Validnost i pouzdanost A-testa u proceni funkcionalnog kapaciteta obolelih od srčane insuficijencije
Sažetak
Uvod/Cilj. Pre početka rane rehabilitacije, potrebno je obolelima od srčane insuficijencije (heart failure – HF) uraditi procenu funkcionalnog statusa. Iako je Bartelov indeks (BI) dobro poznat, nedavno je u širu kliničku praksu uveden A-test, osmišljen primarno za pacijente iz oblasti traumatologije i ortopedije. Cilj studije bio je da se ispita validnost i pouzdanost A-testa za procenu funkcionalnog stanja obolelih od HF. Metode. U studiju su bili uključeni oboleli od HF, pripadnici oba pola, bez obzira na starost ili ejakcionu frakciju leve komore, klasifikovani prema New York Heart Association (NYHA) I–IV klase, sa rezultatima ≥ 24 na mini-testu mentalnog stanja (Mini-Mental State Examination – MMSE), koji su testirani svakog dana u isto vreme. Dva iskusna viša fizioterapeuta su vršila testiranje i odvojeno popunjavala A-test i BI. Rezultati. Studijom je obuhvaćeno ukupno 77 bolesnika, dve trećine muškog pola, prosečne starosti 72 godine i prosečne ejekcione frakcije 41,83% [standardna devijacija (SD) = 11,46]. Prosečna NYHA klasa na prijemu iznosila je 2,75 (SD = 1,05) a na otpustu 2,42 (SD = 1,12), što je predstavljalo statistički značajno poboljšanje (Z = -4,914, p < 0,001). Validnost sadržaja potvrđena je niskim efektima poda (minimalni skor = 2,0%) i plafona (maksimalni skor = 10,8%), širokim opsegom vrednosti skorova (0–50) i odgovarajućom distribucijom skorova. Konkurentna validnost je potvrđena jakom korelacijom između A-testa i BI (ρ = 0,991, p < 0,001). Prediktivna validnost je dokazane jer je skor A-testa prvog dana značajan prediktor za BI na otpustu (β = 0,880, p ˂ 0,001, 95% confidence interval: 1,087–1,562). Konstruktivna validnost potvrđena je kroz četiri hipoteze. Bolesnici NYHA I i II klase, sa višim rezultatima na MMSE testu i višim ejekcionim frakcijama leve komore, pokazali su značajno bolje rezultate na A-testu. Godine starosti imale su značajan uticaj na rezultate. A-test je pokazao izuzetnu internu konzistentnost (α = 0,971) i visoku pouzdanost između ocenjivača (κ = 0,842). Zaključak. A-test je validan i pouzdan instrument za procenu funkcionalne sposobnosti obolelih od HF.
Reference
Shams P, Malik A, Chhabra L. Heart Failure (Congestive Heart Failure). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2023; 118(17): 3272–87. Erratum in: Cardiovasc Res 2023; 119(6): 1453.
Malik A, Brito D, Vaqar S, Chhabra L. Congestive Heart Fail-ure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
Chamberlain AM, Boyd CM, Manemann SM, Dunlay SM, Gerber Y, Killian JM, et al. Risk Factors for Heart Failure in the Community: Differences by Age and Ejection Fraction. Am J Med 2020; 133(6): e237–48.
Triposkiadis F, Sarafidis P, Briasoulis A, Magouliotis DE, Athana-siou T, Skoularigis J, et al. Hypertensive Heart Failure. J Clin Med 2023; 12(15): 5090.
Bergau L, Bengel P, Sciacca V, Fink T, Sohns C, Sommer P. Atrial Fibrillation and Heart Failure. J Clin Med 2022; 11(9): 2510.
Sabah ZU, Aziz S, Wani JI, Masswary A, Wani SJ. The associa-tion of anemia as a risk of heart failure. J Family Med Prim Care 2020; 9(2): 839–43.
Palazzuoli A, Iacoviello M. Diabetes leading to heart failure and heart failure leading to diabetes: epidemiological and clinical evidence. Heart Fail Rev 2023; 28(3): 585–96.
