Advertisement

Validation of the Activities-Specific Balance Confidence Scale With 5-Option Response Format in Slovene Lower-Limb Prosthetic Users

Published:November 20, 2020DOI:https://doi.org/10.1016/j.apmr.2020.10.126

      Abstract

      Objective

      To examine the psychometric properties of the Activities-specific Balance Confidence (ABC) scale administered in the Slovene version with a simplified 5-option response format (ABC-5/SLO) using Rasch analysis.

      Design

      Methodological research on data gathered in a cross-sectional study.

      Setting

      Outpatient university rehabilitation clinic.

      Participants

      A convenience sample of adults with unilateral lower-limb amputation (N=138; 75% men) longer than 6 months who regularly wear a prosthesis.

      Intervention

      Not applicable.

      Main Outcome Measures

      We evaluated functioning of rating scale categories, internal construct validity, reliability indices, and dimensionality using the ABC-5/SLO (0=no confidence to 4=complete confidence).

      Results

      The ABC-5/SLO rating scale fulfilled the category functioning criteria. All items fit the underlying scale construct (balance confidence) except item 8 (“walk outside the house to a car parked in the driveway”), which was overfitting. The person abilities-item difficulty matching (targeting) was good. The person separation reliability was .92, and the item separation reliability was .99. Analysis of the standardized Rasch residuals showed the scale’s unidimensionality and absence of high item dependency (residual correlations, <.30). The correlation between the ABC-5/SLO and the Prosthetic Mobility Questionnaire (Rasch measures) was high (ρ=.84), as expected. Minor signs of item redundancy were found.

      Conclusions

      The simplified ABC-5/SLO scale is a valid and reliable measure of balance confidence for individuals with lower-limb amputation. It is possible to transform the ordinal summed raw scores of the ABC-5/SLO into interval-level measurements using a nomogram.

      Keywords

      List of abbreviations:

      ABC (Activities-specific Balance Confidence scale), ABC-5 (Activities-specific Balance Confidence scale with 5-option response format), ABC-5/SLO (Slovene version of the Activities-specific Balance Confidence scale with 5-option response format), DIF (differential item functioning), LLA (lower-limb amputation), MnSq (mean square statistics), PMQ (Prosthetic Mobility Questionnaire)
      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

