Stroke Outcome Measures Overview: Difference between revisions
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| Canadian Neurological Scale | | Canadian Neurological Scale | ||
| 5 minutes | | 5 minutes | ||
| Brief, valid, reliable. | | Brief, valid, reliable. | ||
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|- | |- | ||
| Global disability scale | | Global disability scale | ||
| Rankin Scale | | Rankin Scale | ||
| 5 minutes | | 5 minutes | ||
| Good for overall assessment of disability. | | Good for overall assessment of disability. | ||
| Walking is the only explicit assessment criterion. Low sensitivity. | | Walking is the only explicit assessment criterion. Low sensitivity. | ||
|- | |- | ||
| Measures of disability/activities of daily living (ADL) | | Measures of disability/activities of daily living (ADL) | ||
| Barthel Index | | Barthel Index | ||
| 5-10 minutes | | 5-10 minutes | ||
| Widely used for stroke. Excellent validity and reliability. | | Widely used for stroke. Excellent validity and reliability. | ||
| Low sensitivity for high-level functioning. | | Low sensitivity for high-level functioning. | ||
|- | |- | ||
| | | | ||
| Functional Independence Measure (FIM) | | Functional Independence Measure (FIM) | ||
| 40 minutes | | 40 minutes | ||
| Widely used for stroke. | | Widely used for stroke. Measures mobility, ADL, cognition, functional communication. | ||
| “Ceiling” and “floor” effects. | | “Ceiling” and “floor” effects. | ||
|- | |- | ||
| Mental status screening | | Mental status screening | ||
| Folstein Mini-Mental State Examination | | Folstein Mini-Mental State Examination | ||
| 10 minutes | | 10 minutes | ||
| Widely used for screening. | | Widely used for screening. | ||
| Several functions with summed score. May misclassify patients with aphasia. | | Several functions with summed score. May misclassify patients with aphasia. | ||
|- | |- | ||
| | | | ||
| Neurobehavioral Cognition Status Exam (NCSE) | | Neurobehavioral Cognition Status Exam (NCSE) | ||
| 10 minutes | | 10 minutes | ||
| Predicts gain in Barthel Index scores. | | 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 | | Does not distinguish right from left hemisphere. No reliability studies in stroke. No studies of factorial structure. Correlates with education. | ||
|- | |- | ||
| Assessment of motor function | | Assessment of motor function | ||
| Fugl-Meyer | | Fugl-Meyer | ||
| 30-40 minutes Extensively evaluated measure. | | 30-40 minutes Extensively evaluated measure. | ||
| Good validity and reliability for assessing sensorimotor function and balance. | | Good validity and reliability for assessing sensorimotor function and balance. | ||
| Considered too complex and time-consuming by many. | | Considered too complex and time-consuming by many. | ||
|- | |- | ||
| | | | ||
| Motor Assessment Scale | | Motor Assessment Scale | ||
| 15 minutes | | 15 minutes | ||
| Good, brief assessment of movement and physical mobility. | | Good, brief assessment of movement and physical mobility. | ||
| Reliability assessed only in stable patients. Sensitivity not tested. | | Reliability assessed only in stable patients. Sensitivity not tested. | ||
|- | |- | ||
| | | | ||
| Motricity Index | | Motricity Index | ||
| 5 minutes | | 5 minutes | ||
| Brief assessment of motor function of arm, leg, and trunk. | | Brief assessment of motor function of arm, leg, and trunk. | ||
| Sensitivity not tested. | | Sensitivity not tested. | ||
|- | |- | ||
| Balance assessment | | Balance assessment | ||
| Berg Balance Assessment | | Berg Balance Assessment | ||
| 10 minutes | | 10 minutes | ||
| Simple, well established with stroke patients, | | Simple, well established with stroke patients, | ||
sensitive to change. | sensitive to change. | ||
| None observed. | | None observed. | ||
|- | |- | ||
| | | | ||
| Rivermead Mobility Index | | Rivermead Mobility Index | ||
| 5 minutes | | 5 minutes | ||
| Valid, brief, reliable test of physical mobility. | | Valid, brief, reliable test of physical mobility. | ||
| Sensitivity not tested. | | Sensitivity not tested. | ||
|- | |- | ||
| Assessment of speech and language functions | | Assessment of speech and language functions | ||
| Boston Diagnostic & Aphasia Examination | | Boston Diagnostic & Aphasia Examination | ||
| 1-4 hours | | 1-4 hours | ||
| Widely used, comprehensive, good | | Widely used, comprehensive, good standardisation data, sound theoretical rationale. | ||
| Time to administer long; half of patients cannot be classified. | | Time to administer long; half of patients cannot be classified. | ||
|- | |- | ||
| | | | ||
| Porch Index of Communicative Ability (PICA) | | Porch Index of Communicative Ability (PICA) | ||
| 1/2-2 hours | | 1/2-2 hours | ||
| Widely used, comprehensive, careful test development and standardisation. | | 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. | | Time to administer long. Special training required to administer. Inadequate sampling of language other than one word and single sentences. | ||
|- | |- | ||
| | | | ||
| Western Aphasia Battery | | Western Aphasia Battery | ||
| 1-4 hours | | 1-4 hours | ||
| Widely used, comprehensive. | | Widely used, comprehensive. | ||
| Time to administer long. “Aphasia quotients” and “taxonomy” of aphasia not well validated. | | Time to administer long. “Aphasia quotients” and “taxonomy” of aphasia not well validated. | ||
|- | |- | ||
| Depression scales | | Depression scales | ||
| Beck Depression Inventory (BDI) | | Beck Depression Inventory (BDI) | ||
| 10 minutes | | 10 minutes | ||
| Widely used, easily administered. Norms available. | | 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. | | 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) | | Center for Epidemiologic Studies Depression (CES-D) | ||
| | | < 15 minutes | ||
| Brief, easily administered, useful in elderly, effective for screening in stroke population. | | Brief, easily administered, useful in elderly, effective for screening in stroke population. | ||
| Not appropriate for aphasic patients. | | Not appropriate for aphasic patients. | ||
|- | |- | ||
| | | | ||
| Geriatric Depression Scale (GDS) | | Geriatric Depression Scale (GDS) | ||
| 10 minutes | | 10 minutes | ||
| Brief, easy to use with elderly, cognitively impaired, and those with visual or physical problems or low motivation. | | 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. | | 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. | |||
|} | |} | ||
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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. |
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