Issues in selecting outcome measures to assess functional recovery after stroke

Abstract

Most patients who survive a stroke experience some degree of physical recovery. Selecting the appropriate outcome measure to assess physical recovery is a difficult task, given the heterogeneity of stroke etiology, symptoms, severity, and even recovery itself. Despite these complexities, a number of strategies can facilitate the selection of functional outcome measures in stroke clinical trial research and practice. Clinical relevance in stroke outcome measures can be optimized by incorporating a framework of health and disability, such as the International Classification of Functioning, Disability, and Health (ICF). The ICF provides the conceptual basis for measurement and policy formulations for disability and health assessment. All outcome measures selected should also have sound psychometric properties. The essential psychometric properties are reliability, validity, responsiveness, sensibility, and established minimal clinically important difference. It is also important to establish the purpose of the measurement (discriminative, predictive, or evaluative) and to determine whether the purpose of the study is to evaluate the efficacy or effectiveness of an intervention. In addition, when selecting outcome measures and time of assessment, the natural history of stroke and stroke severity must be regarded. Finally, methods for acquiring data must also be considered. We present a comprehensive overview of the issues in selecting stroke outcome measures and characterize existing measures relative to these issues.

Persian Translation, Internal Consistency and Reliability of Wolf Motor Function Test

“…Given that in multiple test assessment tools, coefficients higher than 0.7 are considered acceptable; it can be asserted that internal consistency was satisfactory in the version studied. According to Anderson classification, internal consistency higher than or equal to 0.8 is considered excellent, between 0.7 and 0.8 adequate, and less than 0.7 poor [18]. A study showed internal consistency of total score of items of WMFT 0.92.…”

Comparison of quality-of-life instruments for assessing the participation after stroke based on the International Classification of Functioning, Disability and Health (ICF)

“…Stroke was one of the first diseases to receive attention from research groups studying functionality based on the framework of the International Classification of Functioning, Disability and Health (ICF) 6,7 . The theoretical model described by the ICF is based on the use of a biopsychosocial approach that integrates biological, individual and social determinants of health.…”

“…This is in part due to the fact that the components "activity" and "participation" share a single coding list 8 . Thus, the use of instruments previously developed to measure health-related quality of life (HRQoL) constructs have been suggested for use in assessing participation following a stroke 6,11 . According to Geyh et al 12 , both HRQoL and participation are constructs that are geared toward the patient, favoring the interposable use of these concepts.…”

“…However, more recent studies have noted that the concepts on which some items in these instruments are based are not related to the participation component 12,15,16 . Furthermore, although separate assessment of "activity" and "participation" components has been recommended in the literature 6,11 , these components are not differentiated and are therefore listed on a single coding list 8 . Therefore, the categories evaluated in the above-described instruments assess both "activity" and "participation".…”

Assessment of the Influence of Balance on Gait of Persons with Stroke

“…To set suitable therapeutic goals and develop effective treatment plans, predictions need to be made about patients' expected degree of recovery 8) . Selection of assessments is an important process, but it is difficult because of the variability in causes, symptoms, severity, and the possibility of spontaneous recovery following stroke 9) .…”