Marianne Beninato | MGH Institute of Health Professions (original) (raw)

Papers by Marianne Beninato

Archives of Physical Medicine and Rehabilitation, Oct 1, 2014

Physical therapy, Nov 1, 2014

Background. The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The... more Background. The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The minimal clinically important difference (MCID) has yet to be determined for the FGA. Objective. The purposes of this study were to determine: (1) the MCID in the FGA for older community-dwelling adults relative to patients' and physical therapists' estimates of change and (2) the extent of agreement between patients' and physical therapists' estimates of change. Design. This study was a prospective case series. Methods. Patients and physical therapists rated the amount of change in balance while walking after an episode of physical therapy for balance retraining on a 15-point global rating of change (GROC) scale. Weighted kappa statistics were calculated to express agreement between patients' and physical therapists' GROC ratings. Functional Gait Assessment change scores were plotted on receiver operating characteristic curves. A cutoff of ϩ3 on the GROC was the criterion used for important change. The optimal FGA change cutoff score for MCID was determined, and sensitivity (SN), specificity (SP), and likelihood ratios (LRs) were calculated. Results. One hundred thirty-five community-dwelling older adults (average ageϭ78.8 years) and 14 physical therapists participated. There was poor agreement between the patients' and therapists' ratings of change (weighted kappaϭ.163). The estimated MCID value for the FGA using physical therapists' ratings of change as an anchor was 4 points (SNϭ0.66, SPϭ0.84, LRϩϭ4.07, LRϪϭ0.40). No accurate value for the FGA MCID could be determined based on the patients' ratings of change. Limitations. The small sample size was a limitation. Conclusion. Poor agreement between therapists' and patients' ratings indicate the need for further communication relative to patient goals. The 4-point MCID value for the FGA can be used for goal setting, tracking patient progress, and program evaluation.

Physical therapy, Aug 1, 2009

Background. Falls in people with stroke are extremely common and present a significant health ris... more Background. Falls in people with stroke are extremely common and present a significant health risk to this population. Development of fall screening tools is an essential component of a comprehensive fall reduction plan. Objective. The purpose of this study was to examine the accuracy of clinical measures representing various domains of the International Classification of Functioning, Disability and Health (ICF) relative to their ability to identify individuals with a history of multiple falls. Design. A case series study design was used. Setting. The study was conducted in a community setting. Participants. Twenty-seven people with stroke participated in the study. Measurements. Clinical assessment tools included the lower-extremity subscale of the Fugl-Meyer Assessment of Sensorimotor Impairment (FMLE) and Five-Times-Sit-to-Stand Test (STS) representing the body function domain, the Berg Balance Scale (BBS) representing the activity domain, the Activities-specific Balance Confidence (ABC) Scale as a measure of personal factors, and the physical function subscale of the Stroke Impact Scale (SIS-16) as a broad measure of physical function. We used receiver operating characteristic (ROC) curves to generate cutoff scores, sensitivities, specificities, and likelihood ratios (LRs) relative to a history of multiple falls. Results. The FMLE and the STS showed a weak association with fall history. The BBS demonstrated fair accuracy in identifying people with multiple falls, with a cutoff score of 49 and a positive LR of 2.80. The ABC Scale and the SIS-16 were most effective, with cutoff scores of 81.1 and 61.7, respectively, positive LRs of 3.60 and 7.00, respectively, and negative LRs of 0.00 and 0.25, respectively. Limitations. A limitation of the study was the small sample size. Conclusion. The findings suggest that the ICF is a useful framework for selecting clinical measures relative to fall history and support the need for prospective study of tools in more-complex domains of the ICF for their accuracy for fall prediction in people with stroke.

Archives of Physical Medicine and Rehabilitation, Apr 1, 2006

Journal of Neurologic Physical Therapy, Sep 1, 2006

In July 2005, physical therapy clinicians, educators, and researchers gathered for the IIISTEP (S... more In July 2005, physical therapy clinicians, educators, and researchers gathered for the IIISTEP (Symposium on Translating Evidence to Practice) conference. The purpose of IIISTEP was to link research and clinical practice through the exchange of ideas and research findings between scientists and clinicians. This paper represents the personal perspective of a group of colleagues who attended IIISTEP as clinicians/educator teams. The purpose of this paper is to illustrate how information from IIISTEP has challenged our existing concepts regarding physical therapy practice and begun to alter our clinical practice. Some key concepts presented by scientists and clinicians at IIISTEP are reviewed including current perspectives on neuroplasticity and frameworks for considering function, health, and the disablement process. Considerations for clinical application are outlined. Patient cases are used to illustrate how integration of this information has altered our approach to patient management.

