The BAND Test: Improving Reliability and Balance Testing for People with Neurocognitive Impairments: A Pilot Study

Abstract People with neurocognitive impairments have a higher risk of falls compared to other older adults and require specific cues for evaluation. Additional options for balance testing is necessary to improve reliability and assessment of fall risk. This study established the efficacy of the novel Balance Assessment for Neurocognitive Deficits (BAND) in order to improve measurement of fall risk for people with neurocognitive impairments. The BAND was analyzed for construct validity and reliability through comparison with the Berg Balance Scale (BBS). Older adults with neurocognitive impairments (n=15) in subacute and long-term settings performed BAND and BBS assessments during therapy. Clinicians determined ambulation assistance, fall risk, and time. Calculation of intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and minimal detectable change (MDC95) values was completed. Corresponding ICC values were 0.985 (95% confidence interval (95% CI), 0.956-0.995) for test-retest reliability and 0.995 (95% CI, 0.985-0.998) for inter-rater reliability. Other values included SEM=0.79 and MDC95=2.18. A linear-regression graph including Pearson’s coefficient (r) demonstrated validity through comparing BAND and BBS and showed a strong correlation (r=0.94, 95% CI, 0.825-0.98). A Bland-Altman plot was created to assess agreement between clinicians, and the mean difference was 0.2667 with 95% limits of agreement (-0.897 to 1.430). The BAND demonstrated excellent reliability and agreement for clinicians providing the test. Further research is necessary to compare the BAND with additional assessments and to demonstrate the utility in expanded populations including the community.

Download Full-text

Reliability of the Maximal Step Length Test and Its Correlation with Motor Function in Chronic Stroke Survivors

BioMed Research International ◽

10.1155/2018/6985963 ◽

2018 ◽

Vol 2018 ◽

pp. 1-8

Author(s):

Shamay S. M. Ng ◽

Mimi M. Y. Tse ◽

Patrick W. H. Kwong ◽

Isaac C. K. Fong ◽

Sun H. Chan ◽

...

Keyword(s):

Older Adults ◽

Intraclass Correlation ◽

Step Length ◽

Berg Balance Scale ◽

Minimal Detectable Change ◽

Stroke Survivors ◽

Healthy Older Adults ◽

Abc Scale ◽

Walking Speeds ◽

Test Retest Reliability

Objective. This study aimed to (1) investigate the interrater, intrarater, and test-retest reliabilities, as well as the minimal detectable change, of the Maximal Step Length test (MSL) in stroke survivors, (2) examine the concurrent validity of MSL with other stroke-specific impairment measurements in stroke survivors, and (3) compare the MSL performances of stroke survivors and those of age-matched healthy older adults in different directions. Design. Cross-sessional study. Setting. University-based research laboratory. Participants. Stroke survivors (n = 48) and age-matched healthy older adults (n = 39). Methods. Stroke survivors were assessed with MSL, lower limb muscle strength, Limits of Stability (LOS) Test, Berg Balance Scale (BBS), 5-meter walk test, and Activities-specific Balance Confidence (ABC) scale by two trained assessors in 1 session. Their performance on MSL was reassessed 1 week later to establish the test-retest reliability. Healthy older adults were assessed with MSL only. Intraclass correlation coefficient (ICC) was used to assess the reliability of MSL and Spearman’s rho was used to quantify the strength of correlations between MSL and secondary outcomes. Between-group differences of MSL were assessed with the independent t-test. Results. The MSL exhibited excellent intrarater, interrater, and test-retest reliabilities [ICC: 0.885–1.000]. Significant correlations (ρ: 0.447–0.723) were demonstrated between MSLs in most directions and muscle strengths of the affected legs, BBS scores, and walking speeds. The step lengths differed significantly between stroke survivors and healthy older adults in the forward, backward, and sideways directions on both the affected and less affected sides. Conclusions. The MSL is a reliable, valid, and easily administered test of the stepping capabilities of stroke survivors. Stroke survivors had significant shorter MSLs in all directions than the age-matched healthy older adults.

Download Full-text

Toe Clearance Rehabilitative Slippers for Older Adults With Fall Risk: A Randomized Controlled Trial

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/21514593211029102 ◽

2021 ◽

Vol 12 ◽

pp. 215145932110291

Author(s):

Atsuko Satoh ◽

Yukoh Kudoh ◽

Sangun Lee ◽

Masumi Saitoh ◽

Miwa Miura ◽

...

