The reliability and validity of a new observational scale concerning the upper limb during gait in persons after stroke

Samenvatting

Background: Visual gait assessment is a cost-effective clinical method to assess post-stroke gait deviations. Most observation scales focus on the lower limb during gait and therefore contain little information concerning the upper limb. The Upper Limb Observation scale of the Hemiplegic Side during Walking (U.L.O.H.S.W.) is one such measure that assesses the arm swing of the hemiplegic side during walking in stroke. However, no psychometric parameters have been determined for the use of this upper limb scale. Objectives: To establish reliability and validity of the U.L.O.H.S.W. using videos of the post-stroke subjects during walking. Study design: A cross – sectional study. Methods: 24 persons after stroke were recruited from three rehabilitation centers (UZ Ghent, Maria-Middelares and BZIO). Participants underwent several clinical tests and walked along a 10-meter walkway at self-selected speed for four times. Walking was video-taped from a frontal (front view, back view) and sagittal (left view, right view) view. The upper limb scale was scored by using the video recordings. Each participant was scored by three different researchers who were blinded from one another to assess the inter-tester reliability. One researcher scored this scale twice with an interval of two weeks and without consulting the previous scores to assess the intra-tester reliability. Additionally, 3D data collected from four patients using the GRAIL was compared to the scores on the U.L.O.H.S.W. to validate the 2D observation of the upper limb during walking. Results: The outcomes for inter- and intra-tester reliability showed varying results. For the inter-tester reliability the ICC’s ranged from 0.254 to 0.885 and the correlation coefficients from 0.410 to 1.000 (p<0.05, p<0.01). For the intra-tester reliability the ICC’s ranged from 0.594 to 0.957 and the correlation coefficients from 0.585 to 0.945 (p<0.01). Items concerning the more distal parts of the upper limb and the arm swing itself tended to be more reliable than items concerning the more proximal parts. Concerning the validity of this scale, percentages of agreement between the scores on the U.L.O.H.S.W. and the 3D data ranged from 29% to 83%. Conclusion: The varying preliminary results of this study indicate that the U.L.O.H.S.W. is not a sufficiently validated observation tool to assess the arm swing during walking in persons after stroke. Further research with a larger study population and a renewed version of this scale should provide more information concerning its clinical usability.

Datum prijs	2022
Originele taal	English
Begeleider	Anke Van Bladel (Promotor)