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RehabMeasures Instrument

Trunk Control Test

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Purpose

The TCT measures four simple aspects of trunk movement.

Acronym TCT

Area of Assessment

Balance – Non-vestibular
Functional Mobility

Administration Mode

Paper & Pencil

Cost

Not Free

Cost Description

Cost not known

Diagnosis/Conditions

  • Stroke Recovery

Key Descriptions

  • 4 items:
    1) Rolling to weak side
    2) Rolling to strong side
    3) Balance in sitting position
    4) Sit up from lying down
  • Total score range: 0 (minimum) to 100 (maximum, indicating better performance).
  • Score of each item: (0, 12 or 25)
    0 = unable to perform movement without assistance.
    12 = able to perform movement, but in an abnormal style, for example, pulls on bed clothes, rope or monkey pole, or uses arms to steady self when sitting.
    25 = able to complete movement normally.
  • For the sitting balance item, a patient scores 12 if they need to touch anything with their hands to stay upright, and 0 if they are unable to stay up (by any means) for 30 seconds.
  • Total score of TCT = Sum points (rolling to weak side + rolling to strong side + balance in sitting + sit up from lying down) (Collin & Wade,1990)

Number of Items

4

Equipment Required

  • Bed or treatment table

Time to Administer

Less than 5 minutes

Required Training

Reading an Article/Manual

Age Ranges

Adults

18 - 64

years

Older Adults

65 +

years

Instrument Reviewers

Initially reviewed by Irene Ward, PT, DPT, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012; Updated by Rie Yoshida and Heather Anderson of the StrokEdge II Task Force, Neurology Section, APTA in 3/2016

ICF Domain

Body Structure
Body Function

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

NR

NR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

UR

UR

UR

NR

UR

StrokEDGE

NR

NR

NR

NR

NR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

N/A

N/A

N/A

N/A

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

NR

NR

NR

UR

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

No

No

No

Yes

StrokEDGE

No

No

No

Not reported

TBI EDGE

No

Yes

No

Not reported

Considerations

  • Farriols et al (2009) did not find this tool to be effective in predicting recovery of ambulation in the elderly population following acute illness.

Stroke

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Cut-Off Scores

Stroke: (Collin & Wade, 1990; n = 12 female and n = 24 male patients; age range of male patients = 15-77 years; age range of women = 45-69 years; tested 6, 12 and 18 weeks post stroke)

  • At 18 weeks, scores of 50 or more were associated with recovery of walking

  • Patients scoring under 40 were non-ambulatory

Normative Data

Chronic Stroke: (Verheyden et al., 2006; n = 51,16 females, 35 males, mean age = 65 (11) years, range 39-84 years; median days post stroke = 129 days; 29 patients walked without assistance, 22 patients could not walk without assistance or were non-ambulatory)

  • The median score on TCT was 61 points (61%)

  • Subjects unable to walk without physical assistance had a median score on the TCT of 43 points (24-49)

  • Subjects who were able to walk without physical assistance had a median score on the TCT of 61 points (61-100)

Interrater/Intrarater Reliability

Stroke: (Collin & Wade, 1990) 

  • Excellent interrater reliability (0.76, p < 0.001)

Internal Consistency

Stroke: (Franchignoni et al.,1997; n = 49, mean age = 68 (13) years; average interval from onset of stroke to admission to rehab was 46 days (median, 40; range 31-78 days)) 

  • Cronbach’s index suggests that the items of the TCT describe a homogeneous variable: the values for the TCT at admission and at discharge were alpha = 0.86 and alpha = 0.83, respectively.

Criterion Validity (Predictive/Concurrent)

Predictive Validity:

Stroke: (Duarte et al, 2002; n = 28, mean time after stroke onset= 15.3 (6) days; mean initial disability measured with the FIM and motFIM was 84 (22.4) and 52.7 (19.2); mean TCT= 76.4 (24))

  • The better the initial trunk control patients have, the longer walking distance and the faster speed they achieve at hospital discharge.

    • TCT showed a statistically significant difference (p = 0.003) between patients whose walking distance at discharge was longer than 50 m (mean TCT 88.9 (SD 14.3)) and patients whose walking distance was shorter than 50 m (mean TCT 61.9(25.2)).

    • Excellent correlations were also statistically significant between the TCT and the time required to walk a 10 m straight walkway at a comfortable (= -0.644) and at maximal (= -0.654) safe pace: the better initial TCT was, the higher gait velocities at discharge were.

  • Excellent inverse correlation between TCT and length of stay: hemiparetic patients with worse trunk control at admission stay longer in a rehabilitation ward. (r = -0.722).

  • Excellent correlation between admission TCT scores and FIM at discharge. Total FIM = 0.738, motFIM =0.723.

Construct Validity

Stroke: (Collin & Wade, 1990)

  • Excellent construct validity between the TCT and the gross motor function subscale of the Rivermead Motor Assessment at 6, 12 and 18 weeks post stroke. (r = 0.70 to 0.79)

Floor/Ceiling Effects

Chronic Stroke: (Verheyden et al., 2006)

  • Twelve participants (24%) reached the maximum score of 100 points on the TCT. 

  • This indicates a ceiling effect on the TCT in non-acute and chronic stroke patients.

Responsiveness

Stroke: (Franchignoni et al., 1997)

  • 36 patients (72%) changed the overall TCT score at discharge

  • The TCT test showed a good sensitivity to change

Older Adults and Geriatric Care

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Criterion Validity (Predictive/Concurrent)

Elderly: (Farriols et al., 2009; n = 21 patients, mean age 78.5(6.7) years, who had developed walking disability after prolonged bed rest for an acute condition)

  • Contrary to earlier studies involving younger individuals with stroke, this study failed to show a good correlation between TCT and ability to walk in elderly patients after prolonged bed rest for an acute illness.

Brain Injury

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Criterion Validity (Predictive/Concurrent)

Acquired Brain Injury: (Montecchi et al, 2013; n = 59 patients, mean age 48.9 (14.01) years, who had developed ABI following stroke, head trauma or anoxia)

  • Excellent correlation between TCT and TRS (Trunk Recovery Scale). Spearman’s rank correlation coefficient rs = 0.943; 95% CI: 0.904 – 0.967)

Bibliography

Collin, C. and Wade, D. (1990). "Assessing motor impairment after stroke: a pilot reliability study." Journal of Neurology, Neurosurgery and Psychiatry 53(7): 576-579. Find it on PubMed

Duarte, E., Marco, E., et al. (2002). "Trunk control test as a functional predictor in stroke patients." J Rehabil Med 34(6): 267-272. Find it on PubMed

Farriols, C., Bajo, L., et al. (2009). "Functional decline after prolonged bed rest following acute illness in elderly patients: is trunk control test (TCT) a predictor of recovering ambulation?" Archives of Gerontology and Geriatrics 49(3): 409-412. Find it on PubMed

Franchignoni, F. P., Tesio, L., et al. (1997). "Trunk control test as an early predictor of stroke rehabilitation outcome." Stroke (00392499) 28(7): 1382-1385. Find it on PubMed

Verheyden, G., Nieuwboer, A., et al. (2007). "Clinical tools to measure trunk performance after stroke: a systematic review of the literature." Clinical Rehabilitation 21(5): 387-394. Find it on PubMed

Verheyden, G., Vereeck, L., et al. (2006). "Trunk performance after stroke and the relationship with balance, gait and functional ability." Clinical Rehabilitation 20(5): 451-458. Find it on PubMed

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