Clinimetric properties of the Performance-Oriented Mobility Assessment
Clinimetric properties of the Performance-Oriented Mobility Assessment
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DOI：
10.1093/ptj/86.7.944
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发表时间：
2006-07-01
期刊：
影响因子：
3.2
通讯作者：
van Wieringen, PCW
中科院分区：
文献类型：
--
作者：
Faber, MJ;Bosscher, RJ;van Wieringen, PCW
背景和目的。性能导向的移动性评估（POMA）是一种广泛使用的工具，提供了平衡和步态的评估。它在临床上用于确定老年人的活动状态或评估随时间的变化。为了支持POMA用于这些目的，测定了临床特性（特别是反应性）。科目参与者（78%女性;平均年龄=84.9岁）居住在自我护理或护理住宅。同时和判别效度进行了评估与总组（N=245），而可靠性和反应性进行了测定与子样本（n=30）。跌倒相关的预测有效性进行了评估与72名参与者的子样本。方法.除POMA外，还进行了几项参考性能测试。由2名评分员（观察员）连续2天评估POMA。分析包括计算斯皮尔曼等级相关系数（R）、Bland-Altman图的一致性限（LOA）、95%置信水平下的最小可检测变化（MDC 95）以及预测福尔斯的灵敏度和特异性。如果可能，总量表（POMA-T）的结果由其平衡子量表（POMA-B）和步态子量表（POMA-G）的结果补充。结果POMA-T和POMA-B的评定者间和重测信度良好（R=.74-.93），而POMA-G的信度值虽然也很高，但系统性略低（R=.72-.89）。POMA-T和POMA-B的斯皮尔曼相关系数（R= 0.64竖线-0.68竖线）显示了满意的同时效度，而POMA-G的相关系数（R= 0.52竖线-0.56竖线）则不太令人信服。3个量表的判别效度值基本一致。POMA-T的LOA为-4.0至4.0（重测一致性）和-3.0至3.0（评定者间一致性）。在价值观上，得出了结论。MDC 95个人水平的POMA-T评分变化应至少为5分，组水平（n=30）的POMA-T评分变化应至少为0.8分才被认为是可靠的。即使使用最佳临界点，POMA-T及其2个分量表的敏感性和特异性值（在62.5%和66.1%之间变化）表明预测福尔斯的准确性较差。讨论和结论。POMA-T及其子量表POMA-B具有足够的信度和效度，用于评估老年人的活动能力。POMA-T有助于在群体一级展示干预效果。然而，受试者内的变化应至少为5分，然后才能解释为可靠的变化。POMA-T预测福尔斯的准确性较差。
Background. and Purpose. The Performance-Oriented Mobility Assessment (POMA) is a widely used instrument that provides an evaluation of balance and gait. It is used,clinically to determine the mobility status of older adults or to evaluate changes over time. To support the use of the POMA for these purposes, the clinimetric properties (in particular, responsiveness) were determined. Subjects. Participants (78% female; mean age=84.9 years) were living in either self-care or nursing-care residences. Concurrent and discriminant validity were assessed with the total group (N=245), whereas reliability and responsiveness were determined with a subsample (n=30). Fall-related predictive validity was assessed with a subsample of 72 participants. Methods. In addition to the POMA, several reference performance tests were administered. The POMA was assessed on 2 consecutive days by 2 raters (observers). The analyses included the calculation of Spearman rank correlation coefficients (R), limits of agreement (LOA) with Bland-Altman plots, minimal detectable changes at the 95% confidence level (MDC95), and sensitivity and specificity with regard to predicting falls. When possible, findings for the total scale (POMA-T) were complemented by findings for its balance subscale (POMA-B) and its gait subscale (POMA-G). Results. The interrater and test-retest reliability for the POMA-T and the POMA-B were good (R=.74-.93), whereas for the POMA-G, the reliability values, although high as well, were systematically slightly lower (R=.72-.89). The Spearman correlations with the reference performance tests (R=vertical bar.64 vertical bar-vertical bar.68 vertical bar) indicated satisfactory concurrent validity for the POMA-T and the POMA-B, but the corresponding findings for the POMA-G (R= vertical bar.52 vertical bar-vertical bar.56 vertical bar) were less convincing. The discriminant validity values of the 3 scales were about the same. The LOA for the POMA-T were on the order of -4.0 to 4.0 for test-retest agreement and -3.0 to 3.0 for interrater agreement. On the values, it was concluded. that changes in POMA-T scores at the basis of the MDC95 individual,level should be at least 5 points and that those at the group level (n=30) should be at least 0.8 point to be considered reliable. Even when optimal cutoff points were used, sensitivity and specificity values (varying between 62.5% and 66.1%) for the POMA-T as well as for its 2 subscales indicated poor accuracy in predicting falls. Discussion and Conclusion. The POMA-T and its subscale POMA-B have adequate reliability and validity for assessing mobility in older adults. The POMA-T is useful for demonstrating intervention effects at the group level. Changes within subjects, however, should be at least 5 points before being interpreted as reliable changes. The accuracy of the POMA-T in predicting falls is poor.