Keyword(s):

Older Adults ◽

Fall Risk ◽

Controlled Trial ◽

Intervention Group ◽

Berg Balance Scale ◽

Control Group ◽

Mobility Assessment ◽

Before And After ◽

Day Services ◽

And Control

Introduction: To evaluate fall-prevention rehabilitative slippers for use by self-caring, independent older adults. Materials and Methods: This assessor-blinded, randomized, and controlled 1-year study included 59 self-caring, independent participants (49 women) who attended day services. The mean age of participants was 84.0 ± 5.3 years. Participants were randomly selected from 8 nursing homes. We tested slippers top-weighted with a lead bead (200, 300, or 400 g). Intervention group participants walked while wearing the slippers for 10-20 min, 1-3 days/week at the day service center. Fall risk was measured using the Berg Balance Scale and the Tinetti Performance-Oriented Mobility Assessment (POMA) before and at 3-month intervals after the intervention/control phase. Results: After 12 months, the intervention group demonstrated significant improvement. Berg Balance and POMA compared to the control group ( p < .05 p < .01, respectively). Mobility scores improved significantly for both measurements in the intervention group before and after ( p < .01), but the control group had significantly lower scores. Discussion: Overall, falls decreased in the intervention group from 10 to 7, and control group falls increased from 9 to 16 ( p = .02). No adverse events related to the intervention were reported. Conclusions: Rehabilitation training slippers may reduce falls in older adults.

Download Full-text

Physical Activity Health Literacy in Iranian Older Adults: Development and Psychometric Testing

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0221 ◽

2021 ◽

pp. 1-9

Author(s):

Moeini Babak ◽

Barati Majid ◽

Heidarimoghadam Rashid ◽

Tapak Leili ◽

Parsamajd Shahryar

Keyword(s):

Physical Activity ◽

Older Adults ◽

Factor Analysis ◽

Health Literacy ◽

Phase 1 ◽

Intraclass Correlation ◽

Psychometric Testing ◽

Validity And Reliability ◽

Confirmatory Factor ◽

Two Phases

Inadequate health literacy decreases physical activity. This study aimed to develop and examine psychometrics of physical activity health literacy in Iranian older adults. This methodological work was conducted in two phases. Phase 1 consisted of extensive studies review and qualitative study to extract and design the items. The psychometrics were measured in Phase 2 included content, faceconstruct validities, reliability, and stability. The collected data were analyzed in SPSS (version 25.0) and AMOS (version 24.0). The results of the exploratory factor analysis showed four factors— information evaluation, reading skill, perception, and decision making—and used information that explained 70.08% of the variance. The model’s fitness was supported by confirmatory factor analysis. Internal consistency based on Cronbach’s alpha was .89 with composite reliability >0.85. Stability was confirmed through the test–retest method and intraclass correlation coefficient (.89–1). Psychometrics of physical activity health literacy in Iranian older adults supported validity and reliability of the tool.

Download Full-text

A Fall Risk Evaluation and Feedback System for Older Adults

International Journal of Sociotechnology and Knowledge Development ◽

10.4018/ijskd.2021040107 ◽

2021 ◽

Vol 13 (2) ◽

pp. 105-118

Author(s):

Isa Jahnke ◽

Lorraine J. Phillips ◽

Fatih Demir ◽

Carmen Abbott ◽

Marjorie Skubic

Keyword(s):

Older Adults ◽

Fall Risk ◽

Risk Evaluation ◽

Feedback System ◽

Clinical Test ◽

Validity And Reliability ◽

Timed Up And Go ◽

Sociotechnical System ◽

System Usability Scale ◽

System Solution

Falls are widespread among older adults causing serious injuries and threatening their quality of life. An approach to estimate fall risk, and to prevent falls, is the Timed-Up-and-Go (TUG) test. The TUG test has established validity and reliability. However, as a clinical test, it is not accessible for personal use. To enhance its reach, the authors developed a prototype called Fall Risk Evaluation and Feedback System (FREFS). The prototype is a Kinect-based depth sensor system with interfaces that support older adults in completing the TUG test and receiving personalized test results. The personalized feedback feature is novel that existing prototypes do not include. This study's goal was to gain knowledge of the user experience of FREFS. This research applied methods of observation, interviews, and collected responses on the System Usability Scale (SUS). Results show participants perceived the system as usable, with SUS score of 84.3, but also revealed issues. First, users were unsure how to deal with the TUG tests results when the results showed high fall risk. Second, clearer instructions and reduction of information overload specifically for these age groups were needed. Third, a communication approach embedded into the system would be required (i.e., a link to a chatbot feature or a button to connect to a real person). Overall, the study demonstrated that such a prototype cannot be fully automated; it needs a sociotechnical system solution that includes human communication.

