Download PDF
CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(04): 369-376
DOI: 10.1055/s-0043-1767826
Original Article

Measurement properties of the Brazilian Portuguese version of the Lower-Extremity Motor Activity Log for chronic hemiparetic poststroke patients

Propriedades de medida da versão brasileira da Lower-Extremity Motor Activity Log para pacientes hemiparéticos crônicos pós-AVC
Elaine Menezes-Oliveira 
1   Universidade Federal de São Paulo, Programa de Neurologia/Neurociências, São Paulo SP, Brazil.
2   Associação de Assistência à Criança com Deficiência, Departamento de Fisioterapia de Adultos, São Paulo SP, Brazil.
,
Marília Escudero Cecconi 
2   Associação de Assistência à Criança com Deficiência, Departamento de Fisioterapia de Adultos, São Paulo SP, Brazil.
3   Universidade Cidade de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brazil.
,
Clarissa Barros de Oliveira 
2   Associação de Assistência à Criança com Deficiência, Departamento de Fisioterapia de Adultos, São Paulo SP, Brazil.
,
Milena Vegas 
2   Associação de Assistência à Criança com Deficiência, Departamento de Fisioterapia de Adultos, São Paulo SP, Brazil.
,
Sandra Regina Alouche 
3   Universidade Cidade de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brazil.
,
Ricardo Mario Arida 
4   Universidade Federal de São Paulo, Departamento de Fisiologia, São Paulo SP, Brazil.
,
Gabriela da Silva Matuti 
2   Associação de Assistência à Criança com Deficiência, Departamento de Fisioterapia de Adultos, São Paulo SP, Brazil.
3   Universidade Cidade de São Paulo, Departamento de Fisioterapia, São Paulo SP, Brazil.
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background Stroke is among the three leading causes of disability around the world, and it results in immediate difficulty in mobility and gait. There is a lack of instruments to evaluate what daily life is like for these individuals using their lower limbs in real-life environments (outside of the clinical environment).

Objective To perform the translation and cultural adaptation to Brazilian Portuguese of the Lower-Extremity Motor Activity Log (LE-MAL) and test its measurement properties in chronic poststroke individuals.

Methods The LE-MAL was translated into Brazilian Portuguese and adapted to the Brazilian culture. The comprehension and relevance of the final version were analyzed by a committee of specialists. The reliability, validity, and responsiveness of the LE-MAL/Brazil to detect changes after lower extremity constraint-induced movement therapy (LE-CIMT) and an intensive conventional therapy were tested.

Results The LE-MAL/Brazil showed excellent inter- and intrarater reliability, with an intraclass correlation coefficient and Cronbach alpha > 0.70, as well as standard error of measurement and smallest detectable change < 10% of the total instrument score when applied by the same evaluators.

Conclusion The responsiveness of the LE-MAL/Brazil to detect changes showed better results after LE-CIMT than after the intensive conventional therapy, with most of the correlations > 0.50.

Resumo

Antecedentes O acidente vascular cerebral (AVC) é a terceira causa de deficiência ao redor do mundo, e resulta em dificuldades imediatas relativas à marcha e à mobilidade. Nota-se a ausência de instrumentos que avaliem o dia a dia desses indivíduos quanto ao uso dos membros inferiores em ambientes reais (fora do ambiente clínico).

Objetivo Traduzir e fazer a adaptação cultural para o português do Brasil da Lower-Extremity Motor Activity Log (LE-MAL), e testar suas propriedades psicométricas em indivíduos hemiparéticos crônicos pós-AVC.

Métodos A LE-MAL foi traduzida para o português do Brasil e adaptada para a cultura brasileira. A compreensão e a confiabilidade da versão final foram testadas por um comitê de especialistas. A confiabilidade, a validade e a responsividade em detectar mudanças após a terapia de contensão induzida para membros inferiores (TCI-MMII) e uma terapia convencional também foram testadas.

Resultados A LE-MAL/Brazil mostrou excelente confiabilidade intra e interavaliador, com coeficiente de correlação intraclasse e alfa de Cronbach > 0,70, bem como erro padrão da medida e mínima mudança detectável < 10% da pontuação total quando aplicada pelo mesmo avaliador.

Conclusão A responsividade da LE-MAL/Brazil em detectar mudanças após a TCI-MMII apresentou resultados melhores do que após a terapia convencional, com a maioria das correlações > 0,50.

