To review systematically the psychometric properties of balance measures for use in people with cerebellar ataxia.
Data sources:
Medline, AMED, CINAHL, Web of Science and EMBASE were searched between 1946 and April 2014.
Review methods:
Two reviewers independently searched data sources. Cerebellar-specific and generic measures of balance were considered. Included studies tested psychometric properties of balance measures in people with cerebellar ataxia of any cause. Quality of reported studies was rated using the Consensus Based Standards for the selection of health status Measurement INstruments (COSMIN) checklist.
Results:
Twenty-one articles across which 16 measures had been tested were included for review. Using the COSMIN, quality of methodology in studies investigating psychometric properties of generic balance measures (n=10) was rated predominantly as ‘poor’. Furthermore, responsiveness has not been tested for any generic measures in this population. The quality of studies investigating psychometric properties of balance sub-components of the cerebellar-specific measures (n=6) ranged from ‘poor’ to ‘excellent’; however, Minimally Clinically Important Difference has not been determined for these cerebellar-specific measures.
Conclusion:
The Posture and Gait (PG) sub-component of the International Cooperative Ataxia Rating Scale (ICARS) demonstrates the most robust psychometric properties with acceptable clinical utility.
MantoMU. The wide spectrum of spinocerebellar ataxias (SCAs). Cerebellum2005; 4: 2–6.
2.
KlockgetherT. Sporadic ataxia with adult onset: classification and diagnostic criteria. Lancet Neurology2010; 9: 94–104.
3.
WeinshenkerBGIssaMBaskervilleJ. Long-term and short-term outcome of multiple sclerosis: a 3-year follow-up study. Archives of Neurology1996; 53: 353–358.
4.
MariottiCFancellurDi DonatoS. An overview of the patient with ataxia. Journal of Neurology2005; 252 :511–518.
5.
BrazisPWMasdeuJCBillerJ. Cerebellum. In: Localization in Clinical Neurology. Philadelphia, USA: Lippincott Williams and Wilkins, 2001, 371–386.
6.
MortonSMBastianAJ. Cerebellar control of balance and locomotion. The Neuroscientist2004; 06;10(3): 247–59.
MartinCTanDBraggePBialocerkowskiA. Effectiveness of physiotherapy for adults with cerebellar dysfunction: a systematic review. Clinical Rehabilitation2009; 23: 15–26.
9.
MillsRJYapLYoungCA. Treatment for ataxia in multiple sclerosis. Cochrane Database of Systematic Reviews1996. Art. No: CD005029. DOI: 10.1002/14651858.CD005029.pub2.
WinserSJHaleLClaydonLSSmithC. Outcome measures for the assessment of balance and posture control in cerebellar ataxia: A narrative review. Physical Therapy Reviews2013; 18: 117–133.
12.
Organization WHO. International Classification of functioning, disability and health. World Health Organization, Geneva, 2001.
13.
HobartJCLampingDLThompsonAJ. Evaluating neurological outcome measures: the bare essentials. Journal of Neurology, Neurosurgery and Psychiatry1996; 60: 127–130.
14.
BlumLBitenskyNK. Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A systematic review. Physical Therapy2008; 88: 559–566.
15.
HsuehIPWangCHSheuCFHsiehCL. Comparison of psychometric properties of three mobility measures for patients with stroke. Stroke2003; 34: 1741–1745.
16.
TysonSDeSouzaL. A systematic review of methods to measure balance and walking post-stroke. Part 1: Ordinal scales. Physical Therapy Reviews2002; 7: 173–186.
17.
GanSMTungLCTangYHWangCH. Psychometric properties of functional balance assessment in children with cerebral palsy. Neurorehabilitation and Neural Repair2008; 22: 745–753.
18.
LinMRHwangHFHuMHWuHDWandYWHuangFC. Psychometric comparisons of the Timed Up and Go, One-Leg Stand, Functional Reach, and Tinetti Balance Measures in community-dwelling older people comparison of performance balance measures. Journal of the American Geriatrics Society2004; 52: 1343–1348.
19.
TysonSConnellLA. How to measure balance in clinical practice. A systematic review of the psychometrics and clinical utility of measures of balance activity for neurological conditions. Clinical Rehabilitation2009; 23: 824–840.
20.
LangleyFAMackintoshSF. Functional balance assessment of older community dwelling adults: A systematic review of the literatureThe Internet Journal of Allied Health Sciences and Practice2007; 5: 1–11.
21.
MokkinkLBTerweeCBPatrickD. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology2010; 63: 737–745.
22.
TerweeCBMokkinkLBOsteloRWBouterLMde vetHC. Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research2012; 21: 651–657.
23.
SchellingerhoutJMVerhagenAPHeymansMWKoesBWde VetHCTerweeCB. Measurement properties of disease-specific questionnaires in patients with neck pain: a systematic review. Quality of Life Research2012; 21: 659–670.
24.
MokkinkLBTerweeCBPatrickDL. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology2010; 63: 737–745.
25.
HarveyRJHammerAL. Item response theory. The Counselling Psychologist1999; 27: 353–383.
26.
LeslieGPortneyMPW. Validity of measurements. In: CohenM (ed) Foundations of Clinical Research Applications to Practice, third ed. Julie Levin Alexander, 2009. p.102.
27.
LeslieGPortneyMPW. Types of reliability. In: CohenM (ed) Foundations of Clinical Research Applications to Practice. Julie Levin Alexander, 2009. p. 89.
28.
AkramAGhorbanTArashK. Assessments of the reliability of the Iranian version of the Berg Balance Scale in Patients with multiple sclerosis. Acta Neurologica Taiwanica2011; 20: 22–28.
29.
