validity were the most studied measurement properties. Structural validity and invariance for cross-cultural measurement were not reported. The highly rated instruments were the Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire.ConclusionsAlthough numerous instruments for assessing wheelchair mobility and/or skills among individuals with SCI were identified, not many measurement properties have been sufficiently established. The Wheelchair Outcome Measure and Wheelchair Skills Test Questionnaire show the current best potential to be recommended for clinical and research use. Further studies are needed to strengthen or change these recommendations.     

Systematic Review of Measurement Property Evidence for 8 Financial Management Instruments in Populations With Acquired Cognitive Impairment

Objectives

To critically appraise the measurement property evidence (ie, psychometric) for 8 observation-based financial management assessment instruments.

Static body postural misalignment in individuals with temporomandibular disorders: a systematic review

BACKGROUND:

The association between body postural changes and temporomandibular disorders (TMD) has been widely discussed in the literature, however, there is little evidence to support this association.

OBJECTIVES:

The aim of the present study was to conduct a systematic review to assess the evidence concerning the association between static body postural misalignment and TMD.

METHOD:

A search was conducted in the PubMed/Medline, Embase, Lilacs, Scielo, Cochrane, and Scopus databases including studies published in English between 1950 and March 2012. Cross-sectional, cohort, case control, and survey studies that assessed body posture in TMD patients were selected. Two reviewers performed each step independently. A methodological checklist was used to evaluate the quality of the selected articles.

RESULTS:

Twenty studies were analyzed for their methodological quality. Only one study was classified as a moderate quality study and two were classified as strong quality studies. Among all studies considered, only 12 included craniocervical postural assessment, 2 included assessment of craniocervical and shoulder postures,, and 6 included global assessment of body posture.

CONCLUSION:

There is strong evidence of craniocervical postural changes in myogenous TMD, moderate evidence of cervical postural misalignment in arthrogenous TMD, and no evidence of absence of craniocervical postural misalignment in mixed TMD patients or of global body postural misalignment in patients with TMD. It is important to note the poor methodological quality of the studies, particularly those regarding global body postural misalignment in TMD patients.     

Reliability and validity of the simulation learning effectiveness inventory

BackgroundInstruments developed to measure simulation learning outcomes need evidence of their reliability and validity for rigorous research. The purpose of this paper is to report psychometric properties of the English version of the Simulation Learning Effectiveness Inventory.MethodsPsychometric properties of the English version of the Simulation Learning Effectiveness Inventory, which included internal consistency reliability and construct validity with factor analysis, were examined in a sample of 132 undergraduate nursing students.ResultsCronbach's alpha coefficients were >0.70 for all subscales. There was evidence of convergent, discriminant, and known-group validity. The factor analysis resulted in some items being associated with different subscales than in the original Chinese version.ConclusionsThe English version of the Simulation Learning Effectiveness Inventory has evidence of reliability and validity. Additional psychometric studies may result in changes in some of the subscales.     

Noninvasive Brain Stimulation for Rehabilitation of Pediatric Motor Disorders Following Brain Injury: Systematic Review of Randomized Controlled Trials

ObjectiveTo assess the evidence of the effectiveness of noninvasive brain stimulation (NIBS) for rehabilitation of pediatric motor disorders after brain injury.Data SourcesOvid, Cochrane, Science Direct, Web of Science, EBSCOhost, PubMed, and Google Scholar databases were searched up to August 2017 by 2 independent reviewers.Study SelectionRandomized controlled trials (RCTs) published in English were included if they met the following criteria. Population: Pediatric patients with motor disorders following brain injury. Intervention: NIBS, including transcranial direct current stimulation (tDCS) or repetitive transcranial magnetic stimulation (rTMS). Outcomes: Measures related to motor disorders (upper limb functional abilities, gait, balance, and spasticity). Fourteen RCTs were included (10 studies used tDCS, while 4 studies used rTMS).Data ExtractionPredefined data were tabulated by 1 reviewer and verified by another reviewer. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale; also levels of evidence adapted from Sackett were used.Data SynthesisA grouped meta-analysis was performed on balance, gait parameters, and upper limb function. Data were pooled using a random-effects model to assess the immediate effect and 1-month follow-up of NIBS. According to the PEDro scale, 3 studies were excellent, 8 studies were good, and 3 studies were fair. The level of evidence of all of the included studies was 1b, except for 3 studies with grade 2a. There were significant improvements in all upper limb functions (standardized mean differences [SMDs] ranging from 0.94 to 1.83 [P values=.0001]), balance (SMDs ranging between -0.48 to 0.83 [P values<.05]) and some gait variables.ConclusionPediatric patients with brain injury can be safely stimulated by NIBS, and there is evidence for the efficacy of rTMS in improving upper limb function, and tDCS in improving balance and majority of gait variables with persisted effects for 1 month. The efficacy of spasticity is uncertain.     

Upper Limb Assessment in Multiple Sclerosis: A Systematic Review of Outcome Measures and their Psychometric Properties

Objective

To provide an overview of applied upper limb outcome measures in multiple sclerosis (MS) according to the International Classification of Functioning, Disability and Health (ICF) levels and to review their psychometric properties in MS.

Data Sources

PubMed and Web of Knowledge.

Study Selection

Articles published until June 2013 were selected when written in English, published in the last 25 years, peer reviewed, including >5 persons with MS, and including standardized clinical upper limb outcome measures. Included articles were screened based on title/abstract and full text by 2 independent reviewers. In case of doubt, feedback from a third independent reviewer was obtained. Additionally, references lists were checked for relevant articles. Of the articles, 109 met the selection criteria and were included for data extraction.

Data Extraction

All reported clinical upper limb outcome measures were extracted from the included studies and classified according to the ICF levels by 2 independent reviewers. In addition, available psychometric properties (reliability, validity, responsiveness) in MS were summarized and discussed.

Data Synthesis

A diversity of outcome measures assessing impairments on the body functions and structures level (n=33), upper limb capacity (n=11), and performance (n=8) on the activity level were extracted from 109 articles. Hand grip strength and the nine-hole peg test (NHPT) were the most frequently used outcome measures. However, multiple outcome measures are necessary to encapsulate the multidimensional character of the upper limb function. The psychometric properties were insufficiently documented for most of the outcome measures, except for the NHPT.

Conclusions

The results of this review may help with the selection of appropriate outcome measures and may guide future research regarding the psychometric properties in MS.