Rudolf M1, Vidmar G2, Goljar N1
1University Rehabilitation Institute Republic of Slovenia, Department for Rehabilitation of Persons after Stroke, Ljubljana, Slovenia, 2University Rehabilitation Institute Republic of Slovenia, Head of Biostatistics and Scientific Informatics, Ljubljana, Slovenia
Background: A procedure or rule for quickly selecting the most appropriate measurement scale for assessing balance in persons after stroke is desirable. High-quality assessment is required for setting appropriate rehabilitation goals and selecting the most appropriate therapy.
Purpose: We wanted to base the rule on the Functional Ambulation Categories (FAC) test, which should enable us to choose among three scales (Berg Balance Scale - BBS, Modified mini-BESTest - mMBT, and the Functional Gait Assessment - FGA) is the most sensitive for a given person after stroke.
Methods: We included 88 persons after stroke (mean age 56 years, range 24 - 79 years), among them 32 women; 48 with left-sided, 38 with right-sided and two with bilateral impairment. Mean time since stroke was 4 month (range from two weeks to one year). Inclusion criteria were: first admission to inpatient rehabilitation, first stroke, ability to follow instructions (MMSE ≥ 25), informed consent, and ability to walk independently or aided by one person (FAC 2 to 6). All the participants were assessed using all three tests at admission and after four weeks of therapy, i.e., mMBT (as agreed with the author we used a 4-point response scale, 0 - 3), BBS and FGA. To avoid patient fatigue, we performed the tests on three consecutive days (in random order).
Results: The analysis of gain in test score over the four weeks by initial FAC score category revealed that for the participants with FAC = 2 or 3, the BBS was by far the most sensitive (mean gain 9.2 as compared to 4.0 or less for other two tests); for the participants with FAC = 4 or 5, mMBT (mean gain 4.5) and BBS (mean gain 4.6) were more sensitive than the FGA (mean gain 3.4); and for participants with FAC = 6, the mMBT (mean gain 3.6) and the FGA (mean gain 3.0) were much more sensitive than the BBS (mean gain 1.1, exhibiting ceiling effect because average initial score was over 54 points out of 56 possible). All those differences were statistically significant (p≤0.04 from ANOVA). These findings were confirmed by the pattern of correlations (Pearson r) of test score gains among each other and with the admission FAC score. Similarly, a floor effect was observed for mMBT and FGA if the participant´s admission FAC was 2 or 3.
Conclusion(s): We found that for assessing balance in persons after stroke with admission FAC 2 or 3, only the BBS should be used; for those with FAC 4 or 5, either the BBS or the mMBT can be used; and for those with admission FAC 6, the mMBT and the FGA are suitable, whereas the BBS is inefficient because of ceiling effect.
Implications: FAC is a quick and simple scale that can facilitate the decision which assessment scale to use for balance assessment of persons after stroke with a given mobility level in order to gain adequate insight into their balance impairments.
Keywords: ambulation categories, assessment balance scales, stroke
Funding acknowledgements: None
Purpose: We wanted to base the rule on the Functional Ambulation Categories (FAC) test, which should enable us to choose among three scales (Berg Balance Scale - BBS, Modified mini-BESTest - mMBT, and the Functional Gait Assessment - FGA) is the most sensitive for a given person after stroke.
Methods: We included 88 persons after stroke (mean age 56 years, range 24 - 79 years), among them 32 women; 48 with left-sided, 38 with right-sided and two with bilateral impairment. Mean time since stroke was 4 month (range from two weeks to one year). Inclusion criteria were: first admission to inpatient rehabilitation, first stroke, ability to follow instructions (MMSE ≥ 25), informed consent, and ability to walk independently or aided by one person (FAC 2 to 6). All the participants were assessed using all three tests at admission and after four weeks of therapy, i.e., mMBT (as agreed with the author we used a 4-point response scale, 0 - 3), BBS and FGA. To avoid patient fatigue, we performed the tests on three consecutive days (in random order).
Results: The analysis of gain in test score over the four weeks by initial FAC score category revealed that for the participants with FAC = 2 or 3, the BBS was by far the most sensitive (mean gain 9.2 as compared to 4.0 or less for other two tests); for the participants with FAC = 4 or 5, mMBT (mean gain 4.5) and BBS (mean gain 4.6) were more sensitive than the FGA (mean gain 3.4); and for participants with FAC = 6, the mMBT (mean gain 3.6) and the FGA (mean gain 3.0) were much more sensitive than the BBS (mean gain 1.1, exhibiting ceiling effect because average initial score was over 54 points out of 56 possible). All those differences were statistically significant (p≤0.04 from ANOVA). These findings were confirmed by the pattern of correlations (Pearson r) of test score gains among each other and with the admission FAC score. Similarly, a floor effect was observed for mMBT and FGA if the participant´s admission FAC was 2 or 3.
Conclusion(s): We found that for assessing balance in persons after stroke with admission FAC 2 or 3, only the BBS should be used; for those with FAC 4 or 5, either the BBS or the mMBT can be used; and for those with admission FAC 6, the mMBT and the FGA are suitable, whereas the BBS is inefficient because of ceiling effect.
Implications: FAC is a quick and simple scale that can facilitate the decision which assessment scale to use for balance assessment of persons after stroke with a given mobility level in order to gain adequate insight into their balance impairments.
Keywords: ambulation categories, assessment balance scales, stroke
Funding acknowledgements: None
Topic: Outcome measurement; Neurology: stroke; Research methodology & knowledge translation
Ethics approval required: Yes
Institution: Univerzitetni rehabilitacijski inštitut - SOČA
Ethics committee: Komisija za medicinsko etiko - URI Soča
Ethics number: 42401
All authors, affiliations and abstracts have been published as submitted.
