Postural Assessment Scale for Stroke
Original Editor Rachael Lowe
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Objective[edit | edit source]
The Postural Assessment Scale for Stroke (PASS) is an outcome measure specifically designed to assess and monitor postural control after stroke. It was developed in 1999 as an adaptation of the Fugl-Meyer Assessment balance subscale[1]. It contains 12 four-level items of varying difficulty for assessing ability to maintain or change a given lying, sitting or standing posture.
Intended Population[edit | edit source]
Stroke patients.
Available Versions[edit | edit source]
The PASS was was originally developed in French and has since been translated into English, Swedish (SwePASS)[2], Turkish (Turk-PASS)[3] and Spanish[4]. There are also shorter modified versions[5].
Method of Use[edit | edit source]
The PASS consists of 2 sections (maintaining posture and changing a posture) with a 4-point scale to describe each task. The total score ranges from 0 - 36 and is as follows:[1]
Maintaining Posture[edit | edit source]
1: Sitting without support
0 = cannot sit
1 = can sit with slight support (e.g. by 1 hand)
2 = can sit for more than 10 seconds without support
3 = can sit for 5 minutes without support
2: Standing with support
0 = cannot stand, even with support
1 = can stand with strong support of 2 people
2 = can stand with moderate support of 1 person
3 = can stand with support on only 1 hand
3: Standing without support
0 = cannot stand without support
1 = can stand without support for 10 seconds or leans heavily on 1 leg
2 = can stand without support for 1 minute or stands slightly asymmetrically
3 = can stand without support for more than 1 minute and at the same time perform arm movements above the shoulder level
4 and 5: Standing on the nonparetic / paretic leg
0 = cannot stand on the leg
1 = can stand on the leg for a few seconds
2 = can stand on the leg for more than 5 seconds
3 = can stand on the leg for more than 10 seconds
Changing a Posture[edit | edit source]
Items 6 to 11 are to be performed with a 50-cm-high examination table, like a Bobath plinth. Items 10 to 12 are to be performed without any support.
Scoring of items 6 to 12 is as follows:
0 = cannot perform the activity
1 = can perform the activity with much help
2 = can perform the activity with little help
3 = can perform the activity without help
The items:
6. Supine to affected side lateral
7. Supine to non-affected side lateral
8. Supine to sitting up on the edge of the table
9. Sitting on the edge of the table to supine
10. Sitting to standing up
11. Standing up to sitting down
12. Standing, picking up a pencil from the floor
Training requirements [edit | edit source]
No specific training is required to complete the PASS, although it is recommended clinicians should have an understanding of balance and falls risk in the stroke population[5].
Evidence[edit | edit source]
Reliability[edit | edit source]
The PASS is deemed as having high reliability[6]. Multiple studies found excellent internal consistency in sub-acute and acute stroke patients[1][7][8][9].
The inter-rater reliability is well supported. The initial developers reported adequate to excellent inter-rater reliability for individual items (average α=0.88, range 0.64-1) and excellent inter-rater reliability for the total score (r=0.99, p<0.001)[1] , however this was on a small sample size. Koçak et al (2019) found complete consistency between 2 researchers with PASS-Turk total scores (ICC = 0.999, 95% CI: 0.998-0.999, and p < .001)[3]. Mao et al. (2002) assessed two clinicans assessing 112 patients at 14 days post stroke and found inter-rater reliability for individual items was adequate to excellent (median α=0.88, range 0.61-0.96) and inter-rater reliability for the total score was excellent (ICC=0.97, 95% CI 0.95-0.98)[7]. Bergqvist, Nasic and Persson (2019) found a percentage agreement of ≥75% in the assessments of 2 physiotherapists of 64 patients using the SwePASS[10].
There is excellent test-retest reliability in chronic stroke patients, with Intra Class Coefficient of 0.84[11] and 0.97[12].
Benaim et al (1999) reported good intrarater reliability for individual items and excellent intrarater reliability for the total score[1]. Persson et al. (2011) found excellent same-day intrarater reliability of the SwePASS in a study of 114 acute stroke patients [13].
Validity[edit | edit source]
PASS is one of the most valid clinical assessments of postural control in stroke patients during the first 3 months after stroke[1].
For construct validity, Estrada-Barranco et al (2021) found it was excellent in the subacute and chronic (6 and 12 month) phases and moderate to excellent in the acute phase, when assessed with the Functional Ambulatory Category, the Wisconsin Gait Scale, the Barthel Index and the Functional Independence Measure[14].
Multiple studies support the predictive validity of the PASS[5]. For example, Mao et al. (2002)[7] found the PASS demonstrated excellent predictive validity at 14, 30, 90 and 180 days post stroke (α=0.86-0.90), as measured using Spearman's p correlation coefficient.
In addition, there is support from various studies for excellent concurrent validity in acute and subacute stroke with the Fugl-Meyer Assessment Modified Balance Scale, Berg Balance, Trunk Impairment Scale and Modified PASS[15].
