Measurement properties of the postural assessment scale for stroke patients

Uvod: Po možganski kapi je prisotno omejeno ravnotežje, ki je povezano z nestabilno in počasnejšo hojo. Pojavi se asimetrija pri prenosu teže na spodnje ude, poveča se nihanje in nagibanje telesa. Lestvica za oceno uravnavanja drže pri pacientih po možganski kapi (angl. Postural assessment scale for stroke patients – PASS) ocenjuje sposobnost zadrževanja določenega položaja in ohranjanje ravnotežja med spreminjanjem položaja pri pacientih po možganski kapi. Namen: Namen diplomskega dela je bil s pregledom literature ugotoviti stopnjo zanesljivosti, veljavnosti ter občutljivosti PASS in njenih različic. Metode dela: Pregledani sta bili podatkovni zbirki: CINAHL in MEDLINE. Vključene so bile raziskave, ki so proučevale PASS in merske lastnosti ali njene različice objavljene v angleškem jeziku. Rezultati: V pregled je bilo vključenih 15 raziskav. Osem jih je preverjalo lastnosti PASS in sedem lastnosti njenih različic. Tri raziskave so preverjale Švedsko modificirano verzijo PASS (SwePASS), ena kratko obliko PASS (SFPASS), ena 3-stopenjsko PASS (PASS-3P) in dve PASS za ocenjevanje nadzora trupa (PASS-TC). PASS ima v prvih treh mesecih po možganski kapi zelo dobro zanesljivost posameznega preiskovalca (k= 0,72), zanesljivost med preiskovalci (k= 0,88) in notranjo skladnost (α= 0,94-0,96). Zelo dobre so tudi veljavnost konstrukta (r= 0,48-0,78), sočasna veljavnost (r_s= 0,92-0,97), napovedna veljavnost (r_s= 0,69-0,90) in občutljivost (ES= 0,31-1,12). Po treh mesecih pa se zanesljivost, veljavnost in občutljivost izvorne PASS začne zmanjševati.Tudi različice PASS imajo zelo dobro zanesljivost posameznega preiskovalca (SwePASS: k= 0,67-0,93), zanesljivost med preiskovalci (SwePASS: k= 0,70-0,93, SFPASS: ICC= 0,98, PASS-TC: ICC= 0,97) in notranjo skladnost (SFPASS: α = 0,93, PASS-TC: α = 0,94). Zelo dobre so tudi sočasna veljavnost (SFPASS – PASS-3L s petimi nalogami: r= 0,98, PASS-3P: r_s= 0,91-0,94, PASS-TC: r= 0,73-0,89) in napovedna veljavnost (SFPASS: r= 0,48, PASS-3P: r_s= 0,78-0,82, PASS-TC: r= 0,68), ki je primerljiva z lastnostmi izvorne lestvice. Odstopanja so se pojavila le pri občutljivosti (SwePASS: RP= 0,31, SFPASS: ES= 0,43-0,44, PASS-3P: ES= 1,04), ki je slabša kot pri izvorni lestvici, prisotna pa sta tudi učinka stropa in tal. Sklep: PASS je najprimernejša za ocenjevanje v prvih treh mesecih po možganski kapi, medtem ko so modificirane različice, zaradi omejene sposobnosti zaznavanja sprememb, primerne le za okvirno spremljanje pacientovega napredka, prav tako v prvih treh mesecih po možganski kapi.Introduction: After a stroke, limited balance is associated with unstable and slower walking. Asymmetry occurs when the body weight is transferred to the lower limbs, inclination and body sway increases. Postural assessment scale for stroke patients – PASS assesses the ability to hold a certain position and to maintain a balance during changing the positions in patients after a stroke. Purpose: The purpose of diploma tesis was literature review on measurement properties of PASS and its modifications. Methods: Following databases were reviewed: CINAHL, MEDLINE. We included studies that investigated reliability, validity and responsiveness of PASS and ist modifications and were published in English . Results: A total of 15 studies were included in the literature review, of which eight investigated the PASS and seven ist modifications. Three studies investigated Swedish version of PASS (SwePASS), one short form of PASS (SFPASS), one 3-level PASS (PASS-3P) and two PASS for trunk control (PASS-TC). PASS has very good interrater reliability (k= 0,72), intrarater reliability (k= 0,88) and internal consistecy (α= 0,94-0,96). It also has very good construct validity (r= 0,48-0,78), concurrent validity (r_s= 0,92-0,97), predictive validity (r_s= 0,69-0,90) and responsiveness (ES= 0,31-1,12) in the first 3 months after the stroke. After three months reliability, validity and responsiveness begin to decrease. Modified versions also showed very good interrater reliability (SwePASS: k= 0,67-0,93), intrarater reliability (SwePASS: k= 0,70-0,93, SFPASS: ICC= 0,98, PASS-TC: ICC= 0,97) and internal consistency (SFPASS: α = 0,93, PASS-TC: α = 0,94). They also has very good concurrent validity (SFPASS – PASS-3L 5-item: r= 0,98, PASS-3P: r_s= 0,91-0,94, PASS-TC: r= 0,73-0,89) and predictive validity (SFPASS: r= 0,48, PASS-3P: r_s= 0,78-0,82, PASS-TC: r= 0,68) which are comparable to the original scale. Deviations were found only with responsiveness (SwePASS: RP= 0,31, SFPASS: ES= 0,43-0,44, PASS-3P: ES= 1,04), which is not as good as the original scale. In modified versions ceiling or floor effect may be present. Conclusion: PASS is the most suitable for use during first three months after the stroke, but due to low detection of changes modified versions are suitable for orientational monitoring during first three months after stroke