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Published on: May 8, 2014
Reliability, validity, and responsiveness of the locomotor capabilities index in adults with lower-limb amputation
Franco Franchignoni1, Duccio Orlandini, Giorgio Ferriero
1Unit of Occupational Rehabilitation and Ergonomics, Rehabilitation Institute of Veruno, Veruno, Italy. ffranchignoni@fsm.it
Objective:
To assess the reliability, validity, and responsiveness of both the standard and revised Locomotor Capabilities Index (LCI) in people with lower-limb amputation who undergo prosthetic training.
Design:
Reliability and validity study.
Setting:
Two freestanding rehabilitation centers.
Participants:
Fifty inpatients with a recent unilateral lower-limb amputation.
Interventions:
Not applicable. Main outcome measures The standard LCI and a new version with a 5-level ordinal scale (LCI-5) were tested for internal consistency, test-retest reliability, ceiling effect, and effect size. The construct validity of both versions was analyzed by correlation with the Rivermead Mobility Index, a timed walking test, and the FIM instrument.
Results:
The Cronbach alpha of both LCI versions was.95. The item-to-total correlations (Spearman rho) ranged from.50 to.87 (P<.0001 for all). The percent agreement and kappa values for the item scores ranged, respectively, from 78.4% to 100% and.58 to 1.00 in the LCI, and from 75.7% to 97.3% and.54 to.96 in the LCI-5. The intraclass correlation coefficient (model 2,1) for the total scores was.98 for both versions; the Bland-Altman plot revealed no systematic trend for either version. Both the LCI and LCI-5 correlated with all criterion measures (rho range,.61-.76), with the LCI-5 showing a larger effect size during the rehabilitation period and a lower ceiling effect. Patients with transtibial amputation were more independent in performing activities than were those with transfemoral amputation; their locomotor capability negatively correlated with age.
Conclusions:
Both the LCI and LCI-5 captured the global locomotor ability of people with lower-limb amputation during prosthetic training. The new LCI-5 presents similar and sometimes better psychometric properties than the standard LCI.
