Activities with balance limitations among patients with perpheral arthritis : description and assessment
Author: Norén, Anne Marie
Date: 2008-09-15
Location: Sal 202, Alfred Nobels Allé 23
Time: 09.00
Department: Institutionen för neurobiologi, vårdvetenskap och samhälle / Department of Neurobiology, Care Sciences and Society
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Abstract
Background and aim: Patients with peripheral arthritis (PA) have several
impairments that can influence balance and be risk factors for falls and
fear of falling. Since disability varies among these patients, we need to
know what tests are applicable for those with differing degrees of
activity limitation. Only one balance capacity test, and no questionnaire
on balance difficulties, has been developed for patients with PA. More
differentiated balance capacity tests and self-reports validated for this
group are needed in order to prescribe and evaluate balance exercise
programmes tailored to individual needs. The overall aim of the work
reported in the thesis was to develop the assessment of activities with
balance limitations among patients with PA.
Material and Methods: For Study I, three samples of 65, 19 and 22 patients with PA and different degrees of activity limitation were recruited to investigate the applicability, the inter-rater-reliability and the intra-rater reliability, respectively, of the following assessments: walking on soft material, backwards and the figure-of-eight, the balance sub-scale of the Index of Muscle Function (IMF), the Timed Up-and-Go test (TUG) and the Berg Balance Scale (BBS). In Study II, three samples of 10, 22 and 20 female patients with PA participated. Activities with perceived balance limitations were identified from qualitative semi-structured interviews. A self-administered questionnaire (BAQ-PA) based on the interviews was constructed. The BAQ-PA was reviewed regarding content, and test-retest stability was examined twice with a oneweek interval. Construct validity was investigated by correlation to previous falls, activity limitation, self-rated balance limitation, fear of falling and capacity tests.
Results: In Study I, the TUG and the BBS were found applicable and most sensitive for patients with severe activity limitation. The figure of eight and the IMF were applicable and most sensitive for patients with moderate and low activity limitation. Inter-rater reliability was high (R>0.79) and intra-rater reliability was satisfactory for all assessments investigated. In Study II, perceived balance limitations were mainly related to outdoor activities. Test-retest-stability was good (Kw=0.71) for the suggested questionnaire (BAQ-PA) including 18 activities, which correlated higher to self-rated balance (rs=0.48) and activity avoidance because of balance limitation (rs=0.55) and previous falls (rs=0.49) than to capacity tests (rs<0.44), with the exception of the oneleg stance (rs=-0.75). The BAQ-PA score was significantly higher among those reporting fear of falling (p<0.05) than among those not doing so.
Conclusions: Some applicable and reliable balance capacity tests were identified for patients with severe, moderate and low activity limitations. More sensitive tests should be developed for those with no assessable activity limitation. Further, the present work reports a first step towards development of a valid and reliable balance questionnaire where the patient s perspective on individual activities and wishes for improvement receive attention.
Material and Methods: For Study I, three samples of 65, 19 and 22 patients with PA and different degrees of activity limitation were recruited to investigate the applicability, the inter-rater-reliability and the intra-rater reliability, respectively, of the following assessments: walking on soft material, backwards and the figure-of-eight, the balance sub-scale of the Index of Muscle Function (IMF), the Timed Up-and-Go test (TUG) and the Berg Balance Scale (BBS). In Study II, three samples of 10, 22 and 20 female patients with PA participated. Activities with perceived balance limitations were identified from qualitative semi-structured interviews. A self-administered questionnaire (BAQ-PA) based on the interviews was constructed. The BAQ-PA was reviewed regarding content, and test-retest stability was examined twice with a oneweek interval. Construct validity was investigated by correlation to previous falls, activity limitation, self-rated balance limitation, fear of falling and capacity tests.
Results: In Study I, the TUG and the BBS were found applicable and most sensitive for patients with severe activity limitation. The figure of eight and the IMF were applicable and most sensitive for patients with moderate and low activity limitation. Inter-rater reliability was high (R>0.79) and intra-rater reliability was satisfactory for all assessments investigated. In Study II, perceived balance limitations were mainly related to outdoor activities. Test-retest-stability was good (Kw=0.71) for the suggested questionnaire (BAQ-PA) including 18 activities, which correlated higher to self-rated balance (rs=0.48) and activity avoidance because of balance limitation (rs=0.55) and previous falls (rs=0.49) than to capacity tests (rs<0.44), with the exception of the oneleg stance (rs=-0.75). The BAQ-PA score was significantly higher among those reporting fear of falling (p<0.05) than among those not doing so.
Conclusions: Some applicable and reliable balance capacity tests were identified for patients with severe, moderate and low activity limitations. More sensitive tests should be developed for those with no assessable activity limitation. Further, the present work reports a first step towards development of a valid and reliable balance questionnaire where the patient s perspective on individual activities and wishes for improvement receive attention.
List of papers:
I. Norén AM, Bogren U, Bolin J, Stenström C (2001). "Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments." Physiother Res Int 6(4): 193-204
Pubmed
II. Norén AM, Olsson E, Opava CH (2008). "Activities with balance limitations among women with peripheral arthritis. Description and assessment." (Submitted)
I. Norén AM, Bogren U, Bolin J, Stenström C (2001). "Balance assessment in patients with peripheral arthritis: applicability and reliability of some clinical assessments." Physiother Res Int 6(4): 193-204
Pubmed
II. Norén AM, Olsson E, Opava CH (2008). "Activities with balance limitations among women with peripheral arthritis. Description and assessment." (Submitted)
Issue date: 2008-08-25
Rights:
Publication year: 2008
ISBN: 978-91-7409-095-6
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