obta<strong>in</strong>ed from the legal representatives of the participants, as the participants themselves wereunable to give consent. The measurements were performed <strong>in</strong> accordance <strong>with</strong> the guidel<strong>in</strong>esof the Dutch Society of Special Needs Specialists (NVAZ) which are outl<strong>in</strong>ed <strong>in</strong> a code called“Resistance among people <strong>with</strong> an <strong>in</strong>tellectual disability <strong>in</strong> the framework of the Act Govern<strong>in</strong>gMedical-Scientific Research Involv<strong>in</strong>g Humans” [32]. This code <strong>in</strong>tends to guide doctors <strong>in</strong>assess<strong>in</strong>g resistance <strong>in</strong> persons <strong>with</strong> an <strong>in</strong>tellectual disability. Follow<strong>in</strong>g this code, consistentdistress or unhapp<strong>in</strong>ess of the participant was <strong>in</strong>terpreted as a sign of lack of assent, and furtherparticipation <strong>in</strong> the study was reconsidered.Measures and ProtocolsPrior to the measurements, the observers and personal caretakers of the participants completeda checklist that <strong>in</strong>cluded all exclusion criteria. Participants were to be excluded from the study ifthey exhibited any of the exclusion criteria at the time of measurement.As familiarisation, the participants practiced five times prior to formal test<strong>in</strong>g. As Hale et al.[16] have noted, allow<strong>in</strong>g a participant to become familiarized <strong>with</strong> both test and tester may easeproblems concern<strong>in</strong>g misunderstand<strong>in</strong>g of the required tasks ahead. In these practice sessionsthe follow<strong>in</strong>g tasks were found too difficult for the participants to perform: tandem stand<strong>in</strong>g,reach<strong>in</strong>g forward while stand<strong>in</strong>g, turn<strong>in</strong>g one’s trunk while feet are fixed and stand<strong>in</strong>g <strong>with</strong> eyesclosed. Therefore, the protocol was slightly adapted by exclud<strong>in</strong>g these four components whileadd<strong>in</strong>g two new items: walk<strong>in</strong>g on a th<strong>in</strong> l<strong>in</strong>e and walk<strong>in</strong>g on a gymnastic beam (width 30 cm, 40cm above the floor). These two items were added s<strong>in</strong>ce the participants were already familiar <strong>with</strong>these tasks. We co<strong>in</strong>ed the adapted BBS the modified Berg Balance Scale (mBBS). Includ<strong>in</strong>g theaforementioned adaptations, the feasibility and test-retest reliability of the mBBS was exam<strong>in</strong>ed.The mBBS consisted of 12 items, as shown <strong>in</strong> Table 1. The performance on each of these itemswas scored on a 5-po<strong>in</strong>t ord<strong>in</strong>al scale (0-4 po<strong>in</strong>ts), where a score of 0 denotes the <strong>in</strong>ability ofthe participant to perform the task, and a score of 4 is assigned when the participant is able tocomplete the task based on the criterion that has been assigned to it. The maximum score of themBBS is 48 po<strong>in</strong>ts. If a subject did not understand a task, the score of that task was excluded fromthe total score.Dur<strong>in</strong>g test<strong>in</strong>g, two observers completed the score forms <strong>in</strong>dependently and a personalcaretaker <strong>in</strong>structed the participants. In total, two observers and four caretakers participated<strong>in</strong> the study. The observers were physiotherapist students, who performed the study for theirbachelor thesis and were supervised by the first and second author. All observers and caretakerswere <strong>in</strong>structed dur<strong>in</strong>g two separate tra<strong>in</strong><strong>in</strong>g sessions so as to ensure consistency among them.The first tra<strong>in</strong><strong>in</strong>g session was supervised by the first and second author and took 2 h. Theprotocol of the orig<strong>in</strong>al BBS was the topic of the first tra<strong>in</strong><strong>in</strong>g session and a detailed manual wasprovided to each observer. Dur<strong>in</strong>g the five aforementioned practice sessions, both the observersand caretakers practiced us<strong>in</strong>g the <strong>in</strong>structions and scor<strong>in</strong>g procedures. The scor<strong>in</strong>g procedurewas accurately determ<strong>in</strong>ed and the scores of the two observers were compared. The level ofconsistency appeared to be sufficient. After the aforementioned adaptations of the BBS protocol,the second tra<strong>in</strong><strong>in</strong>g session was organised <strong>with</strong> the adapted protocol, which was supervised by thefirst and second author too. This tra<strong>in</strong><strong>in</strong>g session focused on the two new test items.Chapter 6 | 95
