The Italian version of the Postural Assessment Scale for Stroke Patients (PASS): transcultural translation and validation

Elena Lora; Noemi Gaudenzi; Ada Buriani; Antonietta Bacciocchi; Lea Godino; Mattia Ricco; Domenica Gazineo

doi:10.33393/aop.2024.3092

Authors

Elena Lora Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0009-0000-9120-6781
Noemi Gaudenzi Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0009-0007-4209-1958
Ada Buriani Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0009-0009-0463-1794
Antonietta Bacciocchi Department of Continuity of Care and Disability, Physical Medicine and Rehabilitation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0009-0001-3530-7729
Lea Godino Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0000-0002-3763-9372
Mattia Ricco Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna - Italy https://orcid.org/0000-0002-5447-2586
Domenica Gazineo Governo Clinico e Qualità, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Bologna - Italy https://orcid.org/0000-0003-1866-3358

DOI:

https://doi.org/10.33393/aop.2024.3092

Keywords:

Cross-cultural adaptation, Outcome assessment, Postural balance, Postural control, Reproducibility of results, Stroke

Abstract

Introduction: The Postural Assessment Scale for Stroke Patients (PASS) is commonly used by health professionals in Italy in several different translations. This study aimed to provide a validated version in Italian. The main focus is on the evaluator, to guarantee a uniform application and interpretation of the statements and scoring for each item in the Italian context.

Methods: A standardized protocol was used for the translation and cross-cultural adaptation. A pilot study conducted using the first draft of the scale led to a revised version, PASS-IT. A principal component analysis (PCA) was performed. The correlation with the Trunk Control Test (TCT) was examined for concurrent validity. In addition, the relationship with the Barthel Index (BI) and the Functional Ambulation Categories (FAC) was tested. Patients with recent stroke were tested for intra-rater (N = 49) and inter-rater agreement (N = 30). Cronbach’s alpha, item-to-total correlation, corrected inter-item correlation, the intraclass correlation coefficient (ICC), and measurement error were used to evaluate internal consistency and intra-/inter-rater reliability.

Results: The PCA showed a two-dimensional structure, with high reliability in both subsections (“non-weight-bearing” α = 0.865; “weight-bearing” α = 0.949). A strong correlation (ρ > 0.80) was found with the TCT, the BI, and the FAC. The PASS-IT showed high internal consistency, intra-rater (ICC = 0.942) and inter-rater reliability (ICC = 0.940).

Conclusions: The PASS-IT is a recommended scale, suitable for clinical practice and research in the acute and subacute stage. The introduction of operating instructions resulted in the uniform application. A different order of the items allows faster administration, reducing changes of posture.

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References

Adamson J, Beswick A, Ebrahim S. Is stroke the most common cause of disability? J Stroke Cerebrovasc Dis. 2004;13(4):171-177. https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.06.003 PMID:17903971 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2004.06.003

Hankey GJ. Stroke. Lancet. 2017;389(10069):641-654. https://doi.org/10.1016/S0140-6736(16)30962-X PMID:27637676 DOI: https://doi.org/10.1016/S0140-6736(16)30962-X

Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2022 update: a report from the American Heart Association. Circulation. 2022;145(8):e153-e639. https://doi.org/10.1161/CIR.0000000000001052 PMID:35078371 DOI: https://doi.org/10.1161/CIR.0000000000001052

Wafa HA, Wolfe CDA, Emmett E, Roth GA, Johnson CO, Wang Y. Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke. 2020;51(8):2418-2427. https://doi.org/10.1161/STROKEAHA.120.029606 PMID:32646325 DOI: https://doi.org/10.1161/STROKEAHA.120.029606

Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, De Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil. 2004;18(3):326-334. https://doi.org/10.1191/0269215504cr733oa PMID:15137564 DOI: https://doi.org/10.1191/0269215504cr733oa