Physical therapy, Aug 1, 2000

Background and Purpose. Physical therapy interventions are often based on assumed relationships a... more Background and Purpose. Physical therapy interventions are often based on assumed relationships among impairments, functional performance, and disability. The purposes of this study were (1) to describe balance impairments, functional performance, and disability in subjects with unilateral peripheral vestibular hypofunction (UVH) and bilateral peripheral vestibular hypofunction (BVH), (2) to examine the relationship among these factors, and (3) to determine whether disability can be explained by commonly used tests of balance and functional performance. Subjects. Participants were 85 subjects (mean ageϭ62.5 years, SDϭ16.5) with UVH (nϭ41) or BVH (nϭ44) diagnosed by vestibular function tests and clinical examination. Methods. Each subject completed the Dizziness Handicap Inventory (DHI) to obtain a measure of disability. Functional performance was measured with a modified Timed Up & Go Test (TUG). Balance impairments were measured with computerized posturography and balance tests. Descriptive statistics, correlational analyses, and stepwise regressions were performed. Results. Subjects with BVH had poorer balance but similar TUG scores and perceived levels of disability, as compared with subjects with UVH. Weak to moderate correlations existed among balance measurements, TUG scores, and DHI scores. Balance impairments and TUG scores together explained 78% of the variance in DHI scores of the subjects with BVH, whereas balance impairments alone explained 13% of the variance in DHI scores of the subjects with UVH. Conclusion and Discussion. Balance impairments and functional performance appear to be more closely related to disability in individuals with BVH as compared with those with UVH. Clinical tests of balance impairments and functional performance appear to be useful in explaining disability. [Gill-Body KM, Beninato M, Krebs DE. Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction.

Journal of Neurologic Physical Therapy, Dec 1, 2004

Physiotherapy Practice and Research, 2012

Physiotherapy Theory and Practice, Oct 16, 2013

To determine if subscores based on grouping Stroke Impact Scale 16 (SIS-16) items according to In... more To determine if subscores based on grouping Stroke Impact Scale 16 (SIS-16) items according to International Classification of Functioning, Health and Disability (ICF) components are more accurate in identifying individuals with a history of falls than the total SIS-16 score. Case series. 43 community-dwelling people with chronic stroke. Participants were grouped based on six month fall history (no fall versus one or more falls). The SIS-16 items were categorized as belonging to the Body Structure and Function (BSF), Activity (ACT) or Participation (PART) component of the ICF. SIS-16 total score and ICF component subscores were analyzed for their association with falls. Receiver Operating Characteristic Curves were (ROC) analyzed. There were significant differences between groups on SIS-16 total (p = 0.006), BSF (p = 0.041) and ACT (p = 0.003) scores. The BSF and ACT component subscores had the highest specificity (0.91) and sensitivity (0.80), respectively, for categorizing participants according to fall history. The BSF + ACT component subscore demonstrated greater accuracy than the total SIS-16 for identifying people with falls (area under the curve = 0.78). The ICF may be a useful model for analysis of fall screening tools for people with chronic stroke. ICF component subscores are more accurate than the SIS-16 total score for this purpose.

Journal of Rehabilitation Medicine, 2014

Objective: To evaluate the predictive validity of the Mobility Scale for Acute Stroke (MSAS) in d... more Objective: To evaluate the predictive validity of the Mobility Scale for Acute Stroke (MSAS) in determining discharge destination (home or not home) after an acute stroke. Design: Cohort study. Subjects: Two-hundred and twenty-three patients with acute ischemic or intraparenchymal hemorrhagic, unilateral stroke Methods: The MSAS was administered as part of the initial physical therapy examination. The Receiver Operating Characteristic determined the optimal MSAS cutoff score associated with discharge home. A multiple logistic regression equation with discharge destination as the criterion variable (home or not home) was conducted with age, length of stay and optimal MSAS cutoff score as covariates. Results: Subjects were discharged home 35.9% (n = 80) and not home 64.1% (n = 143) of the time. Mean age was 68.5 years (standard deviation 1.8). The ROC determined 26 to be the optimal cutoff score for the MSAS. Results of the multiple logistic regression equation indicated that controlling for age and length of stay, only the MSAS cutoff score of 26 reliably predicted discharge to home with an adjusted odds ratio of 57.79 with a 95% confidence interval of 20.09-166.21. Conclusion: The MSAS may be useful for predicting discharge destination from the acute hospital after stroke.

