편마비장애인의 신체 균형능력 평가도구 개발에 관한 연구

Abstract

A Study for the Development of Clinical Measures on Balance Abilities in Hemiplegia Disabled - Centered on Rasch Analysis -

It is essential for the evaluation of the balance abilities to help individuals with hemiplegic stroke for their medical rehabilitation. However, the organized information of functional evaluation tools is not available, despite of the importance of using accurate and rational tools. Therefore, some of the evaluation tools have meaningless items to be examined or would cause an imminent danger while performing evaluation for the people with specific disabilities, even though the tools are generally used in clinical fields. Those tools have to be carefully reassessed for use as a clinical measuring instrument. That is because using inappropriate clinical evaluation tools would lead to decrease in the rehabilitation effect which eventually being treated, based on the evaluation outcome for the individuals with disabilities.

Currently widely used Korean version of Berg Balance Scale (hereafter ‘BBS’) is widely an evaluation tool for aged and disabled populations and it has been also used to examinate the balance abilities of the disabled with hemiplegic stroke. Thus it would result in a doubtful accuracy to the ultimate goal of evaluation because physical characteristics called 'hemiplegic stroke' was not considered in the evaluation.

Therefore, this study was to analyze how - ⅵ -each items of the Korean version of BBS would work on the balance abilities of people with hemiplegic stroke. In this study BBS was verified through the Rasch Analysis to see if the BBS, which is widely being used for elderly or general disabled populations to evaluate balance abilities, also fits for the people with hemiplegic stroke. And the purpose of this study was also to suggest, with this ground, the reorganized BBS for people with hemiplegic stroke and ultimately to help them to improve gait and ambulation abilities which lead to assist their independent living and social participation.

A total number of participants were 202 people (males 59%, females 41%) diagnosed with hemiplegic stroke in this study (mean age = 58.0 years; post-disease duration = 20 months). Data for 186 people after deducting 16 people who were excluded as unfits was reevaluated through Rasch analysis utilizing a software called 'Winsteps' (version 3.71.01) to identify the validity and reliability of the Korean version of the BBS clinical measures for hemiplegic stroke populations.

The results were as follows: 2 out of 14 items in total ("tandem standing" & "standing on one leg") were found to be 'Unfits'. The most difficult item was "tandem standing". And "standing on one leg" and "stool stepping" was next in order of difficulty for the disabled with hemiplegic stroke. The easiest item was "sitting unsupported". Re-analyzed results with the remaining 12 items except 2 unfit items came out test "stool stepping" and "sitting unsupported" were the most and the least level of difficulty, respectively, for the disabled with hemiplegic stroke. The probability curves for a well-functioning five-category maintained independent in terms of rating scale categories using Rasch analysis for Korean-version BBS in this study.

Hemiplegic stroke mostly occurs among adults and aged people who normally have social and financial responsibilities in their family. Therefore, the rehabilitation of hemiplegic stroke patient has very important social meaning as well as individual. Thus, this study would give directly relevant and meaningful suggestion for hemiplegic stroke patients to precisely assess their balance abilities by considering hemiplegic stroke at the examination stage for clinical decision making before rehabilitation service to be rendered.

Key Words: balance abilities, Berg Balance Scale, clinical measures, hemiplegia.