Show simple item record

dc.contributor.advisorSmith, Catherine
dc.contributor.advisorHale, Leigh
dc.contributor.advisorClaydon, Leica
dc.contributor.advisorWhitney, Susanne
dc.contributor.authorWinser, Stanley John
dc.date.available2015-06-29T23:42:18Z
dc.date.copyright2015
dc.identifier.citationWinser, S. J. (2015). Clinical measures of balance for people with cerebellar ataxia: Use and recommendations (Thesis, Doctor of Philosophy). University of Otago. Retrieved from http://hdl.handle.net/10523/5750en
dc.identifier.urihttp://hdl.handle.net/10523/5750
dc.description.abstractThis thesis aimed to recommend a core set of clinical measures for the assessment of balance of people with cerebellar ataxia. It comprised four studies: Narrative review, Systematic review, Delphi survey and Psychometric property testing. The narrative review revealed a wide spectrum of both laboratory-based and clinically-based assessment tools. Two strategies were then implemented in order to select the most appropriate clinical measures from those identified in the narrative review. First, a systematic review explored the psychometric properties of the measures of balance tested in people with cerebellar ataxia. The systematic review identified the Posture and gait sub-component of the International Co-operative Ataxia Rating Scale (PG of ICARS) as highly appropriate measure. Secondly, a Delphi survey was undertaken to obtain the opinion of experts as to which balance measures they would recommend for the clinical assessment of balance of people with cerebellar ataxia; the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test and the Gait, Stance and Sit sub-components of the Scale for the Assessment and Rating of Ataxia (SARA Bal) were identified. These four measures required further validation prior to recommending them as a core set of clinical measures. The main study of this thesis tested the reliability, validity and interpretability of the BBS, TUG, PG of ICARS and SARA Bal. Fifty participants with multiple sclerosis and secondary cerebellar ataxia were recruited across four centres in New Zealand and the United States of America. Participants were tested by physiotherapists on four measures of balance and this testing process was video-recorded. The Barthel Index, the Expanded Disability Status Scale (EDSS), the full scales of the ICARS and the SARA were also assessed and disease duration recorded. The EDSS was completed by neurologists. To investigate the intra-rater and inter-rater reliability, a repeat assessment was performed by the same physiotherapist (intra-rater) or a second physiotherapist (inter-rater) by observing the video recording. Reliability was strong for all four measures (ICC range 0.95-0.99). Internal consistency was strong for BBS (α=0.94) and PG of ICARS (α=0.87), and moderate for SARA Bal (α=0.72). Moderate to strong correlation was found between the measures of balance (ρS >0.72) and between PG of ICARS (ρS = 0.84) and SARA Bal (ρS = 0.85) against ataxia rating scales. Measures of balance correlated poorly to moderately with disease severity (EDSS), functional independence (Barthel Index) and disease duration (ρS range -0.37 to 0.76). Discriminant validity of all measures were excellent with Area Under the Curve of >0.93. Minimal detectable change was derived for the BBS (2.8), PG of ICARS (2.25) and SARA Bal (1.70). Two items of the PG of ICARS was found to have inconsistency in scoring and in addition all items of PG of ICARS may be scored using the other three measures. Therefore the BBS, TUG and SARA Bal were recommended as the core set of standardised measures. Psychometric properties that need to be studied in future to strengthen the current recommendations such as structural validity and responsiveness of the measures of balance were proposed.
dc.language.isoen
dc.publisherUniversity of Otago
dc.rightsAll items in OUR Archive are provided for private study and research purposes and are protected by copyright with all rights reserved unless otherwise indicated.
dc.subjectBalance
dc.subjectReliability
dc.subjectValidity
dc.subjectCerebellar-ataxia
dc.subjectMultiple-sclerosis
dc.titleClinical measures of balance for people with cerebellar ataxia: Use and recommendations
dc.typeThesis
dc.date.updated2015-06-29T22:22:00Z
dc.language.rfc3066en
thesis.degree.disciplineSchool of Physiotherapy
thesis.degree.nameDoctor of Philosophy
thesis.degree.grantorUniversity of Otago
thesis.degree.levelDoctoral
otago.interloanyes
otago.openaccessAbstract Only
 Find in your library

Files in this item

FilesSizeFormatView

There are no files associated with this item.

This item is not available in full-text via OUR Archive.

If you would like to read this item, please apply for an inter-library loan from the University of Otago via your local library.

If you are the author of this item, please contact us if you wish to discuss making the full text publicly available.

This item appears in the following Collection(s)

Show simple item record