Reproducibility of Trunk Control Assessment and the Clinical Utility of the Distinguishing Barthel Index in Chronic Stroke Patients (만성 뇌졸중 환자들의 체간 조절 평가의 재현성과 Barthel Index구분을 위한 임상 유용성)

Seung-Heon An (안승헌); Dae-Sung Park (박대성)

Reproducibility of Trunk Control Assessment and the Clinical Utility of the Distinguishing Barthel Index in Chronic Stroke Patients

Journal of the Korean Society of Physical Medicine
Abbr : J Korean Soc Phys Med
2024, 19(3), pp.55~63
Publisher : The Korean Society of Physical Medicine
Research Area : Medicine and Pharmacy > Physical Therapy > Other physical therapy
Received : March 28, 2024
Accepted : May 23, 2024
Published : August 31, 2024

Seung-Heon An ¹, Dae-Sung Park ²

¹국립재활원
²건양대학교

Irregular Papers

ABSTRACT

PURPOSE: This study examined the test-retest reliability and clinical utility of the Modified Trunk Impairment Scale (mTIS), Trunk Control Test (TCT), and Postural Assessment Scale for Stroke – Trunk Control (PASS-TC) in patients with chronic stroke. METHODS: Thirty-eight stroke patients were reassessed using the mTIS, TCT, and PASS-TC with a seven-day interval between assessments. The test-retest reliability was evaluated using the intraclass correlation coefficient (ICC2,1), the standard error of measurement (SEM), the minimal detectable change (MDC), and MDC%, as well as Bland–Altman analysis. The relationship between the mTIS, TCT, PASS-TC scores, and the Barthel Index (BI) was also investigated. RESULTS: The test-retest reliability for the mTIS, TCT, and PASS-TC was high, with ICC values ranging from .91 to .94 (95% confidence interval: .83–.97). The MDCs for the mTIS and TCT were 2.35 and 13.9, respectively, while the MDC for the PASS-TC was 2 .54, a ll below 20% o f the maximum possible score, indicating reliable measurement. The optimal mTIS cut-off score for distinguishing between mild (75–95 points) and severe (50–74 points) dependence on the BI was ≥ 9.5, with an accuracy of 79%. Patients with an mTIS score ≥ 9.5 (out of 15) showed an 18-fold higher likelihood of achieving a mild level of functional independence than those with a score < 9.5. CONCLUSION: The mTIS, TCT, and PASS-TC showed high test-retest reliability and no systematic errors in chronic stroke patients. The MDC values were reliable, indicating meaningful change. Among these, the mTIS is a sensitive and a useful tool for predicting functional independence in clinical practice and is straightforward to apply.

KEYWORDS

Barthel index, Minimal detectable change, Reproducibility, Stroke, Trunk control

Citation status

* References for papers published after 2025 are currently being built.

[journal] Kibler WB / 2006 / The role of core stability in athletic function / Sports Med 36(3) : 189~198

[journal] Ryerson S / 2008 / Altered trunk position sense and its relation to balance functions in people poststroke / J Neurol Phys Ther 32(10) : 14~20

[journal] Verheyden G / 2007 / Clinical tools to measure trunk performance after stroke : a systematic review of the literature / Clin Rehabil 21(5) : 387~394

[journal] Hsieh CL / 2002 / Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients / Stroke 33(11) : 2626~2630

[journal] Verheyden G / 2006 / Trunk performance after stroke and the relationship with balance, gait and functional ability / Clin Rehabil 20(5) : 451~458

[journal] De Vet HC / 2006 / When to use agreement versus reliability measures / J Clin Epidemiol 59(10) : 1033~1039

[journal] De Vet HC / 2006 / Minimal changes in health status questionnaires : distinction between minimally detectable change and minimally important change / Health Qual Life Outcomes 4 : 54~

[journal] Gjelsvik B / 2012 / The Trunk Impairment Scale – modified to ordinal scales in the Norwegian version / Disabil Rehabil 34(16) : 1385~1395

[journal] Collin C / 1990 / Assessing motor impairment after stroke : a pilot reliability study / J Neurol Neurosurg Psychiatry 53(7) : 576~579

[journal] Franchignoni FP / 1997 / Trunk control test as an early predictor of stroke rehabilitation outcome / Stroke 28(7) : 1382~1385

[journal] Atkinson G / 1998 / Statistical methods for assessing measurement error(reliability)in variables relevant to sports medicine / Sports Med 26(4) : 217~238

[journal] Kovacs FM / 2008 / Minimum detectable and minimal clinically important changes for pain in patients with nonspecific neck pain / BMC Musculoskelet Disord 9 : 43~

[journal] Lexell JE / 2005 / How to assess the reliability of measurements in rehabilitation / Am J Phys Med Rehabil 84(9) : 719~723

[journal] Schuck P / 2003 / The’smallest real difference’as a measure of sensitivity to change : a critical analysis / Int J Rehabil Res 26(2) : 85~91

[journal] Beckerman H / 2001 / Smallest real difference, a link between reproducibility and responsiveness / Qual Life Res 10(7) : 571~578

[journal] Flansbjer UB / 2012 / The reproducibility of berg balance scale and the single-leg stance in chronic stroke and t he r elationship between t he two t ests / PM R 4(3) : 165~170

[journal] Benaim C / 1999 / Validation of a standardized assessment of postural control in stroke patients : the postural assessment scale for stroke patients(pass) / Stroke 30(9) : 1862~1868

[journal] Prince B / 1980 / Research methodology and applied statistics. Part 2 : The literature search / Physiother Can 32(4) : 201~206

[journal] Beckerman H / 2001 / Smallest real difference, a link between reproducibility and responsiveness / Qual Life Res 10(7) : 571~578

[journal] Smidt N / 2002 / Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis / Arch Phys Med Rehabil 83(8) : 1145~1150

[journal] Bland JM / 1990 / A note on the use of the intraclass correlation coefficient in the evaluation of agreement between two methods of measurement / Comput Biol Med 20(5) : 337~340

[journal] Wang CH / 2005 / Discriminative, predictive, and evaluative properties of a trunk control measure in patients with stroke / Phys Ther 85(9) : 887~894

[journal] Bohannon RW / 1992 / Lateral trunk flexion strength : Impairment, measurement reliability and implications following unilateral brain lesion / Int J Rehabil Res 15(3) : 249~251

[journal] Bohannon RW / 1995 / Recovery and correlates of trunk muscle strength after stroke / Int J Rehabil Res 18(2) : 162~167

[journal] Verheyden G / 2010 / Investigating the internal validity of the Trunk Impairment Scale(TIS)using Rasch analysis : the TIS 2. 0 / Disabil Rehabil 32(25) : 2127~2137

[journal] Verheyden G / 2005 / Discriminant ability of the Trunk Impairment Scale : a comparison between stroke patients and healthy adults / Disabil Rehabil 27(17) : 1023~1028

[journal] Greiner M / 2000 / Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests / Prev Vet Med 45(1-2) : 23~41

[journal] Lee YB / 2018 / Clinical utility of the modified trunk impairment scale for stroke survivors / Disabil Rehabil 40(10) : 1200~1205

[journal] Mahoney FI / 1965 / Functional evaluation : the Barthel Index / Md State Med J 14 : 61~65

KJCKorea
Journal Central

Journal of the Korean Society of Physical Medicine 2025 KCI Impact Factor : 1.09