Keywords

Stroke - Evaluation Study - Gait - Postural Balance

Palavras-chave

Acidente Vascular Cerebral - Estudo de Avaliação - Marcha - Equilíbrio Postural

Authors' Contributions

EMO: conceptualization, data curation, investigation project administration, and writing the original draft; MEC, MV: data curation and investigation; CBO: supervision of the adult physiotherapy department, and writing – review and editing; SRA, RMA: methodology and supervision; GSM: conceptualization, data curation, project administration, supervision, methodology, and statistical analysis.




Publication History

Received: 31 May 2022

Accepted: 16 December 2022

Article published online:
09 May 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 WHO. Mortality and global health estimates. Disponível em: <https://www.who.int/data/gho/data/themes/mortality-and-global-health-estimates>. Acesso em: 9 jul. 2021.
  • 2 Mayo NE, Wood-Dauphinee S, Côté R, Durcan L, Carlton J. Activity, participation, and quality of life 6 months poststroke. Arch Phys Med Rehabil 2002; 83 (08) 1035-1042
    CrossrefPubMedGoogle Scholar
  • 3 Patel AT, Duncan PW, Lai SM, Studenski S. The relation between impairments and functional outcomes poststroke. Arch Phys Med Rehabil 2000; 81 (10) 1357-1363
    CrossrefPubMedGoogle Scholar
  • 4 Jette DU, Latham NK, Smout RJ, Gassaway J, Slavin MD, Horn SD. Physical therapy interventions for patients with stroke in inpatient rehabilitation facilities. Phys Ther 2005; 85 (03) 238-248
    CrossrefPubMedGoogle Scholar
  • 5 Fulk GD, Echternach JL. Test-retest reliability and minimal detectable change of gait speed in individuals undergoing rehabilitation after stroke. J Neurol Phys Ther 2008; 32 (01) 8-13
    CrossrefPubMedGoogle Scholar
  • 6 Hafsteinsdóttir TB, Rensink M, Schuurmans M. Clinimetric properties of the Timed Up and Go Test for patients with stroke: a systematic review. Top Stroke Rehabil 2014; 21 (03) 197-210
    CrossrefPubMedGoogle Scholar
  • 7 Hiengkaew V, Jitaree K, Chaiyawat P. Minimal detectable changes of the Berg Balance Scale, Fugl-Meyer Assessment Scale, Timed “Up & Go” Test, gait speeds, and 2-minute walk test in individuals with chronic stroke with different degrees of ankle plantarflexor tone. Arch Phys Med Rehabil 2012; 93 (07) 1201-1208
    CrossrefPubMedGoogle Scholar
  • 8 Uswatte G, Taub E, Morris D, Vignolo M, McCulloch K. Reliability and validity of the upper-extremity Motor Activity Log-14 for measuring real-world arm use. Stroke 2005; 36 (11) 2493-2496
    CrossrefPubMedGoogle Scholar
  • 9 OMS, O. M. DA S.; CIF, CLASSIFICAÇÃO INTERNACIONAL DE FUNCIONALIDADE, I. E S. Organização Panamericana da Saúde Organização Mundial da Saúde. [s.l: s.n.].
  • 10 Dos Anjos S, Morris D, Taub E. Constraint-Induced Movement Therapy for Lower Extremity Function: Describing the LE-CIMT Protocol. Phys Ther 2020; 100 (04) 698-707
    CrossrefPubMedGoogle Scholar
  • 11 Dos Anjos SM, Mark VW, Rodriguez CM. et al. Reliability and Validity of the Lower Extremity Motor Activity Log for Measuring Real-World Leg Use in Adults With Multiple Sclerosis. Arch Phys Med Rehabil 2021; 102 (04) 626-632
    CrossrefPubMedGoogle Scholar
  • 12 dos Anjos SM, Morris DM, Taub E. Constraint-induced Movement Therapy for improving motor function of the paretic lower extremity after stroke. Am J Phys Med Rehabil 2019; •••: 1
    Google Scholar
  • 13 Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 2000; 25 (24) 3186-3191
    Google Scholar
  • 14 Cristine de Faria L, Barbosa Marques D, Hellen Dos Santos Cerqueira Gomes L, Dos Anjos S, Pereira ND. Self-reported use of the paretic lower extremity of people with stroke: A reliability and validity study of the Lower-Extremity Motor Activity Log (LE-MAL) - Brazil. Physiother Theory Pract 2022; •••: 1-9
    CrossrefPubMedGoogle Scholar
  • 15 ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166 (01) 111-117
    Google Scholar
  • 16 Salbach NM, OʼBrien KK, Brooks D. et al. Considerations for the Selection of Time-Limited Walk Tests Poststroke: A Systematic Review of Test Protocols and Measurement Properties. J Neurol Phys Ther 2017; 41 (01) 3-17
