| Popis: |
Uvod: L-test je modifikacija časovno merjenega testa vstani in pojdi. Vstajanje in sedanje sta poleg hoje pomembni komponenti premičnosti. Za paciente po amputaciji spodnjega uda sta relativno zahtevni nalogi zaradi zmanjšane mišične zmogljivosti in proprioceptivnih informacij. Za ocenjevanje sposobnosti vstajanja se najpogosteje uporabljata test petih vstajanj (5TSTS) in 30-sekundni test vstajanja s stola (30SSTS). Namen: Preveriti zanesljivost L-testa ter sočasno in diskriminacijsko veljavnost ter najmanjšo zaznavno spremembo in velikost učinka L-testa. Namen je bil tudi preveriti zanesljivost 5TSTS in 30SSTS ter preučiti njuno uporabnost pri pacientih po amputaciji spodnjega uda v protetični fazi rehabilitacije. Metode dela: V raziskavi je sodelovalo 36 preiskovancev (30 moških, 6 žensk), starih povprečno 64,4 (SO: 11,8) let, ki so bili na bolnišnični rehabilitaciji prvič oskrbljeni s protezo. Osemindvajset jih je imelo trans-tibialno in 8 trans-femoralno amputacijo. Vzroki amputacije so bile bolezni perifernih žil (86 %) in drugo. Po L-testu smo v naključnem vrstnem redu izvedli še 6-minutni test hoje, test hoje na 10 metrov ter 5TSTS in 30SSTS. Prvo ocenjevanje smo izvedli prvi dan, ko so bili preiskovanci sposobni hoje izven bradlje s svojo protezo, in naslednji dan. Vsi ocenjevalni postopki so bili izvedeni prvi ocenjevalni dan in nato ponovno po dveh in treh tednih. Izračunali smo vrednosti intraklasnih korelacijskih koeficientov (ICC), Pearsonovih (r) in Spearmanovih (ro) korelacijskih koeficientov, t-teste za odvisne in neodvisne vzorce, velikost učinka in najmanjšo zaznavno spremembo ter učinka tal in stropa. Rezultati: Za L-test smo ugotovili odlično zanesljivost posameznega preiskovalca (ICC = 0,94) in med preiskovalcema (ICC = 0,96). Sočasna veljavnost je bila zmerna do odlična (r = 0,60–0,86). Med skupinama preiskovancev po trans-tibialni in trans-femoralni amputaciji je bila statistično značilna razlika v izidih L-testa (F (1, 31) = 5,858 p = 0,022). Z regresijsko analizo izidov L-testa glede na raven amputacije smo ugotovili pomembno skupno linearno povezanost z drugimi spremenljivkami (R2 = 0,55 p < 0,001). Pri tem so bili potrjeni statistično pomembni vplivi starosti preiskovanca, vzroka amputacije in pripomočka za hojo. Z L-testom smo po dveh tednih zaznali velike razlike (velikost učinka = 1,21). Najmanjša zaznavna sprememba je 20,3 s učinka tal ali stropa nismo zaznali. Za 30SSTS in 5TSTS smo ugotovili odlično zanesljivost posameznega preiskovalca (ICC = 0,92 in ICC = 0,93 zaporedno) in učinek tal. Ob modificirani izvedbi obeh testov (z uporabo rok) pa učinka tal ni bilo. Zaključek: L-test je zanesljivo merilno orodje pri pacientih po amputaciji spodnjega uda v protetični fazi rehabilitacije. Zaradi dobrih merskih lastnostih ga je smiselno uvesti v redno fizioterapevtsko prakso. Oba testa vstajanja s stola sta se izkazala za zanesljivi in uporabni meri premičnosti. Introduction: L-test is a modification of the timed up and go test. Standing up and sitting down are in addition to walking important components of mobility. These tasks are relatively demanding for patients after lower-limb amputation, due to their reduced muscular capacity and proprioceptive information. For the assessment of the ability to stand up, the five times sit-to-stand (5TSTS) and the 30-second sit-to-stand test (30SSTS) are most commonly used. Purpose: To assess reliability of the L-test and its concurrent and discriminative validity, minimal detectable change and effect size. The aim was also to assess reliability of the 5TSTS and 30SSTS and to consider their usability in patients after lower-limb amputation in prosthetic phase of rehabilitation. Methods: 36 subjects (30 male, 6 female), mean age 64.0 (SD: 12.8) years, who underwent an inpatient rehabilitation and were provided with a prosthesis for the first time, participated in the study. Twenty-eight had trans-tibial and 8 trans-femoral amputation. They were amputated due to vascular disease (86 %) or other medical conditions. After the L-test we conducted 6-minute walk test, 10-meter walk test, 5TSTS and 30SSTS in randomized order. We conducted the first assessment on the day when patients were able to walk independently with prosthesis and the day after. All tests were conducted on the first assessment day and again after two and three weeks. We calculated values of the intraclass (ICC), Pearson’s (r) and Spearman’s (ro) correlation coefficients, t-tests for dependant and independent samples, effect size, minimal detectable change and floor and ceiling effects. Results: We established excellent intra-rater (ICC = 0.94) and inter-rater (ICC = 0.96) reliability for the L-test. Concurrent validity was moderate to excellent (r = 0.60–0.86). There was a significant difference in mean L-test results (F (1, 31) = 5.858 p = 0.022) between the subjects following trans-tibial and trans-femoral amputation. Regression analysis of the results of the L-test with respect to the level of amputation revealed an important total linear correlation with other variables (R2 = 0.55 p < 0.001). In this regard, statistically significant influences of the age of the subject, the cause of amputation and the walking aid were confirmed. L-test detected large differences after two weeks (effect size = 1.21). Minimal detectable change was 20.3 seconds we did not detect the floor or ceiling effects. For 30SSTS and 5TSTS we established excellent intra-rater reliability (ICC = 0.92 and ICC = 0.93, consecutive) and detected the floor effect. With the modified performance of both tests (using hands) there was no floor effect. Conclusion: The L-test is a reliable measuring tool in patients after lower-limb amputation during the prosthetic phase of rehabilitation. Due to its good measurement properties, it is relevant to introduce it into regular physiotherapy practice. Both sit-to-stand tests are reliable and useful measures of functional mobility. |
