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European Journal of Physical and Rehabilitation Medicine 2013 June;49(3):341-51


language: English

Trunk Recovery Scale: a new tool to measure posture control in patients with severe acquired brain injury. A study of the psychometric properties

Montecchi M. G., Muratori A., Lombardi F., Morrone E., Brianti R.

Intensive Rehabilitation Unit, S. Sebastiano Hospital, Correggio, Reggio Emilia, Italy


Background: Posture control appears deeply impaired in patients with severe Acquired Brain Injury (ABI). One of the main goals of neurorehabilitation specialists is to try to assess this neural function in a standardized manner. However, the tests available to evaluate posture control recovery after brain damage were developed for patients with focal neurological signs. We therefore developed a new test, the Trunk Recovery Scale (TRS).
Aim: To evaluate the inter-rater reliability, internal consistency, external validity, and sensitivity of TRS in patients with ABI.
Design: Validation study
Setting: We examined 59 patients hospitalized after a brain injury in the Intensive and the Extensive Rehabilitation Units of our hospital.
Population: Patients with diagnosis of severe ABI with the capacity to respond to simple verbal orders and with a Level of Cognitive Functioning Scale (LCF scale) ≥ 4.
Methods: Three raters independently assessed 20 subjects. One of the raters also assessed 39 additional subjects using TRS, Trunk Control Test (TCT), and Functional Independence Measure (FIM), and repeated the evaluation after 30 days.
Results: The Inter-rater reliability was generally high (ICC=0,97 and 0,92 for total score and different subscales). Weighted Kappa values indicated “substantial agreement” except for items 2, 7, and 12. Internal consistency was good: Cronbach’s coefficients were 0.900 and 0.910 for different subscales, and the elimination of one item at a time did not substantially improve the internal consistency. External validity was excellent (Spearman rank correlations =0.943 and 0.849 for TCT and FIM). Sensitivity was good.
Conclusions: Our data confirm that TRS reliably assesses posture control in patients with severe ABI. However, as the sample size of internal consistency and validity was limited, the results may be overestimated. We therefore propose that this study be considered the first in a series of similar studies. This series should include a Rasch Analysis, which would further evaluate the suitability of keeping or removing items with less consistency and would define the mathematical properties of different subscales and the total score.
Clinical Rehabilitation Impact: Our data confirm that TRS detects subtle but potentially meaningful motor changes in patients and can therefore allow clinicians to document treatment effectiveness and define treatment objectives.

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