Assessment of locomo,on ability

Transcription

1 Université catholique de Louvain Cliniques universitaires St-Luc Département de Médicine Physique et de Réadapta,on Introduc,on Assessment of locomo,on ability Development of ABILOCO - ABILOCO-Kids Caty G. - Lejeune T. 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) Outcome - PRM Importance of func.onal assessment in rehabilita.on Assessment locomo.on ability (ICF ac.vity domain) gait paaern (ICF impairment domain) 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) «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.»

2 «There is a need to develop outcome measures that can capture a greater range of walking ability, par9cularly in the community.» condi,ons, Tyson 29 «Although there are many tools that measure walking and mobility, nearly all have been developed for use in research and are impractical or 29 inadequately developed for clinical use.» Tyson 29 condi,ons, Tyson 29 condi,ons, Tyson 29 Pathologies Stroke Parkinson Mul.ple Sclerosis Trauma.c Brain Injury Guillain-Barré Syndrome ALS 2

3 condi,ons, Tyson 29 condi,ons, Tyson measures of walking or mobility 22 rejected ( psychometric property assessed) 7 included 4 walking impairment 4 walking ac.vity 9 mobility ac.vity condi,ons, Tyson 29 Clinical u.lity & Psychometric proper.es Walking impairment:.med walk tests (5 & m) 6 min walk test High level mobility assessment Rivermead Mobility Index condi,ons, Tyson 29 Clinical u.lity & Psychometric proper.es Walking ac.vity Mobility ac.vity: none! Func.onal Ambula.on Categories well known, easy and suitable for clinical use incomplete development of their psychometric properties 3

4 Observa,onal Gait Analysis, Ferrarello 23 Walking impairment kinema.cs spa.o-temporal parameters use of assis.ve device 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Analyse of videotaped gait 3 items Total score /62 4

5 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Observa,onal Gait Analysis, Ferrarello 23 Walking impairment Dissemina.on of these tools in research was modest. None of the tools retrieved in this study has been recommended in clinical prac.ce guidelines for stroke rehabilita.on. Walking impairment No validation in comparison to : Gillette Gait Index the Gait Deviation Index the Gait Profile Score 5

6 Part Part Part 2 Part 3 Arch Phys Med Rehab 28 Arch Phys Med Rehab 28 Part 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 Rasch analysis Belvedere 2 Probabilis.c model The answer depends only of the walking ability and of item difficulty. 6

7 Rasch analysis - Linearity Fonc.onal Ambula.on Category Ordinal scales Limited computa9on Non parametric sta9s9cs Merbitz, 989; Wright 989 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 2 3 4???? 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 Methods - 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. Methods - Subjects Un ques.onnaire (4 ac.vités) proposé Marcher entre des barres parallèles Methods - 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 azempted / / 2 / NA 7

8 Methods Item selec,on Methods 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 azempted / / 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 azempted / / NA Results Results - Calibra,on Rasch Analysis: fit to the probabilis,c model 8

9 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 leu) 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 9

10 Method 28 adult stroke pa.ents 3 months auer 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 Leu cerebral lesion with aphasia Leu cerebral lesion with aphasia Two assessments Method 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 Method Method To develop a scale with Rasch method can be rela.vely complex To use the scale in clinical prac.ce is quite easy! Method Method

11 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

12 Methods - 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: effect size.8 CATY et al, Arch Phys Med Rehabil (28) 2

13 Results: reproducibility & validity Results: Concurrent validity ABILOCO-Kids Université catholique de Louvain Cliniques universitaires St-Luc Département de Médicine Physique et de Réadapta,on Thank you for your azen,on Lejeune T. 3