Trunk Control Tests in Post-stroke Context: Validity and Reliability Study
Condition: Stroke
MeSH terms: Stroke
Study type: Observational

Summary: 
      Context:

      After stroke, most patients suffer from hemiparesis with variable functional consequences
      that can strongly impact autonomy in daily activities. Motor recovery is, therefore, an
      essential part of the therapeutic strategy in order to optimize the patient's capacities and
      functional autonomy.

      Some authors suggest that trunk control would be essential in the capacities of standing
      balance, transfer tasks and gait. However, no studies have tested the reliability and
      validity of proprioceptive and sitting balance clinical tests for patients with post-stroke
      hemiparesis. These tests would be very useful in advancing our understanding of trunk
      impairments and for clinicians to manage an appropriate treatment strategy.

      Objective:

      The main objective is to assess the reliability of the Trunk Positional Sense Test, the
      unstable sitting test with forceplate and the Modiﬁed Functional Reach Test (MFRT) in
      individuals with post-stroke hemiparesis. The secondary objectives is 1) to assess the
      validity of the Trunk Positional Sense Test and the unstable sitting test with forceplate, 2)
      to assess the validity of a phone inertial captors to assess the instable sitting.

      Method. - Thirty-two individuals with subacute post-stroke hemiparesis will be included in
      this study. After clinical tests (trunk strength, Balance Assessment in Standing and Sitting,
      Timed Up and Go test), the MFRT, Trunk Positional Sense Test and unstable sitting will be
      evaluated by two physiotherapists in a ﬁrst session (inter-rater reliability). After a rest
      of 2-4 h, a second similar session was conducted with the first physiotherapist (intra-rater
      reliability). For unstable seated balance, two tools will be used: the force platform and a
      smartphone.

      Reliability will be tested by calculating the intraclass correlation (ICC) and Bland-Altman
      analysis. For trunk positional sense test and unstable sitting test, the validity will be
      tested with correlations with each clinical test. The validity, between forceplate variables
      and inertial phone variables, will be tested with correlations.

      Perspectives. - The promotion of quality tests to assess patients in clinical practice is
      essential. The results of this study should provide knowledge for selecting the best trunk
      control tests to assess the individuals after stroke and to understand the influence of trunk
      control on functional activities.
    


Intervention name(s): Trunk strength with hand-held dynamometer; Balance Assessment in Sitting and Standing test (BASS); Timed Up and Go test; Modified Functional Reach Test (MFRT); Joint Position sense test (trunk); Unstable sitting in a seesaw
Intervention type(s): Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test; Diagnostic Test
Intervention description(s): MicroFET 2 Handheld Dynamometer is a force evaluation testing device to evaluate the strength of various trunk muscle groups in flexion, extension, and lateral (N).; The BASS is a test to assess static and dynamic sitting and standing balance, which has been validated for post-stroke hemiparetic patients. Each test is evaluated by a score from "0" (patient needs external support) to "4" (stable without external help) for static condition and from "0" (no possibility to pick up objects) to "3" (objects picked up without external help) for dynamic condition. The maximal score (sitting, standing, static and dynamic) is 14 points.; The participant sits on a chair, gets up, walks 3m, makes a half turn in 1m2, walks 3m and comes back to sit on the chair. The time (s) to complete the task is measured.; The MFRT is a dynamic seated balance test that measures the trunk's ability to move forward, to the paretic and non paretic side (cm).; The joint positional sense test of the trunk consists in evaluating the positional error of the trunk in the sagittal plane (mm) and in the frontal plane (mm) during a trunk flexion posture (target position).; This test evaluates the balance capacities of the subject in an unstable sitting position on a seesaw (mediolateral or anteroposterior instability) with forceplate and phone application using center of pressure variables: total displacement (mm), area (mm2), deltas (mm), mean velocity (mm/s) et maximal velocity (mm/s).
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        We include a group of 32 individuals with post-stroke hemiparesis. These subjects will
        consist of males and females with a minimum age of 50 and a maximum of 80 years. The
        subjects should be able to understand the instructions and be able to sit for 30 seconds
        without assistance to perform the tests.
      
Keywords: Stroke; Trunk; Postural control; Reliability; Validity