    CrossrefPubMedGoogle Scholar
  • 17 Cheng DK, Nelson M, Brooks D, Salbach NM. Validation of stroke-specific protocols for the 10-meter walk test and 6-minute walk test conducted using 15-meter and 30-meter walkways. Top Stroke Rehabil 2020; 27 (04) 251-261
    CrossrefPubMedGoogle Scholar
  • 18 Podsiadlo D, Richardson S. The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 1991; 39 (02) 142-148
    CrossrefPubMedGoogle Scholar
  • 19 Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med 2010; 42 (04) 323-331
    CrossrefPubMedGoogle Scholar
  • 20 Godi M, Franchignoni F, Caligari M, Giordano A, Turcato AM, Nardone A. Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders. Phys Ther 2013; 93 (02) 158-167
    CrossrefPubMedGoogle Scholar
  • 21 Bambirra C. Magalhães LdC, Paula FRd. Confiabilidade e validade do BESTest e do MiniBESTest em hemiparéticos crônicos. Revista Neurociências. 2015; 23 (01) 30-40
    CrossrefGoogle Scholar
  • 22 Potter K, Brandfass K. The Mini-Balance Evaluation Systems Test (Mini-BESTest). J Physiother 2015; 61 (04) 225
    CrossrefPubMedGoogle Scholar
  • 23 Carod-Artal FJ, Coral LF, Trizotto DS, Moreira CM. The stroke impact scale 3.0: evaluation of acceptability, reliability, and validity of the Brazilian version. Stroke 2008; 39 (09) 2477-2484
    CrossrefPubMedGoogle Scholar
  • 24 Mokkink L, Terwee C, de Vet H. Key concepts in clinical epidemiology: Responsiveness, the longitudinal aspect of validity. J Clin Epidemiol 2021; 140: 159-162 [Internet]
    CrossrefPubMedGoogle Scholar
  • 25 Mokkink LB. et al. COSMIN Study Design checklist for Patient-reported outcome measurement instruments. Department of Epidemiology and Biostatistics Amsterdam Public Health research institute Amsterdam University Medical Centers, location VUmc, n. July, p. 1–32, 2009
    Google Scholar
  • 26 De Vet HC. et al. Minimal changes in health status questionnaires: Distinction between minimally detectable change and minimally important change. Health and Quality of Life Outcomes, v. 4, n. Mic, p. 3–7, 2006
    Google Scholar
  • 27 Smidt N, van der Windt DA, Assendelft WJ. et al. Interobserver reproducibility of the assessment of severity of complaints, grip strength, and pressure pain threshold in patients with lateral epicondylitis. Arch Phys Med Rehabil 2002; 83 (08) 1145-1150
    CrossrefPubMedGoogle Scholar
  • 28 Hammer AM, Lindmark B. Responsiveness and validity of the Motor Activity Log in patients during the subacute phase after stroke. Disabil Rehabil 2010; 32 (14) 1184-1193
    CrossrefPubMedGoogle Scholar
  • 29 Menezes-Oliveira E, da Silva Matuti G, de Oliveira CB. et al. Effects of lower extremity constraint-induced movement therapy on gait and balance of chronic hemiparetic patients after stroke: description of a study protocol for a randomized controlled clinical trial. Trials 2021; 22 (01) 463
    CrossrefPubMedGoogle Scholar
  • 30 Vratsistas-Curto A, Sherrington C, McCluskey A. Responsiveness of five measures of arm function in acute stroke rehabilitation. Clin Rehabil 2018; 32 (08) 1098-1107
    CrossrefPubMedGoogle Scholar
  • 31 Middel B, van Sonderen E. Statistical significant change versus relevant or important change in (quasi) experimental design: some conceptual and methodological problems in estimating magnitude of intervention-related change in health services research. Int J Integr Care 2002; 2: e15 DOI: 10.5334/ijic.65. Erratum in: Int J Integr Care. 2008;8:e72. PMID: 16896390; PMCID: PMC1480399
    CrossrefPubMedGoogle Scholar
  • 32 Cohen J. (1988). Statistical Power Analysis for the Behavioral Sciences. New York, NY: Routledge Academic.
  • 33 Faria-Fortini I, Basílio ML, Scianni AA, Faria CDCM, Teixeira-Salmela LF. Performance and capacity-based measures of locomotion, compared to impairment-based measures, best predicted participation in individuals with hemiparesis due to stroke. Disabil Rehabil 2018; 40 (15) 1791-1798
    CrossrefPubMedGoogle Scholar