Merske lastnosti de Morton indeksa premičnosti pri pacientih z mišično-kostnimi okvarami

Zupanc, Aleksander (author), Puh, Urška (mentor), Novak, Primož (comentor)

Uvod: Premičnost je pomemben kazalnik funkcioniranja posameznika. Za oceno sposobnosti izvajanja gibalnih dejavnosti sta pri pacientu ključni oceni ravnotežja in premičnosti. De Morton indeks premičnosti (angl. de Morton mobility index – DEMMI) je standardizirano merilno orodje za oceno premičnosti, ki vključuje izvedbo 15 nalog. Namen: Prevesti DEMMI v slovenščino in ugotoviti njegove merske lastnosti pri pacientih z mišično-kostnimi okvarami na rehabilitaciji. Metode dela: V postopku prevajanja in medkulturne prilagoditve, s katerim smo ugotavljali tudi zanesljivost med preiskovalci za slovenski prevod DEMMI, je sodelovalo devet preiskovancev z mišično-kostnimi okvarami, povprečno starih 78 let (SO 6 let; razpon 71–85 let), vključenih v rehabilitacijo. Za ugotavljanje veljavnosti, odzivnosti, najmanjše klinične pomembne razlike, učinka tal in stropa smo s prevodom DEMMI, razvrstitvijo funkcijske premičnosti, testom hoje na 10 metrov, 6-minutnim testom hoje, Bergovo lestvico za oceno ravnotežja in motoričnim delom lestvice funkcijske neodvisnosti ocenili 30 pacientov povprečno starih 54 let (SO 18 let; razpon 22−84 let), z mišično-kostnimi okvarami, z ali brez okvar perifernega živčevja. Ocenjevanje je potekalo ob sprejemu na rehabilitacijo, po dveh in po štirih tednih obravnave. Za oceno veljavnosti smo izračunali Spermanov koeficient korelacije (ro) med ocenami DEMMI in izidi drugih merilnih orodji. Razlike v ocenah merilnih orodij med ocenjevanji smo ugotavljali s testom t za odvisne vzorce. Za ugotavljanje veljavnosti za znane skupine smo izračunali parni t test za neodvisne vzorce. Za oceno odzivnosti smo uporabili metodo izračuna velikosti učinka. Najmanjšo klinično pomembno razliko smo ugotavljali z metodo izračuna razpršenosti, učinek tal in stropa pa z deleži preiskovancev, ki so dosegli najnižje ali najvišje možno število točk. Rezultati: Zanesljivost med preiskovalci je bila odlična (τ = 0,82–0,97). Sočasna veljavnost DEMMI je bila dobra do zelo dobra (ro = 0,55–0,92). Preiskovanci, ki niso hodili, so imeli statistično značilno nižje ocene DEMMI (povprečje 26; SO 8) v primerjavi s tistimi, ki so hodili s hoduljo (povprečje 33; SO 4) ali berglami (povprečje 44; SO 8). Z DEMMI smo zaznali velike razlike premičnosti po dveh tednih (velikost učinka = 1,15) in še večje razlike po štirih tednih (velikost učinka = 1,97). Najmanjša klinično pomembna razlika je bila 5 točk, učinka tal in stropa za DEMMI nismo ugotovili. Zaključki: Slovenski prevod DEMMI je razumljiv. DEMMI je pri pacientih z mišično-kostnimi okvarami na rehabilitaciji, ne glede na starost, veljavno in občutljivo merilno orodje, ki loči raven premičnosti za znane skupine preiskovancev ter nima učinka tal in stropa. Ocenjevanje z DEMMI je kljub različnim vzrokom in ravnmi zmanjšane sposobnosti premikanja pri preiskovancih, pokazalo izboljšanje premičnosti po dveh in po štirih tednih rehabilitacije, zato ga priporočamo za uporabo v fizioterapiji. Prevod DEMMI bo objavljen za uporabo v Sloveniji.

• Language: Slovenian
• Keywords: DEMMI, fizioterapija, merilno orodje, merske značilnosti, premikanje
• Work type: Master's thesis/paper
• Organization: ZF - Faculty of Health Sciences
• Year: 2017
• PID: 20.500.12556/RUL-98098
• COBISS.SI-ID: 5335659
• Publication date in RUL: 16.11.2017

Secondary language

• Language: English
• Title: Metric properties of de Morton mobility index in patients with musculoskeletal impairments

Abstract

Introduction: Mobility is an important indicator of individual functioning. Patient’s balance and mobility are the key issues for assessment of ability to perform motor activities. De Morton mobility index (DEMMI) is a standardized measurement tool for mobility assessment and includes 15 items. Purpose: to translate DEMMI into Slovenian language and determine metric properties of the translation in patients with musculoskeletal impairments participating in rehabilitation. Methods: nine participants with musculoskeletal impairments in rehabilitation, aged 78 years on average (SD 6 years; range 71–85 years) were included in the inter-rater reliability pilot study, which was part of the cross-cultural adaptation process. In the study of validity, responsiveness, minimal clinical important difference, floor and ceiling effects, 30 patients with musculoskeletal impairments with or without impairments of peripheral nerves, aged 54 years on average (SD 18 years; range 22–84 years), were assessed with the translation of DEMMI, functional ambulation classification, 10 meter walk test, 6 minute walk test, Berg balance scale and motor part of functional independence measure. Assessment was performed at admission to rehabilitation, after two and four weeks of treatment. Spearman’s correlation coefficient calculation (rho) between DEMMI and other measurement tools was used for evaluating validity. Differences in the scores of each measurement tool were established with paired t test. For the known groups validity independent t test was calculated. The effect size was used to calculate measurement responsiveness. Minimal clinical important difference was calculated using the distribution based method, and floor and ceiling effects with percentage of participants who scored the lowest or highest scale score. Results: The inter-rater reliability was excellent (τ = 0.82–0.97). Concurrent validity for DEMMI was good to very good (rho = 0.55–0.92). Participants who were not able to walk had significant lower DEMMI scores (average 26; SD 8) than participant who walked with walker (average 33; SD 4) or crutches (average 44; SD 8). DEMMI was highly responsive to change mobility after two weeks (effect size = 1.15), and even higher after four weeks (effect size = 1.97). Minimal clinical important difference was 5 points, no floor and ceiling effects were identified. Conclusions: Slovenian translation of DEMMI is comprehensible. It is valid and sensitive measurement tool, which differentiates mobility level of known-groups participants, and has no floor or ceiling effects in patients with musculoskeletal impairments in rehabilitation, regardless of age. Despite different causes and levels of mobility decline in patients’ assessment with DEMMI showed improvement of mobility after two and four weeks of rehabilitation, therefore we recommended it for use in physiotherapy. A translation of DEMMI will be published for use in Slovenia.

• Keywords: DEMMI, physiotherapy, outcome measurement, psychometric properties, mobility