Responsiveness of two instruments for assessing balance in patients after thrombolyzed stroke in the acute phase
DOI:
https://doi.org/10.11606/issn.2317-0190.v28i2a183160Keywords:
Stroke, Postural Balance, RehabilitationAbstract
The Berg Balance Scale (BBS) and Postural Assessment for Stroke Scale (PASS) are useful and valid measurement tools in clinical practice. Objective: To compare the responsiveness of BBS and PASS in assessing the balance of post-stroke thrombolyzed individuals in the acute phase. Methods: This is a longitudinal analytical study, conducted in a Stroke Unit, in which BSS and PASS were applied in the first 24 hours and on the seventh day of hospitalization or on the day of discharge. To determine responsiveness, the Effect Size Index (ES) and the Standardized Response Mean (SRM) were adopted, and the soil and ceiling effect of both scales were also calculated. Results: 44 patients, predominantly male, mean age 60 (±13) years and median NIHSS 3.5 [1-6]. Both
assessment instruments detected improved balance. Both scales presented small ES, with the BBS ES being equal to 0.2 and PASS equal to 0.3. The SRM was moderate for both scales, with the SRM of the BBS equal to 0.7 and the PASS equal to 0.6. The PASS had a lower soil effect than BBS in the first 24 hours, and on the seventh day, BBS had a lower ceiling effect. Conclusion: PASS can be a best option for balance assessment in patients post-stroke in the first 24 hours, while BBS may be a better choice for evaluation from the seventh post-stroke in this specific population.
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References
Brasil. Ministério da Saúde. Manual de rotinas para atenção ao AVC. Brasília (DF): Ministério da Saúde; 2013.
Hankey GJ. Stroke. Lancet. 2017;389(10069):641-54. Doi: https://doi.org/10.1016/S0140-6736(16)30962-X
Araújo JP, Darcis JVV, Tomas ACV, Mello WA. Tendência da Mortalidade por Acidente Vascular Cerebral no Município de Maringá, Paraná entre os anos de 2005 a 2015. Int J Cardiovasc Sci. 2017;31(1):56-62. Doi: https://doi.org/10.5935/2359-4802.20170097
Makhoul MP, Maso I, Monteiro M, Rosa I, Vasconcelos L, Mascarenhas L, et al. Clinical and functional characteristics of young adult patients admitted in a stroke unit. Braz J Med Human Health. 2016;4(3):89-98. Doi: http://dx.doi.org/10.17267/2317-3386bjmhh.v4i3.964
Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064-89. Doi: https://doi.org/10.1161/STR.0b013e318296aeca
Lee H, Nam YS, Lee KM. Development-assistance Strategies for Stroke in Low- and Middle-income Countries. J Korean Med Sci. 2015;30 Suppl 2(Suppl 2):S139-42. Doi: https://doi.org/10.3346/jkms.2015.30.S2.S139
Muhl L, Kulin J, Dagonnier M, Churilov L, Dewey H, Lindén T, et al. Mobilization after thrombolysis (rtPA) within 24 hours of acute stroke: what factors influence inclusion of patients in A Very Early Rehabilitation Trial (AVERT)? BMC Neurol. 2014;14:163. Doi: https://doi.org/10.1186/s12883-014-0163-6
Rha JH, Saver JL. The impact of recanalization on ischemic stroke outcome: a meta-analysis. Stroke. 2007;38(3):967-73. Doi: https://doi.org/10.1161/01.STR.0000258112.14918.24
de Graaf JA, van Mierlo ML, Post MWM, Achterberg WP, Kappelle LJ, Visser-Meily JMA. Long-term restrictions in participation in stroke survivors under and over 70 years of age. Disabil Rehabil. 2018;40(6):637-45. doi: https://doi.org/10.1080/09638288.2016.1271466
Chan CKC, Chan DWC, Wong SKM. Evaluation of the functional independence for stroke survivors in the community. Asian J Gerontol Geriatr. 2009; 4(1):24-9.
