Consistency between two subjective assessments of activities of daily living: Patient- and occupational therapist-reported judgments.

Purpose: To examine the consistency between patient- and occupational therapist-reported judgments of patients' ability and change in ADL abilities. Materials: Patient- and therapist-reported ADL abilities were assessed using a Visual Analogue Scale, whilst the changes in patients' ADL abilities were reported by patients and therapists using a 15-point Likert-type scale. Methods: Repeated assessments at a 3-week interval were used. 88 inpatients with stroke and 16 occupational therapists were recruited from rehabilitation wards in a medical center. Results: Moderate correlations (rs = .53-.56) were found between the patient- and therapist-reported ADL abilities. The patient-reported scores were significantly lower (ds = .45; ps < .001 at follow-up) than the therapist-reported scores. Only low correlation (r = .33) was found for the change scores. Conclusions: Our findings indicated that there was only a moderate to low correlation between the patients' reports and the therapists' judgments regarding the patients' ADL ability and its change. Because both patients' reports and therapists' judgments affect decisions on rehabilitation, frequent communication may be beneficial for reaching consensus and helpful in managing the interventions.

Comparison of responsiveness of the Barthel Index and modified Barthel Index in patients with stroke.

PURPOSE: To compare the group- and individual-level responsiveness of the Barthel Index (BI) and modified BI (MBI) in patients with early subacute stroke. MATERIALS AND METHODS: The BI and MBI scores of 63, 63, and 55 patients were retrieved at 3 time points with a 3-weeks interval. The group-level responsiveness was examined using paired t-test and standardized response mean (SRM). The individual-level responsiveness was examined by the percentage of patients who achieved significant improvement exceeding the corresponding minimal detectable change. RESULTS: At the group level, the MBI showed significantly larger SRMs than did the BI in the 1st-2nd assessment (1.10 vs. 0.81 [95% CI of mean difference = 0.05-0.38]) and the 2nd-3rd assessment (0.94 vs. 0.72 [95% CI of mean difference = 0.04-0.41]). At the individual level, the MBI detected significantly more patients with significant improvement than the BI for the 1st-2nd assessments only (34.9 vs. 25.4% [95% CI of mean differences = 3.2-17.5]). CONCLUSIONS: The MBI has better responsiveness than the BI at both the group and individual levels in the patients with early subacute stroke. The MBI is recommended for clinical and research use as an outcome measure for patients with stroke.IMPLICATIONS FOR REHABILITATIONThe MBI is recommended for clinical and research applications because of its superior ability to detect subtle changes in ADL performance in patients with subacute stroke.The MBI and the BI have equal responsiveness for patients whose magnitude of improvement of ADL is substantial.

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients.

OBJECTIVES: To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P. DESIGN: Data were retrieved from a previous study wherein 212 patients were assessed at 14 and 30 days after stroke with the BBS and PASS. SETTING: Medical center. PARTICIPANTS: Patients (N=212) with first onset of stroke within 14 days before hospitalization. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Group-level responsiveness was examined by the standardized response mean (SRM), and individual-level responsiveness was examined by the proportion of patients whose change scores exceeded the minimal detectable change of each measure. The responsiveness was compared using the bootstrap approach. RESULTS: The BBS-3P and PASS-3P had good group-level (SRM, .60 and SRM, .56, respectively) and individual-level (48.1% and 44.8% of the patients with significant improvement, respectively) responsiveness. Bootstrap analyses showed that the BBS-3P generally had superior responsiveness to the BBS and SFBBS, and the PASS-3P had similar responsiveness to the PASS and SFPASS. The BBS-3P and PASS-3P were equally responsive to both group and individual change. CONCLUSIONS: The responsiveness of the BBS-3P and PASS-3P was comparable or superior to those of the original and short-form measures. We recommend the BBS-3P and PASS-3P as responsive outcome measures of balance for individuals with stroke.

Test-retest reliability and minimal detectable change of two simplified 3-point balance measures in patients with stroke.

BACKGROUND: The 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) were simplified from the BBS and PASS to overcome the complex scoring systems. The BBS-3P and PASS-3P were more feasible in busy clinical practice and showed similarly sound validity and responsiveness to the original measures. However, the reliability of the BBS-3P and PASS-3P is unknown limiting their utility and the interpretability of scores. AIM: We aimed to examine the test-retest reliability and minimal detectable change (MDC) of the BBS-3P and PASS-3P in patients with stroke. DESIGN: Cross-sectional study. SETTING: The rehabilitation departments of a medical center and a community hospital. POPULATION: A total of 51 chronic stroke patients (64.7% male). METHODS: Both balance measures were administered twice 7 days apart. The test-retest reliability of both the BBS-3P and PASS-3P were examined by intraclass correlation coefficients (ICC). The MDC and its percentage over the total score (MDC%) of each measure was calculated for examining the random measurement errors. RESULTS: The ICC values of the BBS-3P and PASS-3P were 0.99 and 0.97, respectively. The MDC% (MDC) of the BBS-3P and PASS-3P were 9.1% (5.1 points) and 8.4% (3.0 points), respectively, indicating that both measures had small and acceptable random measurement errors. CONCLUSIONS: Our results showed that both the BBS-3P and the PASS-3P had good test-retest reliability, with small and acceptable random measurement error. These two simplified 3-level balance measures can provide reliable results over time. CLINICAL REHABILITATION IMPACT: Our findings support the repeated administration of the BBS-3P and PASS-3P to monitor the balance of patients with stroke. The MDC values can help clinicians and researchers interpret the change scores more precisely.