Download Full-text

Short Assessment of Health Literacy for Portuguese-speaking Adults

Revista de Saúde Pública ◽

10.1590/s0034-89102012005000047 ◽

2012 ◽

Vol 46 (4) ◽

pp. 702-711 ◽

Cited By ~ 48

Author(s):

Daniel Apolinario ◽

Rafaela de Castro Oliveira Pereira Braga ◽

Regina Miksian Magaldi ◽

Alexandre Leopold Busse ◽

Flavia Campora ◽

...

Keyword(s):

Older Adults ◽

Health Literacy ◽

Construct Validity ◽

Psychometric Properties ◽

Assessment Tool ◽

Characteristic Curve ◽

Intraclass Correlation ◽

Validity And Reliability ◽

Convenience Sample ◽

Inadequate Health Literacy

OBJECTIVE: To develop and validate a short health literacy assessment tool for Portuguese-speaking adults. METHODS: The Short Assessment of Health Literacy for Portuguese-speaking Adults is an assessment tool which consists of 50 items that assess an individual's ability to correctly pronounce and understand common medical terms. We evaluated the instrument's psychometric properties in a convenience sample of 226 Brazilian older adults. Construct validity was assessed by correlating the tool scores with years of schooling, self-reported literacy, and global cognitive functioning. Discrimination validity was assessed by testing the tool's accuracy in detecting inadequate health literacy, defined as failure to fully understand standard medical prescriptions. RESULTS: Moderate to high correlations were found in the assessment of construct validity (Spearman's coefficients ranging from 0.63 to 0.76). The instrument showed adequate internal consistency (Cronbach's alpha=0.93) and adequate test-retest reliability (intraclass correlation coefficient=0.95). The area under the receiver operating characteristic curve for detection of inadequate health literacy was 0.82. A version consisting of 18 items was tested and showed similar psychometric properties. CONCLUSIONS: The instrument developed showed good validity and reliability in a sample of Brazilian older adults. It can be used in research and clinical settings for screening inadequate health literacy.

Download Full-text

Safety, Feasibility, and Reliability of the Maximal Step Length, Gait Speed, and Chair Test Measured by Seniors Themselves: The Senior Step Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2013-0231 ◽

2015 ◽

Vol 23 (3) ◽

pp. 438-443 ◽

Cited By ~ 6

Author(s):

Kim T.J. Bongers ◽

Yvonne Schoon ◽

Maartje J. Graauwmans ◽

Marlies E. Hoogsteen-Ossewaarde ◽

Marcel G.M. Olde Rikkert

Keyword(s):

Older Adults ◽

Gait Speed ◽

Fall Risk ◽

Intraclass Correlation ◽

Step Length ◽

Community Dwelling ◽

Self Management ◽

Training Effect ◽

Community Dwelling Older Adults ◽

At Home

Self-management of mobility and fall risk might be possible if older adults could use a simple and safe self-test to measure their own mobility, balance, and fall risk at home. The aim of this study was to determine the safety, feasibility, and intraindividual reliability of the maximal step length (MSL), gait speed (GS), and chair test (CT) as potential self-tests for assessing mobility and fall risk. Fifty-six community-dwelling older adults performed MSL, GS, and CT at home once a week during a four-week period, wherein the feasibility, test-retest reliability, coefficients of variation, and linear mixed models with random effects of these three self-tests were determined. Forty-nine subjects (mean age 76.1 years [SD: 4.0], 19 females [42%]) completed the study without adverse effects. Compared with the other self-tests, MSL gave the most often (77.6%) valid measurement results and had the best intraclass correlation coefficients (0.95 [95% confidence interval: 0.91−0.97]). MSL and GS gave no significant training effect, whereas CT did show a significant training effect (p < .01). Community-dwelling older adults can perform MSL safely, correctly, and reliably, and GS safely and reliably. Further research is needed to study the responsiveness and beneficial effects of these self-tests on self-management of mobility and fall risk.

Download Full-text

Detectable Changes in Physical Performance Measures in Elderly African Americans

Physical Therapy ◽

10.2522/ptj.20090363 ◽

2010 ◽

Vol 90 (6) ◽

pp. 921-927 ◽

Cited By ~ 52

Author(s):

Kathleen Kline Mangione ◽

Rebecca L. Craik ◽

Alyson A. McCormick ◽

Heather L. Blevins ◽

Meaghan B. White ◽

...