Jijimol G, Fayaz RK, Vijesh PV. Correlation of trunk impairment with balance in patients with chronic stroke. NeuroRehabilitation. 2013;32(2):323-325. https://doi.org/10.3233/NRE-130851 PMID:23535795 DOI: https://doi.org/10.3233/NRE-130851

Hsieh CL, Sheu CF, Hsueh IP, Wang CH. Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke. 2002;33(11):2626-2630. https://doi.org/10.1161/01.STR.0000033930.05931.93 PMID:12411652 DOI: https://doi.org/10.1161/01.STR.0000033930.05931.93

Kim TJ, Seo KM, Kim DK, Kang SH. The relationship between initial trunk performances and functional prognosis in patients with stroke. Ann Rehabil Med. 2015;39(1):66-73. https://doi.org/10.5535/arm.2015.39.1.66 PMID:25750874 DOI: https://doi.org/10.5535/arm.2015.39.1.66

Kong KH, Ratha Krishnan R. Truncal impairment after stroke: clinical correlates, outcome and impact on ambulatory and functional outcomes after rehabilitation. Singapore Med J. 2021;62(2):87-91. https://doi.org/10.11622/smedj.2019153 PMID:31788705 DOI: https://doi.org/10.11622/smedj.2019153

Martins LG, Molle da Costa RD, Alvarez Sartor LC, et al. Clinical factors associated with trunk control after stroke: A prospective study. Top Stroke Rehabil. 2021;28(3):181-189. https://doi.org/10.1080/10749357.2020.1805244 PMID:32772828 DOI: https://doi.org/10.1080/10749357.2020.1805244

Lesser M, Borst J, Dekerlegand J. Use of the Postural Assessment Scale for Stroke Patients in determining acute care discharge recommendations. J Acute Care Phys Ther. 2017;8(3):79-85. https://doi.org/10.1097/JAT.0000000000000057 DOI: https://doi.org/10.1097/JAT.0000000000000057

Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry. 1990;53(7):576-579. https://doi.org/10.1136/jnnp.53.7.576 PMID:2391521 DOI: https://doi.org/10.1136/jnnp.53.7.576

Franchignoni FP, Tesio L, Ricupero C, Martino MT. Trunk control test as an early predictor of stroke rehabilitation outcome. Stroke. 1997;28(7):1382-1385. https://doi.org/10.1161/01.STR.28.7.1382 PMID:9227687 DOI: https://doi.org/10.1161/01.STR.28.7.1382

Fil Balkan A, Salcı Y, Keklicek H, Çetin B, Adın RM, Armutlu K. The trunk control: which scale is the best in very acute stroke patients? Top Stroke Rehabil. 2019;26(5):359-365. https://doi.org/10.1080/10749357.2019.1607994 PMID:31044664 DOI: https://doi.org/10.1080/10749357.2019.1607994

Verheyden G, Vereeck L, Truijen S, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil. 2006;20(5):451-458. https://doi.org/10.1191/0269215505cr955oa PMID:16774097 DOI: https://doi.org/10.1191/0269215505cr955oa

Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31. https://doi.org/10.2340/1650197771331 PMID:1135616 DOI: https://doi.org/10.2340/1650197771331

Cecchi F, Carrabba C, Bertolucci F, et al. Transcultural translation and validation of Fugl-Meyer assessment to Italian. Disabil Rehabil. 2021;43(25):3717-3722. https://doi.org/10.1080/09638288.2020.1746844 PMID:32356509 DOI: https://doi.org/10.1080/09638288.2020.1746844

Sanford J, Moreland J, Swanson LR, Stratford PW, Gowland C. Reliability of the Fugl-Meyer assessment for testing motor performance in patients following stroke. Phys Ther. 1993;73(7):447-454. https://doi.org/10.1093/ptj/73.7.447 PMID:8316578 DOI: https://doi.org/10.1093/ptj/73.7.447

Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999;30(9):1862-1868. https://doi.org/10.1161/01.STR.30.9.1862 PMID:10471437 DOI: https://doi.org/10.1161/01.STR.30.9.1862

Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke. 2002;33(4):1022-1027. https://doi.org/10.1161/01.STR.0000012516.63191.C5 PMID:11935055 DOI: https://doi.org/10.1161/01.STR.0000012516.63191.C5

Chinsongkram B, Chaikeeree N, Saengsirisuwan V, Viriyatharakij N, Horak FB, Boonsinsukh R. Reliability and validity of the Balance Evaluation Systems Test (BESTest) in people with subacute stroke. Phys Ther. 2014;94(11):1632-1643. https://doi.org/10.2522/ptj.20130558 PMID:24925073 DOI: https://doi.org/10.2522/ptj.20130558

Wang CH, Hsueh IP, Sheu CF, Hsieh CL. Discriminative, predictive, and evaluative properties of a trunk control measure in patients with stroke. Phys Ther. 2005;85(9):887-894. https://doi.org/10.1093/ptj/85.9.887 PMID:16117599 DOI: https://doi.org/10.1093/ptj/85.9.887

Huang YJ, Lin GH, Lee SC, Hsieh CL. A comparison of the responsiveness of the Postural Assessment Scale for Stroke and the Berg Balance Scale in patients with severe balance deficits after stroke. J Geriatr Phys Ther. 2020;43(4):194-198. https://doi.org/10.1519/JPT.0000000000000247 PMID:31569171 DOI: https://doi.org/10.1519/JPT.0000000000000247

Estrada-Barranco C, Cano-de-la-Cuerda R, Abuín-Porras V, Molina-Rueda F. Postural Assessment Scale for Stroke Patients in acute, subacute and chronic stage: a construct validity study. Diagnostics (Basel). 2021;11(2):365. https://doi.org/10.3390/diagnostics11020365 PMID:33670068 DOI: https://doi.org/10.3390/diagnostics11020365

Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9):656-661. https://doi.org/10.1080/09638280701400698 PMID:17852318 DOI: https://doi.org/10.1080/09638280701400698

Di Monaco M, Trucco M, Di Monaco R, Tappero R, Cavanna A. The relationship between initial trunk control or postural balance and inpatient rehabilitation outcome after stroke: a prospective comparative study. Clin Rehabil. 2010;24(6):543-554. https://doi.org/10.1177/0269215509353265 PMID:20511303 DOI: https://doi.org/10.1177/0269215509353265

Schuling J, de Haan R, Limburg M, Groenier KH. The Frenchay Activities Index. Assessment of functional status in stroke patients. Stroke. 1993;24(8):1173-1177. https://doi.org/10.1161/01.STR.24.8.1173 PMID:8342192 DOI: https://doi.org/10.1161/01.STR.24.8.1173

Huang YC, Wang WT, Liou TH, Liao CD, Lin LF, Huang SW. Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward. J Rehabil Med. 2016;48(3):259-264. https://doi.org/10.2340/16501977-2046 PMID:26667386 DOI: https://doi.org/10.2340/16501977-2046

Yoneyama SM, Roiz R de M, Oliveira TM, Oberg TD, Lima NMFV. Validação da versão brasileira da Escala de Avaliação Postural para pacientes após acidente vascular encefálico. Acta Fisiatr. 2008;15(2):96-100. https://doi.org/10.11606/issn.2317-0190.v15i2a102920 DOI: https://doi.org/10.11606/issn.2317-0190.v15i2a102920

Persson CU, Hansson P-O, Danielsson A, Sunnerhagen KS. A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural Stroke Study in Gothenburg (POSTGOT). J Neuroeng Rehabil. 2011;8(1):57. https://doi.org/10.1186/1743-0003-8-57 PMID:21978462 DOI: https://doi.org/10.1186/1743-0003-8-57

Cabanas-Valdés R, Girabent-Farrés M, Cánovas-Vergé D, Caballero-Gómez FM, Germán-Romero A, Bagur-Calafat C. [Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients]. Rev Neurol. 2015;60(4):151-158. PMID:25670044 DOI: https://doi.org/10.33588/rn.6004.2014184

