Stroke Outcome Measures Overview
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Introduction[edit | edit source]
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[edit | edit source]
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) |
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US Agency for HCP&R by Problem[edit | edit source]
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 | 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. |
References[edit | edit source]
- ↑ Katherine Salter, Nerissa Campbell, Marina Richardson, Swati Mehta, Jeffrey Jutai, Laura Zettler, Matthew Moses, Andrew McClure. Outcome Measures in Stroke Rehabilitation. EBRSR, 2013
- ↑ 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.