Reliability and validity of trunk assessment for people with multiple sclerosis.

BACKGROUND AND PURPOSE: Standardized scales are a prerequisite for rehabilitation and research. This study was designed to determine the reliability and validity of scores on items of the trunk assessment of the Melsbroek Disability Scoring Test (MDST) and Trunk Impairment Scale (TIS) in people with multiple sclerosis (MS). SUBJECTS: Thirty people with MS participated in the study. METHODS: Interrater and test-retest reliability and construct validity were assessed. RESULTS: Kappa and weighted kappa values for the items of the trunk assessment of the MDST ranged from .74 to .95, and the kappa and weighted kappa values for the TIS items ranged from .46 to 1.00. Intraclass correlation coefficients for interrater and test-retest agreement were .93 and .92, respectively, for the trunk assessment of the MDST and .97 and .95, respectively, for the TIS. Bland-Altman analysis showed consistency of scores without observer bias. Construct validity was established. DISCUSSION AND CONCLUSION: The MDST and TIS provide reliable assessments of the trunk and are valid scales for measuring trunk performance in people with MS.

Self-report assessment of fatigue in multiple sclerosis: a critical evaluation.

SUMMARY Fatigue is among the most common and disabling symptoms of multiple sclerosis. Clinicians usually assess fatigue by asking people to describe and rate their fatigue in a self-report instrument. This paper evaluates the clinical usefulness and the scientific properties of a selection of various self-report instruments for fatigue. To be selected, instruments had to assess fatigue or a related concept, have some published information on reliability and validity, be used in at least one clinical trial of fatigue with people with multiple sclerosis, and demonstrate validity in people with MS. Five fatigue specific scales and four subscales of quality of life instruments were selected and evaluated. In occupational therapy, the fatigue subscales or items of quality of life measurements give limited information about the quality of fatigue. The selection of an instrument may depend on the clinical setting or trial design.

Reduction of spastic hypertonia during repeated passive knee movements in stroke patients.

OBJECTIVES: To quantify changes in spastic hypertonia during repeated passive isokinetic knee movements in stroke patients and to assess the role of muscle activity. DESIGN: A between-groups design with repeated measures. SETTING: Rehabilitation center for stroke patients. PARTICIPANTS: Ten stroke patients with hypertonia and 10 healthy subjects matched for age and gender. INTERVENTION: With an isokinetic apparatus, movements were imposed on the knee in series of 10 repetitions at speeds of 60 degrees /s, 180 degrees /s, and 300 degrees /s. MAIN OUTCOME MEASURES: Spastic hypertonia was assessed on the basis of torque measurement and electromyographic activity of the quadriceps, hamstrings, and gastrocnemius muscles. RESULTS: Compared with the controls, stroke patients presented a significantly stronger torque reduction during the mid- and endphases of movements at all speeds tested (P<.05). The strongest torque decline occurred during knee flexion and during the first movements. The effect increased toward the end phase of movements and with increasing speeds. The effect of movement repetitions on torque measurements was unchanged after electromyographic activity was included in the statistical analysis, except during extension movements at 180 degrees /s and 300 degrees /s. CONCLUSION: Passive movements of the knee induced a decrease of spastic hypertonia in stroke patients through a combination of reflexive and mechanical factors. The role of these mechanisms is velocity dependent and differs for flexion and extension movements.