Reliability and validity of Six-Spot Step Test (SSST) in stroke survivors.

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 and 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 and 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 and 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 (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.

Relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability.

This was a cross-sectional correlation study to explore the relationships between sagittal postures of thoracic and cervical spine, presence of neck pain, neck pain severity and disability. Moreover, the reliability of the photographic measurement of the sagittal posture of thoracic and cervical spine was investigated. Forty-five subjects without neck pain and forty-seven subjects with neck pain were recruited. Using a photographic method, the sagittal thoracic and cervical postures were measured by the upper thoracic and the craniovertebral (CV) angles respectively. The Numeric Pain Rating Scale (NPRS) and Chinese version Northwick Park Neck Pain Questionnaire (NPQ) were used to assess neck pain severity and disability. The upper thoracic angle was positively correlated (r(s) = 0.63, p < 0.01) while the CV angle was negatively correlated (r(s) = -0.56, p < 0.01) with the presence of neck pain. The upper thoracic angle was negatively correlated with the CV angles (r(s) = -0.62, p < 0.01) in subjects with neck pain. Similar to the CV angle, the upper thoracic angle was moderately correlated with the neck pain severity (r(s) = 0.43, p = 0.01) and disability (r(s) = 0.44, p = 0.02). The upper thoracic angle (OR = 1.37, p < 0.01) was a good predictor for presence of neck pain even better than that of the CV angle (OR = 0.86, p = 0.04).