The Reliability, Validity, and Responsiveness of The Fall Risk Assessment Tool for Subjects with Stroke
Date Issued
2010
Date
2010
Author(s)
Kuo, Hsiao-I
Abstract
Background and Purpose: Previous studies have found the physical impairments of intrinsic factors were important risk factors for falls in subjects with stroke. One approach for assessing intrinsic fall risk was Physiological profile Assessment (PPA), which was developed in 1991 by Dr. Lord. To be practical in clinical setting, present study chose the short form of PPA which contained five components, i.e., vision, peripheral sensation, muscle force, reaction time, and balance. The aim of this study was to assess the reliability, acuuracy, and responsiveness of PPA-short form for subjects with stroke. Methods: Sixty subjects with stroke aged 52-81 years were recruited in the study (Mean STREAM= 65.4). We chose PPA-short form to assess the population. The short form contained 5 items: a test of vision (edge contrast sensitivity), proprioception, knee extension force, hand choice reaction time and body sway (sway when standing on the medium-density foam rubber mat). The method included three major parts. The first part was to examine the test-retest reliability of PPA among subjects with stroke on two occasions with one week apart by intraclass correlation coefficient (ICC) analysis. The second part was to calculate the association validity of the PPA to the other measures for fall risk (i.e., Berg balance scale) in subjects with stroke by the Pearson correlation coefficient. The PPA was also be analyzed between fallers and non-fallers for subjects with stroke, and the accuracy was analyzed with receiver operating characteristics curve (ROC-curve). The third part was to assess the responsiveness of PPA by investigating the changes after four weeks balance training in subjects with stroke. The results would help the fall risk assessment in clinics. Results: A strong correlation was observed between PPA overall fall risk score and Berg balance scale (r=-0.605). All PPA tests showed good test-retest reliability (ICC= 0.83-0.96). Twenty-two participants were classified as fallers. Significant differences were found between fallers and non-fallers on all physiological domains (p<0.05). The PPA classified 91% subjects into faller and non-faller group. All PPA variables showed moderate to large responsiveness (ES=0.5-4.8; SRM=3-41) except vision (ES=0.1; SRM=0.3). Conclusions: The PPA which demonstrated good reliability, accuracy and responsiveness was recommended as a good fall risk assessment tool for mild to moderate stroke.
Subjects
Fall
Assessment
Tool
Risk factor
Stroke
Type
thesis
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