Development and validation of an innovative tool for the assessment of biomechanical strategies: The Timed “Up and Go” – Assessment of Biomechanical Strategies (TUG-ABS) for individuals with stroke

Abstract

Objective: To develop and validate a clinical tool based on the biomechanical strategies exhibited by people with hemiparesis due to stroke during the performance of the Timed "Up and Go" test. Design/methods: The Timed "Up and Go" Assessment of Biomechanical Strategies (TUG-ABS) was developed for subjects with stroke, based on the analyses of 3 sources of information: published evidence; opinions of rehabilitation professionals; and observations of TUG performances, followed by a multi-step approach, which involved the investigation of the reliability, content, and criterion-related validity of the preliminary version. Content validity was established by an expert panel, whereas intra-and inter-rater reliability was established by two independent examiners. Criterion-related validity was established by comparing the TUG-ABS scores at the item level obtained by independent analyses of video observations and the gold standard motion analysis system. The final tool included the items, which showed acceptable values for these psychometric properties. Results: The preliminary version consisted of 24 items with 3 response categories. Twenty-one items showed acceptable content validity (0.72 ≤ κ ≤ 1.00; p ≤ 0.01), 19 acceptable intraand inter-rater reliability (0.36 ≤ κ ≤1.00; p ≤ 0.04), and 15 acceptable criterion-related validity (0.29 ≤ κ ≤ 1.00; p ≤ 0.04). Conclusion:The final developed 15-item TUG-ABS version proved to be valid and reliable for individuals with hemiparesis due to stroke, but it should be clinically validated before being used for clinical applications and research purposes.Key words: stroke; assessment; mobility; instrument development; reliability; content validity. J Rehabil Med 2013; 45: 232-240 Correspondence address: Luci F. Teixeira-Salmela, Department of Physical Therapy, Universidade Federal de Minas Gerais, Avenida Antônio Carlos, 6627, Campus Pampulha, 31270-901 Belo Horizonte, Minas Gerais, Brazil. E-mail: lfts@ufmg.br. Accepted Oct 9, 2012; Epub ahead of print Feb 6, 2013 INTRODUCTIONStroke remains one of the most common causes of long-term disability worldwide and is a major public health concern (1). Thus, the understanding of the disabilities following stroke is a high priority for healthcare systems. Among all of the common disabilities of stroke survivors, those related to functional mobility are the most prevalent and disabling (2), and are the primary targets for rehabilitation.A widely recommended test to assess functional mobility after stroke (3-7) is the Timed "Up and Go" (TUG) (6), proposed as a modified timed version of the "Get-up and Go" test (8). The TUG has shown high levels of validity to assess functional mobility (6), is highly reliable (3, 5) and responsive (3, 4) for individuals with stroke, and is able to differentiate between people with stroke from the healthy elderly population (5) and people with stroke with various degrees of disabilities (4). It can also be used as a predictive measure of disabilities (4). Finally, the TUG is easily administered, ...

Gait parameters predicted by Timed Up and Go performance in stroke patients

“…Moreover, kinematics and kinetics might provide more information than spatio-temporal parameters, supplying knowledge of the mechanisms behind the movement disorder (Olney, 1994;Vaughan, 1996;Winter, 1981;Kim, 2003). This assumption is in accordance with Faria et al (2013) who suggested that TUG performance time does not provide sufficient information for clinicians (Faria, 2013).…”

Timed Up and Go test: Comparison of kinematics between patients with chronic stroke and healthy subjects

“…TUG performance is slower following stroke [7], [8], however, little is known regarding the motor strategies used by patients. Biomechanical analysis of each sub-task has thus been recommended [9], [10]. A recent study determined the spatiotemporal and kinematic parameters that were most related to the walking and turning sub-tasks of TUG performance in patients with stroke [11].…”

TUG-ABS Portuguese-Brazil: a clinical instrument to assess mobility of hemiparetic subjects due to stroke

“…Os procedimentos relacionados ao desenvolvimento do TUG-ABS e investigação inicial das suas propriedades de medida foram detalhadamente descritos em recente publicação relacionada à sua versão em inglês 16,17 . Em síntese, este processo consistiu de: -desenvolvimento da primeira versão do instrumento a partir da análise de três fontes de informações: a literatura científica, a opinião de 14 profissionais e a observação do desempenho no TUG de 22 indivíduos hemiparéticos pós-AVC e 22 indivíduos controle, saudáveis, pareados quanto ao sexo, idade e nível de atividade física.…”

“…Para a investigação da validade de construto do TUG-ABS, os profissionais receberam a versão final do instrumento em Português-Brasil (Anexo 1) com informações sobre os procedimentos a serem adotados para que o questionário aberto de avaliação da validade de construto pudesse ser adequadamente respondido. Estes procedimentos foram: avaliar seus pacientes com hemiparesia pós-AVC utilizando o TUG-ABS na versão Português-Brasil, preparar um local adequado e orientar o indivíduo para a realização do TUG 16,17 .…”

“…Com o objetivo de atender a estas demandas, recentemente foi desenvolvido um instrumento de medida, denominado Timed "Up and Go" Assessment of Biomechanical Strategies (TUG-ABS) 16 , para a identificação de estratégias biomecânicas adotadas por indivíduos hemiparéticos pós-AVC durante o desempenho no TUG. As propriedades de medida já investigadas para o TUG-ABS apresentaram resultados adequados: validade de conteúdo (estabelecida por um painel de especialistas), validade de critério concorrente (comparação com as medidas do sistema de análise de movimento, considerado padrão ouro para a avaliação do movimento humano), validade de construto por métodos tradicionais (comparação de grupos conhecidos, análise de convergência e análise discriminante), confiabilidade teste-reteste e inter-examinadores por análise de vídeo e por análise observacional direta 16,17 .…”