Validation of a lateropulsion scale for patients recovering from stroke

OBJECTIVE: To determine the validity and reliability of a clinical scale for assessing lateropulsion following stroke. DESIGN: Serial observational study of Lateropulsion Scale scores. SETTING: Inpatient stroke rehabilitation unit. SUBJECTS: A convenience sample of 85 patients examined 19 +/- 2 SEM days post stroke. MAIN OUTCOME MEASURES: An empirically derived 17-point Lateropulsion Scale was used to assess and follow postural responses to rolling, sitting, standing, transferring and walking. Intraclass correlation coefficients were calculated by having patients evaluated twice by their primary physical therapist (days 1 and 3), and once by an alternate physical therapist (day 2). Concurrent validity was estimated by computing Spearman's rank order correlations between the lateropulsion score and other markers for motor control dysfunction: Fugl-Meyer balance subscore, the Functional Independence Measure (FIM) mobility subscore, and length of rehabilitation hospital stay. RESULTS: Inter-rater and intra-rater reliability were r = 0.93 (p < 0.001) and r = 0.94 (p < 0.05), respectively. Concurrent validity estimates showed the initial lateropulsion score to be correlated with the Fugl-Meyer balance subscore (r = -0.57 p < 0.001), with the admission and discharge FIM mobility subscores (r = -0.56, p < 0.0001 and r = -0.58, p < 0.0001), respectively, and with length of rehabilitation hospital stay (r = 0.6, p < 0.0001). CONCLUSIONS: The Lateropulsion Scale is both a reliable and a valid assessment of lateropulsion following stroke.