Friedemann B.1, Luder G.1, Heldner M.2, Arnold M.2, Verra M.L.1
1Inselspital, Bern University Hospital, Institute for Physiotherapy, Bern, Switzerland, 2Inselspital, Bern University Hospital, Neurology, Bern, Switzerland
Background: Stroke is the most common reason for disability in adults. It results in decreasing balance, mobility and increases the risk of falling. Balance deficits reduce daily activities and quality of life, and extend recovery time from stroke. Postural control is necessary to maintain balance in static as well as dynamic activities. It is important to measure balance early to select an optimum therapy, predict ability of independently walking at discharge and evaluate treatment results. The Postural Assessment Scale for Stroke Patients (PASS) is used to assess static and dynamic balance especially for stroke patients in the acute and subacute phase. The PASS contains 12 items: 5 to assess static posture and 7 to evaluate dynamic balance.
Purpose: The aim of this study was to translate the PASS into German and investigate the interrater reliability and validity (construct and concurrent validity).
Methods: The English version was translated into German according to the international guidelines Recommendations for the Cross-Cultural Adaptation of the DASH & QuickDASH Outcome Measures. In this prospective study a total of 62 stroke patients (mean age 64 years; SD 12.7) were recruted maximum ten days poststroke. Twelve patients were assessed at the PASS in the interrater reliability study. All sessions were videotaped so that six additional raters could score them later independently of each other. The validity study included fifty patients. The concurrent validity was studied using the Berg-Balance-Scale (BBS). The BBS originally assessed balance ability and identified the risk of falling. The Construct validity was assessed by Functional-Independence-Measure (FIM) divided into FIM total, locomotion and transfer, just like the original study. The FIM assesses functional pysicals (e.g. eating, dressing, walking) and cognitive disability in terms of patients need for assistance. Statistical analysis included Friedman-Test, Kendalls W and Spearmans rho. The level of significance was set at p 0.05.
Results: The results showed that the German-PASS demonstrates a high interrater reliability (Kendalls W: one time 0.59 and eleven times ≥ 0.77 to 1), an excellent concurrent validity: high Spearmans correlation between PASS and BBS total score (r=0.93, P 10-16), static balance (r=0.91, P 10-16), dynamic balance (r=0.86, P 10-15) and an excellent construct validity: high Spearmans correlation between PASS and FIM total score (r=0.85, P 10-15), FIM locomotion (r=0.81, P 10-12) and FIM transfer (r=0.86, P 10-15). No floor and ceiling effects were observed.
Conclusion(s): The German-PASS is reliable and valid in assessing balance in persons with acute/subacute stroke. It is a useful clinical tool for evaluating static and dynamic balance in inpatients with stroke.
Implications: The PASS is an international common assessment in clinical practice and in scientific studies. However, in various stroke units an unvalidated German version is used. Now the PASS can be integrated in daily clinical practice in German-speaking countries. It will enable early recognition of motoric deficits and an individual target and therapy planning will be possible.
Funding acknowledgements: This study was supported by the Department of Physiotherapy, Inselspital, Bern University Hospital, Bern, Switzerland.
Topic: Professional practice: other
Ethics approval: The study was approved by the Ethics Committee of the Canton of Bern, Switzerland (Reference Number: 244/2015).
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