Reliability and validity of the functional reach test in ambulatory multiple sclerosis patients

Yıl 2020, Cilt: 7 Sayı: 1, 56 - 63, 31.03.2020

Ayla Fil Balkan , Yeliz Salcı , Hilal Keklicek

Öz

Purpose: The aim of this study was to investigate the reliability and the validity of the Functional Reach Test in multiple sclerosis
(MS) patients.
Methods: Forty-six individuals with MS between the ages of 18-50 years, who were able to walk, between 1.5 and 5 according
to the Extended Disability Status Scale (EDSS) were included in the study. Functional Reach Test (FRT), Berg Balance Scale
(BBS) and computerized dynamic posturography (Limits of Stability Test (LOS): EndPoint Excursion, Maximum Excursion,
Directional Control, Movement Velocity, Reaction Time) were utilized. FRT was repeated after 3-7 days. To evaluate the
differentiation of FRT in MS patients between falling and non-falling patients, ROC (Receiver Operating Characteristic) analysis
was performed and the area under the curve (AUC) was calculated.
Results: Reliability was very good (ICC: 0.988) between initial and repeat measurement of FRT. ROC analysis showed that FRT
have excellent discriminative power to differentiate falling (AUC: 0.946). FRT were not correlated with Reaction Time
(rho=0.161) and Direction Control (rho=0.249) while it was moderately related with Movement Velocity (rho=0.376), EndPoint
Excursion (rho=0.350) and Maximum Excursion (rho=0.349). In addition, FRT was moderately correlated with BBS and EDSS
(rho=0.453, rho=0.370respectively).
Conclusion: Functional reach test is reliable in individuals with MS. It has moderate criterion and construct validity and provides
information about the fall risk. However, it is recommended to use LOS for more detailed results. 

Anahtar Kelimeler

Multiple sclerosis, Postural balance, , Reliability, Validity

Ambulatuvar Multipl Skleroz Hastalarında Fonksiyonel Uzanma Testinin Güvenilirlik ve Geçerliliği

Öz

Amaç: Çalışmanın amacı, multiple skleroz (MS) hastalarının değerlendirilmesinde Fonksiyonel Uzanma Testi’nin güvenirliğinin
ve geçerliğinin incelenmesiydi.
Yöntem: Çalışmaya 18-50 yaş arası, yürüyebilen, Genişletilmiş Özür Durum Ölçeği’ne (Expanded Disability Status Scale-GÖDÖ)
göre skoru 1,5-5 arasında olan, 46 MS’li birey dahil edildi. Katılımcılara sırasıyla Fonksiyonel Uzanma Testi (FUT), Berg Denge
Ölçeği (BDÖ) ve bilgisayarlı dinamik postürografi (Stabilite Limitleri Testi (SLT): son noktadan sapma, ulaşılabilen maksimum
nokta, yön kontrolü, reaksiyon zamanı, hareket hızı) uygulandı. FUT 3-7 gün sonra tekrar edildi. FUT’nin MS hastalarında düşen
ve düşmeyen hastaları ayırt ediciliğini değerlendirmek amacıyla ROC (alıcı işletim karakteristiği eğrisi) analizi yapıldı ve eğri
altında kalan alan hesaplandı (AUC).
Bulgular: FUT’nin ilk ölçümü ile tekrar ölçümü arasında güvenilirlik çok iyi (ICC:0,988) bulundu. ROC analizine göre FUT’nin
düşme ile ilgili ayırt ediciliği yüksek bulundu (AUC: 0,946). FUT ile SLT’nin alt parametreleri arasında ilişki incelendiğinde
reaksiyon zamanı (rho=0,161) ve yön kontrolü (rho=0,249) ile ilişkisinin olmadığı, hareket hızı (rho=0,376), subjektif son nokta
(rho=0,350) ve ulaşabilen son nokta (rho=0,349) arasında orta derecede ilişki olduğu bulundu. FUT’nin, BDÖ ve GÖDÖ
arasındaki korelasyonları orta düzeyde bulundu (rho=0,453, rho=0,370, sırasıyla).
Sonuç: Fonksiyonel uzanma testi, MS’si olan bireylerde güvenilir ve geçerlidir. Orta seviyede kriter ve içerik geçerliliğine sahip
olup düşme riski hakkında bilgi verir. Ancak daha detaylı sonuçlar için SLT kullanılmalıdır.

