脑卒中患者姿势评定量表的效度及信度研究

目的探讨脑卒中患者姿势评定量表(PASS)的效度和信度,为临床应用提供客观依据。方法2组受试对象参加了测试,一组为病例组(27例),另一组为对照组(30例)。1周内对两组对象用PASS和Fugl-Meyer量表中的平衡部分(FM-B)进行2次评定,病例组同时用Berg平衡量表(BBS)评定。将PASS结果与FM-B、BBS作相关性检验来验证PASS的效度;对2次PASS结果作相关性分析来测试PASS的重复测量信度。结果PASS和FM-B、BBS总分高度相关(r=0.943-0.944、r=0.957);PASS各项内容2次重复测试结果高度相关,其组内相关系数ICC=0.945-0.962,组间相关系数ICC=0.982-0.992;病例组和对照组的PASS总分分别为(16.43±10.44)分、(35.32±0.95)分,两者间差异有显著性(P<0.05)。结论PASS具有良好的效度和信度,可用于姿势控制能力的评价。     

中文版改良躯干损伤量表在脑卒中患者中的信度与效度研究

目的:翻译挪威版改良躯干损伤量表(the Trunk Impairment Scale-modified to Norwegian Version,mTIS),并探讨其在脑卒中患者应用中的信度与效度,为其临床应用提供客观依据。方法:将挪威版mTIS翻译为中文版mTIS。共入组30例病例,在入组第一天,评定者A与B同时但独立对患者进行中文版mTIS量表评估,评定者A再对患者进行Fugl-Meyer量表的下肢运动部分(The Fugl-Meyer Assessment of Lower Extremity, FMA-LE)、改良Barthel指数(Modified Barthel Index, MBI)、Berg平衡量表(Berg Balance Scale,BBS)和脑卒中患者姿势评定量表(Postural Assessment Scale for Stroke Patient,PASS)评估。在入组第二天,评定者A再进行一次中文版mTIS评估。采用组内相关系数法(Intra-class Correlation Coefficient,ICC))分析评定者内部的重测信度和评定者间信度,采用Pearson相关系数法检测效度。结果:在信度研究中,评定者A与B之间的中文版mTIS总分、动态坐位平衡分量表得分、协调分量表得分的ICC分别为0.978,0.967,0.902,评定者A两次评定结果之间的中文版mTIS总分、动态坐位平衡分量表得分、协调分量表得分的ICC分别为0.971,0.969,0.901。在效度研究中,中文版mTIS得分与FMA-LE得分的相关系数r=0.806,P0.05;与MBI得分的相关系数r=0.802,P0.05;与BBS得分的相关系数r=0.734,P0.05;与PASS得分的相关系数r=0.775,P0.05。结论:中文版改良躯干损伤量表在脑卒中患者应用中具有良好的重测信度、评定者间信度和较好的效度。     

四方格移步测试(中文版)评定脑卒中患者平衡能力的信效度研究

目的:检测四方格移步测试(four square step test,FSST)中文版在评定脑卒中患者平衡能力的信效度。方法:首次发病的脑卒中患者(最终入组30例)完成了本试验,受试者进行FSST,Berg平衡量表(Berg balance scale,BBS),起立-行走计时测试(timed up and go test,TUGT)和10m步行测试(10 meter walk test,10MWT),48h内完成第二次FSST测试,对其结果进行信度和效度分析。结果:FSST中文版量表的评定者间信度检验总体ICC值为0.89(95%CI:0.87—0.92),重测信度检验显示总体ICC值为0.98(95%CI:0.96—0.99);通过Spearman相关分析,结果显示FSST与BBS量表呈中等程度负相关(r=-0.62,P0.001),与10MWT评分结果呈良好正相关性(r=0.87,P0.001),与TUGT评分结果呈良好正相关性(r=0.86,P0.001)。结论:FSST中文版在用于国内脑卒中患者平衡功能时评定时具有良好的信度与效度,建议可在临床推广使用。     

蒙特利尔认知评估量表在重庆地区应用的初步研究

目的:检验蒙特利尔认知评估量表(MoCA)中文版在重庆地区应用的效度、信度及敏感度。方法:选择病例组22例,对照组30例,分别用MoCA和简易精神状态量表(MMSE)评定2组认知功能,检验MoCA的效度、信度及敏感度。结果:MoCA和MMSE评定结果高度相关(r=0.902,P<0.001),MoCA各项测试2名评定员之间ICC:0.913-1.000;病例组和对照组的MoCA总分差异有显著性意义(P<0.01)。结论:MoCA中文版具有良好的效度、信度和敏感度,可用于重庆地区中重度认知功能障碍的评定。     

