1
|
Aakrann EB, Brincks J. The psychometric properties of the Six-Spot Step Test - a systematic review using the COSMIN guidelines. Clin Rehabil 2024; 38:932-943. [PMID: 38425190 DOI: 10.1177/02692155241236609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Accurate and reliable balance measures are important for prescribing fall prevention treatments and monitoring their effectiveness. Thus, we aimed to systematically review the psychometric properties of the Six-Spot Step Test, an increasingly used measure of dynamic balance. DATA SOURCES A literature search using the free-text term "Six-Spot Step Test" was performed on 12 February 2024, in Medline, Embase, Rehabilitation & Sports Medicine and SPORTDiscus. Eligibility criteria were adults aged 18 or more, trials evaluating the psychometric properties of the Six-Spot Step Test, and English-language articles. Conference abstracts were excluded. REVIEW METHODS Two investigators screened and selected data independently and assessed the methodological quality and evidence using the COSMIN Risk of Bias checklist and modified GRADE approach. One investigator extracted study characteristics such as design, population and psychometric properties. RESULTS Of the 159 articles identified, 16, evaluating multiple measurement properties, were included in the final analysis. A total of 1319 people participated, including people affected by Stroke, multiple sclerosis, Parkison's disease, chronic inflammatory polyneuropathy and older adults with balance problems. Eight articles assessing reliability (n = 618, intraclass correlations coefficient ≥0.7, minimal detectable change = 22%) and 12 construct validity (n = 1082, 83% true hypothesis, area under the curve >0.7) exhibited sufficient methodological quality with high-level evidence, while two studies (n = 167) examining responsiveness showed very low evidence. CONCLUSION Apart from responsiveness, robust evidence supports the reliability and validity of the Six-Spot Step Test for assessing dynamic balance in a specific group of individuals with neurological diseases and older adults. Further, it is considered feasible for clinical use.
Collapse
Affiliation(s)
- Endre Bakke Aakrann
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus N, Denmark
| | - John Brincks
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus N, Denmark
| |
Collapse
|
2
|
Brincks J, Johnsen EL, Callesen J. A study of the reliability and validity of the Six-Spot Step Test Cognitive in ambulatory persons with Parkinson's disease. Parkinsonism Relat Disord 2023; 111:105412. [PMID: 37119663 DOI: 10.1016/j.parkreldis.2023.105412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023]
Abstract
INTRODUCTION Although dual-task walking deficits challenge ambulatory function in persons with Parkinson's disease (PwPD), ambulation measures that incorporate cognitive dual-task loads seem scarce. In its construct and instruction, the Six-Spot Step Test Cognitive (SSSTcog) ensures an equal focus on cognitive and motor tasks. The present study investigated the construct validity and test-retest reliability of the SSSTcog in PwPD. METHODS Seventy-eight PwPD were recruited from outpatient clinics. The SSSTcog was completed twice within the same day and again three to seven days later. In addition, the cognitive Timed "Up and Go" test (TUGcog) and the Mini-BESTest were also conducted on the last day. Reliability and validity were estimated using Bland-Altman statistics, the minimal difference (MD), Intraclass Correlation Coefficient (ICC), and Spearman's rank correlation coefficient (ρ). RESULTS The SSSTcog was found reliable (ICC: 0.84-0.89; MD: 23.7%-30.2%) and showed moderate construct validity to the TUGcog (ρ = 0.62, p < 0.001). Weak correlations to the Mini-BESTest (ρ = -0.33, p < 0.003) indicated low construct validity. Significantly (p < 0.001) higher dual-task costs were seen when performing the SSSTcog (77.6%) compared to the TUGcog (24.3%). CONCLUSIONS In PwPD, the SSSTcog showed promising construct validity, acceptable to excellent reliability, making it a valid measure of functional mobility, including cognitive dual-tasking. Higher dual-task cost for the SSSTcog indicated actual cognitive-motor interference while performing the test.