Keyword(s):

Older Adults ◽

African American ◽

Physical Performance ◽

Performance Measures ◽

Gait Speed ◽

Intraclass Correlation ◽

Assistive Device ◽

Minimal Detectable Change ◽

6Mwt Distance ◽

African American Older Adults

Background African American older adults have higher rates of self-reported disability and lower physical performance scores compared with white older adults. Measures of physical performance are used to predict future morbidity and to determine the effect of exercise. Characteristics of performance measures are not known for African American older adults. Objective The purpose of this study was to estimate the standard error of measurement (SEM) and minimal detectable change (MDC) for the Short Physical Performance Battery (SPPB), Timed “Up & Go” Test (TUG) time, free gait speed, fast gait speed, and Six-Minute Walk Test (6MWT) distance in frail African American adults. Design This observational measurement study used a test-retest design. Methods Individuals were tested 2 times over a 1-week period. Demographic data collected included height, weight, number of medications, assistive device use, and Mini-Mental Status Examination (MMSE) scores. Participants then completed the 5 physical performance tests. Results Fifty-two participants (mean age=78 years) completed the study. The average MMSE score was 25 points, and the average body mass index was 29.4 kg/m2. On average, participants took 7 medications, and the majority used assistive devices. Intraclass correlation coefficients (ICC [2,1]) were greater than .90, except for the SPPB score (ICC=.81). The SEMs were 1.2 points for the SPPB, 1.7 seconds for the TUG, 0.08 m/s for free gait speed, 0.09 m/s for fast gait speed, and 28 m for 6MWT distance. The MDC values were 2.9 points for the SPPB, 4 seconds for the TUG, 0.19 m/s for free gait speed, 0.21 m/s for fast gait speed, and 65 m for 6MWT distance. Limitations The entire sample was from an urban area. Conclusions The SEMs were similar to previously reported values and can be used when working with African American and white older adults. Estimates of MDC were calculated to assist in clinical interpretation.

Download Full-text

Validity and Reliability of the Vestibular/Ocular Motor Screening and Associations With Common Concussion Screening Tools

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738116678411 ◽

2016 ◽

Vol 9 (2) ◽

pp. 174-180 ◽

Cited By ~ 40

Author(s):

Amy M. Yorke ◽

Laura Smith ◽

Mitch Babcock ◽

Bara Alsalaheen

Keyword(s):

Intraclass Correlation ◽

Vestibular Function ◽

Screening Tools ◽

Minimal Detectable Change ◽

Ocular Motor ◽

Validity And Reliability ◽

Level Of Evidence ◽

Test Items ◽

Symptom Scores ◽

The Individual

Background: Sustaining a concussion commonly results in vestibular impairments that may be associated with balance deficits. To screen for vestibular impairments after a concussion, the Vestibular/Ocular Motor Screening (VOMS) tool was developed. The relationship between the VOMS and other concussion screening tools, such as the Balance Error Scoring System (BESS) and King-Devick (K-D), have not been explored. Hypotheses: (1) VOMS would provide reliable results and not provoke symptoms in healthy adolescents and (2) VOMS test items would measure related aspects of vestibular function that are not measured through the BESS or K-D. Study Design: Cross-sectional, descriptive. Level of Evidence: Level 4. Methods: A total of 105 healthy adolescents (53 male, 52 female; mean age, 15.4 years) completed the VOMS, BESS, and K-D tests. A subsample of 21 adolescents (16 male, 5 female; mean age, 15.5 years) completed the VOMS twice. Results: The median total symptom score for all 7 VOMS items was 0 (0-5). The majority of the individual VOMS test items total symptom scores demonstrated a significant correlation with each other ( rs = 0.25-0.66, P < 0.02). The individual VOMS items did not demonstrate a significant relationship to the BESS or K-D. VOMS items demonstrated high agreement in total symptom scores between testing trials, with near point convergence (NPC) distance demonstrating an intraclass correlation coefficient (ICC) of 0.95 (95% CI, 0.89-0.98; P < 0.001). The MDC95 (minimal detectable change with 95 confidence) for NPC distance was 4 cm. Conclusion: The VOMS did not provoke vestibular symptoms in healthy adolescents. The VOMS items measured unique aspects of vestibular function other than those measured by the BESS or K-D with good reliability. Clinical Relevance: Clinicians should consider implementing the VOMS as part of a comprehensive concussion assessment if vestibular impairment is suspected. If NPC distance is measured twice, a difference of >4 cm would be considered real change outside of measurement error.