智能躯干强化训练对脑卒中患者运动及平衡功能的疗效

目的探讨智能躯干强化训练对脑卒中患者运动及平衡功能的影响。方法80例脑卒中患者随机分为治疗组和对照组各40例,两组患者均采用常规康复治疗,治疗组同时给予智能躯干强化训练。共治疗6周。于治疗前后对两组患者采用River-mead运动指数(RMI)、Berg平衡量表(BBS)、Sheikh躯干控制能力进行评定。结果两组患者治疗后,RMI、BBS、躯干控制能力评分均较治疗前显著改善(P<0.001),治疗组各项指标均显著优于对照组(P<0.001);躯干控制能力与平衡及运动功能均呈正相关(r=0.576, r=0.592,均P<0.05)。结论智能躯干强化训练可进一步提高脑卒中患者运动及平衡功能。     

视觉反馈联合躯干强化训练对脑卒中Pusher综合征的疗效观察

目的:探讨视觉反馈联合躯干强化训练对脑卒中Pusher综合征的疗效观察。方法:脑卒中Pusher综合征患者50例,将其随机分为观察组和对照组各25例,2组均给予常规的康复训练,观察组在此基础上加用视觉反馈联合躯干强化训练,训练前后采用Berg平衡量表(BBS)、Burke倾斜量表(BLS)以及Sheikh躯干控制积分进行疗效评定。结果:经过8周治疗,2组BBS及Sheikh评分均较治疗前明显提高(均P0.05),BLS评分明显降低(P0.05),且观察组3项评分改善幅度更高于对照组(均P0.05)。结论:视觉反馈联合躯干强化训练能有效地提高脑卒中Pusher综合征患者的平衡功能,值得临床应用。     

三种常用平衡量表在脑卒中患者中的相关性研究

目的探讨三种常用的平衡量表在脑卒中偏瘫患者中的相关性。方法对57例患者进行Berg平衡量表(Bergbalancescale,BBS)、Fugl-Meyer平衡量表(balancesubscaleoftheFugl-Meyertest,FM-B)、脑卒中患者姿势评定量表(posturalassessmentscaleforstrokepatients,PASS)、下肢运动功能、ADL能力和步行功能评定。用Pearson相关分析方法来确定BBS、FM-B和PASS之间的相关性;确定BBS、FM-B和PASS与下肢运动功能、ADL能力和步行功能之间的相关性。结果BBS、FM-B和PASS之间呈高度相关(r=0.613—0.766,P<0.001);BBS、FM-B和PASS与下肢运动功能、ADL能力和步行功能之间呈高度相关(r=0.479—0.718,P<0.001)。结论BBS、FM-B和PASS均可以反映脑卒中患者的平衡和功能结局。     

核心肌训练对脑卒中偏瘫患者平衡功能的影响

目的 观察核心肌训练对脑卒中偏瘫患者平衡功能的影响。 方法 采用随机数字表法将60例脑卒中偏瘫患者分为观察组和对照组，每组30例。观察组患者予常规康复治疗结合核心肌训练，对照组患者予常规康复治疗结合躯干控制训练。2组患者均于治疗前和治疗8周后（治疗后）分别采用躯干控制能力评定Sheikh评分（TCT）、Berg平衡功能量表（BBS)、Fugl-Meyer平衡功能量表(FM-B)进行平衡功能评定。 结果 治疗后，2组患者TCT、BBS和FM-B评分较组内治疗前均有明显改善，差异均有统计学意义（P<0.05）；且治疗后观察组TCT、BBS和FM-B评分分别为（93.55±3.45）分、（50.21±3.83）分和（11.51±2.18）分，与对照组治疗后比较，差异亦均有统计学意义（P<0.05）。 结论 在常规康复治疗基础上对脑卒中偏瘫患者进行核心肌训练可显著改善脑卒中后偏瘫患者的平衡能力。     

