• Physical Therapy Rehabilitation Science
• /
• v.13 no.2
• /
• pp.143-151
• /
• 2024

Objective: This study aims to assess the test-retest reproducibility of the Short Form Berg Balance Scale (SF-BBS) and the Short Form Postural Assessment Scale for Stroke (SF-PASS) among chronic stroke survivors, focusing on their reliability for consistent measurements over time. Design: A cross-sectional study design Methods: Thirty chronic stroke survivors participated in this study, undergoing evaluations with SF-BBS and SF-PASS scales at two different points, separated by a seven-day interval. The analysis focused on test-retest reliability, employing statistical measures such as the Intra-Class Coefficient (ICC_2,1), Standard Error of Measurement (SEM), Minimal Detectable Change (MDC), and MDC%, the Bland-Altman plot to assess the limits of agreement and the extent of random measurement error. Results: The study found notable test-retest reproducibility for both SF-BBS and SF-PASS, with ICC values demonstrating strong reliability (0.932 to 0.941, with a confidence interval of 0.889 to 0.973). SEM values for SF-BBS and SF-PASS were reported as 1.34 and 0.61, respectively, indicating low measurement error. MDC values of 3.71 for SF-BBS and 1.69 for SF-PASS suggest that the scales have an acceptable level of sensitivity to change, with reliability metrics falling below 20% of the maximum possible score. Conclusions: The findings suggest that both SF-BBS and SF-PASS exhibit high intra-class correlation coefficients, indicating strong test-retest reliability. The SEM and MDC values further support the scales' reproducibility and reliability as tools for evaluating mobility and dynamic balance in chronic stroke survivors. Therefore, these scales are recommended for clinical use in this population, providing reliable measures for assessing progress in rehabilitation.

• Journal of the Korean Society of Physical Medicine
• /
• v.19 no.3
• /
• pp.55-63
• /
• 2024

PURPOSE: This study examined the test-retest reliability and clinical utility of the Modified Trunk Impairment Scale (mTIS), Trunk Control Test (TCT), and Postural Assessment Scale for Stroke - Trunk Control (PASS-TC) in patients with chronic stroke. METHODS: Thirty-eight stroke patients were reassessed using the mTIS, TCT, and PASS-TC with a seven-day interval between assessments. The test-retest reliability was evaluated using the intraclass correlation coefficient (ICC_2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and MDC%, as well as Bland-Altman analysis. The relationship between the mTIS, TCT, PASS-TC scores, and the Barthel Index (BI) was also investigated. RESULTS: The test-retest reliability for the mTIS, TCT, and PASS-TC was high, with ICC values ranging from .91 to .94 (95% confidence interval: .83-.97). The MDCs for the mTIS and TCT were 2.35 and 13.9, respectively, while the MDC for the P ASS-TC was 2.54, all below 20% of the maximum possible score, indicating reliable measurement. The optimal mTIS cut-off score for distinguishing between mild (75-95 points) and severe (50-74 points) dependence on the BI was ≥ 9.5, with an accuracy of 79%. Patients with an mTIS score ≥ 9.5 (out of 15) showed an 18-fold higher likelihood of achieving a mild level of functional independence than those with a score < 9.5. CONCLUSION: The mTIS, TCT, and PASS-TC showed high test-retest reliability and no systematic errors in chronic stroke patients. The MDC values were reliable, indicating meaningful change. Among these, the mTIS is a sensitive and a useful tool for predicting functional independence in clinical practice and is straightforward to apply.

• The Journal of Korean Physical Therapy
• /
• v.29 no.3
• /
• pp.145-151
• /
• 2017

