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Quiz In Arts 6: Digital Painting And Graphic Design
By Muhammad Kashif 1, 2, * , Ashfaq Ahmad 1, * , Muhammad Ali Mohseni Bandpei 1 , Syed Amir Gilani 1 , Humaira Iram 2 and Maryam Farooq 2
Background: The most common assessment tool used in clinical settings to detect changes in balance performance is the Berg Balance Scale (BBS). Thus, the purpose of this study was to translate the BBS into Urdu and investigate the psychometric properties (acceptability, internal consistency reliability, interrater reliability, construct validity) for individuals with Parkinson’s disease (PD). Methods: Eighty patients of either gender with idiopathic Parkinson’s disease, stages I–III on the modified Hoehn–Yahr (H&Y) scale, with intact cognition according to the Mini Mental Score Examination (MMSE) score (greater than or equal to 24) and independent of transfers, were included in this study. The BBS was translated according to international guidelines based on forward and backward translation processes. The test-retest reliability as well as intra- and inter-observer reliability was assessed by calculating the intra-class correlation coefficient (ICC). The internal consistency of the entire BBS score was assessed by calculating Cronbach’s α. The convergent validity was assessed by correlating the scale with the Unified Parkinson Disease Rating Scale (UPDRS) parts II and III and the Activity-specific Balance Confidence Scale (ABCS). The construct validity was assessed using a factor analysis. Results: The mean age of the subjects was 62.35 ± 5.74 in years (range: 60–87 years). The ICC for intra- and inter-observer reliability was 0.95 (p < 0.0001) and 0.99 (p < 0.001), respectively. Cronbach’s α was calculated as 0.81, which showed acceptable internal consistency of the Urdu version of the BBS. The test-retest reliability (ICC) of the Urdu version of the BBS was determined as 0.97 for the total score, and ranged from 0.66–0.95 for individual items. In terms of validity, the Urdu version of the BBS was correlated with the ABCS (in the positive direction) and UPDRS-II and III (in the negative direction) (r = 0.53, p < 0.001; r = −0.68, p < 0.001, r = −0.78, p < 0.0001), respectively. Conclusion: The Urdu version of the BBS is a reliable and valid scale to be used in balance assessment of population diagnosed with PD with excellent psychometric properties.
Parkinson’s disease (PD) is a pathological condition characterised by a variety of motor as well as non-motor problems. Resting tremors, bradykinesia, rigidity, and postural instability are the main problems associated with motor symptomatology [1]. Its onset is more prevalent at 65 years of age or above and is a cause of emotional as well as financial stress on caregivers [2]. In the past 26 years, this problem has doubled in size worldwide, increasing from 2.5 million persons afflicted with the disease in 1990 to 6.1 million people reported to be afflicted with PD in 2016. This increase is likely related to longer life expectancies enabled by better health care outcomes, ultimately leading to an increase in the aging population [3].
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Balance impairments are common among patients presenting with many of the neurological disorders, of which one is PD [4]. Once balance worsens in patients with PD, the healthcare professionals need a quantifiable tool to measure these changes and select a suitable treatment [5]. A systematic assessment of the balance impairments is also important in PD for the development of an efficient plan of care and evaluation of the efficacy of the rehabilitation protocol targeted at improving the balance as well as motor function over a specified period of time [6].
The Berg Balance Scale (BBS) was originally developed in 1989 by Katherine Berg to detect balance impairments in the elderly [7, 8] but later on, the tool was standardised for PD as well as for stroke and similar neurological conditions [8, 9]. The BBS is a short assessment tool that is often used to measure balance and mobility, as well as to find people who are at risk of falling [10, 11, 12]. The tool includes 14 different balance-related tasks, such as sitting, standing, and transferring. Each component is rated on a scale of 0 to 4, with 0 denoting severe impairment and 4 denoting the patient’s normal functioning balance system. The BBS components assess the patient’s ability to shift between different postures as well as their individual posture [8]. The total score ranges from 0 to 56 with a higher score indicating less balance impairment. A score less than 45 indicates the risk of falling, whereas a score of 56 shows good functional balance [1]. According to other criteria, patients with restricted mobility or who are wheel-chair bound, people who require assistance during the gait, and those independent in gait fall within the range of 0–20, 21–40, and 41–56 BBS score, respectively [7].