Breistein K, Gjelsvik BEB, Jørgensen L. The Postural Assessment Scale for Stroke Patients: translation into Norwegian, cultural adaptation, and examination of reliability. Eur J Physiother. 2017;19(4):207-214. https://doi.org/10.1080/21679169.2017.1334817 DOI: https://doi.org/10.1080/21679169.2017.1334817

Koçak FA, Kurt EE, Koçak Y, Erdem HR, Tuncay F, Benaim C. Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk). Top Stroke Rehabil. 2019;26(5):373-381. https://doi.org/10.1080/10749357.2019.1608699 PMID:31032715 DOI: https://doi.org/10.1080/10749357.2019.1608699

Sullivan JE, Crowner BE, Kluding PM, et al. Outcome measures for individuals with stroke: process and recommendations from the American Physical Therapy Association neurology section task force. Phys Ther. 2013;93(10):1383-1396. https://doi.org/10.2522/ptj.20120492 PMID:23704035 DOI: https://doi.org/10.2522/ptj.20120492

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. https://doi.org/10.1097/00007632-200012150-00014 PMID:11124735 DOI: https://doi.org/10.1097/00007632-200012150-00014

Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index. Md State Med J. 1965;14:61-65. PMID:14258950 DOI: https://doi.org/10.1037/t02366-000

Castiglia SF, Galeoto G, Lauta A, et al. The culturally adapted Italian version of the Barthel Index (IcaBI): assessment of structural validity, inter-rater reliability and responsiveness to clinically relevant improvements in patients admitted to inpatient rehabilitation centers. Funct Neurol. 2017;22(4):221-228. https://doi.org/10.11138/FNeur/2017.32.4.221 PMID:29306359 DOI: https://doi.org/10.11138/FNeur/2017.32.4.221

Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther. 1984;64(1):35-40. https://doi.org/10.1093/ptj/64.1.35 PMID:6691052 DOI: https://doi.org/10.1093/ptj/64.1.35

Yaşar M. Attitudes toward statistics scale: validity and reliability study. Pamukkale University Journal of Education. 2014;02:59–75. https://hdl.handle.net/11499/39229 DOI: https://doi.org/10.9779/PUJE640

Chien CW, Lin JH, Wang CH, Hsueh IP, Sheu CF, Hsieh CL. Developing a Short Form of the Postural Assessment Scale for people with stroke. Neurorehabil Neural Repair. 2007;21(1):81-90. https://doi.org/10.1177/1545968306289297 PMID:17172558 DOI: https://doi.org/10.1177/1545968306289297

Terwee CB, Bot SDM, de Boer MR, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012 PMID:17161752 DOI: https://doi.org/10.1016/j.jclinepi.2006.03.012

Lombardi B, Orioli A, Casavola D, Paci M. The Italian version of the Trunk Impairment Scale: development and psychometric properties. Eur J Phys Rehabil Med. 2017;53(4):516-520. https://doi.org/10.23736/S1973-9087.17.04371-4 PMID:28382809 DOI: https://doi.org/10.23736/S1973-9087.17.04371-4

Gorman SL, Radtka S, Melnick ME, Abrams GM, Byl NN. Development and validation of the Function In Sitting Test in adults with acute stroke. J Neurol Phys Ther. 2010;34(3):150-160. https://doi.org/10.1097/NPT.0b013e3181f0065f PMID:20716989 DOI: https://doi.org/10.1097/NPT.0b013e3181f0065f

Hsueh I-P, Chen K-L, Chou Y-T, Wang Y-H, Hsieh C-L. Individual-level responsiveness of the original and short-form postural assessment scale for stroke patients. Phys Ther. 2013;93(10):1377-1382. https://doi.org/10.2522/ptj.20130042 PMID:23723386 DOI: https://doi.org/10.2522/ptj.20130042