Content validation of a clinical assessment instrument
					for stair ascent and descent in individuals with hemiparesis

Natalio, Mavie A.; Faria, Christina D. C. M.; Teixeira-Salmela, Luci F.; Michaelsen, Stella M.

doi:10.1590/bjpt-rbf.2014.0052

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Brazilian Journal of Physical Therapy

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Original Articles • Braz. J. Phys. Ther. 18 (04) • Aug 2014 • https://doi.org/10.1590/bjpt-rbf.2014.0052 copy

Content validation of a clinical assessment instrument for stair ascent and descent in individuals with hemiparesis

Authorship SCIMAGO INSTITUTIONS RANKINGS

Background:

Among the current instruments used to assess stair ambulation, none were observed that specifically evaluated the quality of movement or biomechanical strategies adopted by stroke patients.

Objective:

To evaluate the content validity of a clinical instrument designed to identify the qualitative and kinematic characteristics and strategies adopted by stroke patients during stair ascent and descent.

Method:

The first developed version, which comprised 80 items, had its content evaluated by an expert panel, which was composed of 9 well-known national and international professionals who are involved in stroke rehabilitation. The content validity index (CVI) and modified Kappa coefficients were employed for the statistical analyses. The items that demonstrated a CVI≥0.80 and Kappa≥0.75 were considered valid.

Results:

The content validation was performed in three stages. The final version of the instrument consisted of 38 items, which were divided into descriptive (8 items), a General Characteristics Domain (16 items) and adopted strategies (14 items) during stair ascent and descent. The total scores ranged from zero to 70 and zero to 74 for ascent and descent, respectively. Lower scores corresponded with better performance.

Conclusion:

Despite the satisfactory results obtained during the process of content validation, other psychometric properties of the instrument are necessary and must be evaluated.

physical therapy; stroke; evaluation; biomechanics

General characteristics – common items of stair ascent and descent
Items	Consistency		Represent.**		Relevance		Clarity		Results
	CVI*	Kappa	CVI*	Kappa	IVC*	Kappa	CVI*	Kappa
1. Number of steps	0.86	0.85	0.71	0.65	0.86	0.85	1.00	1.00	Domain change
2. Use of orthoses	0.86	0.85	0.86	0.85	1.00	1.00	1.00	1.00	Domain change
3.1 Level of confidence	0.71	0.65	0.86	0.85	0.86	0.85	0.43	0.41	Corrected
3.2 Level of confidence with a handrail	0.71	0.65	0.86	0.85	0.86	0.85	0.71	0.65	Corrected
3.3 Level of confidence without a handrail	0.71	0.65	0.86	0.85	0.86	0.85	0.71	0.65	Corrected
4. Functional graduation	0.57	0.56	0.71	0.65	0.86	0.85	0.86	0.85	Corrected

Functional performance – common items of stair ascent and descent
Items	Consistency		Represent.**		Relevance		Clarity		RESULTS
	CVI*	Kappa	CVI*	Kappa	IVC*	Kappa	CVI*	Kappa
A. Ascent cadence	0.71	0.65	0.86	0.85	0.86	0.85	0.86	0.85	Domain change
B. Descent cadence	0.71	0.65	0.86	0.85	0.86	0.85	0.86	0.85	Domain change
1. External assistance	0.86	0.85	0.86	0.85	1.00	1.00	0.86	0.85	VALIDATED
2. Handrail	0.71	0.65	0.86	0.85	0.86	0.85	0.86	0.85	Corrected
3. Intensity of handrail use	0.86	0.85	0.71	0.65	0.71	0.65	0.43	0.41	Corrected
4. Positioning of the upper limbs	0.71	0.65	0.71	0.65	0.57	0.56	0.57	0.56	EXCLUDED
5. Position of the paretic upper limb	0.86	0.85	0.57	0.56	0.57	0.56	0.57	0.56	Corrected
6. Balance reactions	0.57	0.56	0.57	0.56	0.57	0.56	0.43	0.41	EXCLUDED
7. Balance of the upper limbs	0.71	0.65	0.57	0.56	0.57	0.56	0.43	0.41	EXCLUDED
8. Pace pattern	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
9. Lower limb that initiates the movement	0.71	0.65	1.00	1.00	1.00	1.00	1.00	1.00	Domain change
10. Supporting time	0.86	0.85	1.00	1.00	0.86	0.85	0.86	0.85	VALIDATED
11. Relative speed of movement	0.57	0.56	0.71	0.65	0.86	0.85	0.86	0.85	Corrected
12. Activity execution strategy	0.57	0.56	0.71	0.65	0.86	0.85	0.43	0.41	Corrected
13. Positioning strategy of the feet	0.71	0.65	0.86	0.85	0.86	0.85	0.71	0.65	Corrected
14. Foothold on the step	0.57	0.56	0.71	0.65	0.71	0.65	0.43	0.41	Corrected
15. Initial foot contact	0.43	0.41	0.86	0.85	0.86	0.85	0.71	0.65	Corrected
16. Plantar support	0.57	0.56	0.57	0.56	0.57	0.56	0.57	0.56	EXCLUDED