Journal of Neurologic Physical Therapy, Jun 1, 2011

Physical therapy, Apr 1, 2016

Background. The Functional Gait Assessment (FGA), a measure of walking balance ability, was devel... more Background. The Functional Gait Assessment (FGA), a measure of walking balance ability, was developed to eliminate the ceiling effect observed in the Dynamic Gait Index (DGI). Three presumably more difficult tasks were added and 1 easier task was removed from the original 8 DGI tasks. The effects of these modifications on item hierarchy have not previously been analyzed. Objective. The purpose of this study was to determine: (1) the ordering of the 10 FGA tasks and the extent to which they map along a clinically logical difficulty continuum, (2) whether the spread of tasks is sufficient to measure patients of varying functional ability levels without a ceiling effect, (3) where the 3 added tasks locate along the task difficulty continuum, and (4) the psychometric properties of the individual FGA tasks. Design. A retrospective chart review was conducted. Methods. Functional Gait Assessment scores from 179 older adults referred for physical therapy for balance retraining were analyzed by Rasch modeling. Results. The FGA task hierarchy met clinical expectations, with the exception of the "walking on level" task, which locates in the middle of the difficulty continuum. There was no ceiling effect. Two of the 3 added tasks were the most difficult FGA tasks. Performance on the most difficult task ("gait with narrow base of support") demonstrated greater variability than predicted by the Rasch model. Limitations. The sample was limited to older adults who were community dwelling and independently ambulating. Findings cannot be generalized to other patient groups. Conclusions. The revised scoring criteria of the FGA may have affected item hierarchy. The results suggest that the FGA is a measure of walking balance ability in older adults that is clinically appropriate and has construct validity. Administration of the FGA may be modified further to improve administration efficiency.

Physiotherapy Practice and Research, 2015

Non-surgical and non-pharmacological interventions for congenital muscular torticollis in the 0-5... more Non-surgical and non-pharmacological interventions for congenital muscular torticollis in the 0-5 year age group.

Spinal Cord, Jun 29, 2004

Study design: Retrospective analysis. Objectives: The objectives of this research were to, in sub... more Study design: Retrospective analysis. Objectives: The objectives of this research were to, in subjects with lower cervical spinal cord injury (SCI), examine the relationship between strength of muscle groups as measured by the manual muscle test (MMT) and function (reflected as burden of care) as measured by individual functional independence measure (FIM) motor tasks, and investigate the extent to which MMT scores explain the variance of the motor FIM scores. Setting: Acute rehabilitation hospitals, Boston, MA, USA. Methods: Retrospective pilot study of 20 in-patients, age 18-62 years, with an SCI between C5 and C7. Discharge demographic variables, MMT and motor FIM scores were analyzed. Descriptive statistics, Spearman's rank correlation coefficients, stepwise regressions were performed. Results: MMT scores for elbow flexion followed by shoulder flexion and wrist extension correlated with the greatest number of FIM tasks. MMT scores explained some part of the variance in the eight of 12 motor FIM tasks. In six of eight tasks, one key muscle explained a large portion of the variance. Conclusion: Key muscles relative to FIM tasks can be identified. These findings may help focus therapeutic interventions aimed at achievement in these tasks.

Journal of Neurologic Physical Therapy, 2006

Physical Therapy, 2009

components, making the distinction among components difficult. Thus, the representation by compon... more components, making the distinction among components difficult. Thus, the representation by component level only may not be adequate enough to tease out specific constructs of functioning that are contained at the chapter and category levels of the ICF. Perhaps, accuracy for the prediction of falls may even vary according to categories and not components. The authors could have gone beyond by selecting instruments based on Core Sets or content analysis of instruments at a level more specific than the component level.

Physiotherapy Practice and Research

Cardiopulmonary Physical Therapy Journal

Physical Therapy, 2015

Background The Functional Gait Assessment (FGA), a measure of walking balance ability, was develo... more Background The Functional Gait Assessment (FGA), a measure of walking balance ability, was developed to eliminate the ceiling effect observed in the Dynamic Gait Index (DGI). Three presumably more difficult tasks were added and 1 easier task was removed from the original 8 DGI tasks. The effects of these modifications on item hierarchy have not previously been analyzed. Objective The purpose of this study was to determine: (1) the ordering of the 10 FGA tasks and the extent to which they map along a clinically logical difficulty continuum, (2) whether the spread of tasks is sufficient to measure patients of varying functional ability levels without a ceiling effect, (3) where the 3 added tasks locate along the task difficulty continuum, and (4) the psychometric properties of the individual FGA tasks. Design A retrospective chart review was conducted. Methods Functional Gait Assessment scores from 179 older adults referred for physical therapy for balance retraining were analyzed by ...