Zanesljivost, veljavnost in učinek stropa slovenskega prevoda funkcijske ocene hoje za paciente z okvaro hrbtenjače

Špoljar, Janez (author), Puh, Urška (mentor), Goljar Kregar, Nika (co-mentor)

Uvod: Ocenjevanje funkcijske sposobnosti za hojo je eden od ključnih ocenjevalnih postopkov v fizioterapevtski obravnavi pacientov z okvaro hrbtenjače. Funkcijska ocena hoje za paciente z okvaro hrbtenjače (angl. spinal cord injury functional ambulation inventory – SCI-FAI) je standardizirano merilno orodje, ki vključuje oceno kinematike, pripomočkov in premičnosti, specifično za to skupino pacientov. Namen: Oceniti zanesljivost posameznega preiskovalca, zanesljivost med preiskovalci, sočasno veljavnost in učinek stropa slovenskega prevoda SCI-FAI. Metode dela: V raziskavi je sodelovalo 30 pacientov z nepopolno okvaro hrbtenjače. Zanesljivost smo ugotavljali za del SCI-FAI, s katerim ocenjujemo kinematiko hoje. Veljavnost in učinek stropa smo ugotavljali za dela SCI-FAI, s katerima ocenjujemo uporabo pripomočkov in premičnost. Zanesljivosti posameznega preiskovalca smo izračunali za pet preiskovalcev. En preiskovalec je hojo preiskovancev prvič ocenil v živo, drugič z video posnetka. Ostali štirje preiskovalci, med katerimi smo ugotavljali tudi zanesljivost med preiskovalci, so dvakrat ocenjevali z video posnetka. Za obe obliki zanesljivosti smo izračunali intraklasne korelacijske koeficiente (ICC). Za oceno veljavnosti smo izračunali vrednosti Pearsonovih (r) in Spearmanovih (ro) korelacijskih koeficientov med omenjenimi deli SCI-FAI in testom hoje na 10 metrov, indeksom hoje za paciente z okvaro hrbtenjače (angl. Walking index for spinal cord injury – WISCI) ter 6-minutnim testom hoje. Učinek stropa smo izrazili v odstotkih preiskovancev, ki so dosegli največje možno število točk. Rezultati: Povprečna vrednost pri ocenjevanju SCI-FAI kinematike je bila 18,8 točk, SCI-FAI pripomočkov 11,9 točke, SCI-FAI premičnosti 4,5 točke, na 2-minutnem testu hoje 138,3 metre, testu hitre hoje na 10 metrov 1,3 m/s, na WISCI 17,6 točke in na 6-minutnem testu hoje 403,6 metra. Ugotovili smo visoko zanesljivost posameznega preiskovalca (ICC = 0,821−0,860) in nizko (ICC = 0,463) do srednjo (ICC = 0,611) zanesljivost med preiskovalci. Sočasna veljavnost je bila dobra (ro = 0,608−0,621) do zelo dobra (r = 0,976−0,996; ro = 0,794−0,922) odvisno od primerjanih merilnih orodij. 46,6 % preiskovancev je doseglo največje število točk pri oceni pripomočkov, 73,3 % pri oceni premičnosti. Zaključek: Ugotovitve naše raziskave so skladne z avtorji SCI-FAI, ki so prav tako ugotovili visoko zanesljivost posameznega preiskovalca. Zaradi nizke do srednje zanesljivosti med preiskovalci, priporočamo, da s SCI-FAI hojo ocenjuje isti fizioterapevt pred in po obravnavi. Tudi rezultati sočasne veljavnosti in učinka stropa so v skladu s predhodnimi raziskavami. Nadaljnje raziskovanje bi morali usmeriti v razjasnitev razlogov za nizko do srednjo zanesljivost med preiskovalci. Smiselno bi bilo ugotoviti usklajenost med preiskovalci po posameznih s SCI-FAI kinematiko ocenjenih spremenljivkah hoje.

• Language: Slovenian
• Keywords: ocenjevanje hoje, merske lastnosti, nepopolna okvara hrbtenjače
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2017
• PID: 20.500.12556/RUL-92322
• COBISS.SI-ID: 5267563
• Publication date in RUL: 18.05.2017

Secondary language

• Language: English
• Title: Reliability, validity and ceiling effect of Slovenian translation of the spinal cord injury functional ambulation inventory

Abstract

Introduction: Assessment of functional gait ability is one of the key assessment procedures in physiotherapeutic treatment of patients with spinal cord injury. Spinal cord injury functional ambulation inventory (SCI-FAI) is a standardized outcome measure, which includes assessment of kinematics, assistive devices and mobility, specific for this patient group. Purpose: To evaluate intra-, interrater reliability, concurrent validity and ceiling effect of Slovenian translation of SCI-FAI. Methods: 30 patients with incomplete spinal cord injury participated in the study. Reliabiliy was assessed for the part of the instrument with which we assess gait kinematics. Validity and ceiling effect were assessed for part of the instrument with which we assess assistive devices and mobility. We calculated intrarater reliability for five raters. One rater assessed participants on-site for the first evaluation and from the video record for the second one. Other four raters, between which we also evaluated interrater reliability, assessed participants from the video record. We calculated intraclass correlation coefficients (ICC) for both reliability measures. For validity evaluation we calculated Pearsons (r) and Spearmans (ro) correlation coefficients between parts of the instrument and 10 meter walk test, Walking index for spinal cord injury (WISCI) and 6-minute walk test. Ceiling effect was reported as percentage of participants that achieved maximal possible score. Results: Average values on assessments of SCI-FAI kinematics was 18,8 points, SCI-FAI assistive devices 11,9 points, SCI-FAI mobility 4,5 points, on 2-minute walk test 138,3 meters, on fast 10 meter walk test 1,3 m/s, on WISCI 17,6 points and on 6-minute walk test 403,6 meters. We evaluated good intrarater reliability (ICC = 0,821– 0,860) and low (ICC = 0,463) to moderate (ICC = 0,611) interrater reliability. Concurrent validity was good (ro = 0,608–0,621) to excellent (r = 0,976–0,996; ro = 0,794–0,922) depending on the compared outcome measures. 46,6 % participants achieved maximal possible score for assistive devices assessment, 73,3 % for mobility assessment. Conclusion: Our findings are in concordance with authors of the SCI-FAI, that also evaluated good intrarater reliability. Due to low to moderate interrater reliability, we recommend, that gait assessment with SCI-FAI is done by the same physiotherapist before and after treatment. Results of validity and ceiling effect are also in concordance with previous research. Further research should point out the reasons for low to moderate interrater reliability. It would be meaningful to investigate consistency between raters regarding all SCI-FAI kinematics evaluated parameters.

• Keywords: gait assessment, psychometric properties, incomplete spinal cord injury