Reproducibility of the ABILOCO questionnaire and comparison between self-reported and observed locomotion ability in adult patients with stroke.

OBJECTIVES: To test the reproducibility of the ABILOCO questionnaire. To validate the patient self-reporting method and the third-party assessment of the stroke patients' locomotion ability by a treating physical therapist. DESIGN: Prospective study. SETTING: University hospital. PARTICIPANTS: Adult stroke patients (N=28; 59+/-13y). The time since stroke ranged from 3 to 253 weeks. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The ABILOCO questionnaire. RESULTS: The results of patient self-assessment and the results of the third-party assessments by the physiotherapists at a 2-week interval were highly correlated (intraclass correlation coefficient [ICC]=.77 and ICC=.89, respectively). The results of the patient self-assessment and the third-party assessment by the physical therapist were both well correlated to assessment by an independent medical examiner who observed the patient during the 13 ABILOCO activities (ICC=.69 and ICC=.87, respectively). CONCLUSIONS: The use of ABILOCO as a self-reporting questionnaire is a valid and reproducible method for assessing locomotion ability in patients with stroke in daily clinical practice and research.

Reliability of lower limb kinematics, mechanics and energetics during gait in patients after stroke.

OBJECTIVE: To assess the reliability of kinematic, mechanical and energetic gait variables at short (1 day) and medium (1 month) intervals in adult patients after stroke. DESIGN: Prospective study. SUBJECTS: Ten patients with chronic post-stroke (mean age 53.5 years; age range 25-80 years). METHODS: Three-dimensional gait analysis was performed 3 times in these subjects: at baseline (T0), after 1 day (T1) and after 1 month (T2). The reliability of the gait analysis was tested by comparing gait variables measured at T1 and T0 (1 day interval), at T2 and T0 (1 month interval). The inter-session reliability of kinematic, mechanical and energetic variables was calculated by intra-class correlation coefficient (ICC). RESULTS: The reliability of kinematic variables ranged from excellent to moderate (ICC >or= 0.51), except for the ankle position at heel strike (ICC = 0.44). The reliability of mechanical and energetic variables ranged from excellent to good (ICC >or= 0.71). The most reliable variable was external mechanical work (ICC = 0.96). The kinematic, mechanical and energetic variables did not change significantly between T0, T1 and T2 (repeated-measures analysis of variance). CONCLUSION: Kinematic, mechanical and energetic gait variables present good reliability when measured at 1 day and 1 month intervals in adult patients after stroke.

Effect of upper limb botulinum toxin injections on impairment, activity, participation, and quality of life among stroke patients.

BACKGROUND AND PURPOSE: The purpose of this study was to study the effect of Botulinum toxin type A (BoNT-A) injections in spastic upper limb muscles on impairment, activity, participation and quality of life in chronic stroke patients. METHODS: BoNT-A (Dysport) was injected into several upper limb spastic muscles in a group of 20 patients. Neurological impairment (muscle tone and strength, dexterity, SIAS), activity (ABILHAND), participation (SATIS-Stroke), and quality of life (SF36) were assessed before and 2 months after the injections. RESULTS: BoNT-A injections improved muscle tone, but had no impact on dexterity, manual ability, social participation, and quality of life. CONCLUSIONS: In this study, BoNT-A injections in spastic upper limbs significantly reduced neurological impairments, but had no functional impact.

Effect of simultaneous botulinum toxin injections into several muscles on impairment, activity, participation, and quality of life among stroke patients presenting with a stiff knee gait.

