Advertisement

Intrarater and Interrater Reliability of the Hierarchical Balance Short Forms in Patients With Stroke

  • Wan-Hui Yu
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
    Search for articles by this author
  • Kuan-Lin Chen
    Affiliations
    Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, Tainan, Taiwan
    Search for articles by this author
  • Sheau-Ling Huang
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
    Search for articles by this author
  • Wen-Shian Lu
    Affiliations
    School of Occupational Therapy, Chung Shan Medical University, Taichung, Taiwan

    Occupational Therapy Room, Chung Shan Medical University Hospital, Taichung, Taiwan
    Search for articles by this author
  • Shu-Chun Lee
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Occupational Therapy, Taipei City Hospital Songde Branch, Taipei, Taiwan
    Search for articles by this author
  • Ching-Lin Hsieh
    Correspondence
    Corresponding author Ching-Lin Hsieh, PhD, School of Occupational Therapy, College of Medicine, National Taiwan University, No.17, Xuzhou Rd, Taipei 100, Taiwan.
    Affiliations
    School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
    Search for articles by this author

      Abstract

      Objective

      To examine the intrarater and interrater reliability of a quick balance measure, the Hierarchical Balance Short Forms (HBSF), in outpatients with stroke receiving rehabilitation.

      Design

      A repeated-assessments design (1wk apart) was used to examine the intrarater and interrater reliability of the HBSF. The HBSF was administered by a single rater in the intrarater reliability study and by 2 raters in the interrater reliability study. The raters had sufficient working experience in stroke rehabilitation.

      Setting

      Seven teaching hospitals.

      Participants

      Two independent groups of outpatients (N=106; each group, n=53) with stroke in chronic stages and in stable medical condition were recruited.

      Interventions

      Not applicable.

      Main Outcome Measure

      HBSF.

      Results

      For the intrarater reliability study, the values of the intraclass correlation coefficient (ICC), minimal detectable change (MDC), and percentage of minimal detectable change (MDC%) were .95, 1.02, and 16.3%, respectively, for the HBSF. The 95% limits of agreement (LOA) of the HBSF ranged from −.69 to 1.19. For the interrater reliability study, the values of the ICC, MDC, and MDC% were .91, 1.22, and 18.3%, respectively, for the HBSF. The 95% LOA of the HBSF ranged from −1.01 to 1.35.

      Conclusions

      Our results suggest that the HBSF has satisfactory intrarater and interrater reliability for assessing balance function in outpatients with stroke. The MDC values of the HBSF are useful for both researchers and clinicians to determine whether the change in balance function of an individual patient is real when administered by an individual rater or by different raters.

      Keywords

      List of abbreviations:

