AN EXAMINATION OF THE CORRELATION BETWEEN THE FUNCTIONAL REACH AND MODIFIED FUNCTIONAL REACH TESTS AND FUNCTIONAL OUTCOMES IN INDIVIDUALS POST CEREBROVASCULAR ACCIDENT.
L. Kahn, MS, PT, MossRehab Hospital, Philadelphia, PA
S. McGhee, MPT MossRehab Hospital, Philadelphia, PA
J. Torkish, MPT Hospital of the University of Pennsylvania, Philadelphia, PA
R. Wellmon, MS, PT, NCS, Widener University, Institute for Physical Therapy Education, Chester, PA
Purpose: Postural instability during sitting and standing is a common problem seen in individuals who have experienced a cerebrovascular accident (CVA). Balance deficits can limit the person's functional independence for a variety of activities. The purpose of this study was to examine the relationship between postural instability, as assessed by the functional reach (FRT) and modified functional reach tests (MFRT), and functional outcome, using the Functional Independence Measure (FIM).
Subjects: Sixty-seven subjects were recruited by convenience sampling from individuals admitted to the stroke center for inpatient rehabilitation. Subjects were recruited for participation based on having a diagnosis of a single CVA and demonstrated ability to follow verbal commands or gestures.
Methods: The subjects' ability to reach forward in standing and sitting was assessed at admit and prior to discharge using the procedure outlined by Duncan et al for the FRT and Lynch for the MFRT. The MFRT examines forward reach in sitting.
Analysis: Spearman Rank-Order Correlation Coefficients were used to examine the relationship between the FRT and MFRT and FIM scores for bed/chair transfers, tub/shower transfers, toilet transfers, step management, walking, and dressing. The Pearson Product-Moment Correlation Coefficient was used to determine the relationship between the FRT and the MFRT and FIM scores for mobility, locomotion, and self care.
Results: The FRT and MFRT were both found to correlate significantly with FIM scores at admit and discharge (r=.54 to .79, p<.001, or rs=.44 to .78, p<.001). The strength of association with FIM scores was higher for the MFRT at admit (rs =.44 to .61, p<.001) when compared to the discharge MFRT score which was found to correlate significantly with only two measures - walking (rs =.41, p<.05) and step management (rs = .36, p<.05). Admit and discharge FRT scores correlated significantly with all FIM scores at admit (r=.55 to .69, p<.001, or rs = .56 to .73, p<.001) and at discharge (r=.71 to .79, p<.001, or rs =.44 to .69, p<.001).
Conclusions: Individuals evidencing higher scores on the FRT at admit and discharge and the MFRT at admit were found to have greater functional independence as assessed by the FIM. The MFRT appears less promising for assessing postural stability at the time of discharge given the results for the present sample.
Relevance: The FRT and MFRT are two measures that can be used to describe the relationship between the degree of postural stability and functional outcome for individuals who are post-CVA and undergoing active rehabilitation. Clinicians should consider incorporating these easy to use clinical measures into the clinical setting. Future research will need to examine the range of postural stability scores associated with each level of the FIM to see if there are cutoff scores that can be used to predict functional outcome.
Poster presented at the 1998 American Physical Therapy Association Combined Sections Meeting, in Boston, MA.