Collapse
Affiliation(s)
- John Brincks
- VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Hedeager 2, 8200, Aarhus N, Denmark.
| | - Erik L Johnsen
- Aarhus University Hospital, Department of Neurology, 8200, Aarhus N, Denmark; Department of Neurology, Clinical Medicine, Aarhus University, Denmark
| | - Jacob Callesen
- VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Hedeager 2, 8200, Aarhus N, Denmark
| |
Collapse
|
3
|
Liu TW, Ng SS, Cheung KY, Cheung MY, Hung RN, Lam MF, Wong AT, Lai CY, Tse MM. Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors. Eur J Phys Rehabil Med 2021; 57:879-888. [PMID: 34128605 DOI: 10.23736/s1973-9087.21.06799-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Six-Spot Step Test (SSST) was originally developed to assess walking ability while challenging balance during walking in patients with multiple sclerosis. It provides more comprehensive information on ambulatory abilities than several existing measures such as the Timed Up & Go test (TUG test), the Functional Gait Assessment, and the Dynamic Gait Index. To assess the advanced balance control ability of stroke survivors, we modified the SSST to serve this purpose. AIM The aim of this study was to expand the current understanding of the psychometric properties of the SSST using healthy older adults and stroke survivors. DESIGN This study adopted an experimental design. SETTING University-affiliated neurorehabilitation laboratory. POPULATION A total of 50 study participants, including 25 chronic stroke survivors and 25 healthy older adults, were recruited from the community. METHODS The SSST was administered to the stroke survivors twice (day 1 & 2) with a 1-week interval. The Fugl-Meyer assessment for the lower extremities (FMA-LE), the Berg Balance scale (BBS), the limit of stability (LOS) test, the Timed Up & Go test (TUG test), and the Chinese version of the Community Integration Measures (CIM-C) were assessed on day 1 by random order. The healthy control group was assessed with the Six-Spot Step Test only on day 1. RESULTS The SSST showed excellent inter-rater, intra-rater, and test-retest reliability (intraclass correlation coefficient>0.95, p<0.001). Significant correlations were found between SSST performance and the FMA-LE results (r=0.517, p<0.05), BBS scores (q r =-0.531, p<0.05), and TUG test scores (r =0.828, p<0.001). The MDC in the mean SSST time for the affected leg and the unaffected leg in stroke survivors was 6.05s. The cutoff time was 10.11s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the affected leg and 10.18s (sensitivity, 80%; specificity, 92%) when kicking obstacles with the unaffected leg. CONCLUSIONS The SSST was a reliable test and showed a significant correlation with FMA-LE scores, BBS scores, and TUG test times in stroke survivors. CLINICAL REHABILITATION IMPACT The SSST can be used to assess the advanced balance control of stroke survivors.
Collapse
Affiliation(s)
- Tai Wa Liu
- School of Nursing and Health Studies, The Open University of Hong Kong, Hong Kong
| | - Shamay S Ng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong -
| | - Ka-Yuen Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ming-Yeung Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Ryan N Hung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Man-Fai Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Adrian T Wong
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Cynthia Y Lai
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Mimi M Tse
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| |
Collapse
|
4
|
Brincks J, Callesen J. Examining the test-retest reliability and construct validity of the Six-Spot Step Test in older adults with self-reported balance problems. Clin Rehabil 2021; 35:1478-1487. [PMID: 33874761 DOI: 10.1177/02692155211010278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the test-retest reliability and construct validity of the Six-Spot Step Test in older adults. DESIGN Cross-sectional study. SETTING Outpatient clinics. SUBJECTS Sixty-six adults aged ⩾65 years with self-reported balance problems. MAIN MEASURE The Six-Spot Step Test was completed twice on day 1. Three days later, the Six-Spot Step Test, the Timed "Up and Go" test, Dynamic Gait Index, the Mini-BESTest, and standing balance test were conducted. Reliability and validity were estimated using Bland-Altman statistics, minimal detectable change, Intraclass Correlation Coefficient (ICC), and Spearman's rank correlation coefficient (ρ). RESULTS Participants had a mean (SD) age of 75.5 (6.6) years, a median (Q1-Q3) Montreal Cognitive Assessment test score of 26 (24-27), and a median (Q1-Q3) Falls Efficacy Scale International score of 22 (20-26). The study found within-day and between-day limits of agreements of ±15.7% and ±18.1%, respectively. The minimal detectable changes at the 95% level of confidence for within-day and between-day were 17.5% and 21.6%, and the ICCs were 0.96 (CI: 0.92-0.98) and 0.94 (CI: 0.86-0.97), respectively. A learning effect was observed between the first and second Six-Spot Step Test. Moderate to strong correlations were found between the Six-Spot Step Test and Mini-BESTest (ρ = -0.62), Dynamic Gait Index (ρ = -0.55), and the Timed "Up and Go" test (ρ = 0.79). Weak correlations were identified between the Six-Spot Step Test and static standing balance test (ρ < 0.38). CONCLUSION The Six-Spot Step Test shows excellent relative consistency and moderate to high construct validity in older adults. A change of 21.6% is a true change in outcome.
