Assessment of locomo,on ability

Transcription

1 3/3/5 Université catholique de Louvain Cliniques universitaires St- Luc Département de Médicine Physique et de Réadapta,on Part Assessment of locomo,on ability Part 2 Development of ABILOCO - ABILOCO- Kids Caty G. - Lejeune T. thierry.lejeune@uclouvain.be Part 3 Outcome - PRM Part Importance of func.onal assessment in rehabilita.on Aim to develop a Rasch- built ques.onnaire to assess locomo.on ability (ICF ac.vity domain) Arch Phys Med Rehab 28 Outcome - PRM Importance of func.onal assessment in rehabilita.on Aim to develop a Rasch- built ques.onnaire to assess locomo.on ability (ICF ac.vity domain) gait paaern (scale or gait analysis) Usefull to plan treatment, not to assess ability Exis.ng scales Func.onal Ambula.on Classifica.on (FAC) Func.onal Walking Category (FWC) Rivermead Mobility Index (RMI) 2 th item Func.onal Independence Measure (FIM) Modified Emory Func.onal Ambula.on Profile New Mobility Scale Walking speed ( m 6 min)

2 3/3/5 «The ICF aims to provide a common language for the descrip9on of health and is becoming the generally accepted conceptual framework to describe an individual s level of func9on and health in rehabilita9on.» Fonc.onal Ambula.on Category «There is a need to develop outcome measures that can capture a greater range of walking ability, par9cularly in the community.» Ordinal scales Limited computa9on Non parametric sta9s9cs Non func.onal A Dependent level B 2 Dependent level 2 C 3 Dependent on supervision 4 Independent on level ground 5 Independent F D E Merbitz, 989; Wright 989 Assess the pa.ent throughout is rehabilita.on from acute inpa.ent to chronic outpa.ent (community) Assess specifically the locomo.on ability in daily life circumstances (ICF ac.vity) = latent variable Assess easily, quickly, everywhere and cheaply Clinical U.lity (Tyson & Connell, 29) Linear, unidimensional, invariant, valid and reliable scale Rasch model Belvedere 2 2

3 3/3/5 Rasch analysis Rasch analysis - Linearity Probabilis.c model The answer depends only of the walking ability and of item difficulty ???? Measure unit Equal between each level Merbitz, 989; Wright 989 A Non func.onal B Dependent level C 2 Dependent level 2 D 3 Dependent on supervision E 4 Independent on level ground F 5 Independent Rasch analysis - Unidimensionality Measure only one variable (latent variable) Locomo.on ability s - items Marcher entre des barres parallèles 43 locomo.on ac.vi.es Exis.ng scales experts opinion (content validity) Adult - children Example: Pa,ent A Pa,ent B Pa,ent C Pa,ent D Standing Walking Running Speaking french Total Score 3 3 Cycling Walking between parallel bars Running on flat and even terrain Walking <5m with the help of one person Turning and walking in a narrow space. s - Subjects Un ques.onnaire (4 ac.vités) proposé Marcher entre des barres parallèles s - items stroke pa.ents in- and outpa.ent visually no.ceable gait disturbances able to par.cipate to walking rehabilita.on no major cogni.ve deficit To rate their perceived difficulty to perform the 43 locomo.on ac.vi.es Impossible / difficult / Easy / not awempted / / 2 / NA 3

4 3/3/5 s Item selec,on s Validity Rasch Analysis. Frequency of missing values (<5%) 2. Ordered ra.ng scale 3. Unidimensionality 4. Differen.al Item Func.oning invariance 5. Redundancy Concurrent validity. FAC 2. FWC 3. 2th item FIM 4. Walking speed ( m) Results Results To rate their perceived difficulty to perform the 43 locomo.on ac.vi.es Dichotomous percep.on Impossible / difficult / Easy / not awempted / / 2 / NA Rasch Analysis: 43 to 3 items. Frequency of missing values (<5%) 4 2. Ordered ra.ng scale - 3. Unidimensionality Differen.al Item Func.oning invariance Redundancy 6. Relevance (impossible for > 75% of subjects) Impossible / Possible / not awempted / / NA Results Results - Calibra,on Rasch Analysis: fit to the probabilis,c model 4

5 3/3/5 Results - Calibra,on Raw Score Logit % - 5,4-3, , , , , , ,9 47 8, ,2 56, , , ,9 Results - Invariance Rasch Analysis: Differen.al Item Func.oning. sex 2. Age (<6 or >6 y) 3. Delay since stroke (< 3 month or > 3 month) 4. Affected side (right or lep) 5.2 sta.s.cal different levels Results Concurrent validity Results Concurrent validity Conclusions ABILOCO is a valid, undimensional, linear, invariant ques.onnaire assessing the locomo.on ability of stroke pa.ents Part 2 Taking into account the unperformed ac.vi.es But what about: its reliability? the validity of self report assessment? Pa.ent with poten.al cogni.ve and psychological impairments 5

6 3/3/5 28 adult stroke pa.ents 3 months aper stroke 3 rehabilita.on facili.es Age (y) 59 ± 3 Sex 3 M 5 W Delay since stroke (month) 33 ± 58 Site of lesion Right cerebral lesion with neglect Right cerebral lesion with neglect Lep cerebral lesion with aphasia Lep cerebral lesion with aphasia Two assessments T ABILOCO self- report by the pa.ent ABILOCO third- party by their PT HAD T2 (2 weeks later) ABILOCO self- report by the pa.ent ABILOCO third- party by their PT ABILOCO observed by a medical examiner To develop a scale with Rasch method can be rela.vely complex To use the scale in clinical prac.ce is quite easy! 6

7 3/3/5 Result Validity of the self- report assessment Result Validity of the third- party assessment ICC=.69 ICC=.87 Blant- Altman.2±3.5 logit Blant- Altman was -.3±2.2 logit Result Reproducibility of the self- report assessment Result Reproducibility of the third- party assessment ICC=.77 ICC=.89 Blant- Altman.2±3.5 logit Blant- Altman.8±2 logit Discussion Discussion No influence of neglect, aphasia, MMSE No influence of anxiety (HAD) or depression (HAD2) Good reproducibility Validity of the self- report assessment Validity of the third- party assessment in case of cogni.ve impairments 7

8 3/3/5 s - ICF - Assessment Part 3 Body function and structure Activity Participation - Ques.onnaires (ordinal scales) Func.onal Walking Category (FWC) Func.onal Ambula.on Categories (FAC) Func.onal Independence Measure item 2 (FIM w ) - ABILOCO - Spontaneous walking speed ( meter Walk Test) Result - Ac,vity Result - Ac,vity Ques.onnaires Ques.onnaires 6 Locomo.on ability (logits) FWC, FAC, FIM w : ceiling effect FWC, FAC, FIM w : ceiling effect 5 2% ABILOCO (p=.3) + logit = 3 locomo.on ac.vi.es Pre- BT- A Post- BT- A Spontaneous walking speed : no change Spontaneous walking speed : no change Results - Calibra,on Discussion - Conclusion «studies have not demonstrated unequivocally that BT- A is effec9ve in improving func9on» Francisco 27. Unsensi.ve outcome assessment method? 2. No rela.on between func.on and spas.city? Responsiveness of ABILOCO CATY et al, Arch Phys Med Rehabil (28) 8

9 3/3/5 Université catholique de Louvain Cliniques universitaires St- Luc Département de Médicine Physique et de Réadapta,on Thank you for your awen,on Lejeune T. 9