RESEARCH REPORT POSTER DISPLAY

SITTING BALANCE IN PATIENTS WITH SUB-ACUTE STROKE UNDERGOING REHABILITATION: COMPARISON OF TWO OUTCOME MEASURES. Amusat N; Rehabilitation Center, Two Hills Health Centre, Two Hills, East Central Health, Alberta, Canada

PURPOSE: Independent sitting is a prerequisite for most functional activities and a determinant of recovery from stroke. A primary goal of physical therapy during the early phases of rehabilitation is to facilitate static and dynamic sitting balance. Accurate clinical assessment of sitting is required to develop appropriate treatment program and evaluate functional outcomes. No widely accepted outcome tool for assessing sitting balance exists. But often therapists based treatment on sitting balance components of other standardized outcome measures. The purpose of this study was to examine some evaluative properties of the sitting balance items of Berg Balance (BBS) and the Clinical Outcome Variables Scales (COVS) among patients with stroke who are receiving rehabilitation. RELEVANCE: The BBS and the COVS have sitting balance items which are commonly used in stroke rehabilitation. Information gained from this study will provide further information on some measurement properties of BBS and COVS to assess sitting balance. PARTICIPANTS: Fifty-one stroke patients admitted for rehabilitation in a Canadian rural health region between January 2003 and June 2005. METHODS: A retrospective study of patients with stroke, with complete admission and discharge BBS and COVS records, was conducted. Admission and discharge BBS and COVS assessments were components of standardized evaluative process for all patients admitted for rehabilitation. ANALYSIS: Frequency distribution was used to evaluate ceiling and floor effects of the sitting balance scores (ordinal). Change was evaluated using Wilcoxon test to compare admission and discharge sitting balance scores and responsiveness assessed using effect sizes for the BBS and COVS. Sign test was used to compare the COVS sitting scores of patients with maximum score on the BBS sitting item. RESULTS: The mean age of the sample was 72 (SD = 11.3) years, 57% were males; 86% of the strokes were due to infarction. The median length of stay was 41days and 52% had strokes within 30 days of admission to the centre. The mean total BBS and COVS scores were 25.0 (SD 15.9) and 56.6 (SD 15.8). There was significant ceiling effect only for the BBS sitting balance item with >90% of the patients having the maximum scores at admission and discharge. There was a significant change (discharge minus admission) in the COVS sitting scores (P < 0.001), but not for the BBS scores (P>0.05). The effect sizes were small and moderate respectively for the BBS and the COVS sitting items. Patients with maximum scores on the BBS sitting balance showed that they had more sitting ability going by their scores on COVS (P < 0.001). CONCLUSIONS: Sitting balance item of the BBS exhibits ceiling effect compared to the COVS. The BBS sitting item did not show any change in sitting ability from admission to discharge despite evidence to the contrary for the COVS sitting item. IMPLICATIONS: The COVS may be a more appropriate choice for evaluating sitting balance in patients with sub-acute stroke undergoing rehabilitation. KEYWORDS: Stroke, Berg Balance Scale, Clinical Outcome Variables Scale, Sitting balance. FUNDING ACKNOWLEDGEMENTS: Paid time of the Health Records officer was supported by the East Central Health. CONTACT: sepet69@hotmail.com

ETHICS COMMITTEE: Community Research Ethics Board of Alberta, Canada.