AN EXAMINATION OF A NON-STANDARDIZED MEASURE OF STANDING BALANCE USED BY PHYSICAL THERAPISTS TO EVALUATE CLIENTS DIAGNOSED WITH A CEREBRAL VASCULAR ACCIDENT.
R. Wellmon, MS, PT, NCS
MossRehab Hospital, Philadelphia, PA
Institute for Physical Therapy Education, Widener University
PURPOSE: Physical therapists commonly evaluate standing balance in individuals who have experienced a cerebral vascular accident (CVA). Often, non-standardized assessments are used to describe and measure change. This occurs despite the availability of numerous measures that have been validated through research. The purpose of this study was to describe and examine the validity of a non-standardized measure of standing balance that was used in one clinical practice.
METHODS: A total of 12 physical therapists working on the Neurological Diseases Service and 44 patients participated in this study. The therapists were asked to rate standing balance at admit and discharge using the instrument and procedures that was common to the facility. The facility uses a scale that requires the therapist to rate standing balance as either stable or unstable. All the patients participating in the study had a diagnosis of a single unilateral CVA and were admitted to a free standing acute rehabilitation facility. The patient’s ability to reach forward in standing was measured at admit and discharge. In addition, the patient’s performance on the Functional Independence Measure (FIM) was examined for locomotion, mobility, and self-care.
ANALYSIS: The patients were grouped according to the balance rating assigned and analysis of variance was used to examine differences in forward reach and functional performance on the composite scores on the FIM.
RESULTS: Patients rated as unstable were significantly different from those rated as stable for forward reach, locomotion, mobility, and self-care. Individuals rated as unstable had lower forward reach scores and scored lower on the FIM. These differences were found when examining both the admission and discharge balance ratings.
CONCLUSIONS: When using a simple 2 point ordinal scale, the therapists participating in the study were able to classify the patient’s level of postural control relative to their ability to reach forward in standing and level of function. On the surface, the present study provides preliminary support for the use of one non-standardized instrument. However, the current study raises numerous questions related to using any instrument without a thorough examination of the psychometric properties of the instrument such as reliability, validity, and the ability of the instrument to detect meaningful change.
RELEVANCE: Therapists should use care when interpreting the results of non-standardized instruments when determining the need for intervention, measuring change, or providing support for specific interventions in improving impairment and disability. Efforts should be made to thoroughly address issues related to reliability and validity before adopting any instrument for clinical use if meaningful interpretations are to be made.
Poster presentation at the American Physical Therapy Association, 1999 Combined Sections Meeting, Seattle, WA