Dataset Information

Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke.

ABSTRACT: The Community Balance and Mobility Scale (CB&M) is increasingly used to evaluate walking balance following stroke.This study applied Rasch analysis to evaluate and refine the CB&M for use in ambulatory community-dwelling adults following stroke.The CB&M content was linked to task demands and motor skill classifications. Rasch analysis was used to evaluate internal construct validity (structural validity) and refine the CB&M for use with ambulatory community-dwelling adults following stroke. The CB&M data were collected at 3 time points: at discharge from inpatient rehabilitation and at 6 and 12 months postdischarge (N=238). Rasch analysis evaluated scale dimensionality, item and person fit, item response bias, scoring hierarchy, and targeting. Disordered scoring hierarchy was resolved by collapsing scoring categories. Highly correlated and "misfitting" items were removed. Sensitivity to change was evaluated with standardized response means (SRMs) and one-way repeated-measures analysis of variance.The CB&M was primarily linked to closed body transport task demands. Significant item-trait interaction, disordered scoring hierarchies, and multidimensionality were found. Scoring categories were collapsed in 15/19 items, and 5 misfitting items were removed. The resulting stroke-specific 14-item unidimensional CB&M (CB&MStroke) fit Rasch model expectations, with no item response bias, acceptable targeting (13% floor effects and 0% ceiling effects), and moderate-to-strong sensitivity to change at 6 months postdischarge (SRM=0.63; 95% confidence interval=-1.523, -0.142) and 12 months postdischarge (SRM=0.73; 95% confidence interval=-2.318, -0.760).Findings are limited to a modest-sized sample of individuals with mild-to-moderate balance impairment following stroke.The CB&MStroke shows promise as a clinical scale for measuring change in walking balance in ambulatory community-dwelling adults poststroke. Future studies are recommended in a larger sample to validate and further refine the scale for use in this clinical population.

SUBMITTER: Miller KJ

PROVIDER: S-EPMC5046192 | biostudies-literature | 2016 Oct

REPOSITORIES: biostudies-literature

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Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke.

Miller Kimberly J KJ Pollock Courtney L CL Brouwer Brenda B Garland S Jayne SJ

Physical therapy 20160414 10

<h4>Background</h4>The Community Balance and Mobility Scale (CB&M) is increasingly used to evaluate walking balance following stroke.<h4>Objective</h4>This study applied Rasch analysis to evaluate and refine the CB&M for use in ambulatory community-dwelling adults following stroke.<h4>Methods</h4>The CB&M content was linked to task demands and motor skill classifications. Rasch analysis was used to evaluate internal construct validity (structural validity) and refine the CB&M for use with ambula ...[more]

PMID: 27081206

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Project description:BACKGROUND:Gait-initiation onset (GI-onset) during sit-to-walk (STW) is commonly defined by mediolateral ground-reaction-force (xGRF) rising and crossing a threshold pre-determined from sit-to-stand peak xGRF. However, after stroke this method [xGRFthresh] lacks validity due to impaired STW performance. Instead, methodologies based upon instance of swing-limb maximum-vertical-GRF [vGRFmaxSWING], maximum-xGRF [xGRFmax], and swing-limb heel-off [firstHEELoff] can be applied, although their validity is unclear. Therefore, we determined these methodologies' validity by revealing the shortest transition-time (seat-off-GI-onset), their utility in routinely estimating GI-onset, and whether they exhibited satisfactory intra-subject reliability. METHODS:Twenty community-dwelling stroke (60 (SD 14) years), and twenty-one age-matched healthy volunteers (63 (13) years) performed 5 standardised STW trials with 2 force-plates and optical motion-tracking. Transition-time differences across-methods were assessed using Friedman tests with post-hoc pairwise-comparisons. Within-method single-measure intra-subject reliability was determined using ICC3,1 and standard errors of measurement (SEMs). RESULTS:In the healthy group, median xGRFthresh transition-time was significantly shorter than xGRFmax (0.183s). In both the healthy and stroke groups, xGRFthresh transition-times (0.027s, 0.695s respectively) and vGRFmaxSWING (0.080s, 0.522s) were significantly shorter than firstHEELoff (0.293s, 1.085s) (p<0.001 in all cases). GI-onset failed to be estimated in 48% of stroke trials using xGRFthresh. Intra-subject variability was relatively high but was comparable across all estimation methods. CONCLUSION:The firstHEELoff method yielded significantly longer transition-times. The xGRFthresh method failed to routinely produce an estimation of GI-onset estimation. Thus, with all methods exhibiting low, yet comparable intra-subject repeatability, averaged xGRFmax or vGRFmaxSWING repeated-measures are recommended to estimate GI-onset for both healthy and community-dwelling stroke individuals.

Dataset Information

Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke.

Publications

Use of Rasch Analysis to Evaluate and Refine the Community Balance and Mobility Scale for Use in Ambulatory Community-Dwelling Adults Following Stroke.

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