Purpose: The purpose of this study was to investigate the validity and reliability of the measurement of shoulder joint motions using an inertial measurement unit (IMU). Methods: For this study, 33 participants (32 females and 1 male) were recruited. The subjects were passively positioned with the shoulder placed at specific angles using a goniometer (shoulder flexion $0^{\circ}-170^{\circ}$, abduction $0^{\circ}-170^{\circ}$, external rotation $0^{\circ}-90^{\circ}$, and internal rotation $0^{\circ}-60^{\circ}$ angles). Kinematic data on the shoulder joints were simultaneously obtained using IMU three-dimensional (3D) angular measurement (MyoMotion) and photographic measurement. Test-retest reliability and concurrent validity were examined. Results: The MyoMotion system provided good to very good relative reliability with small standard error of measurement (SEM) and minimal detectable change (MDC) values from all three planes. It also presented acceptable validity, except for some of shoulder flexion, shoulder external rotation, and shoulder abduction. There was a trend for the shoulder joint measurements to be underestimated using the IMU 3D angular measurement system compared to the goniometer and photo methods in all planes. Conclusion: The IMU 3D angular measurement provided a reliable measurement and presented acceptable validity. However, it showed relatively low accuracy in some shoulder positions. Therefore, using the MyoMotion measurement system to assess shoulder joint angles would be recommended only with careful consideration and supervision in all situations.

• The Journal of Korean Physical Therapy
• /
• v.33 no.4
• /
• pp.187-192
• /
• 2021

Purpose: The purpose of the current study was to determine the intra- and inter-rater reliability of muscle thickness measurement of the TA using ultrasonography (US) conducted at different inward pressures of approximately 0.5 kg, 1.0 kg, and no pressure control. Methods: Twenty healthy subjects were recruited for this study. Two different examiners measured the thicknesses of the dominant TA of each subject randomly to assess the intra- and inter-rater reliability. The measurement values were analyzed using the intra-class correlation coefficient (ICC) with a 95% confidence interval, standard error of measurement, minimal detectable change, and coefficient of variance. Results: All intra-rater reliability ICC values showed high reliability above 0.9. Inter-rater reliability ICC values showed high reliability above 0.9 with 0.5 and 1.0 kg of inward pressure. In contrast, Inter-rater reliability ICC values showed poor reliability (0.23) with no pressure control of inward pressure. Conclusion: The findings showed that maintaining consistent inward pressure is essential for reliable results when the muscle thickness of the TA is measured by different examiners in a clinical setting.

• Journal of The Korean Society of Integrative Medicine
• /
• v.5 no.1
• /
• pp.43-53
• /
• 2017

Purpose : To examine the relative absolute reliability and validity of step test (ST) scores in subjects with chronic stroke. Method : A total of 27 stroke patients, participated in the study. A relative reliability index (intraclass correlation coefficient, ICC) was used to examine the level of agreement of inter-rater test-retest reliability for ST score. Absolute reliability indices, including the standard error of measurement(SEM) and the minimal detectable change (MDC), and limits of agreement by Bland and Altman analysis. The validity was demonstrated by spearman correlation of ST score with 10 m Walk Test (10mWT), Fugl-Meyer Assessment-Lower/Extremity (FMA-L/E)-total score, Berg Balance Scale (BBS)-total score. Result : An excellent inter-rater reliability in ST scores was found (paretic, ICC=0.993~0.996; nonparetic, ICC=0.982~0.991). In addition, excellent test-retest reliability was found (paretic, ICC=0.992; nonparetic, ICC=0.967). It all showed acceptable SEM of the ST score as paretic and nonparetic were 0.22 and 0.46 respectively (average score <10 %), and the MDC of the paretic and nonparetic were 0.61 and 1.27 respectively (possible highest score <20 %). indicating that measures had a small and acceptable measurement error. The ST score of paretic and nonparetic were also found to be significantly associated with 10MWT (r=0.77~0.79), FMA-LE scores (r=0.73~0.81) and BBS scores (r=0.72~0.76). Conclusion : The ST showed highly sufficient Inter-rater test-retest agreement and validity and acceptable measurement errors caused by due to chance variation in measurement. It also can be used by clinicians and researchers to assess the balance and mobility performance and monitor functional change in chronic stroke patients.