非受累侧上肢运动训练对脑卒中患者躯干控制与平衡功能的影响

目的：探讨非受累侧上肢运动训练对脑卒中患者躯干控制能力及平衡功能的影响。方法：选取我科收治的脑卒中患者36例，随机分配至试验组与对照组各18例，两组患者均接收常规康复治疗，试验组在此基础上增加非受累侧上肢运动训练，训练4周后评估两组患者的TIS、BBS、TUG以及ABC评分。结果：治疗后两组TIS、BBS、TUG和ABC均显著改善（P<0.001），试验组TIS(t=2.94,P=0.006)、BBS(t=2.82,P=0.006)、TUG(t=3.70,P=0.001)和ABC(t=﹣2.17,P=0.037)均显著优于对照组，差异有显著性意义。结论：非受累侧上肢运动训练可以提高脑卒中患者躯干控制能力和平衡功能。     

香港版偏瘫上肢功能测试评定脑卒中患者上肢功能的效度和信度研究

目的探讨香港版偏瘫上肢功能测试(FTHUE-HK)评定脑卒中患者上肢功能的效度和信度。 方法采用FTHUE-HK、Fugl-Meyer量表上肢部分(FMA)和改良巴氏指数(MBI)对42例入选脑卒中患者在1周内进行2次评定,分析其FTHUE-HK、FMA和MBI评定结果,并验证FTHUE-HK的效度;分析2次FTHUE-HK的评定结果,验证FTHUE-HK的重测信度和评估者间信度。 结果2次FTHUE-HK评定结果与FMA总分具有高度相关性（r=0.981、0.982,P<0.01）,且与MBI总分高度相关（r=0.892、0.896,P<0.01）。FTHUE-HK的重测结果和组间结果高度相关,其重测组内相关系数ICC=0.983,组间相关系数ICC=0.985。 结论FTHUE-HK量表评定脑卒中后上肢功能状况具有良好的效度和信度。     

坐立试验评价脑卒中患者平衡功能的研究

目的：以5次坐立试验（five—times—sit—to—stand test，FTSST）评定脑卒中患者平衡功能，并与其他平衡量表比较，探讨其临床应用的稳定性和相关因素。方法：按条件选择脑卒中患者66例（实验组）和正常人63例（对照组）。采用5次坐立试验、BBS评定、FM—B评定、Barthel指数和步行速度进行测试，对脑卒中患者和正常人两组资料进行比较分析。结果：实验组与对照组之间5次坐立试验时间的差异均有非常显著性意义（P〈0．01）。实验组患者中5次坐立试验时间与BBS评定、FM—B评定、Barthel指数及步行速度之间的相关系数分别为-0．873（P〈0．01）、-0．826（P〈0．011、-0．740（P〈0．01）、-0．876（P〈0．01）。结论：FTSST临床评测脑卒中患者平衡功能的稳定性好，方法简便实用，干扰因素少，可用于临床评定脑卒中患者的平衡功能。     

两种平衡量表在脑卒中患者平衡功能评定的实用性研究

目的探讨Berg平衡功能评定表(BBS)和Fugl-Meyer平衡功能评定表(FM-B)在脑卒中患者平衡功能评定的临床实用性及相关性。方法对68例脑卒中患者，于平衡功能训练前后分别应用BBS和FM-B由专人进行评定，然后对每位患者进行静态姿势平衡测试仪(BPM)测试。BPM测试分别在睁眼和闭眼状态下进行，取摆幅指数(SI)、摆动的轨迹长(ing)、外周面积(area)进行分析。结果治疗前后比较，FM-B评定无显著性差异(P＞O．05)；BBS评定和BPM各检测指标均有非常高度显著性差异(P＜O．001)；FM-B与BBS之间呈中度的正相关(r=O．517，P＜O．001)，FM-B与BPM各观察指标之间无相关性(r=-O．074～-O．247，P＞O．05)；BBS与BPM各观察指标之间呈中度负相关(r=-O．410～-O．587，P＜O．01～O．001)。结论BBS与BPM在评定脑卒中患者平衡功能方面具有良好的一致性，都可以反映患者的平衡状态；但FM-B对治疗前后的效果评定敏感性较差，其临床实用性较低。     

