Stroke Outcome Measures Overview

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Introduction

This overview 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.

Outcome Measures

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	Folstein Mini-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.