The support for predictive validity varies. For example the predicted validity ranges from adequate to excellent for function in the shorter term (90 days post-stroke or on discharge from rehabiliation) but poor predictive validity of function longer term (>1 year)[5]. One retrospective study of 341 stroke patients found initial static PASS score, dynamic PASS score and rolling can be predictors for independent ambulation of stroke patients on discharge from inpatient rehabilitation[16].
Responsiveness[edit | edit source]
The PASS is more responsive in moderate to severe stroke than mild stroke, and also more responsive earlier in recovery (>90 days post stroke) than in the later stages[5]. It was found the original PASS has better individual-level responsiveness than the modified short-form PASS[17].
Resources[edit | edit source]
Postural Assessment Scale for Stroke Patients
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Benaim C, Pérennou DA, Villy J, Rousseaux M, Pelissier JY. Validation of a standardized assessment of postural control in stroke patients: the Postural Assessment Scale for Stroke Patients (PASS). Stroke. 1999 Sep;30:1862-8.
- ↑ Persson CU, Hansson PO, Danielsson A, Sunnerhagen KS: A validation study using a modified version of the postural assessment scale for stroke patients: Postural Stroke Study in Gothenburg (POSTGOT). J Neuroeng Rehabil 2011, 8: 57
- ↑ 3.0 3.1 Koçak FA, Kurt EE, Koçak Y, Erdem HR, Tuncay F, Benaim C. Validity and interrater/intrarater reliability of the Turkish version of the postural assessment scale for stroke patients (PASS-Turk). Top Stroke Rehabil. 2019 Jul;26(5):373-381.
- ↑ Cabanas-Valdés R, Girabent-Farrés M, Cánovas-Vergé D, Caballero-Gómez FM, Germán-Romero A, Bagur-Calafat C. Traducción y validación al español de la Postural Assessment Scale for Stroke Patients (PASS) para la valoración del equilibrio y del control postural en pacientes postictus [Spanish translation and validation of the Postural Assessment Scale for Stroke Patients (PASS) to assess balance and postural control in adult post-stroke patients]. Rev Neurol. 2015 Feb 16;60(4):151-8.
- ↑ 5.0 5.1 5.2 5.3 5.4 McDermott A. Stroke Engine. Postural Assessment Scale for Stroke Patients (PASS). Available from: https://strokengine.ca/en/assessments/postural-assessment-scale-for-stroke-patients-pass/. (Accessed 27/06/2022).
- ↑ Chien CW, Hu MH, Tang PF, Sheu CF, Hsieh CL. A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Arch Phys Med Rehabil. 2007 Mar;88(3):374-80
- ↑ 7.0 7.1 7.2 Mao HF, Hsueh IP, Tang PF, Sheu CF, Hsieh CL. Analysis and comparison of the psychometric properties of three balance measures for stroke patients. Stroke 2002; 33: 1022-7
- ↑ Hseih, C-L., Sheu, C-F., Hsueh, I-P., & Wang, C-H. (2002). Trunk control as an early predictor of comprehensive activities of daily living function in stroke patients. Stroke, 33, 2626-30.
- ↑ Chien CW, Lin JH, Wang CH, Hsueh IP, Sheu CF, Hsieh CL. Developing a Short Form of the Postural Assessment Scale for people with Stroke. Neurorehabil Neural Repair. 2007 Jan-Feb;21(1):81-90
- ↑ Bergqvist GM, Nasic S, Persson CU. Inter-rater reliability of the Swedish modified version of the Postural Assessment Scale for Stroke Patients (SwePASS) in the acute phase after stroke. Top Stroke Rehabil. 2019 Jul;26(5):366-372
- ↑ Chien CW, Hu MH, Tang PF, Sheu CF, Hsieh CL. A comparison of psychometric properties of the smart balance master system and the postural assessment scale for stroke in people who have had mild stroke. Arch Phys Med Rehabil. 2007 Mar;88(3):374-80.
- ↑ Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9):656-61
- ↑ Persson, C.U., Hansson, P-O., Danielsson, A., & Sunnerhagen, K.S. (2011). A validation study using a modified version of Postural Assessment Scale for Stroke Patients: Postural stroke study in Gothenburg (POSTGOT). Journal of NeuroEngineering and Rehabilitation, 8, 57-64.
- ↑ Estrada-Barranco C, Cano-de-la-Cuerda R, Abuín-Porras V, Molina-Rueda F. Postural Assessment Scale for Stroke Patients in Acute, Subacute and Chronic Stage: A Construct Validity Study. Diagnostics (Basel). 2021 Feb 21;11(2):365.
- ↑ Shirley Ryan Ability Lab. Postural Assessment Scale Stroke. Available from: https://www.sralab.org/rehabilitation-measures/postural-assessment-scale-stroke (Accessed 27/06/2022).
- ↑ Huang YC, Wang WT, Liou TH, Liao CD, Lin LF, Huang SW. Postural Assessment Scale for Stroke Patients Scores as a predictor of stroke patient ambulation at discharge from the rehabilitation ward. J Rehabil Med. 2016 Mar;48(3):259-64
- ↑ Hsueh IP, Chen KL, Chou YT, Wang YH, Hsieh CL. Individual-level responsiveness of the original and short-form postural assessment scale for stroke patients. Phys Ther. 2013 Oct;93(10):1377-82.
