Translation, reliability, and validity of the trunk impairment scale in a Polish population after stroke
DOI:
https://doi.org/10.2340/jrm.v58.44789Keywords:
stroke, outcome measure, TIS, FMA, ARAT, trunk impairmentAbstract
Objective: This study was conducted to estimate the reliability and validity of the translated and culturally adapted Polish version of the Trunk Impairment Scale in post-stroke patients and to determine the strength of the relationship between trunk and upper limb physical function after stroke.
Design: The Polish version of the Trunk Impairment Scale was developed through cultural adaptation. Internal consistency, test–retest reliability, and inter-rater reliability were determined, and construct validity was evaluated by analysing the Polish version of the Trunk Impairment Scale, the Polish version of the Fugl-Meyer Assessment Scale, and the Polish version of the Action Research Arm Test.
Participants: Eighty patients with diagnosed stroke in the subacute and chronic stages.
Results: The internal consistency for the Polish version of the Trunk Impairment Scale was excellent (α = 0.85–0.91). Test–retest and inter-rater reliability were almost perfect (ICC = 0.94–1.0, κ = 0.92–1.0). Construct validity was moderate (rho = 0.71–0.76). A moderate correlation was also found between the Polish version of the Trunk Impairment Scale and Polish version of the Action Research Arm Test total scores (rho = 0.60).
Conclusion: The Polish version of the Trunk Impairment Scale is a reliable and moderately valid outcome measure to assess trunk impairment in Polish stroke survivors. Trunk function is moderately related to gross and fine motor skills of the arm, hand, and fingers among individuals with stroke.
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References
Gjelsvik B, Breivik K, Verheyden G, Smedal T, Hofstad H, Strand LI. The Trunk Impairment Scale modified to ordinal scales in the Norwegian version. Disabil Rehabil 2012; 34: 1385–1395.
https://doi.org/10.3109/09638288.2011.645113 DOI: https://doi.org/10.3109/09638288.2011.645113
Kılınç M, Avcu F, Onursal O, Ayvat E, Savcun Demirci C, Aksu Yildirim S. The effects of Bobath-based trunk exercises on trunk control, functional capacity, balance, and gait: a pilot randomized controlled trial. Top Stroke Rehabil 2016; 23: 50–58.
https://doi.org/10.1179/1945511915Y.0000000011 DOI: https://doi.org/10.1179/1945511915Y.0000000011
Verheyden G, Vereeck L, Truijen S, Troch M, Herregodts I, Lafosse C, et al. Trunk performance after stroke and the relationship with balance, gait and functional ability. Clin Rehabil 2006; 20: 451–458.
https://doi.org/10.1191/0269215505cr955oa DOI: https://doi.org/10.1191/0269215505cr955oa
Likhi M, Jidesh Vv, Kanagaraj R, George JK. Does trunk, arm, or leg control correlate best with overall function in stroke subjects? Top Stroke Rehabil 2013; 20: 62–67.
https://doi.org/10.1310/tsr2001-62
Bohannon RW, Leary KM. Standing balance and function over the course of acute rehabilitation. Arch Phys Med Rehabil 1995; 76: 994–996.
https://doi.org/10.1016/s0003-9993(95)81035-8 DOI: https://doi.org/10.1016/S0003-9993(95)81035-8
Büyükavcı R, Şahin F, Sağ S, Doğu B, Kuran KB. The impact of additional trunk balance exercises on balance, functional condition and ambulation in early stroke patients: randomized controlled trial. Turk J Phys Med Rehab 2016; 62: 248–256.
https://doi.org/10.5606/tftrd.2016.84770 DOI: https://doi.org/10.5606/tftrd.2016.84770
Cabanas-Valdes R, Cuchi GU, Bagur-Calafat C. Trunk training exercises approaches for improving trunk performance and functional sitting balance in patients with stroke: a systematic review. NeuroRehabilitation 2013; 33: 575–592.