JonssonLRKristensenMTTibaekSAndersenCWJuhlC. Intra- and Interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments. Archives of Physical Medicine and Rehabilitation2011; 92: 1630–1635.
30.
McConveyJBennettSE. Reliability of the Dynamic Gait Index in individuals with multiple sclerosis. Archives of Physical Medicine and Rehabilitation2005; 86: 130–133.
31.
JacobsJVKasserSL. Balance impairment in people with multiple sclerosis: preliminary evidence for the Balance Evaluation Systems Test. Gait Posture2012; 36: 414–418.
32.
ForsbergAAndreassonMNilsagårdYE. Validity of the Dynamic Gait Index in people with multiple sclerosis. Physical therapy2013; 93: 1369–1376.
33.
CattaneoDJonsdottirJRepettiS. Reliability of four scales on balance disorders in persons with multiple sclerosis. Disability and Rehabilitation2007; 29: 1920–1925.
34.
CattaneoDRegolaAMeottiM. Validity of six balance disorders scales in persons with multiple sclerosis. Disability and Rehabilitation2006; 28: 789–795.
35.
FrzovicDMorrisMEVowelsL. Clinical tests of standing balance: Performance of persons with multiple sclerosis. Archives of Physical Medicine and Rehabilitation2000; 81: 215–221.
36.
TesioLPeruccaLFranchignoniFPBattagliaMA. A short measure of balance in multiple sclerosis: Validation through Rasch analysis. Functional Neurology1997; 12: 255–265.
37.
LearmonthYCPaulLMcFadyenAKMattisonPMillerL. Reliability and clinical significance of mobility and balance assessments in multiple sclerosis. International Journal of Rehabilitation Research2012; 35: 69–74.
38.
BurkKMalzigUWolfSHeckS. Comparison of Three Clinical Rating Scales In Friedreich Ataxia (FRDA). Movement Disorders2009; 24: 1779–1784.
39.
LeeYCLiaoYCWangPSLeeIHLinKPSoongBW. Comparison of cerebellar ataxias: A three-year prospective longitudinal assessment. Movement Disorders2011; 26: 2081–2087.
40.
Schmitz-HübschTMontcelSTBalikoLBoeschS. Reliability and validity of the International Cooperative Ataxia Rating Scale: A study in 156 spinocerebellar ataxia patients. Movement Disorders2006; 21: 699–704.
41.
WeyerAAbeleMSchmitz-HubschTSchochBFringsM. Reliability and validity of the scale for the assessment and rating of ataxia: A study in 64 ataxia patients. Movement Disorders2007; 22: 1633–1637.
42.
YabeIMatsushimaMSomaHBasriRSasakiH. Usefulness of the Scale for Assessment and Rating of Ataxia (SARA). Journal of the Neurological Sciences2008; 266: 164–166.
43.
Schmitz-HubschTMontcelSTBalikoLBercianoJ. Scale for the assessment and rating of ataxia: Development of a new clinical scale. Neurology2006; 66: 1717–1720.
44.
D’AbreuAFrancaMJrLopes-CendesICendesF. The international cooperative ataxia rating scale in Machado-Joseph disease. Comparison with the unified multiple system atrophy rating scale. Movement Disorders2007; 22: 1976–1979.
45.
MortonSMTsengYWZackowskiKMDalineJRBastianAJ. Longitudinal tracking of gait and balance impairments in cerebellar disease. Movement Disorders2010; 25: 1944–1952.
46.
StoreyETuckKHesterRHughesAChurchyardA. Inter-rater reliability of the International Cooperative Ataxia Rating Scale (ICARS). Movement Disorders2004; 19: 190–192.
47.
CanoSJHobartJCHartPEKoriliparaLVSchapiraAHCooperJM. International cooperative ataxia rating scale (ICARS): Appropriate for studies of Friedreich’s ataxia?Movement Disorders2005; 20: 1585–1591.
48.
SchochBRegelJPFringsMGerwigM. Reliability and validity of ICARS in focal cerebellar lesions. Movement Disorders2007; 22: 2162–2169.
49.
FriedmanLSFarmerJMPerlmanSWilmotG. Measuring the rate of progression in Friedreich ataxia: Implications for clinical trial design. Movement Disorders2010; 25: 426–432.
50.
Schmitz-HübschTFimmersRRakowiczMRolaR. Responsiveness of different rating instruments in spinocerebellar ataxia patients. Neurology2010; 74: 678–684.
51.
LynchDRFarmerJMTsouAYPerlmanS. Measuring Friedreich ataxia: Complementary features of examination and performance measures. Neurology2006; 66: 1711–1716.
52.
LynchDRFarmerJMWilsonRLBalcerLJ. Performance measures in Friedreich ataxia: Potential utility as clinical outcome tools. Movement Disorders2005; 20: 777–782.
53.
AssadiMLeonePVeloskiJJSchwartzmanRJJansonCGCampelloneJV. Validating an Ataxia Functional Composite Scale in spinocerebellar ataxia. Journal of the Neurological Sciences2008; 268: 136–139.
54.
HopewellS LKClarkeMJOxmanADDickersinK. Publication bias in clinical trials due to statistical significance or direction of trial results. Cochrane Database of Systematic Reviews2009 (1):1–26. Art. No.: MR000006. DOI: 10.1002/14651858.MR000006.pub3.
55.
StevensJP. Introduction: Type I error, Type II error, and Power. In: StevensJP (ed) Applied Multivariate Statistics for the Social Sciences. 5th ed.USA: Taylor & Francis Group, LLC; 2009. p.4.
56.
EngJ. Sample size estimation: how many individuals should be studied?Radiology2003; 227: 309–313.
JaeschkeR. Measurement of health status. Controlled Clinical Trials. 1989; 10: 407–415.
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