RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE

KARNATAKA

ANNEXURE – II

1 / NAME OF THE CANDIDATE
AND ADDRESS / KULDEEP GUPTA
POLT NO. 1088/3, CHANDIPURWA,
NAI BASTI, NAUBASTA,
KANPUR, U.P. PIN – 208021
2 / NAME OF THE
INSTITUTION / KRUPANIDHI COLLEGE OF PHYSIOTHERAPY, BANGALORE
3 / COURSE OF THE STUDY
AND SUBJECT / MASTER OF PHYSIOTHERAPY
(NEUROLOGICAL AND PSYCHOSOMATIC DISORDER)
4 / DATE OF ADMISSION
TO COURSE / JUNE 2007
5 / TITLE OF THE TOPIC:
A COMPARISION OF TRUNK IMPAIRMENT SCALE AND TRUNK CONTROL TEST ON TRUNK PERFORMANCE IN CHRONIC STROKE PATIENTS.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

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8 / BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Stroke is the most common cause of disability or dependence in Activities of Daily Living (ADL) among the elderly. Among the various impairment trunk control impairment play a major role in active recovery and functional abilities including ambulation. Trunk control is required to maintain a body position, to remain stable when changing positions, to perform activities of daily living, and for mobility. Trunk control is a crucial component to perform ADL. The function of trunk muscles is an essential factor for sitting balance, transfer, gait, and activities of daily living in stroke patients. The ability to control trunk muscle performance in sitting and activities of daily living is a fundamental skill in successful stroke rehabilitation. The value of an early assessment of sitting balance in predicting the functional outcome of stroke patients has been pointed out in recent studies.
Collin and Wade developed an instrument called the Trunk Control Test (TCT) to assess trunk function in patients with stroke, it is valid and reliable to evaluate trunk function after stroke and Franchignoni reported that adding the admission TCT score as one of the predictors explained the discharge FIM™ scores better than with the FIM admission score alone.
Although the literature is abundant addressing limb muscle performance and its recovery after stroke, few studies have investigated the impairment of trunk function. The TCT is one of the few instruments that attempt to evaluate trunk function after stroke, and it has been used in stroke rehabilitation research.
Fujiwara, Toshiyuki and Liu, developed a measure called Trunk Impairment Scale, and it is reliable and valid and responsive for the use in stroke outcome research. Verheyden G and Vereeck L told the use of the Trunk Impairment Scale has the advantage that it has no ceiling effect in stroke patient.
In this study the researcher aims of study is to compare the validity and reliability of Trunk Impairment Scale and Trunk Control Test. Both the Trunk Impairment Scale and Trunk Control Test have the validity and reliability. We need to know the better reliable one among the each, by comparing them.
6.1 NEED FOR THE STUDY
Various studies the in the past has shown that both Trunk Impairment Scale and Trunk Control Test are reliable and valid for the trunk assessment in chronic stroke patients.
Thereby the significance of this study is to compare the validity and reliability both on a selected group under normal circumstances and to draw an inference about the efficacy of one over the other in chronic stroke patients.
Thus, the proposed study is intended to compare these two scales on chronic stroke patients.
6.2 REVIEW OF LITERATURE
Collin C, Wade D. 12 1990 Jul
Two short tests of motor function, the Motricity Index (MI) and the Trunk Control Test (TCT), were assessed at regular intervals after stroke and compared with a detailed physiotherapy test, the Rivermead Motor Assessment (RMA). The MI and TCT were valid and reliable tests, which were usually quicker to perform than the RMA. The TCT was of predictive value when related to eventual walking ability. All three tests appeared to be of equal sensitivity in detecting change.
Duarte E, Marco E, Muniesa JM, Belmonte R, Diaz P, Tejero M, Escalada F.10 2002 Nov
The purpose of this study was to evaluate prospectively the Trunk Control Test (TCT) correlation at admission to rehabilitation with length of stay; functional independence measure (FIM), gait velocity, walking distance and balance measured at discharge in 28 hemiparetic patients. FIM and TCT were registered on admission. Outcome measures at discharge were: FIM, gait velocity, walking distance and balance assessed with the Berg Balance Scale and computerized posturography. TCT was significantly correlated with length of stay (r = -0.722), discharge FIM (r = 0.738), discharge motor FIM (r = 0.723), gait velocity (r = 0.654), walking distance (p = 0.003), center of gravity symmetry r = 0.601) and Berg Balance Scale (r = 0.755). Initial TCT predicts the 52% of the variation in length of stay and 54% in the discharge FIM. The predictive value of a compound variable (TCT and admission FIM) reaches 60% of the variation in length of stay and 66% in the FIM at discharge.