Anahtar Kelimeler

Multipl skleroz, postüral denge, güvenirlik, geçerlilik

Kaynakça

• 1. Lassmann H. The pathology of multiple sclerosis and its evolution. Philos Trans R Soc Lond B Biol Sci. 1999;354:1635-1640.
• 2. Solaro C: Management of symptoms in Multiple Sclerosis. Milano: Edra; 2013.
• 3. Corradini ML, Fioretti S, Leo T, et al. Early recognition of postural disorders in multiple sclerosis through movement analysis: a modeling study. IEEE Trans Biomed Eng. 1997;44:1029-1038.
• 4. Benedetti MG, Piperno R, Simoncini L, et al. Gait abnormalities in minimally impaired multiple sclerosis patients. Mult Scler. 1999;5:363-368.
• 5. Martin CL, Phillips BA, Kilpatrick TJ, et al. Gait and balance impairment in early multiple sclerosis in the absence of clinical disability. Mult Scler. 2006;12:620-628. 6. Cameron MH, Lord S. Postural control in multiple sclerosis: implications for fall prevention. Curr Neurol Neurosci Rep. 2010;10:407-412.
• 7. Horlings CG, van Engelen BG, Allum JH, et al. A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol. 2008;4:504-515.
• 8. Cattaneo D, Ferrarin M, Jonsdottir J, et al. The virtual time to contact in the evaluation of balance disorders and prediction of falls in people with multiple sclerosis. Disabil Rehabil. 2012;34:470-477.
• 9. Cattaneo D, Regola A, Meotti M. Validity of six balance disorders scales in persons with multiple sclerosis. Disabil Rehabil. 2006;28:789-795.
• 10. Cattaneo D, Jonsdottir J, Repetti S. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disabil Rehabil. 2007;29:1920-1925.
• 11. Duncan PW, Weiner DK, Chandler J, et al. Functional reach: a new clinical measure of balance. J Gerontol. 1990;45:M192-197.
• 12. Erdeo F, Salcı Y, Uca AU, et al. Examination of the effects of coordination and balance problems on gait in ataxic multiple sclerosis patients. Neurosciences (Riyadh). 2019;24:269.
• 13. Rosenblum U, Melzer I. Reliability and concurrent validity of the narrow path walking test in persons with multiple sclerosis. J Neurol Phys Ther. 2017;41:43-51.
• 14. Jamali A, Sadeghi-Demneh E, Fereshtenajad N, et al. Somatosensory impairment and its association with balance limitation in people with multiple sclerosis. Gait Posture. 2017;57:224-229.
• 15. Kalron A, Rosenblum U, Frid L, et al. Pilates exercise training vs. physical therapy for improving walking and balance in people with multiple sclerosis: a randomized controlled trial. Clin Rehabil. 2017;31:319-328.
• 16. Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology. 1983;33:1444-1452.
• 17. Godi M, Franchignoni F, Caligari M, et al. Comparison of reliability, validity, and responsiveness of the mini-BES Test and Berg Balance Scale in patients with balance disorders. Phys Ther. 2013;93:158-167.
• 18. Trueblood PR, Rivera M, Lopez C, et al. Age-based normative data for a computerized dynamic posturography system that uses a virtual visual surround environment. Acta Otolaryngol. 2018;138:597-602.
• 19. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539-549.
• 20. Bi j, Kuesten C. Intraclass Correlation Coefficient (ICC): A Framework for Monitoring and Assessing Performance of Trained Sensory Panels and Panelists. J Sens Stud 2012;27:352-364.
• 21. Dancey CP, Reidy J. Statistics Without Maths for Psychology. Pearson/Prentice Hall; 2007.
• 22. Wagner JM, Norris RA, Van Dillen LR, et al. Four Square Step Test in ambulant persons with multiple sclerosis: validity, reliability, and responsiveness. Int J Rehabil Res. 2013;36:253-259.
• 23. Wallmann HW. Comparison of elderly nonfallers and fallers on performance measures of functional reach, sensory organization, and limits of stability. J Gerontol A Biol Sci Med Sci. 2001;56:M580-M583.
• 24. Maranesi E, Di Nardo F, Rabini R, et al. Muscle activation patterns related to diabetic neuropathy in elderly subjects: A Functional Reach Test study. Clin Biomech (Bristol, Avon). 2016;32:236-240.
• 25. Takatori K, Okada Y, Shomoto K, et al. Does assessing error in perceiving postural limits by testing functional reach predict likelihood of falls in hospitalized stroke patients? Clin Rehabil. 2009;23:568-575.
• 26. Goodgold S, Kiami S, Ule D, et al. Applicability of the functional reach and timed up and go tests for elderly individuals with Alzheimer's disease: pilot investigation. Phys Occup Ther Geriatr. 2001;19:21-36.
• 27. Riolo L. Attention contributes to functional reach test scores in older adults with history of falling. Phys Occup Ther Geriatr. 2004;22:15-28.
• 28. Bennie S, Bruner K, Dizon A, et al. Measurements of balance: comparison of the Timed" Up and Go" test and Functional Reach test with the Berg Balance Scale. J Phys Ther Sci. 2003;15:93-97.
• 29. DeWaard BP, Bentrup BR, Hollman JH, et al. Relationship of the functional reach and lateral reach tests in elderly females. J Phys Ther Sci. 2002;25:4.
• 30. Karanfil E, Ceren A, Çetin B, et al. Multipl sklerozlu bireylerde fonksiyonel uzanma testinin kullanılabilirliği. Turk j physiother rehabil. 2017;28:S89.
• 31. Bohannon RW, Wolfson LI, White WB. Functional reach of older adults: normative reference values based on new and published data. Physiotherapy. 2017;103:387-391.
• 32. Rosa MV, Perracini MR, Ricci NA. Usefulness, assessment and normative data of the Functional Reach Test in older adults: A systematic review and meta-analysis. Arch Gerontol Geriatr. 2019;81:149-170.
• 33. Isles RC, Choy NLL, Steer M, et al. Normal values of balance tests in women aged 20–80. J Am Geriatr Soc. 2004;52:1367-1372.
• 34. Soyuer F, Mirza M, Erkorkmaz Ü. Balance performance in three forms of multiple sclerosis. Neurol Res. 2006;28:555-562.