      BBS (Berg Balance Scale), CAT (computerized adaptive test), HBSF (Hierarchical Balance Short Forms), ICC (intraclass correlation coefficient), IRT (item response theory), LOA (limits of agreement), MDC (minimal detectable change), MDC% (percentage of minimal detectable change), PASS (Postural Assessment Scale for Stroke Patients)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Tyson S.F.
        • Hanley M.
        • Chillala J.
        • Selley A.
        • Tallis R.C.
        Balance disability after stroke.
        Phys Ther. 2006; 86: 30-38
        • Tyson S.F.
        • Hanley M.
        • Chillala J.
        • Selley A.B.
        • Tallis R.C.
        The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment.
        Neurorehabil Neural Repair. 2007; 21: 341-346
        • Maeda N.
        • Kato J.
        • Shimada T.
        Predicting the probability for fall incidence in stroke patients using the Berg Balance Scale.
        J Int Med Res. 2009; 37: 697-704
        • Ballinger C.
        • Ashburn A.
        • Low J.
        • Roderick P.
        Unpacking the black box of therapy—a pilot study to describe occupational therapy and physiotherapy interventions for people with stroke.
        Clin Rehabil. 1999; 13: 301-309
        • Lennon S.
        • Baxter D.
        • Ashburn A.
        Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK.
        Disabil Rehabil. 2001; 23: 254-262
        • Tinetti M.E.
        • Williams T.F.
        • Mayewski R.
        Fall risk index for elderly patients based on number of chronic disabilities.
        Am J Med. 1986; 80: 429-434
        • Berg K.
        Measuring balance in the elderly: preliminary development of an instrument.
        Physiother Can. 1989; 41: 304-311
        • Benaim C.
        • Pérennou D.A.
        • Villy J.
        • Rousseaux M.
        • Pelissier J.Y.
        Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS).
        Stroke. 1999; 30: 1862-1868
        • Horak F.B.
        • Wrisley D.M.
        • Frank J.
        The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
        Phys Ther. 2009; 89: 484-498
        • Stevenson T.J.
        Detecting change in patients with stroke using the Berg Balance Scale.
        Aust J Physiother. 2001; 47: 29-38
        • Chinsongkram B.
        • Chaikeeree N.
        • Saengsirisuwan V.
        • Viriyatharakij N.
        • Horak F.B.
        • Boonsinsukh R.
        Reliability and validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke.
        Phys Ther. 2014; 94: 1632-1643
        • Jette D.U.
        • Halbert J.
        • Iverson C.
        • Miceli E.
        • Shah P.
        Use of standardized outcome measures in physical therapist practice: perceptions and applications.
        Phys Ther. 2009; 89: 125-135
        • Chou C.Y.
        • Chien C.W.
        • Hsueh I.P.
        • Sheu C.F.
        • Wang C.H.
        • Hsieh C.L.
        Developing a short form of the Berg Balance Scale for people with stroke.
        Phys Ther. 2006; 86: 195-204
        • Chien C.W.
        • Lin J.H.
        • Wang C.H.
        • Hsueh I.P.
        • Sheu C.F.
        • Hsieh C.L.
        Developing a short form of the Postural Assessment Scale for People With Stroke.
        Neurorehabil Neural Repair. 2007; 21: 81-90
        • Franchignoni F.
        • Horak F.
        • Godi M.
        • Nardone A.
        • Giordano A.
        Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest.
        J Rehabil Med. 2010; 42: 323-331
        • Hsueh I.P.
        • Chen J.H.
        • Wang C.H.
        • et al.
        Development of a computerized adaptive test for assessing balance function in patients with stroke.
        Phys Ther. 2010; 90: 1336-1344
        • Yu W.H.
        • Hsueh I.P.
        • Hou W.H.
        • Wang Y.H.
        • Hsieh C.L.
        A comparison of responsiveness and predictive validity of two balance measures in patients with stroke.
        J Rehabil Med. 2012; 44: 176-180
        • Chen C.H.
        • Lin S.F.
        • Yu W.H.
        • Lin J.H.
        • Chen H.L.
        • Hsieh C.L.
        Comparison of the test-retest reliability of the Balance Computerized Adaptive Test and a computerized posturography instrument in patients with stroke.
        Arch Phys Med Rehabil. 2014; 95: 1477-1483
        • Hou W.H.
        • Chen J.H.
        • Wang Y.H.
        • et al.
        Development of a set of functional hierarchical balance short forms for patients with stroke.
        Arch Phys Med Rehabil. 2011; 92: 1119-1125
        • Yu W.H.
        • Chen K.L.
        • Chou Y.T.
        • Hsueh I.P.
        • Hsieh C.L.
        Responsiveness and predictive validity of the Hierarchical Balance Short Forms in people with stroke.
        Phys Ther. 2013; 93: 798-808
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: applications to practice.
        3rd ed. Pearson Prentice Hall, Upper Saddle River2009
        • Hopkins W.G.