• PNF and Movement
• /
• v.16 no.3
• /
• pp.405-414
• /
• 2018

Purpose: The purpose of this study was to examine test-retest reliability and criterion-related validity of a trunk stability robot when measuring the weight-bearing symmetry static sitting and standing in stroke patients. Methods: For 27 stroke patients, weight-bearing symmetry was assessed twice, 7 days apart. The intraclass correlation coefficient (ICC2,1) and minimal detectable change (MDC) were used to examine the level of agreement between test and retest. The criterion-related validity of weight -bearing symmetry was demonstrated by Spearman correlation of modified Barthel index (MBI), the sit to stand test (STS), the timed up & go Test (TUG), and the function in sitting test (FIST). Results: the test-retest agreements were excellent for the weight-bearing symmetry of static sitting (ICC2,1: 0.90) and standing (ICC2,1: 0.89). It all showed that the acceptable MDC for the weight-bearing symmetry of static sitting and standing was 0.11 and 0.16, respectively (highest possible score<20 %), indicating that the measures had a small and acceptable degree of measurement error. The weight-bearing symmetry of static sitting was significantly correlated with the TUG(r=-0.45) and FIST(r=0.46)(p<0.05); the weight-bearing symmetry of static standing was also significantly correlated with MBI (r=0.65), TUG (r=-0.67), FIST (r=0.61)(p<0.01), and STS (r=-0.47)(p<0.05). Conclusion: The weight-bearing symmetry of static sitting and standing assessed by the trunk stability robot showed highly sufficient test-retest agreement and mild-to-moderate validity. It could also be useful for clinicians and researchers to evaluate balance performance and monitor functional change in stroke patients.

• Physical Therapy Rehabilitation Science
• /
• v.6 no.3
• /
• pp.152-157
• /
• 2017

Objective: The aim of this study was to determine the intra-rater and inter-rater reliability of the dual rehabilitative ultrasound imaging (D-RUSI) when simultaneously measuring muscle thickness changes at rest and during co-contraction of the biceps brachii (BB) and triceps brachii (TB). Design: Cross-sectional study. Methods: This study included 36 healthy participants (23 men, 13 women). The participants sat on a chair in a comfortable position with a cushion placed under their elbow to maintain a 90-degree elbow flexion angle. The muscle thickness of the biceps brachii and triceps brachii was measured twice using the D-RUSI by two examiners during resting and co-contraction states. One week later, the same procedure was performed once again. Results: The intra-class correlation coefficients (ICCs) for intra-rater reliability ranged from 0.887 to 0.989 and the confidence interval was within an acceptable range of 0.778 to 0.994. The standard error of measurement (SEM) values ranged from 0.303 to 0.866 and the minimal detectable change (MDC) values ranged from 0.84 to 2.40. The ICCs for inter-rater reliability ranged from 0.758 to 0.925. The SEM values ranged from 0.702 to 1.486 and the MDC values ranged from 1.95 to 4.12. Conclusions: The use of the D-RUSI of the BB muscle had a very good intra-rater reliability and very good inter-rater reliability at the resting state, and a, good inter-rater reliability at the co-activation state. ICC values showed very good intra-reliability and inter-reliability for the TB muscle. the D-RUSI is a useful tool for simultaneously measuring the thickness of two muscles when the BB is an agonist and the TB is an antagonist during co-activation of the upper arm.

• Physical Therapy Rehabilitation Science
• /
• v.8 no.4
• /
• pp.218-224
• /
• 2019

Objective: This reliability study examined the effects of applying varying induced inward pressures using a transducer placed at 0° neutral ankle position (NEU) and 15° ankle dorsiflexion (DF) on tibialis anterior (TA) muscle thickness using a custom-made device with a force indicator during rehabilitative ultrasound imaging. Design: Cross-sectional study. Methods: Twenty-four healthy subjects were recruited in this study. Two examiners measured the muscle thickness of the TA at 0° NEU and 15° DF in 3 conditions of inward pressures (1.0 N, 2.0 N, and 4.0 N) using a custom-made holder. The muscle thickness was measured three times for each of the conditions arranged in random order. For intra- and inter-rater reliability, the intraclass correlation coefficients (ICCs) with 95% confidence intervals, standard error of measurement, minimal detectable change, and coefficient of variation were analyzed. One-way repeated measures analysis of variance was conducted for investigating changes of TA muscle thickness according to the inward pressures of the transducers. Results: The intra-rater reliability of TA muscle thickness measurement was excellent (ICC_3,1: 0.92-0.96) for all conditions (at both ankle joint angles per varying inward pressure). Likewise, the inter-rater reliability of TA muscle thickness measurement was excellent (ICC_2,1: 0.89-0.97) under same conditions. The mean of TA thickness showed the trend of decreasing significantly with increased inward pressures at all ankle joint angles (p<0.05). Conclusions: Use of this custom-made device with a force indicator is useful to accomplish the high intra- and inter-rater reliability of TA muscle thickness measurement at both ankle joint angles in reducing the measurement error.

