Comparison between two functional mobility scales for Parkinson's disease directly applied to physical therapy practice: cross-cultural adaptation and measurement properties.

BACKGROUND: The Modified Parkinson Activity Scale (PASm) and Lindop Parkinson's Disease Mobility Assessment (LPA) scales were developed to assess the functional mobility in patients with Parkinson's disease (PD) being directly applied to physical therapy practice. AIM: To translate and perform the cross-cultural adaptation of PASm and LPA scales to Portuguese-Brazil, and to analyze some psychometric properties. DESIGN: Cross-cultural validation study. SETTING: Clinical environment. POPULATION: Thirty-two Brazilian subjects with Parkinson's disease. METHODS: The study consisted of two stages: 1) cross-cultural adaptation process; 2) evaluation of psychometric properties. RESULTS: Considering the total score, the interrater and test-retest reliabilities showed a coefficient of intra-class correlation that ranged between 0.97 and 0.98. Both scales showed excellent internal consistency (α=0.83 and 0.94). Positive correlations were obtained between the Brazilian versions of the LPA and PASm and PAS (ρ=0.63 and 0.92). The concurrent validity between scales and part III of UPDRS, established a moderate negative correlation, (ρ=-0.54 and -0.65). The one way ANOVA showed that LPA-Brazil discriminates the individual with PD between all stages according HY, and the PASm- Brazil between mild and severe stages, and moderate and severe. The MDC of scales ranging from 1 to 2 points. There was Ceiling effect only for the LPA-Brazil. CONCLUSIONS: Brazilian versions of PASm and LPA are valid and reliable instruments to assess the functional mobility in patients with PD, being directly applied to physical therapy clinical practice. CLINICAL REHABILITATION IMPACT: The major goal of physical therapy in PD is to maintain functional mobility and independence of the patient. The results of study are relevant and could improve the physical therapy practice in Brazil, since it provides the Brazilian version of two mobility scales (one of them recommended by the European Guidelines for Physical Therapy Practice in patients with Parkinson disease).

Parkinson Activity Scale: cross-cultural adaptation and reliability of the Brazilian version.

AIM: Following the substantial growth of the elderly population in Brazil, there has been an increase in cases of Parkinson's disease (PD), which raises the need for reliable and culturally adapted scales specific to the disease. The Parkinson Activity Scale (PAS) was developed in order to assess the activity level of people with PD through tasks related to mobility. The aims of the present study were to translate the cross-cultural adaptation of the PAS into Brazilian Portuguese and analyze its reliability during the "on" phase of PD. METHODS: A total of 25 patients with PD participated in the study. The intrarater reliability was evaluated using a test-retest design with a 1-week interval. RESULTS: The interrater reliability was tested twice on the same day by two different raters. The intraclass correlation coefficient (ICC), and the Bland and Altman plots were calculated to examine the test-retest and interrater reliabilities for total score of the PAS, whereas the weighted Kappa (Wk) was used to assess interrater agreement. The interrater ICC was 0.89 and Wk was 0.65 for the total score. For intrarater reliability, the total score ICC was 0.88. CONCLUSIONS: The present study suggests that the Brazilian version of the PAS is a reliable instrument for the assessment of mobility in elderly patients with PD.

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis.

BACKGROUND: The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. OBJECTIVES: To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. METHOD: a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. RESULTS: In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). CONCLUSIONS: Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Strength deficit of knee flexors is dependent on hip position in adults with chronic hemiparesis

BACKGROUND: The extent to which muscle length affects force production in paretic lower limb muscles after stroke in comparison to controls has not been established. OBJECTIVES: To investigate knee flexor strength deficits dependent on hip joint position in adults with hemiparesis and compare with healthy controls. METHOD: a cross-sectional study with ten subjects with chronic (63±40 months) hemiparesis with mild to moderate lower limb paresis (Fugl-Meyer score 26±3) and 10 neurologically healthy controls. Isometric knee flexion strength with the hip positioned at 90° and 0° of flexion was assessed randomly on the paretic and non-paretic side of hemiparetic subjects and healthy controls. Subjects were asked to perform a maximal isometric contraction sustained for four seconds and measured by a dynamometer. The ratio of knee flexor strength between these two hip positions was calculated: Hip 0°/Hip 90°. Also, locomotor capacity was evaluated by the timed up and go test and by walking velocity over 10 meters. RESULTS: In subjects with hemiparesis, absolute knee flexion torque decreased (p<0.001) with the hip in extension (at 0°). The ratio of knee flexor torque Hip 0°/Hip 90° on the paretic side in hemiparetics was lower than in controls (p=0.02). CONCLUSIONS: Weakness dependent on joint position is more significant in the paretic lower limb of adults with hemiparesis when compared to controls. More attention should be given to lower limb muscle strengthening exercises in individuals with stroke, with emphasis on the strengthening exercises in positions in which the muscle is shortened.