三种量表评定脑卒中急性期患者姿势控制能力的分析研究

目的探讨3种量表在评定脑卒中急性期患者姿势控制能力方面的应用情况。方法对45例脑卒中急性期患者分别采用脑卒中患者姿势评定量表（PASS）、Fugl—Meyer平衡量表（FM—B）及Berg平衡量表（BBS）对其姿势控制能力进行评定。所有病例均评定3次，评定时间分别为脑卒中起病后1周内、起病第3周时及出院前。选用Spearman统计法分析3种量表间的相关性；并同时计算3种量表的地板效应及天花板效应。结果PASS与FM—B及BBS间均具有高度相关性（r=0.867—0．957，P〈0．01）；在本研究各次评定中，PASS无明显的地板效应和天花板效应，而FM-B和BBS在第1次评定时均存在明显的地板效应（FM—B为26．6％．BBS为26．6％）。结论PASS与FM—B及BBS均能客观反映脑卒中急性期患者的姿势控制能力，而且PASS还能对脑卒中患者的卧位姿势控制能力进行评定，故在评定脑卒中急性期患者姿势控制能力方面，PASS优于FM—B和BBS。     

脑卒中患者平衡功能与自理能力的相关性

摘要 目的:评估脑卒中患者的平衡功能,以助于确定脑卒中严重程度、判断预后和制定康复方案。本研究观察Berg平衡功能评定表(BBS)和Fugl-Meyer平衡功能评定表(FM-B)在脑卒中偏瘫患者临床上的实用价值,并探讨平衡能力与日常生活活动能力的相关性。 方法：将符合条件的38例住院脑卒中偏瘫患者纳入本研究,对其进行3周的康复治疗,于康复治疗前后分别采用BBS、FM-B以及改良的Barthel指数（MBI）进行评定,对所得资料进行比较分析。 结果：康复治疗后患者BBS、FM-B、MBI评分均有增加,治疗前后各评分差异性比较,其中FM-B为P<0.05,BBS和MBI均为P<0.01。患者康复治疗前的BBS、FM-B评分与康复治疗前MBI评分的相关系数分别为0.58和0.55（P<0.05);患者康复治疗前的BBS、FM-B评分与康复治疗后MBI评分的相关系数分别为0.75和0.69（P<0.01)。 结论:BBS与FM-B都可反映急性脑卒中患者的平衡能力,在平衡功能评定上都有良好的一致性,但BBS对效果评定更为敏感,临床使用性更高;平衡功能与自理能力有较密切的相关性,平衡功能的缺失对脑卒中患者生存质量有显著的影响,可预测生存质量。 关键词 脑卒中;平衡功能;平衡量表;日常生活活动能力;康复 中图分类号：R743.3,R493 文献标识码：A 文章编号：1001-1242（2010）-02-0149-03     

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.     

Evaluation of the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS) in patients with acute stroke

OBJECTIVE: To investigate the inter-rater reliability and validity of the Swedish version of the Modified Elderly Mobility Scale (Swe M-EMS). DESIGN: A correlation study. SETTING: A stroke unit which provides acute care and rehabilitation for all stroke admissions in Northern Alvsborg County Hospital, Sweden. SUBJECTS: Thirty consecutive patients with an acute first-time stroke. Seventeen were women and 13 were men, with a median age of 79 years (41-92) and with a median hospital stay of 21 days (8-35). INTERVENTION: The patients were assessed twice with the Swe M-EMS on admission and at discharge, before and after midday, by two independent physiotherapists. They were assessed by an independent physiotherapist using the three evaluation instruments on admission, once a week during their hospital stay and at discharge. MAIN OUTCOME MEASURES: The primary evaluation instrument was the Swe M-EMS. The two other evaluation instruments were the Modified Motor Assessment Scale of Uppsala Akademiska Sjukhus-95 (M-MAS UAS-95) and the Berg Balance Scale (BBS). RESULTS: The Swe M-EMS was a reliable instrument (ICC 0.98-0.99). It correlated well with both the M-MAS UAS-95 (r(s) = 0.69-0.88) and the BBS (r(s) = 0.86-0.94). The Swe M-EMS was sensitive to change over time, but the patients obtained the maximum score quickly. CONCLUSION: The instrument shows a high inter-rater reliability. The Swe M-EMS correlates well with both the M-MAS UAS-95 and the BBS and is sensitive to change. However, it is not sensitive enough to use as a single instrument in evaluating the improvement of a patient with acute stroke.     