        • Wong C.K.
        • Chen C.C.
        • Blackwell W.M.
        • Rahal R.T.
        • Benoy S.A.
        Balance ability measured with the Berg balance scale: a determinant of fall history in community-dwelling adults with leg amputation.
        J Rehabil Med. 2015; 47: 80-86
        • Wong C.K.
        • Chihuri S.T.
        • Li G.
        Risk of fall-related injury in people with lower limb amputations: a prospective cohort study.
        J Rehabil Med. 2016; 48: 80-85
        • Wong C.K.
        • Chihuri S.T.
        Impact of vascular disease, amputation level, and the mismatch between balance ability and balance confidence in a cross sectional study of the likelihood of falls among people with limb loss: perception versus reality.
        Am J Phys Med Rehabil. 2019; 98: 130-135
        • Matjačić Z.
        • Burger H.
        Dynamic balance training during standing in people with trans-tibial amputation: a pilot study.
        Prosthet Orthot Int. 2003; 27: 214-220
        • Steinberg N.
        • Gottlieb A.
        • Siev-Ner I.
        • Plotnik M.
        Fall incidence and associated risk factors among people with a lower limb amputation during various stages of recovery - a systematic review.
        Disabil Rehabil. 2019; 41: 1778-1787
        • Major M.J.
        • Fatone S.
        • Roth E.J.
        Validity and reliability of the Berg Balance Scale for community-dwelling persons with lower-limb amputation.
        Arch Phys Med Rehabil. 2013; 94: 2194-2202
        • Miller W.C.
        • Speechley M.
        • Deathe A.B.
        Balance confidence among people with lower-limb amputations.
        Phys Ther. 2002; 82: 856-865
        • Franchignoni F.
        • Martignoni E.
        • Ferriero G.
        • Pasetti C.
        Balance and fear of falling in Parkinson’s disease.
        Park Relat Disord. 2005; 11: 427-433
        • Murphy S.L.
        • Williams C.S.
        • Gill T.M.
        Characteristics associated with fear of falling and activity restriction in community-living older persons.
        J Am Geriatr Soc. 2002; 50: 516-520
        • Sions J.M.
        • Manal T.J.
        • Horne J.R.
        • Sarlo F.B.
        • Pohlig R.T.
        Balance-confidence is associated with community participation, perceived physical mobility, and performance-based function among individuals with a unilateral amputation.
        Physiother Theory Pract. 2018; 28: 1-8
        • Miller W.C.
        • Deathe A.B.
        • Speechley M.
        The influence of falling, fear of falling, and balance confidence on prosthetic mobility and social activity among individuals with a lower extremity amputation.
        Arch Phys Med Rehabil. 2001; 82: 1238-1244
        • Miller W.C.
        • Deathe A.B.
        • Speechley M.
        • Wc A.M.
        • Ab D.
        • Speechley M.
        Psychometric properties of the Activities-Specific Balance Confidence Scale among individuals with a lower-limb amputation.
        Arch Phys Med Rehabil. 2003; 84: 656-661
        • Myers A.M.
        • Fletcher P.C.
        • Myers A.H.
        • Sherk W.
        Discriminative and evaluative properties of the Activities-specific Balance Confidence (ABC) Scale.
        J Gerontol A Biol Sci Med Sci. 1998; 53: 287-294
        • Arnadottir S.A.
        • Lundin-Olsson L.
        • Gunnarsdottir E.D.
        • Fisher A.G.
        Application of Rasch analysis to examine psychometric aspects of the Activities-Specific Balance Confidence Scale when used in a new cultural context.
        Arch Phys Med Rehabil. 2010; 91: 156-163
        • Wang Y.C.
        • Sindhu B.
        • Lehman L.
        • Li X.
        • Yen S.C.
        • Kapellusch J.
        Rasch analysis of the Activities-specific Balance Confidence (ABC) scale in older adults seeking outpatient rehabilitation services.
        J Orthop Sports Phys Ther. 2018; 48: 574-583
        • Raad J.
        • Moore J.
        • Hamby J.
        • Rivadelo R.L.
        • Straube D.
        A brief review of the Activities-specific Balance Confidence Scale in older adults.
        Arch Phys Med Rehabil. 2013; 94: 1426-1427
        • Shirley Ryan AbilityLab
        Rehabilitation Measures Database. Activities-specific Balance Confidence Scale. Available at:.
        (Accessed July 10, 2020)
        • Heinemann A.W.
        • Connelly L.
        • Ehrlich-Jones L.
        • Fatone S.
        Outcome instruments for prosthetics: clinical applications.
        Phys Med Rehabil Clin N Am. 2014; 25: 179-198
        • Sakakibara B.M.
        • Miller W.C.
        • Backman C.L.
        Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations.
        Arch Phys Med Rehabil. 2011; 92: 1257-1263
        • Franchignoni F.
        • Giordano A.
        • Ronconi G.
        • Rabini A.
        • Ferriero G.
        Rasch validation of the Activities-specific Balance Confidence Scale and its short versions in patients with Parkinson's disease.
        J Rehabil Med. 2014; 46: 532-539
        • Seamon B.A.
        • Kautz S.A.
        • Velozo C.A.
        Rasch analysis of the Activities-Specific Balance Confidence Scale in individuals post-stroke.
        Arch Rehabil Res Clin Transl. 2019; 1: 100028
        • Beaton D.E.
        • Bombardier C.
        • Guillemin F.
        • Ferraz M.B.
        Guidelines for the process of cross-cultural adaptation of self-report measures.
        Spine. 2000; 25: 3186-3191
        • Franchignoni F.
        • Monticone M.
        • Giordano A.
        • Rocca B.
        Rasch validation of the Prosthetic Mobility Questionnaire: a new outcome measure for assessing mobility in people with lower limb amputation.
        J Rehabil Med. 2015; 47: 460-465
        • Burger H.
        • Giordano A.
        • Bavec A.
        • Franchignoni F.
        The Prosthetic Mobility Questionnaire, a tool for assessing mobility in people with lower-limb amputation: validation of PMQ 2.0 in Slovenia.
        Int J Rehabil Res. 2019; 42: 263-269
        • Wright B.D.
        Model selection: Rating Scale Model (RSM) or Partial Credit Model (PCM)?.
        Rasch Meas Trans. 1998; 12: 641-642
        • Linacre J.M.
        Comparing and choosing between "Partial Credit Models" (PCM) and "Rating Scale Models" (RSM).
        Rasch Meas Trans. 2000; 14: 768
        • Linacre J.M.
        Optimizing rating scale category effectiveness.
        J Appl Meas. 2002; 3: 85-106
        • Bond T.G.
        • Fox C.M.
        Applying the Rasch model – fundamental measurement in the human sciences.
        3rd ed. Routledge, New York2015
        • Linacre J.M.
        Size vs. significance: standardized chi-square fit statistic.
        Rasch Meas Trans. 2003; 17: 918
        • Linacre J.M.
        Sample size and item calibration stability.
        Rasch Meas Trans. 1994; 7: 328
        • Tang K.
        • Beaton D.E.
        • Lacaille D.
        • Gignac M.A.
        • Zhang W.
        • Anis A.H.
        • et al.
        The Work Instability Scale for Rheumatoid Arthritis (RA-WIS): does it work in osteoarthritis?.
        Qual Life Res. 2010; 19: 1057-1068
        • Linacre J.M.
        Differential Item Functioning (DIF) sample size nomogram.
        Rasch Meas Trans. 2013; 26: 1391
        • Wolfe E.W.
        • Smith Jr., E.V.
        Instrument development tools and activities for measure validation using Rasch models: part II – validation activities.
        J Appl Meas. 2007; 8: 204-234
        • Franchignoni F.
        • Giordano A.
        • Ferriero G.
        • Orlandini D.
        • Amoresano A.
        • Perucca L.
        Measuring mobility in people with lower limb amputation: Rasch analysis of the mobility section of the Prosthesis Evaluation Questionnaire.
        J Rehabil Med. 2007; 39: 138-144
        • Shumway-Cook A.
        • Woollacott M.
        Motor control: translating research into clinical practice.
        4th ed. Lippincott Williams & Wilkins, Philadelphia2012
        • Horak F.B.
        • Wrisley D.M.
        • Frank J.
        The Balance Evaluation Systems Test (BESTest) to differentiate balance deficits.
        Phys Ther. 2009; 89: 484-498
        • 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
        • Lehman L.A.
        • Sindhu B.S.
        • Johnson J.
        • Velozo C.A.
        Creating a clinically useful data collection form for the DASH questionnaire.
        Am J Occup Ther. 2011; 65: 45-54
        • Scott N.W.
        • Fayers P.M.
        • Aaronson N.K.
        • et al.
        A simulation study provided sample size guidance for differential item functioning (DIF) studies using short scales.
        J Clin Epidemiol. 2009; 62: 288-295