The ABLE Scale

244 Pages·2017·4.16 MB·English

Seton Hall University
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Seton Hall University Dissertations and Theses
Seton Hall University Dissertations and Theses
(ETDs)
2010
The ABLE Scale: The Development and
Psychometric Properties of a New Outcome
Measure for the Spinal Cord Injury Population
Elizabeth Ardolino
Seton Hall University
Follow this and additional works at:https://scholarship.shu.edu/dissertations
Part of thePhysical Therapy Commons
Recommended Citation
Ardolino, Elizabeth, "The ABLE Scale: The Development and Psychometric Properties of a New Outcome Measure for the Spinal
Cord Injury Population" (2010).Seton Hall University Dissertations and Theses (ETDs). 1491.
https://scholarship.shu.edu/dissertations/1491
The ABLE Scale: The Development And Psychometric Properties Of A
New Outcome Measure For The Spinal Cord Injury Population
BY
Elizabeth Ardolino
Dissertation Committee:
Dr. Genevieve Pinto Zipp, Chair
Dr. MaryAnn Clark
Dr. Karen Hutchinson
Approved by the Dissertation Committee:
3-&-/0
Date:
3
Date: -241 - /d
3 -/q-p/d
Date:
Submitted in partial fulfillment of the requirements for the degree of
Doctor of Philosophy in Health Sciences
Seton Hall University
Acknowledgements
As I learned rather early in this journey, the development of a
new outcome measure is a huge undertaking. I am fortunate to have
had the help of many generous and talented people. To all of those
listed below, I owe my sincerest gratitude.
To my dissertation committee for their undying patience and
support. To Dr. Genevieve Pinto Zipp, who showed me where to begin,
and how to end. To Dr. MaryAnn Clark, for her fire-cracker way of
keeping our discussions on track. To Dr. Karen Hutchinson, who never
stopped asking the hard questions, and who challenged me to make
the ABLE scale great.
To the members of the NRN Balance Committee for reading 14
versions of the ABLE scale before the first patient was ever tested on it,
and for providing the clinical and financial support necessary to
accomplish this study.
To the many data collectors and physical therapists at Magee
Rehabilitation Hospital, Frazier Rehabilitation, The Shepherd Center,
and Kessler Rehabilitation, who generously donated their time and
talents to collect data on over 100 subjects in 5 months.
To all of my colleagues at Magee, especially: Elizabeth Watson,
Carol Owens, Melania Dieterick, Alice Kennedy and Mary Schmidt,
who not only helped me with data collection, but who helped
maintain my sanity on a daily basis.
To Dr. Mike Linacre, Dr. Craig Velozo, Dr. Elaine Walker and Dr.
Sergio Romero, for all of their statistical assistance with the Rasch
analysis.
To Andrea Behrman and Susie Harkema, whose passion for
promoting recovery after SCI inspired me.
To my parents, Frank and Thomasine Roberts, for their endless
words of encouragement and financial support.
To my wonderful husband, Art, who taught himself how to
program the Rasch analysis software, who helped me with all things
computer-related, and who never doubted that I would finish this
project.
Dedication
To Meredith: for being not only my sister, but my first best friend.
To Art: for being not only my husband, but my soul mate.
Table of Contents
Acknowledgements ...................................................................................... 2
Dedication ..................................................................................................... 4
Table of Contents ..........................................................................................5
List of Tables .................................................................................................1 1
................................................................................................
List of Figures 12
........................................................................................................
Abstract 13
Chapter I ......................................................................................................1 5
.............................................................................................
INTRODUCTION 15
..................................................................
Background of the Problem 15
...............................................................................
Research Questions: 25
Chapter II ..................................................................................................... 26
......................................................................
REVIEW OF THE LITERATURE 26
..........................................................................
Description of Balance 26
................................................................................
Measuring Balance 35
............................................
Development of the Berg Balance Scale 38
Psychometric Properties of the Berg Balance Scale ...........................4 1
Current Uses of the Berg Balance Scale ..............................................6 1
Development of the Tinetti Performance-OrientedM obility
Assessment (POMA). ....................................................................................7 6
.................................................
Psychometric Properties of the POMA 78
Current Uses of the POMA ..................................................................... 84
................
The Development of the Modified Functional Reach Test 89
The Psychometric Properties of the MFRT ............................................ 90
.......................................................................
