5-Repetition Sit-To-Stand Test in Subjects With Chronic Stroke
5-Repetition Sit-To-Stand Test in Subjects With Chronic Stroke
5-Repetition Sit-To-Stand Test in Subjects With Chronic Stroke
ORIGINAL ARTICLE
AUC
BBS
COP
ICC
LOS
MVL
MXE
5-repetition STS test
RT
408
Hip flexors
Knee flexors
Knee extensors
Ankle
dorsiflexors
Ankle
plantarflexors
Testing Position
Dynamometer Placement
High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: 90o flexion
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: full extension
Ankle: neutral
High sitting
Hip: 90o flexion
Knee: full extension
Ankle: neutral
On anterior aspect of
femur, 5cm proximal
to superior border of
patella
On posterior aspect of
tibia, 5cm proximal
from inferior tip of
medial malleoli
On anterior aspect of
tibia, 5cm proximal
from inferior tip of
medial malleoli
On ventral aspect of foot,
across 1st to 5th
metatarsophalangeal
joints
On dorsum aspect of foot,
across 1st to 5th
metatarsophalangeal
joints
409
the muscle strength of affected and unaffected limbs and balance performance in subjects with stroke was established by
the Spearman correlation coefficient because the data were not
normally distributed. When multiple correlation tests were
performed, the Bonferroni adjustment was applied to adjust for
the alpha level.31 In order to assess the correlation between the
5-repetition STS test and 9 primary outcomes (affected and
unaffected knee extensors strength, affected and unaffected
knee flexors strength, affected and unaffected ankle dorsiflexors, BBS, and maximal excursion in forward and backward
direction of LOS), the P value after Bonferroni correction is
.05/9 (ie, .00556). The strength of the correlation was defined
by the correlation coefficient obtained as little or no (.250),
fair (.250 .500), moderate to good (.500 .750), or good
to excellent (.750) relationship.31 A significance level of
.050 was set for all analyses.
Sensitivity indicates the true-positive probability, whereas
specificity indicates the false-positive probability.31 A trade-off
between sensitivity and 1 minus specificity was performed
using the Youden index32 to obtain the most appropriate 5-repetition STS test cut-off score. The AUC then provides a quantitative measure of the accuracy of the test based on the null
hypothesis of AUC equal to 0.5.31
RESULTS
Descriptive statistics of all subjects and mean values of all
outcome measures are presented in tables 2 and 3, respectively.
Excellent intrarater reliability (ICC.970 .976) (table 4), interrater reliability (ICC.999), and test-retest reliability of
experienced physiotherapists (ICC1.000) and students
(ICC.994) were achieved in the present study.
Table 5 demonstrates the Spearman correlation analyses
of 5-repetition STS test scores in lower limb muscle
strength, BBS, and LOS. Five-repetition STS test scores had
significant negative correlation after Bonferroni correction
with affected (.753; P.005) and unaffected (.830;
P.001) knee flexors of subjects with stroke. No significant
associations were found between 5-repetition STS test score
with BBS and LOS performance in subjects with stroke.
Five-repetition STS test cut-off scores of 9.4 seconds and
12.2 seconds were found to be the best discriminators between
our young versus healthy elderly (sensitivity75%; specificity75%) and healthy elderly versus subjects with stroke (sensitivity83%; specificity75%), respectively. AUC analysis is
shown in figures 2a and 2b.
DISCUSSION
Reliability of the 5-Repetition Sit-to-Stand Test
This is the first study to investigate the intrarater, interrater,
and test-retest reliability of the 5-repetition STS test in people
with chronic stroke. A better reliability range of the 5-repetition STS test was noted in subjects with stroke (ICC range,
.971.999) than those previously reported in community-dwellArch Phys Med Rehabil Vol 91, March 2010
410
Young (n12)
Healthy Elderly
(n12)
Demographics
Age (y)
Sex (M/F)
Height (cm)
Weight (kg)
Body mass index (kg/m2)
5-repetition STS test (s)
26.22.9
9/3
160.85.5
57.511.0
22.13.4
8.90.7
56.03.7
10/3
155.36.0
57.911.5
23.93.8
10.81.7
60.04.8
6/6
157.612.7
61.612.1
24.62.0
17.17.5
.001*
.194
.311
.628
.160
.001*
Young vs
Stroke
Healthy Elderly
vs Stroke
.001
.001*
.013
NA
NA
NA
NA
.004*
Young vs Healthy
Elderly
.001
.569
Denotes significant difference at P.05 using Tukey Honestly Significant Difference adjustment.
Table 3: Mean Values of All Outcome Measures in Subjects With Stroke (n12)
Mean Values
Parameters
Affected
13.94.5
6.83.7
14.84.7
6.14.1
13.05.4
Unaffected
Forward
19.04.7
14.53.6
21.75.8
12.83.7
21.76.6
Backward
NA
49.17.1
0.90.4
2.81.3
60.322.1
1.00.4
4.22.3
70.323.1
1.10.5
2.81.5
55.917.9
0.70.5
1.61.1
35.617.3
411
Mean 5-Repetition
STS test score (s)
17.17.5
16.97.6
.975 (.935.992)
.976 (.937.992)
16.97.6
16.77.6
17.07.5
.976 (.939.992)
.971 (.925.991)
.974 (.932.992)
16.97.6
16.87.5
16.87.5
.970 (.932.990)
.970 (.924.991)
.972 (.929.991)
Examiner
A
B
Experienced
C
D
E
Inexperienced
F
G
H
Affected
Unaffected
Forward
.587
.753*
.687
.007
.406
.336
.830*
.483
.629
.510
.551
.210
.147
.084
.210
.147
.084
Backward
NA
NA
NA
NA
NA
.531
.480
.578
Fig 2. ROC curves for 5-repetition STS test scores between (A)
young versus healthy elderly (AUC.816) and (B) healthy elderly
versus stroke (AUC.840). The curved line indicates ROC curve. The
straight line indicates nondiscriminating characteristics of the test.
Abbreviation: ROC, receiver operating characteristic.
.255
.179
.267
412
ability. Significant negative correlations with lower-limb muscle strength indicated that the 5-repetition STS test could be
used as a functional muscle strength assessment tool in people
with stroke.
Acknowledgment:
statistical advice.
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