Siao WZ, Chen YH, Tsai CF, Lee CM, Jong GP. Diabetes Melli-tus and Heart Failure. J Pers Med 2022; 12(10): 1698.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129–200. Erratum in: Eur Heart J 2018; 39(10): 860.
Ilic D, Jovic Z, Mladenovic Z, Pejovic V, Lung B, Kozic A, Obradovic S. Acupuncture and Kinesitherapy Improve Physical Activity More than Kinesitherapy Alone in Patients with Acute De-compensated Chronic Heart Failure with Reduced Ejection Fraction Who Are Already on Optimal Drug Therapy: A Ran-domized, Sham-Controlled, Double-Blind Clinical Study. Bi-omedicines 2025; 13(1): 176.
Delgado B, Novo A, Lopes I, Rebelo C, Almeida C, Pestana S, et al. The effects of early rehabilitation on functional exercise tolerance in decompensated heart failure patients: Results of a multicenter randomized controlled trial (ERIC-HF study). Clin Rehabil 2022; 36(6): 813–21.
Aimo A, Barison A, Mammini C, Emdin M. The Barthel Index in elderly acute heart failure patients. Frailty matters. Int J Cardiol 2018; 254: 240–1.
Motoki H, Nishimura M, Kanai M, Kimura K. Impact of inpa-tient cardiac rehabilitation on Barthel Index score and progno-sis in patients with acute decompensated heart failure. Int J Cardiol 2019; 293: 125–30.
Katano S, Yano T, Ohori K, Kouzu H, Nagaoka R, Honma S, et al. Barthel Index Score Predicts Mortality in Elderly Heart Fail-ure - A Goal of Comprehensive Cardiac Rehabilitation. Circ J 2021; 86(1): 70–8.
Vukomanović A, Djurović A, Popović A, Ilić D. The A-test – reli-ability of functional recovery assessment during early rehabili-tation of patients in an orthopedic ward. Vojnosanit Pregl 2014; 71(7): 639–45.
Vukomanovic А, Djurovic А, Brdareski Z. Diagnostic accuracy of the A-test and cutoff points for assessing outcomes and plan-ning acute and post-acute rehabilitation of patients surgically treated for hip fractures and osteoarthritis. Vojnosanit Pregl 2016; 73(12): 1139–48.
Vukomanović A, Djurović A, Popović Z, Pejović V. The A-test: as-sessment of functional recovery during early rehabilitation of patients in an orthopedic ward – content, criterion and con-struct validity. Vojnosanit Pregl 2014; 71(8): 715–22.
Leonardi M, Lee H, Kostanjsek N, Fornari A, Raggi A, Martinuz-zi A, et al. 20 Years of ICF-International Classification of Functioning, Disability and Health: Uses and Applications around the World. Int J Environ Res Public Health 2022; 19(18): 11321.
Krzoska C. International classification of functioning, disabil-ity and health (ICF) in daily clinical practice: Structure, bene-fits and limitations. Eur Psychiatry 2021; 64(Suppl 1): S63–4.
Ahmed I, Ishtiaq S. Reliability and validity: Importance in Medical Research. J Pak Med Assoc 2021; 71(10): 2401–6.
Li F, Li D, Yu J, Jia Y, Jiang Y, Chen T, et al. Barthel Index as a Predictor of Mortality in Patients with Acute Coronary Syn-drome: Better Activities of Daily Living, Better Prognosis. Clin Interv Aging 2020; 15: 1951–61.
Takabayashi K, Kitaguchi S, Iwatsu K, Morikami Y, Ichinohe T, Yamamoto T, et al. A decline in activities of daily living due to acute heart failure is an independent risk factor of hospital-ization for heart failure and mortality. J Cardiol 2019; 73(6): 522–9.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33(1): 159–74.
Golden L, Rogers JG. Heart Failure Drug Therapy: New Treat-ments, New Guidelines. Tex Heart Inst J 2022; 49(5): e227920.
Spoto A, Nucci M, Prunetti E, Vicovaro M. Improving content validity evaluation of assessment instruments through formal content validity analysis. Psychol Methods 2025; 30(2): 203–22.