Wagner JM, Lang CE, Sahrmann SA, Edwards DF, Dromerick AW. Sensorimotor impairments and reaching performance in subjects with poststroke hemiparesis during the first few months of recovery. Phys Ther. 2007;87(6):751-65. Doi: https://doi.org/10.2522/ptj.20060135
Singam A, Ytterberg C, Tham K, von Koch L. Participation in complex and social everyday activities six years after stroke: predictors for return to pre-stroke level. PLoS One. 2015;10(12):e0144344. Doi: https://doi.org/10.1371/journal.pone.0144344
Joseph C, Rhoda A. Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape. Afr Health Sci. 2013;13(3):646-54. Doi: https://doi.org/10.4314/ahs.v13i3.18
Matos I, Fernandes A, Maso I, Oliveira Filho J, Jesus PA, Fraga-Maia H, et al. Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study. PLoS One. 2020;15(5):e0233015. Doi: https://doi.org/10.1371/journal.pone.0233015
Daly JJ, Ruff RL. Construction of efficacious gait and upper limb functional interventions based on brain plasticity evidence and model-based measures for stroke patients. ScientificWorldJournal. 2007;7:2031-45. Doi: https://doi.org/10.1100/tsw.2007.299
Oliveira AIC, Silveira KRM. Utilização da CIF em pacientes com sequelas de AVC. Rev Neurociencias. 2011;19(4):653-62. Doi: https://doi.org/10.34024/rnc.2011.v19.8336
Berg K, Wood-Dauphinee S, Williams JI, Gayton D. Measuring balance in the elderly: preliminary development of an instrument. Physiother Canada. 1989;41(6):304-11. Doi: https://doi.org/10.3138/ptc.41.6.304
Huang YC, Wang WT, Liou TH, Liao CD, Lin LF, Huang SW. Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward. J Rehabil Med. 2016;48(3):259-64. Doi: https://doi.org/10.2340/16501977-2046
Chinsongkram B, Chaikeeree N, Saengsirisuwan V, Horak FB, Boonsinsukh R. Responsiveness of the Balance Evaluation Systems Test (BESTest) in People With Subacute Stroke. Phys Ther. 2016;96(10):1638-47. Doi: https://doi.org/10.2522/ptj.20150621
Huang YJ, Lin GH, Lee SC, Hsieh CL. A Comparison of the Responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in Patients With Severe Balance Deficits After Stroke. J Geriatr Phys Ther. 2020;43(4):194-8. Doi: https://doi.org/10.1519/JPT.0000000000000247
Miyamoto ST, Lombardi Junior I, Berg KO, Ramos LR, Natour J. Brazilian version of the Berg balance scale. Braz J Med Biol Res. 2004;37(9):1411-21. Doi: https://doi.org/10.1590/s0100-879x2004000900017
Vieira C, Fernandes S, Mimoso TP. Adaptação cultural e linguística e contributo para a validação da Escala de Avaliação postural para Pacientes com sequelas de AVE (PASS). EssFisi Online. 2008;4(1):50-65.
Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999;30(9):1862-8. Doi: https://doi.org/10.1161/01.str.30.9.1862
Cincura C, Pontes-Neto OM, Neville IS, Mendes HF, Menezes DF, Mariano DC, et al. Validation of the National Institutes of Health Stroke Scale, modified Rankin Scale and Barthel Index in Brazil: the role of cultural adaptation and structured interviewing. Cerebrovasc Dis. 2009;27(2):119-22. Doi: https://doi.org/10.1159/000177918
Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol. 2000;53(5):459-68. Doi: https://doi.org/10.1016/s0895-4356(99)00206-1
Cohen J. Statistical power analysis for the behavioral sciences: Jacob Cohen. J Am Stat Assoc. 1988;84(363):19-74.
McHorney CA, Ware JE Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32(1):40-66. Doi: https://doi.org/10.1097/00005650-199401000-00004
Portney L, Watkins M. Foundations of clinical research: applications to practice. 3rd ed. Norwalk: Appleton & Lange; 2007.
Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002;33(4):1022-7. Doi: https://doi.org/10.1161/01.str.0000012516.63191.c5
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