Individuals with HD have progressive motor, cognitive and behavioral impairments that contribute to difficulty with stair negotiation leading to falls on stairs. To assess stair safety, we developed a tool called the Step Test Evaluation of Performance on Stairs (STEPS) that allows systematic observation of movement and analysis of stair performance. The purpose of this study was to examine 1) the agreement of STEPs ratings between healthcare professionals who were experienced versus novice in movement analysis, and 2) STEPS items with the lowest ratings indicating areas to target fall prevention interventions.
Methods Forty ambulatory individuals with a diagnosis of HD (mean age 50.35) participated. Three observers (2 experienced physical therapists (PTs) and one nurse with minimal experience in movement analysis) concurrently rated live performances of the STEPS.
Results The nurse’s average total STEPS ratings did not significantly differ from the experienced PTs’ ratings with a difference of -0.05 (CI=-0.53, 0.43; p=0.83). Out of 16 items, the agreement between all raters was less than 75% for continuity of ascent (69%) and descent (72%), foot placement during ascent (74%) and eccentric control of the knee during descent (74%). Individuals with HD were most likely to have difficulty during ascent/descent of stairs with foot placement and trunk stability. Additionally many clients exhibited deficits in balance and eccentric control of the knee during descent.
Conclusions Observation for continuity of movement has greater inter-rater variability than other STEPS items. Principal impairments that may negatively impact stair performance in HD are foot placement and control of descent along with trunk stability. Healthcare providers other than PTs can quickly be trained to use the STEPS tool reliably. Future areas to study would be whether therapy aimed at improving foot placement, trunk control and eccentric quadriceps strength would improve safety on stairs.
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