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Examining the Function In Sitting Test for Validity, Responsiveness, and Minimal Clinically Important Difference in Inpatient Rehabilitation

Published:August 23, 2014DOI:https://doi.org/10.1016/j.apmr.2014.07.415

      Abstract

      Objectives

      To determine the responsiveness of the Function In Sitting Test (FIST), compare scores at admission and discharge from inpatient rehabilitation (IPR) with other balance and function measures, and determine the minimal clinically important difference (MCID).

      Design

      Prospective, nonblinded, reference-standard comparison study.

      Setting

      Four accredited inpatient rehabilitation units.

      Participants

      Population-based sample of adults (N=125) with sitting balance dysfunction, excluding persons with spinal cord injury, significant bracing/orthotics, and inability to perform testing safely.

      Interventions

      Not applicable.

      Main Outcome Measures

      FIST, FIM, and Berg Balance Scale (BBS) at admission and discharge, and Global Rating of Change for function and balance at discharge.

      Results

      The FIST demonstrated good to excellent concurrent validity with the BBS and FIM at admission and discharge (Spearman ρ=.71–.85). Significant improvement (P<.000; 95% confidence interval [CI], 10.73–15.41) occurred in the FIST from admission (mean ± SD: 36.81±15.53) to discharge (mean ± SD: 49.88±6.90). The standard error of measurement for the FIST was 1.40, resulting in a minimal detectable change of 5.5 points. The receiver operator characteristic curve differentiated participants with meaningful balance changes (area under the curve, .78; P>.000; 95% CI, .66–.91), with a change in FIST score of ≥6.5 points designating the MCID. Findings support the strong responsiveness of the FIST during IPR as evidenced by the large effect size (.83), standardized response mean (1.04), and index of responsiveness (1.07).

      Conclusions

      In this study, the FIST correlated well with balance and function measures (concurrent validity) and was responsive to change during IPR. A clinically meaningful change was indicated by an increase in score of ≥6.5 points.

      Keywords

      List of abbreviations:

      BBS (Berg Balance Scale), CI (confidence interval), ES (effect size), FIST (Function In Sitting Test), GRC (Global Rating of Change), IPR (inpatient rehabilitation), MCID (minimal clinically important difference), MDC (minimal detectable change), ROC (receiver operator characteristic), SRM (standardized response mean)
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