The relative and absolute reliability of two balance performance measures in chronic stroke patients

PURPOSE: To examine the relative reliability and absolute reliability of the Berg Balance Scale (BBS) and the Postural Assessment Scale for Stroke Patients (PASS) in chronic stroke patients. METHOD: A total of 52 mild to moderate stroke patients, who had a stroke more than 6 months previously, participated in the study. Both balance measures were administered twice, seven days apart, to the patients. A relative reliability index (intra-class correlation coefficient, ICC2,1) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement (SEM), and the smallest real differences (SRD), were used to define the extent to which a balance score varies on test-retest measurements. RESULTS: Test-retest agreements were high (ICC2,1: BBS = 0.98; PASS = 0.97), indicating excellent agreement from a relative perspective. The SEM of the BBS and PASS, representing the smallest change threshold that indicates a real improvement for a group of individuals, were 2.4 and 1.1, respectively. The SRD of the BBS and PASS were 6.7 and 3.2, respectively, exhibiting the smallest change threshold that indicates a real improvement for a single individual. CONCLUSIONS: The test-retest agreements of the BBS and PASS were high in mild to moderate chronic stroke patients. The thresholds of both measures to detect real change are acceptable in research and clinical settings.     

Berg balance scale: intrarater test-retest reliability among older people dependent in activities of daily living and living in residential care facilities

BACKGROUND AND PURPOSE: The Berg Balance Scale (BBS) is frequently used to assess balance in older people, but knowledge is lacking about the absolute reliability of BBS scores. The aim of this study was to investigate the absolute and relative intrarater test-retest reliability of data obtained with the BBS when it is used among older people who are dependent in activities of daily living and living in residential care facilities. SUBJECTS: The participants were 45 older people (36 women and 9 men) who were living in 3 residential care facilities. Their mean age was 82.3 years (SD=6.6, range=68-96), and their mean score on the Mini Mental State Examination was 17.5 (SD=6.3, range=4-30). METHODS: The BBS was assessed twice by the same assessor. The intrarater test-retest reliability assessments were made at approximately the same time of day and with 1 to 3 days in between assessments. Absolute reliability was calculated using an analysis of variance with a 95% confidence level, as suggested by Bland and Altman. Relative reliability was calculated using the intraclass correlation coefficient (ICC). RESULTS: The mean score was 30.1 points (SD=15.9, range=3-53) for the first BBS test and 30.6 points (SD=15.6, range=4-54) for the retest. The mean absolute difference between the 2 tests was 2.8 points (SD=2.7, range=0-11). The absolute reliability was calculated as being 7.7 points, and the ICC was calculated to .97. DISCUSSION AND CONCLUSION: Despite a high ICC value, the absolute reliability showed that a change of 8 BBS points is required to reveal a genuine change in function among older people who are dependent in activities of daily living and living in residential care facilities. This knowledge is important in the clinical setting when evaluating an individual's change in balance function over time in this group of older people.     

Translation and validation of the Swedish version of the mini-BESTest in subjects with Parkinson's disease or stroke: A pilot study

Recently, a comprehensive clinical balance test, the balance evaluation systems test (BESTest), was developed to identify the postural control systems causing balance impairments. A short version, the mini-BESTest, was thereafter developed by eliminating redundant and insensitive items. This study aimed to translate the mini-BESTest to Swedish, adapt it and investigate its validity in subjects with Parkinson's disease (PD) or stroke. The Mini-BESTest was translated and back-translated in accordance with Guillemin's guidelines. Discrepancies were discussed and solved by a panel and the test was culturally adapted. Concurrent validity of the final version was explored by correlating well-known clinical tests - the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test and the Falls Efficacy Scale (FES(s)) - with the new mini-BESTest in nine subjects with mild-to-moderate PD (60 years, range 46-85) and nine with chronic stroke (78 years, range 66-90). A high-to-very-high correlation was shown between the mini-BESTest and the BBS (PD: r(s)?=?0.94, stroke: r(s)?=?0.86). The mini-BESTest correlated highly with the TUG (PD: r(s)?=?-0.81, stroke: r(s)?=?-0.89). In the PD group, a low correlation (r(s)?=?0.26) was seen between the mini-BESTest and the FES(s). The mini-BESTest has high concurrent validity and is a comprehensive assessment of balance. However, its psychometric properties should be evaluated further.