아급성기 뇌졸중 환자의 6점 스텝 검사의 검사 재검사 신뢰도와 수렴
The Test Retest Reliability and Convergent Validity of the Six Spot Step Test in Subacute Stroke Patients
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본 연구의 목적은 아급성기 뇌졸중 환자들의 6점 스텝 검사(Six Spot Step Test, SSST) 소요시간의 검사 재검사 신뢰도와 최저 식별 변화(Minimal Detectable Change, MDC) 및 수렴타당도를 알아보고자 하였다. 뇌졸중 환자 30명을 대상으로 SSST 소요 시간의 검사-재 검사 신뢰도는 급간내상관계수(Intra Class Coefficient, ICC3,1)로 구하였고, 측정 오류를 추정하기 위하여 측정 오차(Standard Error of Measurement, SEM)와 최저 식별 변화를 구하였다. SST 소요 시간의 수렴타당도는 퓨글 마이어 하지 기능 평가(Fugl Meyer Assessment-Lower/extremity, FMA-L/E), 버그 균형 척도(Berg Balance Scale, BBS), 10m 보행 검사(10meter Walk Test, 10MWT), 일어나 걸어가기 검사(Timed Up and Go Test, TUG), 네 막대 스텝 검사(Four Square Step Test, FSST), 마비측 족관절 배측·저측 굴곡근의 근긴장도(Modified Ashworth Scale, MAS)와의 관련성을 스피어만 계수 (Spearman coefficient)로 평가하였다. 본 연구 결과 SSST 마비측 하지 소요 시간의 검사 -재검사 신뢰도 ICC=.909(.818∼.956), 비마비측 하지 소요 시간의 검사-재검사 신뢰도 ICC=.949(.896∼.975)로 일치율은 높은 것으로 확인되었다. SSST 마비측의 MDC는 4.73초, 비마비측의 SEM은 3.13초로 획득 가능한 최고 소요 시간의 20% 미만으로 측정 오차 수준 은 수용할 수 있었다. SSST 마비측과 비마비측 하지의 소요 시간의 수렴타당도는 FMA-L/E(r=-.582, -.547), BBS(r=-.743, -.739)와는 중간 정도의 음의 관련성이 있었고, 10mWT(r=.742, .733), TUG(r=.611, .588), FSST(r=.526, .533)와 중간 정도의 양의 관련 성이 있었으며, SSST 마비측하지의 소요시간은 족관절 배측굴곡근(r=.389), 저측굴곡근의 강직(r=.405)과 약한 양의 관련성이 있는 것으로 확인되었다. SSST는 검사-재검사의 신뢰 도가 높고, 뇌졸중 환자의 특이성 장애를 반영하는 평가들과 유의한 수렴 타당도가 있음이 입증되었다. 따라서 아급성기 뇌졸중 환자의 기능적 보행과 동적 균형 및 마비측 하지 운동 조절 능력을 포괄적으로 쉽고 간단하게 평가할 수 있으며 임상적인 변화를 감지할 수 있는 민감도가 있는 검사 방법으로 추천할만하다.
Abstract
The aim of this study was to determine the test retest reliability, minimal detectable change(MDC), and convergent validity of the Six Spot Step Test(SSST) in subacute stroke patients. Thirty stroke patients participated in the study. Test retest reliability of the SSST time was assessed using the Intraclass Correlation Coefficient(ICC3,1).Measurement error was estimated using the Standard Error of Measurement(SEM) and the MDC. Convergent validity of the SSST time was evaluated using the Spearman coefficient, correlating with the Fugl Meyer Assessment-Lower Extremity(FMA-L/E), Berg Balance Scale(BBS), 10-meter Walk Test(10MWT), Timed Up and Go Test(TUG), Four Square Step Test(FSST), and the Modified Ashworth Scale(MAS) for spasticity of the dorsiflexor and plantarflexor muscles of the affected ankle. The test-retest reliability for the SSST time on the affected leg was ICC=.909(95% CI: 818–.956) and on the unaffected leg was ICC=.949(95% CI: 896–.975), indicating high reliability. The MDC for the affected leg was 4.73 seconds, and the SEM for the unaffected leg was 3.13 seconds, both less than 20% of the highest achievable score, indicating acceptable measurement error. Convergent validity showed moderate negative correlations between SSST time and FMA-L/E(r=-.582, -.547) and BBS(r=-.743, -.739), and moderate positive correlations with 10MWT(r=.742, .733), TUG(r=.611, .588), and FSST(r=.526, .533). There were weak positive correlations between SSST time on the affected leg and spasticity of the dorsiflexor(r=.389) and plantarflexor muscles(r=.405). The SSST shows high test-retest reliability and significant convergent validity with other stroke-specific assessments, making it a sensitive and easy test for evaluating gait, balance, and motor control in subacute stroke patients.
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