The BBS has been translated into many languages, including Persian, Turkish, and Russian, as well as Korean, Norwegian, and Japanese, due to its widespread use, and each version has proven to be reliable and valid [13, 14, 15, 16, 17, 18]. The BBS is relatively safe and easy to use, and it has good inter- and intra-rater reliability in a wide range of patients, including those who have had brain injuries, strokes, or are old. Similarly, BBS has been shown to have high inter-rater and intra-rater reliability in PD patients [7, 19, 20, 21, 22]. The psychometric properties of BBS translation in different languages have been evaluated in people with Parkinson’s disease [23, 24, 25, 26]. However, no study reported the psychometric properties of the Urdu translation for patients with PD. More than 65 million people worldwide speak Urdu, mostly from Pakistan and India. Moreover, Urdu is the national language of Pakistan [27, 28]. In Pakistan, people do not read or understand English very well, so different questionnaires should be translated into Urdu. Therefore, the current study was aimed at determining the psychometric properties of the Urdu translation of BBS (BBS-U) in the context of its acceptability, internal consistency, reliability, interrater reliability, and construct validity among patients with PD.
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This cross-sectional study was conducted from July to August 2020. Patients with a diagnosis of PD by the neurologist were recruited from the neurology and neurosurgical departments of tertiary hospitals in Faisalabad. The patients were then referred to the Department of Physical Therapy at Safi Hospital, where they were further evaluated for study eligibility by the Principal Investigator. Patients with PD who were being treated at the outpatient physical therapy department of Safi Hospital were also included in this study. PD patients with score ≥ 24 on Mini-Mental State Examination (MMSE) specifying intact cognition were included. MMSE is useful in detecting cognitive deterioration in patients with PD [29]. Patients with other neurological or orthopedic pathologies, visual and auditory impairments that can impair their balance ability, medications known to affect balance, severe pain (visual analogue scale > 75 mm) [30], amputations of the lower extremities, and unwillingness to participate in the study were excluded. The basic demographic information was recorded on the initial visit. Moreover, Parkinson’s specific tools including, modified (H&Y), UPDRS parts II and III, and ABCS were used and the findings were recorded. During this period, the patients were not given any type of treatment. To avoid any unexpected changes in motor symptoms, participants with PD were examined under the same conditions, i.e., during the “on” period [18].
The approval was taken via email from Katherine Berg for the Urdu translation of BBS. The translation and the cross-cultural modification of BBS in the Urdu language were executed using six steps in compliance with previously published guidelines and in accordance with the criteria of consensus-based standards for the selection of health status measurement instrument (COSMIN) [31] (Figure 1).
The translation of BBS was done by two native Urdu-speaking Pakistani translators. One of these bilingual and experienced translators was a physiotherapist who was aware of the concept of this study, and the other was a translation expert with a non-medical or clinical background. Both translators independently translated the BBS into the Urdu language and provided a written translated report
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This cross-sectional study was conducted from July to August 2020. Patients with a diagnosis of PD by the neurologist were recruited from the neurology and neurosurgical departments of tertiary hospitals in Faisalabad. The patients were then referred to the Department of Physical Therapy at Safi Hospital, where they were further evaluated for study eligibility by the Principal Investigator. Patients with PD who were being treated at the outpatient physical therapy department of Safi Hospital were also included in this study. PD patients with score ≥ 24 on Mini-Mental State Examination (MMSE) specifying intact cognition were included. MMSE is useful in detecting cognitive deterioration in patients with PD [29]. Patients with other neurological or orthopedic pathologies, visual and auditory impairments that can impair their balance ability, medications known to affect balance, severe pain (visual analogue scale > 75 mm) [30], amputations of the lower extremities, and unwillingness to participate in the study were excluded. The basic demographic information was recorded on the initial visit. Moreover, Parkinson’s specific tools including, modified (H&Y), UPDRS parts II and III, and ABCS were used and the findings were recorded. During this period, the patients were not given any type of treatment. To avoid any unexpected changes in motor symptoms, participants with PD were examined under the same conditions, i.e., during the “on” period [18].
The approval was taken via email from Katherine Berg for the Urdu translation of BBS. The translation and the cross-cultural modification of BBS in the Urdu language were executed using six steps in compliance with previously published guidelines and in accordance with the criteria of consensus-based standards for the selection of health status measurement instrument (COSMIN) [31] (Figure 1).
The translation of BBS was done by two native Urdu-speaking Pakistani translators. One of these bilingual and experienced translators was a physiotherapist who was aware of the concept of this study, and the other was a translation expert with a non-medical or clinical background. Both translators independently translated the BBS into the Urdu language and provided a written translated report
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