Improving the utility of the Brunnstrom recovery stages in patients with stroke: Validation and quantification.

The Brunnstrom recovery stages (the BRS) consists of 2 items assessing the poststroke motor function of the upper extremities and 1 assessing the lower extremities. The 3 items together represent overall motor function. Although the BRS efficiently assesses poststroke motor functions, a lack of rigorous examination of the psychometric properties restricts its utility. We aimed to examine the unidimensionality, Rasch reliability, and responsiveness of the BRS, and transform the raw sum scores of the BRS into Rasch logit scores once the 3 items fitted the assumptions of the Rasch model.We retrieved medical records of the BRS (N = 1180) from a medical center. We used Rasch analysis to examine the unidimensionality and Rasch reliability of both upper-extremity items and the 3 overall motor items of the BRS. In addition, to compare their responsiveness for patients (n = 41) assessed with the BRS and the Stroke Rehabilitation Assessment of Movement (STREAM) on admission and at discharge, we calculated the effect size (ES) and standardized response mean (SRM).The upper-extremity items and overall motor items fitted the assumptions of the Rasch model (infit/outfit mean square = 0.57-1.40). The Rasch reliabilities of the upper-extremity items and overall motor items were high (0.91-0.92). The upper-extremity items and overall motor items had adequate responsiveness (ES = 0.35-0.41, SRM = 0.85-0.99), which was comparable to that of the STREAM (ES = 0.43-0.44, SRM = 1.00-1.13).The results of our study support the unidimensionality, Rasch reliability, and responsiveness of the BRS. Moreover, the BRS can be transformed into an interval-level measure, which would be useful to quantify the extent of poststroke motor function, the changes of motor function, and the differences of motor functions in patients with stroke.

Validation and Establishment of an Interval-Level Measure of the Balance Assessment in Sitting and Standing Positions in Patients With Stroke.

OBJECTIVE: To validate the psychometric properties of the Balance Assessment in Sitting and Standing Positions, including validity (unidimensionality and concurrent validity), reliability (Rasch reliability), and responsiveness (compared with the Postural Assessment Scale for Stroke Patients [PASS]) and to transform the Balance Assessment in Sitting and Standing Positions from an ordinal-level measure into an interval-level measure. DESIGN: Retrospective cross-sectional study. SETTING: Medical records from a medical center. PARTICIPANTS: Patients with stroke (N=1193). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4-item Balance Assessment in Sitting and Standing Positions was used, assessing static sitting balance, dynamic sitting balance, static standing balance, and dynamic standing balance. RESULTS: Data of 1193 patients with stroke were included for Rasch analysis. The 4 items of the Balance Assessment in Sitting and Standing Positions constituted a unidimensional construct (infit/outfit mean square, .75-1.05), had good concurrent validity (r=.70-.90), and had sufficient Rasch reliability (.93). The Balance Assessment in Sitting and Standing Positions had large responsiveness (effect size, 1.20; standardized response mean, 1.51) and was comparable with the PASS (effect size, .90; standardized response mean, 1.32). CONCLUSIONS: The Balance Assessment in Sitting and Standing Positions has sound psychometric properties. The transformed-Rasch scores of the Balance Assessment in Sitting and Standing Positions can be used to identify patients' balance function and detect patients' changes.

The impact of stroke: insights from patients in Taiwan.

Clinical stroke trials have been increasing interest in patient-centred assessments such as functional status and health-related quality of life. There is a consensus that these measurement factors must be relevant to, and obtained from, the patients of interest. The main purpose of this study was to evaluate the patients' reactions and concerns that individuals experience after having had a stroke. A focus group and individual interviews were conducted to identify and describe the patients' reactions to living with the results of a stroke. One hundred twelve patients participated in the study. Fifteen factors were identified as problems for the 112 participants. For the level of impact and importance, the highest percentages of responses rated by the participants in each factor were all towards the physical aspects of functioning such as hand/arm function and mobility. These findings provide important information on the impact of stroke that could be useful for occupational therapists in treatment planning and outcome measurement. Further research is recommended to understand the impact of a stroke on an individual's adjustment at home and in the community.