BACKGROUND AND PURPOSE: Walking is an essential activity for daily life and social participation, and it is frequently limited after stroke. A lack of knee flexion during the swing phase (stiff knee) is one of the impairments that restrict walking ability among patients with hemiparetic spasticity. Our purpose was to study the effect of Botulinum toxin type A (BoNT A) injections in several spastic muscles on the impairment, activity, participation, and quality of life of patients with chronic stroke presenting with a stiff knee gait. METHODS: Twenty chronic hemiparetic poststroke patients with stiff knee gait and ability to walk on a treadmill were recruited. BoNT A was injected into several spastic muscles: the rectus femoris (200 U), semitendinosus (100 U) and triceps surae (200 U). Patients' neurological impairments (Ashworth scale, Duncan-Ely test, Stroke Impairment Assessment Set, and instrumented gait analysis), activity (ABILOCO and 10-m walking test), and participation (SATISPART-Stroke and 36-item Short-Form Health Survey) were assessed before and 2 months after the injection. RESULTS: BoNT A injection reduced the impairments. It improved Stroke Impairment Assessment Set (56.5 [48-63] to 56.5 [52.5 to 63]; P<0.001), reduced rectus femoris muscle tone (2 [1 to 2.5] to 0 [0 to 1]; P<0.001), and reduced semitendinosus muscle tone (1 [1 to 1.5] to 1 [0 to 1]; P<0.001). Gait analysis demonstrated increased knee flexion during the swing phase (22+/-19 degrees to 27+/-16 degrees ; P=0.03), decreased external mechanical work (0.66+/-0.38 to 0.59+/-0.25 J kg(-1) m(-1); P=0.04), and demonstrated a lower energy cost (5.8+/-1.9 to 4.9+/-1.9 J kg(-1) m(-1); P=0.03). The patients' locomotion ability was improved (2.2+/-1.9 to 3.2+/-2.1 logits; P=0.03). The participation and quality of life remained unchanged. CONCLUSIONS: BoNT A injections in several muscles improved the stiff knee gait and the locomotion ability in adult stroke patients.

ABILOCO: a Rasch-built 13-item questionnaire to assess locomotion ability in stroke patients.

OBJECTIVE: To develop a questionnaire (ABILOCO), based on the Rasch measurement model, that can assess locomotion ability in adult stroke patients (International Classification of Functioning, Disability and Health activity domain). DESIGN: Prospective study and questionnaire development. SETTING: A faculty hospital. PARTICIPANTS: Adult stroke patients (N=100) (age, 64+/-15y). The time since stroke ranged from 1 to 260 weeks. INTERVENTION: A preliminary questionnaire included 43 items representing a large sample of locomotion activities. This questionnaire was tested on the 100 stroke patients, and their responses were analyzed using the Rasch model (RUMM 2020 software) to select items that had an ordered rating scale and fitted a unidimensional model. MAIN OUTCOME MEASURE: The ABILOCO questionnaire. RESULTS: The retained items resulted in a 13-item questionnaire, which includes a wide range of locomotion abilities well targeted to the sample population, leading to good reliability (R=.93). The item calibration was independent of age, sex, time since stroke, and affected side. The concurrent validity of ABILOCO was also investigated by comparing it with well-known, criterion standard scales (Functional Walking Category, Functional Ambulation Categories, item 12 of the FIM instrument evaluating walking ability) and the walking speed measured with the 10-meter walk test. CONCLUSIONS: The ABILOCO questionnaire presents good psychometric qualities to measure locomotion ability in adult stroke patients. Its range and measurement precision make it attractive for clinical use throughout the rehabilitation process and for clinical research.

ABILOCO-Kids: a Rasch-built 10-item questionnaire for assessing locomotion ability in children with cerebral palsy.

OBJECTIVE: To develop a questionnaire (ABILOCO-Kids) based on the Rasch measurement model that assesses locomotion ability in children with cerebral palsy. DESIGN: Prospective study and questionnaire development. SUBJECTS: A total of 113 children with cerebral palsy (10 (standard deviation 2.5) years old). METHODS: A 41-item questionnaire was developed based on existing scales and on the clinical experience of professionals in the field of rehabilitation. This questionnaire was tested separately on the 113 children with cerebral palsy and their parents. Their responses were analysed using the Rasch model (RUMM-2020) to select items that had an ordered rating scale and that fit a unidimensional model. RESULTS: The final ABILOCO-Kids scale consisted of 10 locomotion activities, of which difficulty was rated by the parents. The parents gave a more precise assessment of their children's ability than the children themselves, leading to a wider range of measurement that was well-targeted on the sample population and that had good reliability (r=0.97) and reproducibility (intraclass correlation coefficient=0.96). Item calibration did not vary with age, sex or clinical presentation (hemiplegia, diplegia, quadriplegia). The concurrent validity of the ABILOCO-Kids questionnaire was also shown by its correlation with the Gross Motor Function Classification System. CONCLUSION: The ABILOCO-Kids questionnaire has good psychometric qualities for measuring a wide range of locomotion abilities in children with cerebral palsy.