Franchignoni FP, Tesio L, Ricupero C, Martino MT.11 1997 Jul
BACKGROUND AND PURPOSE: The aim of this study was to investigate the construct and predictive validity of the Trunk Control Test (TCT) in post acute stroke patients by comparing TCT scores at admission and discharge with the Functional Independence Measure (FIM) scores. METHODS: Forty-nine patients participated in the study. The TCT examines four movements: rolling from a supine position to the weak side (T1) and to the strong side (T2), sitting up from a lying-down position (T3), and sitting balance (T4). The FIM is an 18-item scale (13 motor [motFIM] and 5 cognitive [cognFIM]) used to determine the level of dependence of patients in daily life. RESULTS: Thirty-six patients (73%) increased their TCT overall score at discharge. The TCT item-total correlations were high, both at admission and discharge (P < .0001). The individual TCT items were intercorrelated. Furthermore, the homogeneity of the TCT was confirmed by a high Combat’s index. High correlations were found between admission and discharge scores in the different tests (TCT, FIM, and motFIM; P < .0001) and between TCT at admission and FIM (P < .0001) and motFIM (P < .0001) at admission. TCT at admission alone explained 71% of the variance in motFIM at discharge. CONCLUSIONS: The TCT showed a good sensitivity to change in assessing recovery of stroke patients. The high item-total correlation and Cronbach's alpha value of the TCT suggest that there is one homogeneous construct underlying the item list. The TCT construct validity was confirmed by the correlation between this test and the FIM scores. TCT at admission predicted motFIM at discharge even better than motFIM at admission alone. Possibly, the TCT captures basic motor skills that foreshadow the recovery of more complex behavioral skills described by the FIM.
Fujiwara T, Liu M, Tsuji T, Sonoda S, Mizuno K, Akaboshi K, Hase K, Masakado Y, Chino N.08 2004 sep
OBJECTIVE: The purpose of this study was to investigate reliability, validity, internal structure, and responsiveness of our newly developed Trunk Impairment Scale (TIS) for patients with stroke. DESIGN: A total of 73 patients with stroke participated in this prospective study. Interrater reliability (weighted kappa statistics), content validity (principal component analysis), concurrent validity (Spearman's rank correlation with the Trunk Control Test), predictive validity (prediction of discharge FIM scores), and responsiveness (standardized response mean values) were examined. Internal consistency and item difficulties were analyzed with Rasch analysis. RESULTS: The weighted kappa of each TIS item ranged from 0.66 to 1.0. Principal component analysis revealed that the TIS measured a domain similar to the Stroke Impairment Assessment Set trunk items but different from the Stroke Impairment Assessment Set motor and visuospatial items. The TIS correlated with the Trunk Control Test (r = 0.91). To predict discharge FIM motor scores, addition of the TIS as one of the predictors to age, time from onset, and admission FIM score increased the adjusted R2 from 0.66 to 0.75. With Rasch analysis, the misfit was acceptable, except for the abdominal muscle strength item. The difficulty patterns were similar at admission and discharge, except for the abdominal muscle strength item. The responsiveness of the TIS was satisfactory and comparable with that of the Trunk Control Test (standardized response mean values, 0.94 and 1.06). CONCLUSIONS: Our newly developed TIS are reliable, valid, and responsive for use in stroke outcome research.
J Beatus, D W Klima, S Carter, S M Williams, R Todd. 04 2006 Dec
Purpose/Hypothesis: Due to the high costs of hospitalization and rehabilitation associated with cerebrovascular accident (CVA), it is imperative that physical therapists provide an early estimate of patients' potential recovery and future care needs. Prognostic tools, in conjunction with measures of functional performance, are valuable in assisting with clinical management decisions. While considerable outcomes measures are available to measure functional recovery following acute CVA, fewer instruments are available related to trunk performance and recovery. This pilot study's purposes were to 1) Determine the relationship between the: Trunk Control Test (TCT), Orpington Prognostic Score (OPS), and Functional Independence Measure (FIM) during the recovery trajectory among patients with acute CVA and 2) Measure and validate trunk performance in conjunction with patients' length of stay. Number of Subjects: Eighteen patients with an acute CVA (7 male/11 female) participated in this study. Patients ranged in age from 37 to 87 years of age (x=72; SD+/-13.3). Materials/Methods: Within 72 hours of their admission their to a local community rehabilitation hospital, eighteen patients were administered the OPS, TCT, and FIM instruments by two trained testers and then again prior to discharge. Inclusion criteria required patients to be evaluated within 14 days following their CVA. Patients were excluded if cognitive deficits or medical complications prohibited formal testing. Results: The patient's average length of stay was 18 days (range: 4-46 days). Designated correlations were analyzed with Spearman rho coefficients. On admission, the TCT scores showed significant moderate to high correlations with the OPS (-0.673; p<.01) and total FIM scores (0.732; p<.01). In addition, significant correlations were noted between both patients' admission OPS measures (0.550; p<0.05), TCT scores (- .715; p<0.001), and their overall length of stay. TCT and FIM scores at discharge were not statistically significant (p<0.05). Conclusions: Findings of this pilot study support that the Trunk Control Test demonstrates appropriate concurrent validity with the Orpington Prognostic Score and Functional Independence Measure during initial admission testing and can be utilized in tandem with other outcomes measures to predict patients' length of stay. A ceiling effect may limit its overall responsiveness at the time of discharge assessment. Additional follow-up is needed with larger sample sizes to further assess the concurrent and predictive capacity of this measure. Clinical Relevance: The Trunk Control Test is a short quantitative tool, which can be administered during the bed mobility assessment for patients with a variety or trunk impairments following acute CVA, including the pusher syndrome. Clinically, these findings are beneficial to quantify trunk impairments during rehabilitation management.