Collapse
Affiliation(s)
- John Brincks
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus, Denmark
| | - Jacob Callesen
- Faculty of Health Science, VIA University College, Research Centre for Health and Welfare Technology - Programme for Rehabilitation, Aarhus, Denmark
| |
Collapse
|
5
|
Reliability and Validity of the Six Spot Step Test in People with Intellectual Disability. Brain Sci 2021; 11:brainsci11020201. [PMID: 33562007 PMCID: PMC7914911 DOI: 10.3390/brainsci11020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/24/2021] [Accepted: 02/03/2021] [Indexed: 11/16/2022] Open
Abstract
Clinical tests for the evaluation of balance in people with intellectual disability that have been most commonly used depend on the subjective evaluation of the evaluator, easily reach the ceiling effect and are poorly sensitive to small changes; but new tests have been developed, such as the Six Spot Step Test. The aim of this study was to determine the validity and within-day and day-to-day test–retest reliability of the Six Spot Step Test in people with intellectual disability. A descriptive cross-sectional study was conducted with 18 people with intellectual disability. The participants conducted the Six Spot Step Test three times and a set of five clinical tests for the balance assessment. The relative reliability was excellent (Intraclass Correlation Coefficient (ICC) = 0.86 − 0.97), and the absolute reliability ranged between 4.7% and 7.3% for coefficient variation and between 0.6 and 1.2 for the standard error of measurement. Linear regression models showed that that test can explain the results of the Timed Up & Go, Four Square Step Test and the Berg Balance Scale. The Six Spot Step Test proved to be as valid and reliable for the evaluation of dynamic balance in people with intellectual disability as the most frequently used tests for the clinical evaluation of postural control.
Collapse
|
6
|
Arvidsson Lindvall M, Forsberg A, Appelros P, Anderzén-Carlsson A. "I can manage the challenge" - a qualitative study describing experiences of living with balance limitations after first-ever stroke. Int J Qual Stud Health Well-being 2020; 16:1857044. [PMID: 33323049 PMCID: PMC7744151 DOI: 10.1080/17482631.2020.1857044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: To describe experiences of living with balance limitations after first-ever stroke. Materials and methods: This study has a qualitative design, comprising interviews with 19 persons with first-ever stroke, ten women and nine men. Their mean age was 77 years and the mean time since stroke was 15 months. Stroke survivors who were able to walk outdoors with or without a walking aid and who were independent in toileting and dressing were invited to participate. Semi-structured individual interviews were performed. An inductive qualitative content analysis of the manifest and latent content was conducted. Results: The results are presented in two themes illustrating the latent content of the data, “Feeling dizzy and unstable is a continuous challenge” and “Feeling confidence despite dizziness and unsteadiness”, and seven categories illustrating the manifest content: Limitations in daily life; Being emotionally affected; The need for physical support; Everything takes time; I can still manage; Feelings of acceptance; and Finding individual solutions. Conclusions: All participants experienced the balance limitations as a continuous challenge in their everyday life, yet they also felt confidence. They had to some degree adapted their activities and were able to manage their daily life.
