Evaluation of balance in youth with an acquired brain injury: reliability of the community balance and mobility scale

Evaluation of balance in youth with an acquired brain injury: reliability of the community balance and mobility scale
1 Research, Bloorview Research Institute, Toronto, ON;
2 Brain Injury Rehab Team, Bloorview Kids Rehab, Toronto, ON, Canada

Background/Objectives: Balance impairments are common following acquired brain injury (ABI). Children with ABI often have goals related to participation in sports and recess activities that require high-level balance skills. The community balance & mobility (CB&M) scale (Howe et al, 2006) is used by physiotherapists (PTs) at our pediatric centre to measure balance, and may be better at detecting changes in this area than the Gross Motor Function Measure (GMFM). While the CB&M’s psychometric strength has been shown with adults, it has not been tested in pediatrics. The purpose of this study was to determine inter-rater and test-retest reliability of the CB&M in ambulatory youth who have an ABI.
Design: Prospective, repeated measures design.
Participants and Setting: Twenty-four ambulatory youth (13 females and 11 males) with an ABI, ages 8 to 17 years (mean age=14 year 1 month, SD=2.1) who were in-patients or day-patients at a pediatric rehabilitation centre.
Materials/Methods: Six PTs were trained as assessors. Each passed the study’s CB&M criterion test. The PTs were assigned in pairs to do the CB&M assessment. At baseline, one PT assessor administered and scored the CB&M, while a second PT observed and independently scored it (inter-rater reliability). Children were reassessed 3-10 days later by the PT assessor who administered the baseline CB&M (test-retest reliability). Each PT had equal opportunity to serve as assessor or observer over the course of the study.
Results: The participants’ GMFM mean score at baseline was 93.4% (SD=7.8). CB&M baseline mean scores were 63.5% (SD=18.4) and 64.7% (SD=18.5) for PT assessors and observers respectively. The inter-rater reliability ICC was 0.93 (95% confidence interval [CI] =0.85-0.97), and a Bland-Altman plot revealed an indication of smaller inter-rater differences for CB &M scores (i.e., slightly greater agreement on lower scores). The assessor retest mean score was 68.7% (SD=1.7.0).The test-retest ICC was 0.92 (95% CI=0.84-0.96).No systematic bias was indicated in the test –retest Bland-Altman plot. The minimum detectable change (MDC90) estimate was 12.6%points. Previous clinical CB&M follow-up at our centre of 17 youth with ABI with similar baseline scores to our reliability sample showed mean change score of 23.6% points [SD=13.5] from baseline to discharge assessment, suggesting that this study’ MDC estimate is clinically realistic.
Conclusions/ significance: The CB&M showed excellent inter-rater and test-retest reliability in youth with an ABI with estimates similar to those of the published reliability work by Howe et al (2006) with adults post-ABI> In our sample, there was little room for gain on the GMFM, while the CB&M showed scoring scope to detect improvement. Future work should focus on formal evaluation of the CB&M’s responsiveness to change in rehabilitation centre and community intervention contexts.
Reference: Howe Ja et al. The community balance and Mobility Scale –a balance measure for individuals with traumatic brain injury Clin Rebabil 2006; 20: 885-895.

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