Test-Retest Reproducibility and Smallest Real Difference of 5 Hand Function Tests in Patients With Stroke
Test-Retest Reproducibility and Smallest Real Difference of 5 Hand Function Tests in Patients With Stroke
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DOI：
10.1177/1545968308331146
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发表时间：
2009-06-01
影响因子：
4.2
通讯作者：
Hsieh, Ching-Lin
中科院分区：
文献类型：
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作者：
Chen, Hui-Mei;Chen, Christine C.;Hsieh, Ching-Lin
目标。探讨脑卒中患者握力、掌捏、侧捏3项手部力量测试和2项灵巧性测试（盒块测试[BBT]和九孔钉测试[NHPT]）的重测再现性和最小真实差异（SRD）。方法。这5项测试分2期对62例中风患者进行，间隔3至7天。用类内相关系数（ICC）确定两次测量之间的可重复性水平。SRD用于确定由于个别患者的偶然性变化而导致的测量误差的程度。SRD百分比（相对于平均得分的SRD）用于比较测试间的重测信度。我们将该组作为一个整体进行分析，然后分为两个亚组（手痉挛与无手痉挛）。结果。所有患者5项试验的重测重现性均较高，ICCs范围为0.85 ~ 0.98。受影响较多/较少的手的SRDs为：握力测试2.9/4.7 kg；掌捏试验1.2/1.3 kg；侧夹试验1.4/1.0 kg；BBT为5.5/7.8块/分钟；NHPT为32.8/6.2秒。使用NHPT（54%）、手掌捏（35%）和侧面捏（34%），发现患手的SRD百分比高得令人无法接受（bbb30 %）。在所有5项测试中，当比较痉挛组和无痉挛组的这些指标时，痉挛组的ICCs较低，SRD和SRD百分比较高。结论。所有5项试验对不同组的脑卒中患者均表现出满意的重测再现性。然而，所有的测试都显示，当受影响更严重的那只手和患有高张力的那只手进行测量时，测量误差水平更高。因此，使用这些常见的力量和灵活性测试的基线和康复后改变评分必须谨慎解释，特别是在控制不良的临床试验中。在一项包括手高渗参与者的试验中，重复测量应该被纳入检验可靠性。
Objective. To investigate the test-retest reproducibility and smallest real difference (SRD) of 3 hand strength tests (grip, palmar pinch, and lateral pinch) and 2 dexterity tests (the Box and Block test [BBT] and the Nine Hole Peg test [NHPT]) in patients with stroke. Methods. The 5 tests were administered on 62 stroke patients in 2 sessions, 3 to 7 days apart. The intraclass correlation coefficient (ICC) was used to determine the level of reproducibility between measurements on 2 sessions. The SRD was used to determine the extent of measurement error because of chance variation in individual patients. SRD percentage (SRD relative to mean score) was used to compare test-retest reliability across tests. We analyzed the group as a whole, then in 2 subgroups (hand spasticity vs none). Results. The test-retest reproducibility of all 5 tests was high for all the patients, with ICCs ranging from 0.85 to 0.98. The SRDs for the more/less affected hand were: 2.9/4.7 kg for the grip test; 1.2/1.3 kg for the palmar pinch test; 1.4/1.0 kg for the lateral pinch test; 5.5/7.8 blocks/minute for the BBT; and 32.8/6.2 seconds for the NHPT. Unacceptably high SRD percentages (>30%) were found for the affected hand using the NHPT (54%), palmar pinch (35%), and lateral pinch (34%). When comparing these indices for participants with spasticity versus none for all 5 tests, the ICCs were lower and the SRD and SRD percentage were higher for the spasticity group. Conclusions. All 5 tests demonstrated satisfactory test-retest reproducibility for a diverse group of patients with stroke. However, all tests showed higher levels of measurement error when performed with the more affected hand and in patients with hypertonicity of that hand. Thus, baseline and postrehabilitation change scores using these common tests of strength and dexterity must be interpreted with some caution, especially in poorly controlled clinical trials. Repeated measures ought to be incorporated to examine reliability within a trial that includes participants with a hypertonic hand.