General characteristics – common items of stair ascent and descent
Item	Consistency		Represent.**		Relevance		Clarity		Results
	CVI*	Kappa	CVI*	Kappa	IVC*	Kappa	CVI*	Kappa
1.1 Level of Confidence	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
1.2 Level of Confidence with a handrail	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
1.3 Level of Confidence without a handrail	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
2. Functional graduation	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
4. Use of a handrail	0.80	0.76	0.80	0.76	0.80	0.76	0.60	0.54	Corrected
5. Intensity of use of a handrail	0.80	0.76	0.80	0.76	0.60	0.54			Corrected
6. Position of the paretic upper limb	0.80	0.76	0.80	0.76	0.60	0.54	0.60	0.54	Corrected
9. Relative speed of lower limb movement	1.00	1.00	0.80	0.76	0.60	0.54	0.80	0.76	Corrected
10. Body alignment	0.80	0.76	0.80	0.76	0.80	0.76	0.80	0.76	Corrected
11. The feet of alignment	0.80	0.76	1.00	1.00	0.80	0.76	0.80	0.76	Corrected
12. Foothold	0.80	0.76	0.80	0.76	0.80	0.76	0.60	0.54	Corrected
13. Initial foot contact	0.80	0.76	0.80	0.76	0.80	0.76	0.80	0.76	Corrected

General characteristics – items referring to stair ascent
Items	Consistency		Represent.**		Relevance		Clarity		Results
	CVI*	Kappa	CVI*	Kappa	IVC*	Kappa	CVI*	Kappa
1. Lower limb that initiates stair ascent	1.00	1.00	1.00	1.00	0.80	0.76	1.00	1.00	VALIDATED
2. Collision of the foot with the step	0.80	0.76	1.00	1.00	1.00	1.00	0.60	0.54	Corrected
General characteristics – items referring to stair descent
1. Lower limb that initiates stair descent	1.00	1.00	1.00	1.00	0.80	0.76	1.00	1.00	VALIDATED
2. Safety during stair descent	0.80	0.76	0.80	0.76	0.60	0.54	0.60	0.54	Corrected
3. Need for aids	0.80	0.76	1.00	1.00	0.80	0.76	0.80	0.76	Corrected

General characteristics – common items of stair ascent and descent
Items	Consistency		Represent.**		Relevance		Clarity		Results
	CVI*	Kappa	CVI*	Kappa	IVC*	Kappa	CVI*	Kappa
- Use of a handrail and upper limbs	1.00	1.00	1.00	1.00	1.00	1.00	0.80	0.76	VALIDATED
- Time of use of a handrail	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
- Position of the upper limbs	0.80	0.76	0.80	0.76	0.80	0.76	0.80	0.76	VALIDATED
- Symmetry of the lower limb support time	0.80	0.76	0.80	0.76	1.00	1.00	0.80	0.76	VALIDATED
- Body alignment	0.80	0.76	1.00	1.00	1.00	1.00	0.80	0.76	VALIDATED
- Feet alignment on the step	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
- Foothold on the step	1.00	1.00	1.00	1.00	1.00	1.00	0.80	0.76	VALIDATED
General characteristics – items referring to stair ascent
- Collision of the foot during stair ascent	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
General characteristics – items referring to stair descent
- Difficulty in reaching the lower step during stair descent	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED
- Need for aids	1.00	1.00	1.00	1.00	1.00	1.00	1.00	1.00	VALIDATED

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[1] Correspondence Mavie Amaral Natalio Universidade do Estado de Santa Catarina (UDESC) Laboratório de Controle Motor (LADECOM) Rua Pascoal Simone, 358, Coqueiros CEP 88080-350, Florianópolis, SC, Brasil e-mail: mavie_fisio@yahoo.com.br