Authors (including presenting author) :
Yeung SCS, Wan SPC, Liu BKP, Wong GHS, Yu GCW, Chao CYL, Chan ACM
Affiliation :
Physiotherapy Department, Queen Elizabeth Hospital
Introduction :
Patients with stroke are facing long term challenges when ambulating at different environment in daily life. They usually require advanced motor skills to maintain balance; e.g. pivot turning, change in direction of pathway and negotiate or avoid obstacles to avoid falling. Among the outcome measures commonly used in the clinical settings, there is no single test measures all the components of balance and motor functions in patients with stroke. Figure-of-Eight Walk Test (F8WT) measures the walking performance for people with mobility disability in straight and curved paths involving both clockwise and anti-clockwise directions that cater the assessment for both the left and right turns. Through establishment of reliability of F8WT and its correlation with balance and motor functions, F8WT can be adopted to offer an overall evaluation of advanced walking performance in patients with stroke in a simple, quick and accurate manner.
Objectives :
To evaluate the inter-rater, intra-rater and test-retest reliability of F8WT and its correlation with balance and motor functions in people with chronic stroke.
Methodology :
Chronic stroke patients receiving physiotherapy outpatient training from September 2019 to November 2020 were invited to participate in the study. Participants were instructed to walk at their usual pace in a figure-of-8 path around the 2 cones placed 1.52 meter (5 feet) apart. The total time and number of steps taken to complete the course were recorded. Faster time and fewer steps indicate better walking ability. Two trials of walking test were performed in 2 separate days at 1-week time intervals by 2 experienced physiotherapists. The 2 trials administered by the same and different assessors within the same visit were used to determine intra-rater and inter-rater reliability respectively. The trials of the initial and second visits conducted by the same assessor were used to calculate the test-retest reliability. In addition, muscle strength of knee extensor, 10-meter Walk Test (10MWT), Berg Balance Scale (BBS) and Timed Up and Go Test (TUGT) were also evaluated by one fixed assessor on the first visit. The orders of testing were randomized. Two-minute rest was given to all participants between different outcome measurements to eliminate the effect of fatigue.
Result & Outcome :
Twenty-four chronic stroke patients with mean age of 58.13±5.80 years old were analyzed. 11 of them were right hemiparesis and 13 of them were left hemiparesis. For time component of F8WT, excellent intra-rater reliability (ICC=0.980-0.990), inter-rater reliability (ICC=0.963-1.000) and test-retest reliability (ICC=0.908-0.985) were found. F8WT time were significantly correlated with 10MWT (r=0.974, p< 0.001), BBS (r=-0.814, p< 0.001), TUGT in affected side turning (r=0.944, p< 0.001) and TUGT in unaffected side turning (r=0.938, p< 0.001). For the steps component of F8WT, excellent intra-rater reliability (ICC=0.977-0.988), inter-rater reliability (ICC=1.000) and test-retest reliability (ICC=0.943-0.944) were demonstrated. F8WT steps were significantly correlated with knee extensor strength of affected side (r=-0.452, p=0.026), 10MWT (r=0.471, p=0.020), BBS (r=-0.695, p< 0.001), TUGT in affected side turning (r=0.459, p=0.024) and TUGT in unaffected side turning (r=0.470, p=0.020). Alternation between straight and curved paths requires switching motor strategies. Our results demonstrated that both the time and step component of F8WT was a reliable measurement for assessing the walking performance in people with chronic stroke. It also acts as an indicator on the balance and motor functions of the patients.