• Physical Therapy Rehabilitation Science
• /
• v.6 no.1
• /
• pp.7-13
• /
• 2017

Objective: The aim of this study was to investigate the inter-rater and intra-rater reliability of rehabilitative ultrasound imaging (RUSI) for measurement of muscle thickness with changes in angles of the gluteus maximus (GM) at rest and during contraction. Design: Cross-sectional study. Methods: Twenty-two healthy men volunteered for this study. GM muscle images were obtained in the resting position and during prone hip extension with knee flexion at hip abduction angles of $0^{\circ}$ and $30^{\circ}$, respectively. Two examiners randomly measured the thickness of the GM twice in three different positions. The first position was a comfortable prone position. The second position was prone hip extension with knee flexion (PHEKF) to $90^{\circ}$. The third position was achieved by hanging a 1-kg weight on the ankle of the lifted leg during PHEKF with the angle of the lifted leg the same as the second position. Intra-class correlation coefficients (ICCs), standard error measurements, and minimal detectable changes were used to estimate reliability. Results: The intra-rater reliability ICCs (95% confidence interval) of the GM were >0.870, indicating good reliability. Inter-rater reliability ICCs ranged from 0.668 to 0.913. The reliability of measurements of muscle thickness at each position was similar to the reliability of the angle change. Differences in muscle thickness and ratios for each position with $0^{\circ}$ and $30^{\circ}$ of hip abduction were not statistically significant. Conclusions: In the present study, the intra-rater reliability of muscle thickness measurements of the GM was good, and the inter-rater reliability was moderate to good. Reliable RUSI measurements of wide and large muscles, such as the GM muscle at rest and during contraction, are feasible. Further investigation is required to establish the reproducibility of the protocols presented in this study.

• Journal of the Korean Society of Physical Medicine
• /
• v.9 no.2
• /
• pp.201-211
• /
• 2014

PURPOSE: The purpose of this study was to investigate the inter-rater absolute reliability and the concurrent validity of the Tinetti-gait scale that was translated into Korean for chronic stroke patients. METHODS: Fifty-two patients with post-stroke participated in this study. Inter-rater reliability was analyzed by Intraclass Correlation Coefficient ($ICC_{3,1}$) and Kappa coefficient, and absolute reliability was analyzed by the Standard Error of Measurement (SEM), and the Minimal Detectable Change (MDC). Concurrent validity was analyzed by correlating between the Tinetti-gait scale and physical functions. The physical functions were measured by using the Dynamic Gait Index(DGI), 10m walking test(10WT), One Leg Standing Test of affected/non-affected side(OLST), Sit to Stand test(STS), (Fugl Meyer assessment of Lower Extremity(FM-LE). RESULTS: The inter-rater reliability of the Tinetti-gait scale was high; $ICC_{(3,1)}=.91$ (95% CI=.85~.95) (very reliable), the range of Kappa coefficient were .73~.92 (substantial~good). The inter-rater agreement of the each item in Tinetti-gait scale ranged from .74 to .92 (95 % CI=.59~.95) (reliable~very reliable). The SEM and MDC were .56 and 1.55, respectively. In the results of concurrent validity, there were moderate positive correlation between Tinetti-gait scale and DGI (r=.78), 10WT (r=.74), OLST (r=.65~.73), FM-LE (r=67). And there was moderate negative correlation between Tinetti-gait scale and STS (r=-79) (p<.01). CONCLUSION: The Tinetti-gait scale(Korean version) was a reliable and valid tool to measure gait ability in patients with chronic stroke. Thus, it could be a useful tool for examining a gait ability of post-stroke patients. Further study should be conducted to investigate the usability to predict fall risk of post-stroke patients of the Tinetti-gait scale.