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

Physiother Res Int. 2019 Jan;24(1):e1744. doi: 10.1002/pri.1744. Epub 2018 Sep 12.

Abstract

Objective: 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.

Methods: 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).

Results: 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.

Conclusion: 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.

Keywords: accidental falls; attention; stroke; walking.

Publication types

  • Validation Study

MeSH terms

  • Accidental Falls / prevention & control
  • Aged
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mobility Limitation
  • Physical Therapy Modalities
  • Postural Balance*
  • Reproducibility of Results
  • Stroke / physiopathology*
  • Stroke Rehabilitation / standards*
  • Walk Test / standards*
  • Walking