The Cone Evasion Walk test: Reliability and validity in acute stroke

To estimate the reliability and validity of the Cone Evasion Walk test (CEW), a new test assessing the ability to evade obstacles, in people with acute stroke.

To estimate the reliability of the CEW, video recordings of 20 people with acute stroke performing the test were assessed by 10 physiotherapists on two occasions, resulting in a total of 400 ratings. Patients performed the CEW (n = 221), functional ambulation classification (FAC; n = 204), Timed Up and Go (TUG; n = 173), TUG cognitive (TUG-cog; n = 139), Serial 7s attention task from the Montreal Cognitive Assessment (MoCA-S7; n = 127), and the Star Cancellation Test (SCT; n = 151). These tests and side of lesion (n = 143) were used to examine construct validity. The predictive validity was evaluated in relation to falls during the following 6 months (n = 203).

The intraclass correlation coefficients for intrarater and interrater reliability were 0.88-0.98. For validity, there were significant correlations between the CEW and FAC (rs  = -0.67), TUG (rs  = 0.45), MoCA-S7 (rs  = -0.36), and SCT total score (rs  = -0.36). There was a significant correlation between the number of cones touched on the left side and the proportion of cancelled stars on the left (rs  = -0.23) and right (rs  = 0.23) side in the SCT. Among right hemisphere stroke participants (n = 79), significantly more persons hit cones on the left side (n = 25) than the right side (n = 8), whereas among those with a left hemisphere stroke (n = 64) significantly more persons hit cones on the right side (n = 11) than the left (n = 3). Cox regression showed that participants who touched four to eight cones had an increased risk of falls over time (hazard ratio 2.11, 95% CI [1.07, 4.17]) compared with those who touched none.

The new CEW test was reliable and valid in assessing the ability to evade obstacles while walking and to predict falls in patients with acute stroke.