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      Instrumented Static and Dynamic Balance Assessment after Stroke Using Wii Balance Boards: Reliability and Association with Clinical Tests

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          Abstract

          Background and Objectives

          The Wii Balance Board (WBB) is a globally accessible device that shows promise as a clinically useful balance assessment tool. Although the WBB has been found to be comparable to a laboratory-grade force platform for obtaining centre of pressure data, it has not been comprehensively studied in clinical populations. The aim of this study was to investigate the measurement properties of tests utilising the WBB in people after stroke.

          Methods

          Thirty individuals who were more than three months post-stroke and able to stand unsupported were recruited from a single outpatient rehabilitation facility. Participants performed standardised assessments incorporating the WBB and customised software (static stance with eyes open and closed, static weight-bearing asymmetry, dynamic mediolateral weight shifting and dynamic sit-to-stand) in addition to commonly employed clinical tests (10 Metre Walk Test, Timed Up and Go, Step Test and Functional Reach) on two testing occasions one week apart. Test-retest reliability and construct validity of the WBB tests were investigated.

          Results

          All WBB-based outcomes were found to be highly reliable between testing occasions (ICC  = 0.82 to 0.98). Correlations were poor to moderate between WBB variables and clinical tests, with the strongest associations observed between task-related activities, such as WBB mediolateral weight shifting and the Step Test.

          Conclusions

          The WBB, used with customised software, is a reliable and potentially useful tool for the assessment of balance and weight-bearing asymmetry following stroke. Future research is recommended to further investigate validity and responsiveness.

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          Most cited references28

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          Statistical methods for assessing agreement between two methods of clinical measurement.

          In clinical measurement comparison of a new measurement technique with an established one is often needed to see whether they agree sufficiently for the new to replace the old. Such investigations are often analysed inappropriately, notably by using correlation coefficients. The use of correlation is misleading. An alternative approach, based on graphical techniques and simple calculations, is described, together with the relation between this analysis and the assessment of repeatability.
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            Validity and reliability of the Nintendo Wii Balance Board for assessment of standing balance.

            Impaired standing balance has a detrimental effect on a person's functional ability and increases their risk of falling. There is currently no validated system which can precisely quantify center of pressure (COP), an important component of standing balance, while being inexpensive, portable and widely available. The Wii Balance Board (WBB) fits these criteria, and we examined its validity in comparison with the 'gold standard'-a laboratory-grade force platform (FP). Thirty subjects without lower limb pathology performed a combination of single and double leg standing balance tests with eyes open or closed on two separate occasions. Data from the WBB were acquired using a laptop computer. The test-retest reliability for COP path length for each of the testing devices, including a comparison of the WBB and FP data, was examined using intraclass correlation coefficients (ICC), Bland-Altman plots (BAP) and minimum detectable change (MDC). Both devices exhibited good to excellent COP path length test-retest reliability within-device (ICC=0.66-0.94) and between-device (ICC=0.77-0.89) on all testing protocols. Examination of the BAP revealed no relationship between the difference and the mean in any test, however the MDC values for the WBB did exceed those of the FP in three of the four tests. These findings suggest that the WBB is a valid tool for assessing standing balance. Given that the WBB is portable, widely available and a fraction of the cost of a FP, it could provide the average clinician with a standing balance assessment tool suitable for the clinical setting. Copyright 2009 Elsevier B.V. All rights reserved.
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              Global rating of change scales: a review of strengths and weaknesses and considerations for design.

              Most clinicians ask their patients to rate whether their health condition has improved or deteriorated over time and then use this information to guide management decisions. Many studies also use patient-rated change as an outcome measure to determine the efficacy of a particular treatment. Global rating of change (GRC) scales provide a method of obtaining this information in a manner that is quick, flexible, and efficient. As with any outcome measure, however, meaningful interpretation of results can only be undertaken with due consideration of the clinimetric properties, strengths, and weaknesses of the instrument. The purpose of this article is to summarize this information to assist appropriate interpretation of the GRC results and to provide evidence-informed advice to guide design and administration of GRC scales. These considerations are relevant and applicable to the use of GRC scales both in the clinic and in research.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, USA )
                1932-6203
                2014
                26 December 2014
                : 9
                : 12
                : e115282
                Affiliations
                [1 ]University of Melbourne, Department of Physiotherapy, Melbourne, VIC, Australia
                [2 ]Royal Melbourne Hospital – Royal Park Campus, Department of Physiotherapy, Melbourne, VIC, Australia
                [3 ]University of British Columbia, Department of Physical Therapy, Vancouver, BC, Canada
                [4 ]Australian Catholic University, School of Exercise Science, Melbourne, VIC, Australia
                University of South Florida, United States of America
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Conceived and designed the experiments: KB JM KM RC. Performed the experiments: KB. Analyzed the data: KB RA. Contributed reagents/materials/analysis tools: RA. Wrote the paper: KB JM KM RA.

                Article
                PONE-D-14-27659
                10.1371/journal.pone.0115282
                4277284
                25541939
                00d27086-d322-4d77-ac86-91c4b8723fe1
                Copyright @ 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 23 June 2014
                : 21 November 2014
                Page count
                Pages: 12
                Funding
                This study was funded in part by a National Health and Medical Research Council postgraduate scholarship ( https://www.nhmrc.gov.au/) awarded to author KB. The authors received no additional specific funding for this work.
                Categories
                Research Article
                Engineering and Technology
                Measurement
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                Trauma Medicine
                Neurorehabilitation and Trauma
                Geriatrics
                Balance and Falls
                Health Care
                Physiotherapy
                Neurology
                Vascular Medicine
                Stroke
                Custom metadata
                The authors confirm that all data underlying the findings are fully available without restriction. All relevant data are within the paper and its Supporting Information files.

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                Uncategorized

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