RICHARD W. BOHANNON. School of Allied Health ... ability of the procedure when applied at bedside (Rodgers, htken, Bates, &. 'Direct enquiries to R W ...
Perceptual and Motor Skills, 1995, 80, 379-385. O Perceptual and Motoc Skills 1995
STANDING BALANCE, LOWER EXTREMITY MUSCLE STRENGTH, AND WALKING PERFORMANCE OF PATIENTS REFERRED FOR PHYSICAL THERAPY ' RICHARD W. BOHANNON School of Allied Health Professions University of Connecliczit Department of Rehabilitation Hartford (CT) Hospi/al Summary.-The purposes of this study of 30 patients referred to physical therapy were to describe the reliab&ty of two measures of impairment and a measure of gait performance and to examine the relationships between the impairment and gait measures. The impairments measured were standing balance and muscle strength of the lower extremities, the former with a seven-level ordinal scale and the latter with a handheld dynamometer. Gait performance was measured using the seven-category scale of the Functional Indeoendence Measure. Interdav reliabilitv was acceptable for all three measures, standing balance (weighted Kappa = .905), muscle strength (intraclass correlation coefficients=.871 to .951), and gait (weighted Kappa=.915). A Spearman correlation of .860 was found between balance and gait measures. The correlations between the strengths of various muscle groups and gait were lower (.I38 to ,581). Multiple regression identified none of the strength scores as offering additional independent explanation of gait performance. Balance, as scored, appears to be a reliable and valid measure worth broader application among hospitalized patients.
The content of the rehabhtation assessment can vary widely, but assorted measures of standmg balance (Lee, Deming, & Sahgal, 1988; Duncan, Weiner, Chandler, & Studenski, 1990; Bohannon & Walsh, 1991; Bohannon, Walsh, & Joseph, 1993), muscle strength (Bohannon, 1992), and walking performance (McGavin, Gupta, & McHardy, 1976; Holden, Gdl, Magliozzi, Nathan, & Piehl-Baker, 1984; Wade, Wood, Heller, Maggs, & LangtonHewer, 1987; Bohannon, 1989; Stewart, Burns, Dunn, & Roberts, 1990; Ozgirgin, B~liikbasi,Beyazova, & Orkun, 1993) are frequent components. Many of the measures used to quantdy the aforementioned variables, although routine in some clinical settings, have not been shown to be reliable and meaningful therein. Specifically, a simple seven-category ordinal scale has been described for measuring balance. Its application, however, has been lunited primarily to patients with stroke (Bohannon, 1989; Bohannon & Walsh, 1991; Bohannon, et al., 1993). Hand-held dynamometry has been studed extensively (Bohannon, 1993) but concerns remain regarcGng the reliability of the procedure when applied at bedside (Rodgers, htken, Bates, &
'Direct enquiries to R W Bohannon, Ed.D., School of Allied Health Professions, U-101, University of Connecticut. Srorrs, C T 06269-2101.
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James, 1992; Lennon & Ashburn, 1993). Extensive research on the Functional Independence Measure (FIM) notwithstanding (Granger, Cotter, Hamilton, & Fiedler, 1993), the locomotion component of the measure has not been the target of much focussed research. The purposes of this study, therefore, were two. The first purpose was to describe the interday reliabhty (consistency) of an ordinal balance scale, measurements of lower extremity strength obtained bedside with a hand-held dynamometer, and the locomotion scale of the Functional Independence Measure. The second purpose was to describe the relationship of the two measures of impairment (balance and lower extremity muscle strength) with the disabihty measure (FIM locomotion score).
Subjects Thirty hospitalized patients referred for rehabitttation participated as subjects after providing informed consent. All were able to follow verbal instructions of at least two parts. All had at least one muscle group of the lower extremity which was identified by manual muscle testing as less than normal (specifically 5 4/good). Fourteen of the subjects had a primary diagnosis of stroke. Ten had another neurologic diagnosis. Six had other nonneurologic diagnoses. Sixteen were men and 14 were women. Their mean (range) age was 63.3 (22 to 88) yr. Measurements Standing balance was measured using the following ordinal scale: O= unable, 1=able with feet apart (
