Interrater and Test-Retest Reliability of Performance-Based Clinical Tests Administered to Established Users of Lower Limb Prostheses.

Abstract

A major barrier to reducing falls among users of lower limb prostheses (LLP) has been an absence of statistical indices required for clinicians to select and interpret scores from performance-based clinical tests. The study aimed to derive estimates of reliability, measurement error, and minimal detectable change values in performance-based clinical tests administered to unilateral LLP users. A total of 60 unilateral LLP users were administered the Narrowing Beam Walking Test, Timed ``Up and Go'' (TUG), Four Square Step Test (FSST), and 10-Meter Walk Test on 2 occasions, 3 to 9days apart. Intraclass correlation coefficients (ICCs) were calculated to assess interrater and test-retest reliability, while standard error of measurement (SEM) and minimal detectable change (MDC90) were derived to establish estimates of measurement error in individual scores or changes in score for each test. Interrater reliability ICCs (1,1) were high for all tests (ie, ≥0.98). Test-retest ICCs (2,1) varied by test, ranging from .88 for the TUG to .97 for the FSST. SEM and MDC90 varied between .39 and .96 and between .91seconds and 2.2seconds for the time-based tests (FSST, TUG, 10-Meter Walk Test). SEM and MDC90 for the Narrowing Beam Walking Test were .07 and .16, respectively. With the exception of the TUG, studied tests had test-retest ICCs (2,1) that exceeded the minimum required threshold to be considered suitable for group- and individual-level applications (ie, ICC≥0.70 and ≥0.90, respectively). Future research on individuals with dysvascular and transfemoral amputations or in specific age categories is required. Along with published validity indices, these reliability, error, and change indices can help clinicians select balance tests suitable for LLP users. They can also help clinicians interpret test scores to make informed, evidence-based clinical decisions.