Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation

Kristensen, Morten Tange; Nielsen, Anni Østergaard; Topp, Ulla Madsen; Jakobsen, Berit; Nielsen, Kirsten Juel; Juul‐Larsen, Helle Gybel; Jakobsen, Thomas

doi:10.1016/j.gaitpost.2013.08.017

Cited by 22 publications

(41 citation statements)

References 20 publications

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“…Adopting this test procedure reduces the number of trials to be collected, since there is no longer a need to determine each individual’s period of stable performance post-hoc. Thus, administrative burden of the proposed narrowing beam-walking test (Appendix SI 1 ) would be similar to that of existing single-task balance tests, such as the Timed Up and Go (3–6 trials) (26, 31), Four Square Step Test (3 trials) (28), and the Single Leg Stance Test (5 trials) (32) and less than multiple-task tests such as the Berg Balance Scale (33), Dynamic Gait Index (34) or Fullerton Advanced Balance scale (35). …”

Section: Discussionmentioning

confidence: 96%

“…This may be particularly important with balance tests, as measuring an individual’s best performance over a small number of trials may overestimate their ability and underestimate the presence of deficits that contribute to fall risk. Notably, developers often recommend scoring a test using the best trial (28, 29) even when consecutive trials in performance-based tests are shown to vary (26, 27, 30). Thus, it remains unclear to what extent an individual’s best performance on a clinical test is representative of his or her true ability.…”

Section: Discussionmentioning

confidence: 99%

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Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Sawers¹,

Hafner²

2018

J Rehabil Med

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Objective: Challenging clinical balance tests are needed to expose balance deficits in lower-limb prosthesis users. This study examined whether narrowing beam-walking could overcome conceptual and practical limitations identified in fixed-width beam-walking. Design: Cross-sectional. Participants: Unilateral lower-limb prosthesis users. Methods: Participants walked 10 times along a low, narrowing beam. Performance was quantified using the normalized distance walked. Heuristic rules were applied to determine whether the narrowing beam task was “too easy,” “too hard,” or “appropriately challenging” for each participant. Linear regression and Bland-Altman plots were used to determine whether combinations of the first 5 trials could predict participants’ stable beam-walking performance. Results: Forty unilateral lower-limb prosthesis users participated. Narrowing beam-walking was appropriately challenging for 98% of participants. Performance stabilized for 93% of participants within 5 trials, while 62% were stable across all trials. The mean of trials 3–5 accurately predicted stable performance. Conclusion: A clinical narrowing beam-walking test is likely to challenge a range of lower-limb prosthesis users, have minimal administrative burden, and exhibit no floor or ceiling effects. Narrowing beamwalking is therefore a clinically viable method to evaluate lower-limb prosthesis users’ balance ability, but requires psychometric testing before it is used to assess fall risk.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Sawers¹,

Hafner²

2018

J Rehabil Med

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“…The OLST is commonly used in rehabilitation programs, and is suggested as a predictor of the 1‐year post‐amputation functional level . Within the first 2 weeks after the index amputation, all patients able to stand up using their non‐amputated leg, therefore, also were evaluated with the standardized OLST . This was carried out to examine the feasibility of the BAMS in comparison with the OLST in dysvascular amputee patients.…”

Section: Methodsmentioning

confidence: 99%

“…The one‐leg stand test (OLST) using the unaffected leg 2 weeks after a lower extremity amputation (LEA) has been proposed as a predictor of function and prosthetic use 1 year post‐amputation . Thus, prosthetic fitting is associated with improved quality of life, and is the long‐term goal for most patients after a LEA, although early postural control seems extremely limited . However, prosthetic fitting is not possible in every patient after a major LEA, and particularly not in every dysvascular amputee, and not the primary focus of today's acute in‐hospital rehabilitation programs .…”

Section: Introductionmentioning

confidence: 99%

“…Further, to target the early rehabilitation optimally, and to monitor the day‐to‐day progress in such basic activities considered essential for the lower limb amputee patient, a valid, reliable and easily applicable measurement is required. However, although a large number of amputee measurements exist, they commonly include scoring of walking and prosthetic use, while, to our knowledge, none of them specifically seem to target the activities considered the most basic for the LEA patient . Through consensus meetings with experienced amputee physiotherapists, we, therefore, developed the Basic Amputee Mobility Score (BAMS), with four items and three response categories, and similar to that previously established for the reliable and easily applicable Cumulated Ambulation Score .…”

