Stroke Outcome Measures Overview

Original Editor - Rachael Lowe

Top Contributors - Sheik Abdul Khadir, Naomi O'Reilly and Evan Thomas  

Introduction

Measuring the effectiveness of interventions is accepted as being central to good practice.  This page presents the best available information on how outcome measures for stroke might be classified and selected for use, based upon their measurement qualities.

EBRSR Review by ICF

The EBRSR reviewed a selection of outcome measures put together a review that provides the best available information on how outcome measures might be classified and selected for use, based upon their measurement qualities[1].

Body structure (impairments) Activities (limitations to activity–disability)
Participation (barriers to participation--handicap)
  • Beck Depression Inventory
  • Behavioral Inattention Test
  • Canadian Neurological Scale
  • Clock Drawing Test
  • Frenchay Aphasia Screening Test
  • Fugl-Meyer Assessment
  • General Health Questionnaire -28
  • Geriatric Depression Scale
  • Hospital Anxiety and Depression Scale
  • Line Bisection Test
  • Mini Mental State Examination
  • Modified Ashworth Scale
  • Montreal Cognitive Assessment
  • Motor-free Visual Perception Test
  • National Institutes of Health Stroke Scale
  • Orpington Prognostic Scale
  • Stroke Rehabiliation Assessment of Movement
  • Action Research Arm Test
  • Barthel Index
  • Berg Balance Scale
  • Box and Block Test
  • Chedoke McMaster Stroke Assessment Scale
  • Chedoke Arm and Hand Activity Inventory
  • Clinical Outcome Variables Scale
  • Functional Ambulation Categories
  • Functional Independence Measure
  • Frenchay Activities Index
  • Motor Assessment Scale
  • Nine-hole Peg Test
  • Rankin Handicap Scale
  • Rivermead Mobility Scale
  • Rivermead Motor Assessment
  • Six Minute Walk Test
  • Timed Up and Go
  • Wolf Motor Function Test
  • Canadian Occupational Performance Measure
  • EuroQol Quality of Life Scale
  • LIFE-H
  • London Handicap Scale
  • Medical Outcomes Study Short- Form 36
  • Nottingham Health Profile
  • Reintegration to Normal Living Index
  • Stroke Adapted Sickness Impact Profile
  • Stroke Impact Scale
  • Stroke Specific Quality of Life

See the full 141 page review

US Agency for HCP&R by Problem

The overview below was developed from the "Post-Stroke Rehabilitation: Assessment, Referral, and Patient Management Quick Reference Guide Number 16", published by the US Agency for Health Care Policy and Research[2].

Type Name Approx time to administer Strengths Weaknesses
Level of consciousness Glasgow Coma Scale 2 minutes Simple, valid, reliable. None observed.
Stroke deficit scales NIH Stroke Scale 2 minutes Brief, reliable, can be administered by non-neurologists. Low sensitivity.
Canadian Neurological Scale 5 minutes Brief, valid, reliable.
Global disability scale Rankin Scale 5 minutes Good for overall assessment of disability. Walking is the only explicit assessment criterion. Low sensitivity.
Measures of disability/activities of daily living (ADL) Barthel Index 5-10 minutes Widely used for stroke. Excellent validity and reliability. Low sensitivity for high-level functioning.
Functional Independence Measure (FIM) 40 minutes Widely used for stroke. Measures mobility, ADL, cognition, functional communication. “Ceiling” and “floor” effects.
Mental status screening FolsteinMini-Mental State Examination 10 minutes Widely used for screening. Several functions with summed score. May misclassify patients with aphasia.
Neurobehavioral Cognition Status Exam (NCSE) 10 minutes Predicts gain in Barthel Index scores. Unrelated to age. Does not distinguish right from left hemisphere. No reliability studies in stroke. No studies of factorial structure. Correlates with education.
Assessment of motor function Fugl-Meyer 30-40 minutes Extensively evaluated measure. Good validity and reliability for assessing sensorimotor function and balance. Considered too complex and time-consuming by many.
Motor Assessment Scale 15 minutes Good, brief assessment of movement and physical mobility. Reliability assessed only in stable patients. Sensitivity not tested.
Motricity Index 5 minutes Brief assessment of motor function of arm, leg, and trunk. Sensitivity not tested.
Balance assessment Berg Balance Assessment 10 minutes Simple, well established with stroke patients, sensitive to change. None observed.
Rivermead Mobility Index 5 minutes Valid, brief, reliable test of physical mobility. Sensitivity not tested.
Assessment of speech and language functions Boston Diagnostic & Aphasia Examination 1-4 hours Widely used, comprehensive, good standardisation data, sound theoretical rationale. Time to administer long; half of patients cannot be classified.
Porch Index of Communicative Ability (PICA) 1/2-2 hours Widely used, comprehensive, careful test development and standardisation. Time to administer long. Special training required to administer. Inadequate sampling of language other than one word and single sentences.
Western Aphasia Battery 1-4 hours Widely used, comprehensive. Time to administer long. “Aphasia quotients” and “taxonomy” of aphasia not well validated.
Depression scales Beck Depression Inventory (BDI) 10 minutes Widely used, easily administered. Norms available. Good with somatic symptoms. Less useful in elderly and in patients with aphasia or neglect.High rate of false positives. Somatic items may not be due to depression.
Center for Epidemiologic Studies Depression (CES-D) < 15 minutes Brief, easily administered, useful in elderly, effective for screening in stroke population. Not appropriate for aphasic patients.
Geriatric Depression Scale (GDS) 10 minutes Brief, easy to use with elderly, cognitively impaired, and those with visual or physical problems or low motivation. High false negative rates in minor depression.
Hamilton Depression Scale < 30 minutes Observer rated; frequently used in stroke patients. Multiple differing versions compromise interobserver reliability.
Measures of instrumental ADL PGC Instrumental Activities of Daily Living 5-10 minutes Measures broad base of information necessary for independent living. Has not been tested in stroke patients.
Frenchay Activities Index 10-15 minutes Developed specifically for stroke patients; assesses broad array of activities. Sensitivity and interobserver reliability not tested; sensitivity probably limited.
Family assessment Family Assessment Device (FAD) 30 minutes Widely used in stroke. Computer scoring available. Excellent validity and reliability. Available in multiple languages. Assessment subjective; sensitivity not tested; “ceiling” and “floor” effects.
Health status/ quality of life measures Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey 10-15 minutes Generic health status scale SF36 is improved version of SF20. Brief, can be self – administered or administered by phone or interview. Widely used in the United States. Possible “floor” effect in seriously ill patients (especially for physical functioning), suggests it should be supplemented by an ADL scale in stroke patients.
Sickness Impact Profile (SIP) 0-30 minutes Comprehensive and well-evaluated. Broad range of items reduces “floor” or “ceiling” effects. Time to administer somewhat long. Evaluates behavior rather than subjective health; needs questions on well-being, happiness, and satisfaction.


References

  1. Katherine Salter, Nerissa Campbell, Marina Richardson, Swati Mehta, Jeffrey Jutai, Laura Zettler, Matthew Moses, Andrew McClure. Outcome Measures in Stroke Rehabilitation. EBRSR, 2013
  2. Post-stroke rehabilitation: assessment, referral, and patient management. U.S. Department of Health and Human Services Public Health Service. Agency for Health Care Policy and Research. Clin Pract Guidel Quick Ref Guide Clin. 1995 May;(16):i-iii, 1-32.