Table 1. The 12 items of the mBBS*NumberTest item1. Sitt<strong>in</strong>g unsupported2. Change of position: sitt<strong>in</strong>g to stand<strong>in</strong>g3. Change of position: stand<strong>in</strong>g to sitt<strong>in</strong>g4. Transfers5. Stand<strong>in</strong>g unsupported6. Stand<strong>in</strong>g <strong>with</strong> feet together7. Turn<strong>in</strong>g 360 degrees8. Retriev<strong>in</strong>g objects from floor9. Stool stepp<strong>in</strong>g10. Walk<strong>in</strong>g on a th<strong>in</strong> l<strong>in</strong>e11. Stand<strong>in</strong>g on one leg12. Walk<strong>in</strong>g on a gymnastic beammBBS, modified Berg Balance ScaleData analysesThe data were analyzed us<strong>in</strong>g SPSS 14.0.FeasibilityTo assess feasibility, we held the number of successful measurements per task aga<strong>in</strong>st thetotal number of measurements. As it only makes sense to use a test if there is a reasonablepercentage of successful measurements, feasibility was considered to be sufficient if 85% of themeasurements were successful [33].Test-retest reliabilityTo determ<strong>in</strong>e the test-retest reliability, we computed <strong>in</strong>traclass correlation coefficients (ICC;two-way random, absolute agreement). Reliability was considered to be moderate, if the ICC wasbetween .41 and .60, strong if the ICC was between .61 and .80, good if the ICC was greater than.81 [34] and very good if the ICC was greater than .90 [35]. To assess the <strong>in</strong>ternal consistencybetween the 12 test tasks, we computed Cronbach’s alpha. Internal consistency was acceptableif Cronbach’s alpha was .70 or more [36]. To analyse the level of agreement between the scoresfor test and retest of the dist<strong>in</strong>ct tasks, the proportion of equal scores and its Wilson confidence<strong>in</strong>tervals (CI) were computed, as suggested by Brown et al [37]. The level of agreement wasconsidered to be sufficient if the proportion of equal scores is .80 or more and the Wilson CI(95 % CI) are between .60 and 1.0. Furthermore, we computed the power of the study <strong>with</strong> thehypothesis that the population proportion of agreement is 0.50, tak<strong>in</strong>g a one-sided test andsample size 39 [38, 39].96 | Chapter 6
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Measuring physical fitnessin person
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Rijksuniversiteit GroningenMeasurin
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Chapter 1IntroductionChapter 1 | 9
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overweight [15]. This prevalence is
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2002;40:436-444.19 Temple VA, Frey
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Chapter 2Feasibility and reliabilit
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IntroductionPhysical fitness and he
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GMFCS was presented to the investig
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Body weightTo determine the body we
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Table 1 Results of Wilcoxon rank te
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Calculation of heightThe mean (SD)
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References1 Bouchard C, Shepard RJ,
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37 Rimmer J, Kelly LE, Rosentswieg
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Chapter 3Measuring waist circumfere
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IntroductionChildren and adults wit
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participants. These calculations as
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studies. Randomized Controlled Tria
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of these individuals require more?
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19 Lahtinen U, Rintala P, Malin A.
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problems in both locomotor skills a
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subjects are to be applied to perso
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InleidingVoldoende bewegen en fithe
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verstandelijk niveau en bepaalde mo
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Hieruit bleek, dat de motivatie van
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De leden van de leescommissie, prof
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Judith van der Boom, dank je wel vo
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Curriculum vitaeCurriculum vitae |
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