        Measures of reliability in sports medicine and science.
        Sports Med. 2000; 30: 1-15
        • Donner A.
        • Eliasziw M.
        Sample size requirements for reliability studies.
        Stat Med. 1987; 6: 441-448
        • McHorney C.A.
        • Tarlov A.R.
        Individual-patient monitoring in clinical practice: are available health status surveys adequate?.
        Qual Life Res. 1995; 4: 293-307
        • Shrout P.E.
        • Fleiss J.L.
        Intraclass correlations: uses in assessing rater reliability.
        Psychol Bull. 1979; 86: 420-428
        • Prince B.
        • Makrides L.
        • Richman J.
        Research methodology and applied statistics. Part 2: the literature search.
        Physiother Can. 1980; 32: 201-206
        • Kottner J.
        • Audige L.
        • Brorson S.
        • et al.
        Guidelines for Reporting Reliability and Agreement Studies (GRRAS) were proposed.
        Int J Nurs Stud. 2011; 48: 661-671
        • Huang S.L.
        • Hsieh C.L.
        • Wu R.M.
        • Tai C.H.
        • Lin C.H.
        • Lu W.S.
        Minimal detectable change of the Timed “Up & Go” Test and the Dynamic Gait Index in people with Parkinson disease.
        Phys Ther. 2011; 91: 114-121
        • Atkinson G.
        • Nevill A.M.
        Statistical methods for assessing measurement error (reliability) in variables relevant to sports medicine.
        Sports Med. 1998; 26: 217-238
        • Haley S.M.
        • Fragala-Pinkham M.A.
        Interpreting change scores of tests and measures used in physical therapy.
        Phys Ther. 2006; 86: 735-743
        • Schreuders T.A.
        • Roebroeck M.E.
        • Goumans J.
        • van Nieuwenhuijzen J.F.
        • Stijnen T.H.
        • Stam H.J.
        Measurement error in grip and pinch force measurements in patients with hand injuries.
        Phys Ther. 2003; 83: 806-815
        • Guilford J.P.
        Psychometric methods.
        2nd ed. McGraw-Hill, New York1954
        • Flansbjer U.B.
        • Holmback A.M.
        • Downham D.
        • Patten C.
        • Lexell J.
        Reliability of gait performance tests in men and women with hemiparesis after stroke.
        J Rehabil Med. 2005; 37: 75-82
        • Lee Y.C.
        • Yu W.H.
        • Lin Y.F.
        • Hsueh I.P.
        • Wu H.C.
        • Hsieh C.L.
        Reliability and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system in patients with stroke.
        Arch Phys Med Rehabil. 2014; 95: 2055-2063
        • Liaw L.J.
        • Hsieh C.L.
        • Lo S.K.
        • Chen H.M.
        • Lee S.
        • Lin J.H.
        The relative and absolute reliability of two balance performance measures in chronic stroke patients.
        Disabil Rehabil. 2008; 30: 656-661
        • Rodrigues L.C.
        • Marques A.P.
        • Barros P.B.
        • Michaelsen S.M.
        Reliability of the Balance Evaluation Systems Test (BESTest) and BESTest sections for adults with hemiparesis.
        Braz J Phys Ther. 2014; 18: 276-281
        • Lexell J.E.
        • Downham D.Y.
        How to assess the reliability of measurements in rehabilitation.
        Am J Phys Med Rehabil. 2005; 84: 719-723
        • Scholtes V.A.
        • Terwee C.B.
        • Poolman R.W.
        What makes a measurement instrument valid and reliable?.
        Injury. 2011; 42: 236-240
        • Terwee C.B.
        • Mokkink L.B.
        • Knol D.L.
        • Ostelo R.W.
        • Bouter L.M.
        • de Vet H.C.
        Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist.
        Qual Life Res. 2012; 21: 651-657
        • Wade D.T.
        Measurement in neurological rehabilitation.
        Curr Opin Neurol. 1992; 5: 682-686
        • Hobart J.
        • Lamping D.
        • Thompson A.
        Evaluating neurological outcome measures: the bare essentials.
        J Neurol Neurosurg Psychiatry. 1996; 60: 127-130
        • Streiner D.L.
        • Norman G.R.
        • Cairney J.
        Health measurement scales: a practical guide to their development and use.
        Oxford Univ Pr, Oxford2014
        • Michael K.
        • Goldberg A.P.
        • Treuth M.S.
        • Beans J.
        • Normandt P.
        • Macko R.F.
        Progressive adaptive physical activity in stroke improves balance, gait, and fitness: preliminary results.
        Top Stroke Rehabil. 2009; 16: 133-139
        • Stewart A.L.
        • Hays R.D.
        • Ware Jr., J.E.
        The MOS short-form general health survey. Reliability and validity in a patient population.
        Med Care. 1988; 26: 724-735
        • Schunemann H.J.
        • Guyatt G.H.
        Commentary—goodbye M(C)ID! Hello MID, where do you come from?.
        Health Serv Res. 2005; 40: 593-597
        • Copay A.G.
        • Subach B.R.
        • Glassman S.D.
        • Polly D.W.
        • Schuler T.C.
        Understanding the minimum clinically important difference: a review of concepts and methods.
        Spine J. 2007; 7: 541-546