Psychometric Properties of a Core Set of Measures of Balance for People With Cerebellar Ataxia Secondary to Multiple Sclerosis

Stanley Winser; Catherine M Smith; Leigh A Hale; Leica S Claydon; Susan L Whitney; Brooke Klatt; John Mottershead; Islam Zaydan; Rock Heyman

doi:10.1016/j.apmr.2016.07.023

Psychometric Properties of a Core Set of Measures of Balance for People With Cerebellar Ataxia Secondary to Multiple Sclerosis

Arch Phys Med Rehabil. 2017 Feb;98(2):270-276. doi: 10.1016/j.apmr.2016.07.023. Epub 2016 Aug 27.

Authors

Stanley Winser¹, Catherine M Smith², Leigh A Hale², Leica S Claydon³, Susan L Whitney⁴, Brooke Klatt⁵, John Mottershead⁶, Islam Zaydan⁷, Rock Heyman⁸

Affiliations

¹ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong. Electronic address: stanley.j.winser@polyu.edu.hk.
² School of Physiotherapy, University of Otago, Dunedin, NZ.
³ Department of Allied and Public Health, Anglia Ruskin University, Chlemsford, UK.
⁴ School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Research Chair, King Saud University, Riyadh, Saudi Arabia.
⁵ School of Health and Rehabilitation Sciences, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
⁶ Department of Neurology, Southern District Health Board, Dunedin Public Hospital, Dunedin, NZ.
⁷ Departments of Neurology and Ophthalmology, School of Medicine, Neurology, University of Pittsburgh, Pittsburgh, PA.
⁸ Pittsburgh Institute for Multiple Sclerosis Care and Research at the University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Neuroimmunology and Multiple Sclerosis, University of Pittsburgh, Pittsburgh, PA.

PMID: 27577181
DOI: 10.1016/j.apmr.2016.07.023

Abstract

Objective: To examine the reliability, validity, and interpretability of 4 clinical measures in assessing the severity of balance dysfunction among people with cerebellar ataxia (CA) secondary to multiple sclerosis (MS).

Design: Cross-sectional observation study.

Setting: Outpatient clinics.

Participants: Consecutive participants with CA secondary to MS (N=60).

Interventions: Not applicable.

Main outcome measures: Balance was assessed and video recorded using the Berg Balance Scale (BBS), timed Up and Go (TUG) test, posture and gait subcomponent of the International Co-operative Ataxia Rating Scale (ICARS), and gait, stance, and sit subcomponents of the Scale for the Assessment and Rating of Ataxia (SARA). The videos were later used to estimate reliability. The Barthel Index, Expanded Disability Status Scale (EDSS), ICARS, and SARA were assessed, and disease duration was recorded.

Results: Reliability was good for all 4 measures (intraclass correlation coefficient range, .95-.99). Internal consistency was moderate to good for all 4 measures (α range, .72-.94), with a moderate to good correlation between the measures of balance (Spearman ρ range, .72-.85) and poor to moderate correlation with disease severity (EDSS), functional independence (Barthel Index), and disease duration (Spearman ρ range, -.37 to .76). Minimal detectable change was derived for the BBS (3), posture and gait subcomponent of the ICARS (2), and gait, stance, and sit subcomponents of the SARA (2). Measures were able to discriminate between assistive walking device users and nonusers.

Conclusions: All 4 measures showed good reliability and acceptable validity; however, because of the item repetition in scoring of the posture and gait subcomponent of the ICARS and moderate construct, criterion, and convergent validity of the TUG, the BBS and gait, stance, and sit subcomponents of the SARA are recommended for balance assessment in clinical practice for people with CA secondary to MS.

Keywords: Cerebellar ataxia; Multiple sclerosis; Postural balance; Psychometrics; Rehabilitation.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Canes
Cerebellar Ataxia / etiology*
Cerebellar Ataxia / rehabilitation*
Cross-Sectional Studies
Disability Evaluation*
Female
Gait / physiology
Humans
Male
Middle Aged
Multiple Sclerosis / complications*
Multiple Sclerosis / rehabilitation*
Observer Variation
Physical Therapy Modalities / standards*
Postural Balance / physiology
Psychometrics
Reproducibility of Results
Severity of Illness Index
Walkers

Associated data

ANZCTR/ACTRN12613000079741