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Outcome Measures in Stroke Rehabilitation

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Outcome Measures in Stroke Rehabilitation EBRSR [Evidence-Based Review of Stroke Rehabilitation] 20 Outcome Measures in Stroke Rehabilitation Katherine Salter PhD (cand.), Nerissa Campbell PhD, Marina Richardson MSc, Swati Mehta PhD (cand.), Jeffrey Jutai PhD, Laura Zettler MSc, Matthew Moses BA, Andrew McClure MSc, Rachel Mays BSc (cand.), Norine Foley MSc, Robert Teasell MD Last Updated: September 2013 Abstract To enhance the clinical meaningfulness of the SREBR, the present review provides the best available information on how outcome measures might be classified and selected for use, based upon their measurement qualities. For this purpose, we have selected for review some of the most commonly-used measures in stroke rehabilitation. The ICF conceptual framework is used to classify measures in stroke rehabilitation and aspects of measurement theory pertinent for evaluating measures are discussed. Each measure reviewed in this chapter was evaluated in terms of appropriateness, reliability, validity, responsiveness, precision, interpretability, applicability and feasibility. All measures were assessed for the thoroughness with which its reliability, validity and responsiveness have been reported. The present document contains summary reviews of 38 assessment tools used in the evaluation of Body Structure (14 tools), Activity (15 tools) and Participation (9 tools) outcomes. 20. Outcome Measures in Stroke Rehabilitation pg. 1 of 141 www.ebrsr.com Table of Contents Abstract .................................................................................................................................................. 1 Table of Contents.................................................................................................................................... 2 20.1 Introduction................................................................................................................................. 4 20.1.1 Domains of Stroke Rehabilitation.............................................................................................................................4 20.1.2 Evaluation Criteria for Outcome Measures..........................................................................................................6 20.1.3 Has the Measure Been Used in a Stroke Population? .....................................................................................8 20.1.4 Has the Measure Been Tested for Use with Proxy Assessment? ................................................................8 20.1.5 What is the Recommended Timeframe for Measurement? .........................................................................9 20.2 Body Structure/Impairment Outcome Measures ........................................................................ 9 20.2.1 Beck Depression Inventory (BDI) ........................................................................................................................... 10 20.2.2 Behavioral Inattention Test (BIT) ........................................................................................................................... 11 20.2.3 Canadian Neurological Scale (CNS) ....................................................................................................................... 15 20.2.4 Clock Drawing Test (CDT) .......................................................................................................................................... 16 20.2.5 Frenchay Aphasia Screening Test (FAST) ............................................................................................................ 18 20.2.6 Fugl-Meyer Assessment of Motor Recovery after Stroke (FMA) ............................................................. 20 20.2.7 General Health Questionnaire – 28 (GHQ-28) ................................................................................................. 22 20.2.8 Geriatric Depression Scale (GDS) ........................................................................................................................... 24 20.2.9 Hospital Anxiety and Depression Scale (HADS) ............................................................................................... 26 20.2.10 Line Bisection Test (LBT) ......................................................................................................................................... 28 20.2.11 Mini-Mental State Examination (MMSE) ......................................................................................................... 29 20.2.12 Modified Ashworth Scale (MAS) ......................................................................................................................... 31 20.2.13 Montreal Cognitive Assessment (MoCA) ......................................................................................................... 33 20.2.14 Motor-free Visual Perception Test (MVPT) .................................................................................................... 35 20.2.15 National Institutes of Health Stroke Scale (NIHSS) ...................................................................................... 36 20.2.16 Orpington Prognostic Scale (OPS)....................................................................................................................... 38 20.2.17 Stroke Rehabilitation Assessment of Movement (STREAM) ................................................................... 40 20.3 Activity/Disability Outcome Measures ...................................................................................... 42 20.3.1 Action Research Arm Test (ARAT) ......................................................................................................................... 42 20.3.2 Barthel Index (BI) .......................................................................................................................................................... 43 20.3.3 Berg Balance Scale (BBS) ........................................................................................................................................... 46 20.3.4 Box and Block Test (BBT) ........................................................................................................................................... 48 20.3.5 Chedoke-McMaster Stroke Assessment Scale (CMSA) ................................................................................ 49 20.3.6 Chedoke Arm and Hand Activity Inventory (CAHAI)...................................................................................... 50 20.3.7 Clinical Outcome Variables (COVS) ....................................................................................................................... 52 20.3.8 Functional Ambulation Categories (FAC) ........................................................................................................... 53 20.3.9 Functional Independence Measure (FIM).......................................................................................................... 54 20.3.9.1 Barthel Index vs. the Functional Independence Measure ...................................................................... 56 20.3.9.2 CIHI - National Rehabilitation Reporting System ........................................................................................ 57 20.3.10 Frenchay Activities Index (FAI) ............................................................................................................................. 57 20.3.11 Modified Rankin Handicap Scale (MRS) ........................................................................................................... 60 20.3.12 Motor Assessment Scale (MAS) ........................................................................................................................... 62 20.3.13 Nine-hole Peg Test (NHPT) .................................................................................................................................... 64 20.3.14 Rivermead Mobility Index (RMI) ......................................................................................................................... 66 20.3.15 Rivermead Motor Assessment (RMA)............................................................................................................... 67 20.3.16 Six-Minute Walk Test (6MWT) ............................................................................................................................. 68 20. Outcome Measures in Stroke Rehabilitation pg. 2 of 141 www.ebrsr.com 20.3.17 Timed “Up & Go” Test (TUG) ................................................................................................................................ 71 20.3.18 Wolf Motor Function Test ...................................................................................................................................... 73 20.4 Participation/Handicap Outcome Measures.............................................................................. 76 20.4.1 Canadian Occupational Performance Measure (COPM) ............................................................................. 76 20.4.2 EuroQol Quality of Life Scale (EQ5D) ................................................................................................................... 79 20.4.3 LIFE-H (Assessment of Life Habits) ........................................................................................................................ 81 20.4.4 London Handicap Scale (LHS) .................................................................................................................................
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