Mujić-Skikić E, Trebinjac S, Avdić D, Dzumhur-Sarić A.03 2006 Aug
In General Hospital setting, where varieties of patients are included in neuro-rehabilitation process, set of multidisciplinary functional tests were established, as a routine in daily work. Physiotherapists and occupational therapists that were members of rehabilitation team did tests. Our aim was to select the tests, which can be used as a routine and are applicable for different neurological impairments in daily work. Tests were applied to inpatients admitted to the Medical, Trauma, Neurology and Neurosurgery wards in the Rashid Hospital, DOHMS, and Dubai. Fifty inpatients with different neurological impairments admitted to totally 8 wards, were tested in the beginning of rehabilitation process and on discharge from the hospital. Nine tests were used as standardized tests for measuring motor, cognitive, focal impairment, ADL activities and disability: Motricity Index, Trunk Control Test, Standing Balance score, Functional Ambulation Categories test, Mini Mental State Examination, Canadian Neurological Scale, Action Research Arm test, Bartel Index and Functional Independent Measurements. FIM, Motricity Index and Trunk Control Test were applicable for all tested patients, with required adaptation for different neurological conditions within the same score. Other tests were not applicable for all patients as routine, but there were very useful for certain number of patients as a measurement of functional improvement. It is very important to have proper setup of tests, which are simple, reliable and valid for measuring impairment, disability and handicap and which can be used as standardized part of assessment protocol. Also, they must be applicable for different neurological impairments to monitor treatment progress. Combination of tests performed by different professionals and comprehensive approach of all team members is very important for measuring outcomes in rehabilitation and evaluating patient's impairment and disability. Proper hospital setup, optimal number of staff, good communication and teamwork are leading to better outcome in neuro-rehabilitation process.
Verheyden, G., Hughes, J., Jelsma, J., Nieuwboer, A. and De Weerdt, W.02 2006)
Traumatic Brain Injury (TBI) is a significant cause of morbidity in the South African context (Reed and Welsh, 2002). Although statistics regarding TBI in South Africa are limited, a study in Johannesburg in 1991 recorded an incidence of 316 TBI patients per 100,000 inhabitants annually (Nell and Brown, 1991). Following TBI, there is often an associated loss of trunk control and balance (Davies, 1994), which are considered as some of the most disabling aspects following TBI (Black et al, 1999). Selective trunk control is required for balance, limb function, gait, respiration and speech (Davies, 1990). Furthermore, sitting balance has been cited as an important predictor of functional outcome following TBI (Black et al, 1991). The condition of TBI patients is often characterized by poor concentration, attention and memory. These patients are also frequently confused, disoriented and agitated (Sohlberg and Mateer, 1989, Quinn and Sullivan, 2000). It is therefore important that evaluation instrument should be brief and not complex. Although an accurate and reliable instrument of trunk function is required to define appropriate aims of rehabilitation (Mazaux, M.L. et al, 2001) there are few instruments that have been developed for measuring this in the TBI population. The Clinical Outcome Scale is a scale, which consists of 13 items, one of which assesses sitting balance using a 7-point ordinal scale. In a study of 16 TBI patients, the sitting-balance item was found to be reliable (Low-Choy et al, 2002). The results should be interpreted with caution however, due to the small sample size and the use of intraclass correlation coefficients, which may not be the appropriate statistical analysis to evaluate rater-agreement for an ordinal item. The validity of the instrument was not examined. The Trunk Impairment Scale (TIS) was developed by Verheyden et al (2004) as a comprehensive tool to assess impairments in trunk control after a stroke. The TIS contains 3 subsections, which assess static, sitting balance, dynamic sitting balance and trunk co-ordination.