21. Outcome measures in Stroke Rehabilitation

1 1 21. Outcome measures in Stroke Rehabilitation Katherine Salter BA, Jeffrey Jutai PhD, Laura Zettler BHSc, Matthew Moses BA, J. Andrew McClure BA, Norine Foley MSc, Robert Teasell MD 2 Table of Contents Introduction ..3 Domains of Stroke Evaluation Criteria for Outcome Has the Measure Been Used in a Stroke Population? ..8 Has the Measure Been Tested for Use with Proxy Assessment?.. 9 What is the Recommended Timeframe for Measurement? .. 9 Body Structure/Impairment Outcome measures ..10 Beck Depression Inventory (BDI) .. 10 Behavioral Inattention Test (BIT).. 11 Canadian Neurological Scale (CNS) .. 17 Clock Drawing Test (CDT) .. 18 Frenchay Aphasia Screening Test (FAST).. 19 Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA).

2 21 General Health Questionnaire 28 (GHQ-28) .. 22 Geriatric Depression Scale (GDS).. 25 Hospital Anxiety and Depression Scale (HADS) .. 26 Line Bisection Test (LBT).. 28 Mini-Mental State Examination (MMSE) .. 29 Modified Ashworth Scale (MAS).. 31 Montreal Cognitive Assessment (MoCA) .. 33 Motor-free Visual Perception Test (MVPT) .. 35 National Institutes of Health Stroke Scale (NIHSS) .. 36 Orpington Prognostic Scale (OPS) .. 38 Activity/Disability Outcome Action Research Arm Test (ARAT).. 41 Barthel Index (BI).. 42 Berg Balance Scale (BBS) .. 44 Box and Block Test (BBT) .. 45 Chedoke-McMaster Stroke Assessment Scale (CMSA) .. 47 Chedoke Arm and Hand Activity Inventory (CAHAI).. 48 Clinical Outcome Variables (COVS) .. 49 Functional Ambulation Categories (FAC) .. 51 Functional Independence Measure (FIM).

3 52 Barthel Index vs. the Functional Independence Measure .. 54 CIHI - National Rehabilitation Reporting 54 Frenchay Activities Index (FAI) .. 55 3 Modified Rankin Handicap Scale (MRS) ..56 Motor Assessment Scale (MAS) .. 58 Nine-hole Peg Test (NHPT).. 60 Rivermead Mobility Index (RMI) .. 62 Timed Up & Go Test (TUG) .. 63 Wolf Motor Function Test (WMFT).. 65 Participation/Handicap Outcome Canadian Occupational Performance Measure (COPM) ..69 EuroQol Quality of Life Scale (EQ5D) ..72 London Handicap Scale (LHS)..74 Medical Outcomes Study Short Form 36 (SF-36)..76 Nottingham Health Profile (NHP) ..78 Reintegration to Normal Living Index (RNLI) ..80 Stroke -Adapted Sickness Impact Profile (SA-SIP-30)..82 Stroke Impact Scale (SIS) ..84 Stroke Specific Quality of Life Scale (SSQOL) ..85 Conclusions and Evaluation Summaries by ICF 21.

4 Outcome measures in Stroke Rehabilitation Introduction Van der Putten(1999) The Stroke Rehabilitation Evidence-Based Review (SREBR) SREBR ICF clinimetric qualities Finch et al Domains of Stroke Rehabilitation WHO ICF ICF 2001.

5 2002 3 ICIDH ( ) 5 (Brenner et al. 1995; Roberts & Counsell, 1998). 3 ICF ICF 3 1 6 Evaluation Criteria for Outcome measures Reliability( ) Validity( ) Responsiveness( ) Duncan et al.

6 2002; van der Putten et ; Roberts&Counsell,1998;Law,2002 Finch et al (2002) The Health Technology Assessment HTA programme (Fitzpatrick et of Southampton,UK,1998 ) 413 8 standard 7 Table Evaluation Criteria and Standards (Criterion) (Definition (standard) 1. Appropriateness 2. Reliability (internal consistency) (reproducibility) (random error) ICC (split-half reliability) (ICC ) Excellent: ; ; Poor:< Note:Fitzpatrick et al.)

7 (1998) ( ) Excellent: ; ; Poor:< Note:Fitzpatrick et al.(1998) (redundancy) : Adequate levels 3. Validity gold standard gold standard (Finch et ) Excellent , , Poor: ROC AUC: Excellent: , , Poor:< (Riddle&Stratford1999) 8 4. Responsiveness standardized response means relative efficacy ROC detectable change Excellent: < = small = moderate = large ROC Adequate: Evidence Evidence Poor: Evidence P Floor Ceiling Effect: Excellent: Floor Ceiling Effect Adequate: Floor Ceiling Effect 20 Poor: >20% 5.

8 Precision Yes/No 6. Interpretability Jutai&Teasell(2003) 7. Acceptability 8. Feasibility Unless otherwise noted within the table, criteria and definitions: Fitzpatrick et al. (1998); McDowell & Newell (1996). Sources for evaluation standards: 1 Andresen (2000); Hseuh et al. (2001); Wolfe et al. (1991); 2 Andresen (2000);3 Hobart et al. (2001); Fitzpatrick et al. (1998); 4,6 Andresen (2000); McDowell & Newell (1996); Fitzpatrick et al. (1998); Cohen et al. 9 2000; 5 McDowell & Newell (1996); 7 Hobart et al.

9 (2001). MaDowell&Newell(1996) Anderson(2000) Table Evaluation Standards - Rigor Excellent Adequate Poor N/a rigor Table excellent adequate poor Table excellent 3 (proxy assessment) Has the Measure Been Used in a Stroke Population? (Fitzpatrick et al. 1998; Lorentz et al. 2002) Van der Putten 1999 BI FIM MS 10 Buck et William QOL Has the Measure been Tested for Use with Proxy Assessment?

10 : (proxy respondent) (Segal et al. 1996; Sneeuw et al. 1997; Hachisuka et al. 1997) Hachisuka et al. (1997) (Sneeuw et al. 1997; McGinnis et al. 1986) (McGinnis et al. 1986) What is the Recommended Timeframe for Measurement ICF Duncan et Body structure Participation Duncan et Jorgensen et al.