File
Sjöholm H1,2, Hägg S1,3, Nyberg L4, Rolander B3, Kammerlind A-S1,3
1Linköping University, Department of Medical and Health Sciences, Linköping, Sweden, 2Region Jönköping County, Rehabilitation Centre, Jönköping, Sweden, 3Region Jönköping County, Futurum, Jönköping, Sweden, 4Luleå University of Technology, Department of Health Sciences, Luleå, Sweden
Background: Persons with stroke are less successful in obstacle avoidance during walking, have slower muscular reactivity to balance perturbations and have an increased risk of falling compared with controls. Physical exercise can improve the ability to negotiate obstacles while walking which decreases the fall incidence. We developed the Cone Evasion Walk test (CEW) to assess fall risk by the ability to evade obstacles. This test can be performed with or without a walking aid and to the best of our knowledge no such test has previously been published.
Purpose: To estimate the reliability and validity of the CEW, a new test assessing the ability to evade obstacles, in persons with acute stroke.
Methods: To estimate the reliability of the CEW, video recordings of 20 persons with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n=221), Functional Ambulation Classification (FAC) (n=204), Timed Up & Go (TUG) (n=173), TUG cognitive (TUG-cog) (n=139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA-S7) (n=127) and the Star Cancellation Test (SCT) (n=151). These tests and side of lesion (n=143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n=203).
Results: The intra-class correlation coefficients for intra- and inter-rater reliability were 0.88−0.98. For validity, there were significant correlations between the CEW and FAC (rs=-0.67), TUG (rs =0.45), MoCA-S7 (rs =-0.36) and SCT total score (rs =-0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs =-0.23) and right (rs =0.23) side in the SCT. Among right hemisphere stroke participants (n=79), significantly more persons hit cones on the left side (n=25) than the right side (n=8), whereas among those with a left hemisphere stroke (n=64) significantly more persons hit cones on the right side (n=11) than the left (n=3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (Hazard ratio 2.11, 95% CI 1.07−4.17) compared with those who touched none.
Conclusion(s): The new CEW test was reliable and valid in assessing the ability to evade obstacles while walking and to predict falls in persons with acute stroke. Further research is needed to evaluate the test-retest reliability.
Implications: The results of this study show that the CEW test can be used to reliably assess the ability of persons with acute stroke to evade obstacles while walking and to predict falls. The test complements the existing range of assessments for subjects with impaired attention and proactive gait control.
Keywords: Walking, stroke, accidental falls
Funding acknowledgements: Supported by grants from Futurum, Region Jönköping County, The Swedish Stroke National Association, and Medical Research Council of Southeast Sweden.
Purpose: To estimate the reliability and validity of the CEW, a new test assessing the ability to evade obstacles, in persons with acute stroke.
Methods: To estimate the reliability of the CEW, video recordings of 20 persons with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n=221), Functional Ambulation Classification (FAC) (n=204), Timed Up & Go (TUG) (n=173), TUG cognitive (TUG-cog) (n=139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA-S7) (n=127) and the Star Cancellation Test (SCT) (n=151). These tests and side of lesion (n=143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n=203).
Results: The intra-class correlation coefficients for intra- and inter-rater reliability were 0.88−0.98. For validity, there were significant correlations between the CEW and FAC (rs=-0.67), TUG (rs =0.45), MoCA-S7 (rs =-0.36) and SCT total score (rs =-0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs =-0.23) and right (rs =0.23) side in the SCT. Among right hemisphere stroke participants (n=79), significantly more persons hit cones on the left side (n=25) than the right side (n=8), whereas among those with a left hemisphere stroke (n=64) significantly more persons hit cones on the right side (n=11) than the left (n=3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (Hazard ratio 2.11, 95% CI 1.07−4.17) compared with those who touched none.
Conclusion(s): The new CEW test was reliable and valid in assessing the ability to evade obstacles while walking and to predict falls in persons with acute stroke. Further research is needed to evaluate the test-retest reliability.
Implications: The results of this study show that the CEW test can be used to reliably assess the ability of persons with acute stroke to evade obstacles while walking and to predict falls. The test complements the existing range of assessments for subjects with impaired attention and proactive gait control.
Keywords: Walking, stroke, accidental falls
Funding acknowledgements: Supported by grants from Futurum, Region Jönköping County, The Swedish Stroke National Association, and Medical Research Council of Southeast Sweden.
Topic: Outcome measurement; Neurology: stroke
Ethics approval required: Yes
Institution: Department of Medical and Health Sciences, Linköping University, Sweden
Ethics committee: Regional Ethical Review Board in Linköping
Ethics number: 2013/14-31, 2013/132-32, 2013/291-32, 2017/577-32, 2017/578-32
All authors, affiliations and abstracts have been published as submitted.
