Stroke Outcome Measures Overview
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Introduction[edit | edit source]
This overview was developed from the "Post-Stroke Rehabilitation: Assessment, Referral, and Patient Management Quick Reference Guide Number 16",
| 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. |