Current Uses of the MFRT 91
........................................................
Outcome Measure Development 93
.............................................................................
The Delphi Technique 93
.........................................................................................
Rasch Analysis 96
..................................................................................................
Chapter 111 102
....................................................................................................
METHODS 102
...........................................................................................
Introduction 102
.................................................................................................
Subjects 103
Design and Variables .....................................................................1. 03
..............................................................................
Measurement Tools 104
Demographic data ..............................................................................1 04
The Activity-based Balance Level Evaluation. ................................. 105
..............................................................................................
Procedure 106
.........................................................................................
Data analysis 107
Chapter IV .................................................................................................. 112
........................................................................................................
RESULTS 112
Demographics ......................................................................................1 12
Targeting and Item Difficulty. .............................................................1.1 3
..............
Effect of Pivot Anchoring on Targeting and Item Difficulty 115
........................................................................
Examination of Item Fit: 120
..........................................
Examination of Rating Scale Categories: 123
.................................................................................
Person Separation 126
Chapter IV .................................................................................................. 128
................................................................................................
DISCUSSION 128
..............................
The Strengths and Weaknesses of the ABLE Scale 137
Limitations of the Study ...........................................................................1 41
Implications for Future Research ........................................................... 142
..................................................................................................
Chapter VI 145
CONCLUSION .............................................................................................1 45
................................................................................................
References 147
................................................................................................
Appendix A 166
.................................................................................................
Appendix B 195
PILOT STUDY 1 : THE DELPHI TECHNIQUE ..................................................1..9 5
..............................................................................
Purpose of the Study 195
...................................................................................................
Subjects 195
...............................................................................................
Procedure 197
................................................................................................
Round 1 197
Round 2 ................................................................................................ 197
Advanced Review ..............................................................................1 98
Results ...................................................................................................... 199
................................................................................................
Round 1 199
..................... .. ..................................................................
Round 2 201
..............................................................................
Advanced Review 201
................................................................................................
Discussion 201
..............................................................................................
Conclusion 203
................................................................................................
Appendix C 205
Pilot Study 2: The Feasibility of Administering the ABLE Scale in the
......................................................................
Incomplete SCI Population 205
Purpose of the Study: .............................................................................2 05
Subjects: .................................................................................................. 206
Patient Subjects: .................................................................................. 206
Therapist Raters:. .................................................................................2. 07
..............................................................................................
Procedure: 207
..........................................................................................
Data Analysis: 208
.....................................................................................................
Results: 208
...............................................................................................
Discussion: 210
.............................................................................................
Conclusion: 213
................................................................................................
Appendix D 214
. .
Category Probab~lltyC urves ....................................................................2 14
Item 1 : Unsupported sitting ................................................................... 214
Item 2: Seated forward reach ..............................................................2 15
Item 3a: Seated Lateral Reach (Right) ................................................2 16
Item 3b: Seated Lateral Reach (Left). ..................................................2 17
Item 4: Pick up/touch object from the floor from a seated position218
....................................................
Item 5: Scooting forward in a chair 219
Item 6: Posterior external perturbations in sitting ................................ 220
....................................................
Item 7: Wheelchair to chair transfers 221
ltem 8: Support surface displacement while seated in a wheelchair
Item 9: Arising from a chair ................................................................... 223
..........................................................
Item 10: Static standing balance 224
Item 1 1 : Stand to sit ................................................................................ 225
............................
Item 12: Static standing balance with eyes closed 226
ltem 13: Static standing balance with feet together and eyes open
..................................................................................................................2 27
Item 14: External perturbations in standing ......................................... 228
......................................................
Item 15: Standing forward reach 229
ltem 16: Pick upltouch object from the floor from a standing position
.................................................................................................................2. 30
Item 17: Standing trunk rotation ...........................................................2. 31
Item 18: Turn 180 degrees .................................................................. 232
................................................................
Item 19: Alternating step test 233
Item 20: Balance in tandemlstride stance ........................................2 34
..........................
Item 210: Single leg stance on right lower extremity 235
............................
Item 21 b: Single leg stance on left lower extremity 236
......................................................
Item 22: Walking over level surface 237
.......................................
Item 23: Walking with horizontal head turns 238
..........................................
Item 24: Walking with change in direction 239
Item 25: Stepping over object while walking ...................................... 240