Collapse
Affiliation(s)
- Mialinn Arvidsson Lindvall
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Anette Forsberg
- Department of Physiotherapy, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Peter Appelros
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- Department of University Health Care Research Center, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
| |
Collapse
|
7
|
SPIDER as A Rehabilitation Tool for Patients with Neurological Disabilities: The Preliminary Research. J Pers Med 2020; 10:jpm10020033. [PMID: 32365884 PMCID: PMC7354426 DOI: 10.3390/jpm10020033] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/12/2020] [Accepted: 04/29/2020] [Indexed: 11/25/2022] Open
Abstract
(1) Background and purpose: SPIDER (Strengthening Program for Intensive Developmental Exercises and activities for Reaching health capability) is dedicated for patients suffering from Cerebral Palsy, Sclerosis Multiplex, Spinal Bifida, Spinal Muscular Atrophy and strokes. Authors proposed a computer model for the evaluation patient’s condition and the rehabilitation progress. (2) Methods: The 2-year-old and 76-year-old patients with neurological problems, who underwent individual therapy included balancing and coordination practising with SPIDER device. The model comparing the forces, which act during the therapy process, such as the expander and gravity forces, was worked out using Matlab software. (3) Results: The model allowed controlling the changes into the patients centre of gravity forces continuous adjustment and postural stability during any patient’s movement. After rehabilitation sessions, lasted for 28 days during which patients received the progress information and the therapist got the numeric data, regarding the period of the therapy. (4) Conclusions: The first patient was able to move, dramatically improved the ability to balance and coordination. The second one presented change in gait, improvement in mobility, motor function and decreased fall risk. The proposed computer model gives information about the forces acting to the patient body. The physiotherapist can evaluate the progress of patient verticalization and receive information, in the form of numbers and charts.
Collapse
|
8
|
Brincks J, Jørgensen JB, Giese IE, Palle ML, Callesen J, Johnsen E, Næss-Schmidt ET, Dalgas U. A study of the discriminative properties of the Six-Spot Step Test in people with Parkinson's disease at risk of falling. NeuroRehabilitation 2019; 45:265-272. [PMID: 31498144 DOI: 10.3233/nre-192801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clinical tests that can discriminate between people at risk of falling and those not at risk are warranted. The discriminative properties of the Six-Spot Step Test was investigated in people with Parkinson's disease at risk of falling. METHODS Eighty-one participants with a median age of 69 years (Q1-Q3:63-74) and a median Hoehn and Yahr score of 2.5 (Q1-Q3:2-3) completed the Six-Spot Step Test and the Timed "Up and Go" test. A mini-BESTest score of 19 or below was used as a cut-off for defining risk of falling, and a receiver operating characteristics curve was generated to determine clinical relevant cut-off scores. RESULTS A cut-off score of 7.0 and 6.8 seconds identified people not at risk of falling, while 11.1 and 9.4 seconds identified people at risk of falling for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. When maximizing the sensitivity and specificity a cut-off score of 9.2 (accuracy of 84%) and 8.1 seconds (accuracy of 70%) was found for the Six-Spot Step Test and the Timed "Up and Go" test, respectively. CONCLUSION The Six-Spot Step Test discriminates accurately between people with Parkinson's disease at risk of falling and people not at risk.
Collapse
Affiliation(s)
- John Brincks
- Department of Research in Rehabilitation and Health Promotion, VIA University College, Faculty of Health Science, Aarhus, Denmark
| | - Julie Brøbech Jørgensen
- Department of Research in Rehabilitation and Health Promotion, VIA University College, Faculty of Health Science, Aarhus, Denmark
| | - Iben Engelbrecht Giese
- Department of Research in Rehabilitation and Health Promotion, VIA University College, Faculty of Health Science, Aarhus, Denmark
| | - Marie Louise Palle
- Department of Research in Rehabilitation and Health Promotion, VIA University College, Faculty of Health Science, Aarhus, Denmark
| | - Jacob Callesen
- Department of Research in Rehabilitation and Health Promotion, VIA University College, Faculty of Health Science, Aarhus, Denmark.,Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
| | - Erik Johnsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Ulrik Dalgas
- Department of Public Health - Section of Sport Science, Aarhus University, Aarhus, Denmark
| |
Collapse
|