Download Full-text

Reliability and Validity of Force Platform Measures of Balance Impairment in Individuals With Parkinson Disease

Physical Therapy ◽

10.2522/ptj.20160099 ◽

2016 ◽

Vol 96 (12) ◽

pp. 1955-1964 ◽

Cited By ~ 10

Author(s):

Cathy C. Harro ◽

Alicia Marquis ◽

Natasha Piper ◽

Chris Burdis

Keyword(s):

Parkinson Disease ◽

Disease Severity ◽

Fall Risk ◽

Intraclass Correlation ◽

Community Dwelling ◽

Force Platform ◽

Minimal Detectable Change ◽

Retest Reliability ◽

Balance Impairment ◽

Test Retest Reliability

Abstract Background Complex movement and balance impairments in people with Parkinson disease (PD) contribute to high fall risk. Comprehensive balance assessment is warranted to identify intrinsic fall risk factors and direct interventions. Objective The purpose of this study was to examine the psychometric properties of 3 balance measures of a force platform (FP) system in people with PD. Methods Forty-two community-dwelling individuals with idiopathic PD completed the testing protocol. Test-retest reliability was assessed for the Limits of Stability Test (LOS), Motor Control Test (MCT), and Sensory Organization Test (SOT). Intraclass correlation coefficients (ICC [2,1]) were calculated to determine test-retest reliability and minimal detectable change. Validity was assessed by comparing the FP measures with criterion gait and balance measures using Pearson product moment correlations. Multiple regression analyses examined the contribution of PD characteristics to FP measures. Results All primary FP variables demonstrated excellent test-retest reliability (ICC=.78–.92). The SOT and LOS demonstrated fair to good correlations with criterion measures, whereas the MCT had fair correlations to balance measures only. Both SOT composite equilibrium and MCT average latency were moderately associated with disease severity. Limitations This study's sample had a relatively small number of participants with a positive fall history, which may limit the generalizability of the findings. Conclusions This study's findings provide support that FP measures are reliable and valid tests of balance impairment in people with PD. Disease severity was significantly associated with SOT and MCT measures, perhaps reflecting that these tests are meaningful indicators of decline in postural control with disease progression. Force platform measures may provide valuable quantitative information about underlying balance impairments in people with PD to guide therapeutic interventions for fall risk reduction.

Download Full-text

Outdoor circuit test: construction and validation of an instrument for the prediction of cardiorespiratory capacity for older adults

Revista Brasileira de Geriatria e Gerontologia ◽

10.1590/1981-22562020023.200064 ◽

2020 ◽

Vol 23 (6) ◽

Author(s):

Gabriela Rezende de Oliveira Venturini ◽

Paulo de Tarso Veras Farinatti ◽

Nádia Souza Lima da Silva

Keyword(s):

Older Adults ◽

Heart Rate ◽

Execution Time ◽

Statistical Significance ◽

Intraclass Correlation ◽

Positive Association ◽

Test Construction ◽

Subjective Perception ◽

Validity And Reliability ◽

Predictive Capacity

Abstract Objective: the present study aimed to construct, validate and verify the reliability of a protocol for assessing the cardiorespiratory capacity of older adults attending the Rio ao Ar Livre (Open Air Rio, or RAL) project entitled the “Outdoor Circuit Test” (OCT). Method: validity and reliability tests were carried out to assess the accuracy of the OCT, with 50 older adults (70.6 ± 6.3 years) of both sexes who regularly attended the RAL. Validity was tested by collecting VO2max data under maximal cardiopulmonary exercise test conditions, and the OCT variables: a) Circuit Execution Time; b) Heart Rate; c) Subjective Perception of Exertion; d) Average Heart Rate (HRméd). Reliability was tested through the reproducibility of the measurements of the OCT variables, expressed by the Intraclass Correlation Coefficient (ICC). The predictive capacity of VO2max was given by multiple linear regression and the final stability of the model by the analysis of the residues and the calculation of Cook’s distances, with a value of P≤ 0.05 adopted for statistical significance. Results: the predictive model based on age, sex, waist circumference, BMI and circuit execution time explained 41% of VO2max variance, with a standard error of estimate of 18.5%. Conclusion: the OCT exhibited satisfactory reproducibility (0.62 to 0.93), and proved to be valid, reliable, and specific for predicting the cardiorespiratory fitness of older adults attending RAL, demonstrating adequate reproducibility and a positive association with the physical fitness of older adults.

Download Full-text