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Development of the Brunel Balance Assessment: a new measure of balance disability post stroke

Centre for Research in Rehabilitation, Department of Health and Social Care, Brunel University, London, now at Centre for Rehabilitation and Human Performance Research, University of Salford, London, UK

Lorraine H DeSouza

Centre for Research in Rehabilitation, Brunel University, London, UK

Objective: To report the psychometric properties of the Brunel Balance Assessment (BBA), a new test of balance disability post stroke.

Design: Data from 92 subjects were collected and cohorts used to test hierarchical scaling, reliability and validity. Data from 80 people were used to test the hierarchical scaling using an inter-item correlation for redundancy, coefficient of reproducibility (CR) and scalability (CS) for the hierarchy and Cronbach's alpha coefficient for the internal consistency. Thirty-seven people participated in the reliability testing. Test / retest and inter-tester reliability were tested using the kappa coefficient. The testing was repeated on consecutive days to assess test / retest reliability and was scored simultaneously by two physiotherapists for inter-tester reliability. Fifty-five people participated in validity testing. The BBA was compared with the sitting Motor Assessment Scale (MAS), Berg Balance Test (Berg), Rivermead Mobility Index (RMI) using Spearman's rho.

Setting: Physiotherapy stroke services of six UK NHS trusts.

Participants: Hemiplegic stroke patients were recruited from physiotherapy services and the BBA used to assess their balance.

Results: The order of the items was revised and the original 14-point scale reduced to 12 points in the scale development. The revised scale formed a hierarchical scale. Inter-item correlations were < 0.9, coefficients of reproducibility and scalability were 0.99 and 0.69 respectively and Cronbach's alpha was 0.92. Reliability was high (100% agreement) for both aspects of reliability. Correlations with other balance measures were significant (0.83 / 0.97, p<0.01) indicating validity as measure of balance disability.

Conclusion: The BBA is a reliable, valid, hierarchical measure of balance disability post stroke that is suitable for use in the clinical setting.

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