https://doi.org/10.3233/NRE-130996 DOI: https://doi.org/10.3233/NRE-130996
Shin JW, Kim KD. The effect of enhanced trunk control on balance and falls through bilateral upper extremity exercises among chronic stroke patients in a standing position. J Phys Ther Sci 2016; 28: 194–197.
https://doi.org/10.1589/jpts.28.194 DOI: https://doi.org/10.1589/jpts.28.194
Wee SK, Hughes AM, Warner MB, Brown S, Cranny A, Mazomenos EB, et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy. Phys Ther 2015; 95:1163–1171.
https://doi.org/10.2522/ptj.20140487
Verheyden G, Nieuwboer A, de Wit L, Thijs V, Dobbelaere J, Devos H, et al. Time course of trunk, arm, leg, and functional recovery after ischemic stroke. Neurorehabil Neural Repair 2008; 22: 173–179.
https://doi.org/10.1177/1545968307305456 DOI: https://doi.org/10.1177/1545968307305456
Lee KB, Lim SH, Kim KH, Kim KJ, Kim YR, Chang WN, et al. Six-month functional recovery of stroke patients: a multi-time-point study. Int J Rehabil Res 2015; 38: 173–180.
https://doi.org/10.1097/MRR.0000000000000108 DOI: https://doi.org/10.1097/MRR.0000000000000108
Verheyden G, Nieuwboer A, Mertin J, Preger R, Kiekens C, de Weerdt W. The Trunk Impairment Scale: a new tool to measure motor impairment of the trunk after stroke. Clin Rehabil 2004; 18: 326–334.
https://doi.org/10.1191/0269215504cr733oa DOI: https://doi.org/10.1191/0269215504cr733oa
Seo HD, Kim NJ, Chung YJ. Reliability of the Korean Version of the Trunk Impairment Scale in patients with stroke. Phys Ther Korea 2008; 15: 87–96.
Castellassi CS, Ribeiro EAF, Fonseca VC, Beinotti F, Oberg TD, Lima NMF. Reliability of Brazilian version trunk impairment scale for stroke patients [Portuguese]. Fisioter Mov 2009; 20: 114–125.
Cabanas-Valdés R, Urrútia G, Bagur-Calafat C, Caballero-Gómez FM, Germán-Romero A, Girabent-Farrés M. Validation of the Spanish version of the Trunk Impairment Scale Version 2.0 (TIS 2.0) to assess dynamic sitting balance and coordination in post-stroke adult patients. Top Stroke Rehabil 2016; 23: 225–232.
https://doi.org/10.1080/10749357.2016.1151662 DOI: https://doi.org/10.1080/10749357.2016.1151662
Lombardi B, Orioli A, Casavola D, Paci M. The Italian version of the Trunk Impairment Scale: development and psychometric properties. Eur J Phys Rehabil Med 2017; 53: 516–520.
https://doi.org/10.23736/S1973-9087.17.04371-4 DOI: https://doi.org/10.23736/S1973-9087.17.04371-4
Sağ S. The validity and reliability of the Turkish Version of the Trunk Impairment Scale in stroke patients. North Clin Istanb 2018; 6: 156–165.
https://doi.org/10.14744/nci.2018.01069 DOI: https://doi.org/10.14744/nci.2018.01069
Fujiwara T, Liu M, Tsuji T, Sonoda S, Mizuno K, Akaboshi K, et al. Development of a new measure to assess trunk impairment after stroke (Trunk Impairment Scale): its psychometric properties. Am J Phys Med Rehabil 2004; 83: 681–688.
https://doi.org/10.1097/01.PHM.0000137308.10562.20 DOI: https://doi.org/10.1097/01.PHM.0000137308.10562.20
Bernstein I, Nunnally J. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
Hinkle DE, Wiersma W, Jurs SG. Applied statistics for the behavioral sciences. 2nd ed. Boston: Houghton Mifflin; 1988.