Section: Introductionmentioning

confidence: 99%

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Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation

Kristensen

Nielsen

Topp

et al. 2017

Geriatrics Gerontology Int

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Aim: To develop and examine the psychometric properties, including responsiveness and interrater reliability, of a new outcome measure for the evaluation of basic mobility activities after a major lower extremity amputation -The Basic Amputee Mobility Score (BAMS). Methods:The four following essential activities were chosen through consensus meetings with experienced amputee physiotherapists: (i) supine in bed to sitting on the edge of the bed; (ii) bed to wheelchair transfer; (iii) indoor wheelchair mobility; and (iv) get up from a wheelchair to standing on the non-amputated leg. Each activity is scored from 0 to 2 (0 = not able to; 1 = able to with assistance/guiding; and 2 = independent), and cumulated to a 1-day BAMS score of 0-8. Validity and responsiveness were established in 106 consecutive in-hospital patients with a major dysvascular lower extremity amputation, while reliability and agreement were examined in an additional sample of 30 patients.Results: The 30-day mortality risk was reduced by 88% (HR = 0.12, 95% CI 0.02-0.68) for those out of bed (BAMS ≥2 points) at the first physiotherapy assessment, while BAMS scores improved between the first and the discharge assessment, with a standardized response mean of 1.3. Reliability assessments resulted in a weighted Kappa value of 0.98, a standard error of measurement of 0.32 and a minimal detectable change of 0.89 points. No systematic between-rater bias was seen (P = 0.3). Conclusions:The BAMS was feasible in all patients, and showed a large responsiveness, excellent interrater reliability and with a change of 1 point indicating a real change in performances. Geriatr Gerontol Int 2017; ••: ••-••.

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Characterizing Practice Effects in Performance‐Based Tests Administered to Users of Unilateral Lower Limb Prostheses: A Preliminary Study

Sawers

Hafner

2020

PM&R

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Background Performance‐based tests are viewed as a gold standard for measuring physical capability. Practice effects, however, may threaten their predictive, discriminative, and evaluative applications. Despite these potential consequences, practice effects have received limited attention in users of lower limb prostheses (LLP). Objective To perform an initial characterization of the occurrence, time‐course, and magnitude of practice effects in three performance‐based tests administered to users of LLP. Design Secondary analysis of data from a multisite repeated‐measures study. Setting Outpatient clinic and research laboratory. Participants Convenience sample of established ambulatory users of unilateral transtibial and transfemoral prostheses (n = 60). Intervention Not applicable. Main Outcome Measures Practice effects were identified as significant changes in slope of participants' cumulative trial‐by‐trial records. The occurrence, time‐course, and magnitude of practice effects were computed for the Timed Up and Go (TUG), Four Square Step Test (FSST), and the 10‐m Walk Test (10mWT). Results Across tests, practice effects were observed in 45% to 76% of participants. The proportion of participants with practice effects (ie, occurrence) was significantly greater for the FSST than the 10mWT (P = .008). The median number of trials (ie, time‐course) required for participants to reach a consistent level of performance was not significantly different between tests (FSST: 4 trials, TUG: 4 trials; 10mWT: 3.5 trials; P = .481). Practice effect magnitude (ie, difference between the mean of trials during the plateau and best performance over the first two trials) was significantly greater than zero for the FSST (1.6 s; 16%) and TUG (1.4 s; 13%) (P < .05). Conclusion Results indicate that the FSST, TUG, and 10mWT were susceptible to practice effects in this sample of users of LLP. Practice effects may obscure significant differences in walking and balance ability, and thereby, in the absence of modifications, limit the use of these tests for making individual patient clinical decisions and analyzing group‐level data.

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Number of test trials needed for performance stability and interrater reliability of the one leg stand test in patients with a major non-traumatic lower limb amputation

Cited by 22 publications

References 20 publications

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Narrowing beam-walking is a clinically feasible approach for assessing balance ability in lower-limb prosthesis users

Development and psychometric properties of the Basic Amputee Mobility Score for use in patients with a major lower extremity amputation

Characterizing Practice Effects in Performance‐Based Tests Administered to Users of Unilateral Lower Limb Prostheses: A Preliminary Study

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