Reliability of the Brazilian version of the Wolf Motor Function Test in adults with hemiparesis.

BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.

Confiabilidade da versão brasileira do Wolf Motor Function Test em adultos com hemiparesia / Reliability of the brazilian version of the Wolf Motor Function Test in adults with hemiparesis

CONTEXTUALIZAÇÃO: O Wolf Motor Function Test (WMFT) avalia o membro superior (MS) de adultos com hemiparesia combinando medidas de tempo e qualidade de movimento em movimentos isolados e em tarefas funcionais. OBJETIVOS: Traduzir e adaptar para a língua portuguesa o formulário, a escala de habilidade funcional (EHF) e o manual de aplicação do WMFT e avaliar a confiabilidade intra e inter-observadores. MÉTODOS: Participaram 15 indivíduos com média de idade de 57,9±11,1 anos e 68,5±53,5 meses pós acidente vascular encefálico (AVE). O WMFT foi aplicado por um fisioterapeuta utilizando as informações do manual e cotado por dois outros fisioterapeutas independentes pela observação dos vídeos. Foram acrescentadas informações mais detalhadas na EHF sobre a movimentação compensatória em relação à escala original. A confiabilidade intra e interobservadores do desempenho no tempo e da EHF dos itens individuais e do escore total foi avaliada pelo Coeficiente de Correlação Intraclasse (CCI) e pelo método Bland e Altman. Kappa ponderado (Kp) foi utilizado para avaliar a concordância intra e interobservadores da EHF. RESULTADOS: O CCI interobservador do desempenho no tempo foi >0,75 em 13 das 15 tarefas. A EHF apresentou CCI interobservador entre 0,87 e 0,99 em todas as tarefas e Kp entre 0,63 e 0,92. O CCI intraobservador do tempo variou entre 0,99 e 1 e na EHF, entre 0,96 e 1. O Kp intraobservador na EHF nas tarefas variou entre 0,79 e 0,96, sendo 0,93 para o escore total. CONCLUSÃO: A versão brasileira do WMFT demonstrou confiabilidade adequada para avaliar o MS parético pós-AVE.

BACKGROUND: The Wolf Motor Function Test (WMFT) evaluates the upper limb (UL) performance of adults with hemiparesis by combining time and quality of movement measures in both isolated movements and functional tasks. OBJECTIVES: To translate and adapt the WMFT form, functional ability scale (FAS) and manual to Brazilian Portuguese and evaluate the intra and inter-rater reliabilities. METHODS: Fifteen individuals with a mean age of 57.9±11.1 years and a mean time since stroke onset of 68.5±53.5 months participated. The WMFT was administered by one physiotherapist based on information in the manual, and video observations were assessed by two other independent physical therapists. Information regarding compensatory movements was included in the FAS. Intra-class correlation coefficients (ICCs) and Bland-Altman plots were calculated to examine the intra- and inter-rater reliabilities for performance time and FAS, whereas weighted kappa (Kp) was used to examine the agreement strength for FAS. RESULTS: The inter-rater ICC values for performance time were above 0.75 in 13 of the 15 tasks. For the FAS, they ranged from 0.87-0.99 for all evaluated tasks, with Kp values ranging from 0.63-0.92. For intra-rater reliability, the ICC ranged from 0.99-1.0 and from 0.96-1.0 for time measurement and FAS, respectively. Kp values ranged from 0.79-0.96 for individual and 0.93 for total scores. CONCLUSION: The Brazilian version of the WMFT showed adequate intra- and inter-rater reliabilities for evaluating the paretic UL of individuals with stroke.