Propriedades de medida do Stroke Upper Limb Capacity Scale (SULCS-Brasil): um instrumento de avaliação da capacidade manual para indivíduos com hemiparesia

• Ano de defesa: 2021
• Autor(a) principal: Gabriela dos Santos Bretas Assunção
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; Brasil; EEFFTO - ESCOLA DE EDUCAÇÃO FISICA, FISIOTERAPIA E TERAPIA OCUPACIONAL; Programa de Pós-Graduação em Estudos da Ocupação; UFMG
• Palavras-chave em Português: Acidente Vascular Cerebral; reabilitação; extremidade superior; extremidade superior; propriedades de medida; Acidentes vasculares cerebrais; Membros superiores
• Link de acesso: http://hdl.handle.net/1843/40827

Stroke is the second leading cause of death worldwide and leading cause of disability in adults. In post-stroke individuals, the limitation of upper limb function (UL) can profoundly alter their daily lives, being associated with greater restriction in participation and worse perception of quality of life. Thus, the restoration of upper limb function is an important goal to rehabilitation process of post-stroke individuals. Therefore, evaluation is crucial, both in clinical practice and in research, to assess effectiveness of rehabilitation treatments and to follow up the functional evolution of individuals after the event. The Stroke Upper Limb Capacity Scale (SULCS) aims to measure upper limb capacity by means of items that assess both proximal and distal capacity. Recently, SULCS was cross-culturally adapted for use in Brazil. However, cross-cultural adaptation process ensures only the face and content validity of the adapted version, and it is necessary to evaluate other measuring properties in the population which instrument is intended to be applied. Thus, the objective of this study was to evaluate measurement properties (reliability, construct validity and interpretability) of SULCS-Brazil in post-stroke individuals. To this end, a methodological study was carried out, following the recommendations of the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) and Guidelines for Reporting Reliability and Agreement Studies. Individuals were recruited from the general community, from Bias Fortes Outpatient Clinic of Hospital das Clínicas of Universidade Federal de Minas Gerais (ABF-HC/UFMG) and from the Specialized Rehabilitation Center (CER-II) of Itabirito/MG, according to following inclusion criteria: (i) clinical diagnosis of primary or recurrent unilateral stroke with at least six weeks of evolution; (ii) age ≥20 years; (iii) hemiparesis, characterized by increased tone of elbow flexors, and/or handgrip muscle weakness, determined by a difference greater than 10% between the measurement of the paretic and non-paretic limb, measured by the Jamar® dynamometer; and (iv) absence of cognitive deficits, assessed by Mini Mental State Examination. Individuals with comprehension difficulties, uncorrected visual deficits, bilateral hemiplegia/hemiparesis, and other disabling neuromusculoskeletal conditions of the upper limbs not related to stroke were excluded. For reliability analysis, the test-retest reliability of the items was evaluated by calculating the Kappa coefficient, and of the total score, determined by analyzing the intraclass correlation coefficient (ICC). Additionally, measurement error analysis was performed using the Bland-Altman plot, as well as calculation of the standard error of measurement (SEM) and the minimum detectable difference (MDD). To analyze construct validity, Spearman's correlation coefficient was used to determine the magnitude and direction of the relationship between the SULCS-Brazil and measures of disability (grip strength - Jamar® dynamometer and sensorimotor function - Fugl Meyer scale/EFM); ability (gross manual dexterity - Box and Block Test /BBT and digital dexterity - Nine Hole Peg Test/NHPT), and perception of performance (ABILHAND-Brazil). The interpretability was analyzed through the occurrence of ceiling and floor effects, which are present when more than 15% of the sample reaches the maximum score (ceiling) or minimum score (floor). Eighty subjects participated in the study, with a median age of 64 years and a median time since stroke of 24 months. Among the 80 participants, the median age was 64 years, 60% were male, and the median time to follow-up was 24 months. The 30 participants who came for the second application of the SULCS-Brazil had a median age of 65 years, 60% were male, and a median time to evolution of 24 months. The results showed that 80% of the items showed almost perfect reliability (κ>0.81) and the total score showed excellent reliability (ICC=0.98; 95% CI=0.96-0.99). Results showed that 80% of the items showed almost perfect reliability (κ>0.81) and the total score showed excellent reliability (ICC=0.98; 95% CI=0.96-0.99). No systematic errors were found between applications and the EPM values were acceptable (EPM<5%), and it was possible to detect real change in upper limb capacity over time, with no evidence of ceiling and floor effects. Total SULCS-Brazil score was correlated with residual deficit in palmar grip strength (ρ=-0.73; p<0.0001); motor function (ρ=0.85; p<0.0001), residual deficit in gross manual dexterity (ρ=- 0.77; p<0.0001) and digital dexterity (ρ=-0.81; p<0.0001); as well as perceived performance (ρ=0.71; p<0.0001). All elaborated hypotheses were confirmed, indicating adequate validity of the SULCS-Brazil. The results of the present study indicated that the SULCS-Brazil is a valid and reliable measure to be used with individuals with stroke and shoud be applied within clinical and research contexts.