Alhwoaimel N, Turk R, Warner M, Verheyden G, Thijs L, Wee SK, et al. Do trunk exercises improve trunk and upper extremity performance, post stroke? A systematic review and meta-analysis. NeuroRehabilitation 2019; 43: 95–412.
https://doi.org/10.3233/NRE-182446 DOI: https://doi.org/10.3233/NRE-182446
Yozbatiran N, Der-Yeghiaian L, Cramer SC. A standardized approach to performing the action research arm test. Neurorehabil Neural Repair 2008; 22: 78–90.
https://doi.org/10.1177/1545968307305353 DOI: https://doi.org/10.1177/1545968307305353
Goliwas M, Malecka J, Adamczewska K, Flis-Maslowska M, Lewandowski J, Kocur P. Polish cultural adaptation and reliability of the Fugl-Meyer Assessment of Motor Performance and Sensory Assessment Scale in stroke patients. J Clin Med 2024; 13: 3710.
https://doi.org/10.3390/jcm13133710 DOI: https://doi.org/10.3390/jcm13133710
Cecchi F, Carrabba C, Bertolucci F, Castagnoli C, Falsini C, Gnetti B, et al. Transcultural translation and validation of Fugl-Meyer assessment to Italian. Disabil Rehabil 2021; 43: 3717–3722.
https://doi.org/10.1080/09638288.2020.1746844 DOI: https://doi.org/10.1080/09638288.2020.1746844
Fugl-Meyer AR, Jääskö L, Leyman I, Olsson S, Steglind S. The post-stroke hemiplegic patient 1. A method for evaluation of physical performance. Scand J Rehabil Med 1975; 7: 13–31. DOI: https://doi.org/10.2340/1650197771331
Page SJ, Hade E, Persch A. Psychometrics of the wrist stability and hand mobility subscales of the Fugl-Meyer Assessment in moderately impaired stroke. Phys Ther 2015; 95: 103–108.
https://doi.org/10.2522/ptj.20130235 DOI: https://doi.org/10.2522/ptj.20130235
Gladstone DJ, Danells CJ, Black SE. The Fugl-Meyer Assessment of motor recovery after stroke: a critical review of its measurement properties. Neurorehabil Neural Repair 2002; 16: 232–240.
https://doi.org/10.1177/154596802401105171 DOI: https://doi.org/10.1177/154596802401105171
Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993; 46: 1417–1432.
https://doi.org/10.1016/0895-4356(93)90142-N DOI: https://doi.org/10.1016/0895-4356(93)90142-N
Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976) 2000; 25: 3186–3191.
https://doi.org/10.1097/00007632-200012150-00014 DOI: https://doi.org/10.1097/00007632-200012150-00014
Mokkink LB, Prinsen CA, Donald PL, Alonso J, Bouter LM, de Vet HC, et al. COSMIN methodology for systematic reviews of Patient-Reported Outcome Measures (PROMs). VU Univ Med Cent 2018; 27: 1147–1157. DOI: https://doi.org/10.1007/s11136-018-1798-3
Szczechowicz J, Lewandowski J, Sikorski J. Polish adaptation and validation of Burn Specific Health Scale - Brief. Burns 2014; 40: 1013–1018.
https://doi.org/10.1016/j.burns.2013.11.026 DOI: https://doi.org/10.1016/j.burns.2013.11.026
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, et al. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. J Clin Epidemiol 2010; 63: 737–745.
https://doi.org/10.1016/j.jclinepi.2010.02.006 DOI: https://doi.org/10.1016/j.jclinepi.2010.02.006
TIBCO Software Inc. Statistica (data analysis software system), version 13. 2017. Available from: http://statistica.io
Revelle W. psych: Procedures for Psychological, Psychometric, and Personality Research. Version 2.1.3. Northwestern University; 2021. Available from: https://CRAN.R-project.org/package=psych
Andresen EM. Criteria for assessing the tools of disability outcomes research. Arch Phys Med Rehabil 2000; 81: S15–20.
https://doi.org/10.1053/apmr.2000.20619 DOI: https://doi.org/10.1053/apmr.2000.20619
Bernstein I, Nunnally J. Psychometric theory, 3rd ed. New York: McGraw-Hill; 1994.
McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22: 276–282.
https://doi.org/10.11613/bm.2012.031 DOI: https://doi.org/10.11613/BM.2012.031
Barreca, S, Stratford, PW, Lambert, CL, Masters, LM, Streiner, DL. Test–retest reliability, validity, and sensitivity of the Chedoke Arm and Hand Activity Inventory: a new measure of upper-limb function for survivors of stroke. Arch Phys Med Rehabil 2005; 86: 1616–1622.
https://doi.org/10.1016/j.apmr.2005.03.017 DOI: https://doi.org/10.1016/j.apmr.2005.03.017
Duncan PW, Goldstein LB, Horner RD, Landsman PB, Samsa GP, Matchar DB. Similar motor recovery of upper and lower extremities after stroke. Stroke 1994; 25: 1181–1188. DOI: https://doi.org/10.1161/01.STR.25.6.1181
Wee SK, Hughes AM, Warner MB, Brown S, Cranny A, Mazomenos EB, et al. Effect of trunk support on upper extremity function in people with chronic stroke and people who are healthy. Phys Ther 2015; 95: 1163–1171.
https://doi.org/10.2522/ptj.20140487 DOI: https://doi.org/10.2522/ptj.20140487
Akkurt L, Yağcıoğlu GA, Aksoy CC, Yaman F. The effect of trunk control on sitting balance and upper extremity functions in patients with subacute stroke. Neurological Sciences 2024; 45: 5807–5812.
https://doi.org/10.1007/s10072-024-07817-w
Okada T, Huxel Bliven KC, McMullen J. Relationship between core stability, functional movement, and performance. J Strength Cond Res 2011; 25: 252–261. DOI: https://doi.org/10.1519/JSC.0b013e3181b22b3e
https://doi.org/10.1007/s10072-024-07817-w DOI: https://doi.org/10.1007/s10072-024-07817-w
Karthikbabu S, Chakrapani M, Ganeshan S, Rakshith, KC, Nafeez S, Prem V. A review on assessment and treatment of the trunk in stroke: A need or luxury? Disabil Rehabil 2012; 33: 2119–2126.
https://doi.org/10.3109/09638288.2011.574776 DOI: https://doi.org/10.3109/09638288.2011.574776
Shumway-Cook A, Woollacott H. Motor control. 5th ed. Philadelphia: Wolters Kluwer; 2017. p. 183–305.
Robertson J, Roby-Brami A. The trunk as a part of the kinematic chain for reaching movements in healthy subjects and hemiparetic patients. Brain Res 2011; 1382: 137–146. http://doi.org/10.1016/j.brainres.2011.01.043 DOI: https://doi.org/10.1016/j.brainres.2011.01.043
Małecka J, Goliwąs M, Adamczewska K, Lewandowski J, Łochyński D. The translation into Polish, cultural adaptation, and initial validation of the Action Research Arm Test in subacute stroke patients. Adv Clin Exp Med 2025; 34: 1165–1173.
https://doi.org/10.17219/acem/191775 DOI: https://doi.org/10.17219/acem/191775
Likhi M, Jidesh VV, Kanagaraj R, George JK. Does trunk, arm, or leg control correlate best with overall function in stroke subjects? Top Stroke Rehabil 2013; 20: 62–67.
https://doi.org/10.1310/tsr2001-62 DOI: https://doi.org/10.1310/tsr2001-62
Monticone M, Ambrosini E, Verheyden G, Brivio F, Brunati R, Longoni L, et al. Development of the Italian version of the trunk impairment scale in subjects with acute and chronic stroke. Cross-cultural adaptation, reliability, validity and responsiveness. Disabil Rehabil 2019; 41: 66–73.
https://doi.org/10.1080/09638288.2017.1373409 DOI: https://doi.org/10.1080/09638288.2017.1373409
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Copyright (c) 2026 Joanna Małecka, Magdalena Goliwąs, Katarzyna Adamczewska, Jacek Lewandowski, Geert Verheyden, Dawid Łochyński
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