Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis

Park, Chang Sik; An, Seung Heon

doi:10.1589/jpts.28.2264

Cited by 21 publications

(15 citation statements)

References 19 publications

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“…The ambulatory status of stroke patients was used as a tool to measure functional outcomes in both SSU and NSU. The inter-and intra-reliability and high validity of ambulation as an assessment tool for functional recovery in the mobility of stroke patients is well reported in the literature (Tsang et al, 2014;Park et al, 2016). All patients that did not have their ambulatory status defined at admission or discharge were excluded from the analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

M.D.¹,

Blum²,

Brechtel³

et al. 2017

J Exp Stroke Transl Med

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Background-The disparities in stroke care between specialized stroke units and non-stroke units have been reported. While most of the existing studies investigated how intrinsic characteristics of specific treatment units have impact on the outcomes, the influence of patients' characteristics on functional outcomes of recombinant tissue plasminogen activator-treated patients in specialized stroke units and non-stroke units is not fully understood. Method-The demographic and clinical risk factors that significantly impact functional improvement outcomes in recombinant tissue plasminogen activator-treated acute ischemic stroke in the non-stroke unit and the specialized stroke unit were determined. Univariate analysis was used to determine improved functional differences, while adjusted multivariable models were used to determine the association between demographic and clinical variables on the functional outcome. Results-In stroke patients that received recombinant tissue plasminogen activator in the specialized stroke unit and the non-stroke unit, a history of previous transient ischemic attack (ORadj, 0.347, 95% CI (0.160, 0.752); p=0.007) and patients taking antiplatelet medications (ORadj, 1.954, 95% CI (1.116, 3.421, p=0.019) were significantly associated with improved functional outcome. Patients with a history of carotid artery stenosis (ORadj, 5.265, 95% CI (1.067, 2.977), p=0.041) and a history of transient ischemic attack (ORadj, 0.295, 95% CI (0.100, 0.872), p=0.027) were significantly associated with improved functional outcome following treatment with recombinant tissue plasminogen activator in the specialized stroke unit. In the adjusted model analysis for the non-stroke unit, the major predictors of functional outcome were: the NIH stroke scale (ORadj=1.381, 95% CI (1.086, 1.757), p=0.009), the risk of mortality (ORadj =0.691, 95% CI (0.518, 0.922) p=0.012), female gender (ORadj=0.306, 95% CI (0.120, 0.778), p=0.013), and race/ethnicity (ORadj=0.285, 95% CI (0.084, 0.970), p=0.045). Conclusion-After the adjusted analysis, the specialized stroke unit and non-stroke unit reveal significantly improved functional outcomes for patients treated with recombinant tissue plasminogen activator in few clinical variables. Values for functional outcomes were not significantly associated with most of the variables for treated patients in both the specialized stroke unit and non-stroke unit even after adjustment in the recombinant tissue plasminogen activator-treated stroke population.

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Section: Discussionmentioning

confidence: 99%

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

M.D.¹,

Blum²,

Brechtel³

et al. 2017

J Exp Stroke Transl Med

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“…The associative group significantly improved in their median (interquartile range, IQR) lower extremity LE-FM from 23.5(18.75-26.25) to 32(26.25-32), Z = 3.06, p = 0.002. The sham group also significantly improved from 25.5(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) to 29.5 (21-31), Z = 2.63, p = 0.009. However, there was a significant median absolute pre-post intervention difference between the associative (6.5, 3.5-8.25) and sham (3, 0.75-3) groups, indicating that the associative group improved significantly more on the LE-FM compared to the sham group, Z = 2.19, p = 0.029, 95%CI: [1, 6].…”

mentioning

confidence: 90%

“…Assessment were made by a clinician blinded to the protocol and included the modified Ranking scale score (mRS) 14 , LE-FM motor performance assessment 15 , the Ashworth scale for spasticity (ASS) of the affected leg 16 and the functional ambulation classification (FAC) scale 17 and the 10m walk test at their fastest pace 18 . The choice of using only one trained clinician was based on previous literature that demonstrated high test-retest and interrater reliability of the mRS scale 19,20 , LE-FM scale 21 , the ASS scale 22 and the FAC scale 23 .…”

Section: Clinical and Behavioral Measuresmentioning

confidence: 99%

Brain state–dependent stimulation boosts functional recovery following stroke

Mrachacz-Kersting

Stevenson

Jørgensen

et al. 2018

Annals of Neurology

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Objective: Adjuvant protocols devised to enhance motor recovery in subacute stroke patients have failed to show benefits with respect to classic therapeutic interventions. Here we evaluate the efficacy of a novel brain-state dependent intervention based on known mechanisms of memory and learning, that is integrated as part of the weekly rehabilitation program in subacute stroke patients. Methods: Twenty-four hospitalized subacute stroke patients were randomly assigned to two intervention groups; 1. The associative group received thirty pairings of a peripheral electrical nerve stimulus (ES) such that the generated afferent volley arrived precisely during the most active phase of the motor cortex as patients attempted to perform a movement; 2. In the control group the ES intensity was too low to generate a stimulation of the nerve. Functional (including the lower extremity Fugl-Meyer assessment (LE-FM; primary outcome measure)) and neurophysiological (changes in motor evoked potentials (MEPs)) assessments were performed prior to and following the intervention period. Results: The associative group significantly improved functional recovery with respect to the control group (median (interquartile range) LE-FM improvement: 6.5 (3.5-8.25) and 3 (0.75-3), respectively; p=0.029). Significant increases in MEP amplitude were seen following all sessions in the associative group only (p's≤0.006).

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“…15 MFAC divided gait into seven categories (Category I to Categories VII), ranging from no ability to walk and requires manual assistance to sit or is unable to sit for 1 min without back or hand support (MFAC 1; Category: I, stage: Lyer) to the ability to walk independently on level and non-level surfaces, stairs, and inclines (MFAC 7; Category: VII, stage: Outdoor walker). 9 The inter-rater reliability of the MFAC (intraclass correlation coefficient (ICC)) was 0.982 (0.971–0.989), with a kappa coefficient of 0.923 and a consistency ratio of 94% for stroke patient 12 and the ICC of the MFAC in patients with hip fractures is 0.96, with a construct validity of r=0.81 on the Elderly Mobility Scale (EMS). 9…”

Section: Methodsmentioning

confidence: 99%

“…Modified Functional Ambulation Category (MFAC) is a 7-point Likert Scale 9 which is easy-to-use, inexpensive and commonly used to classify walking capacity of patients with stroke in Hong Kong 10,11 and Korea. 12 The objective of the study was to explore whether MFAC can serve as a stratification tool of patients with stroke in inpatient rehabilitation.…”

Section: Introductionmentioning

confidence: 99%

Stratification of stroke rehabilitation: Five-year profiles of functional outcomes

Chung

2018

Hong Kong Physiother. J.

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Background: Stroke rehabilitation in inpatient setting requires high intensity of manpower and resources. Early stratification of patients with stroke could facilitate early discharge plan and reduce avoidable length of stay (LOS) in hospital. Stratification of patients with stroke in clinical setting is usually based on functional scores which are quite time-consuming and require a special training to complete the full score. Objective: The objective of the study was to explore whether Modified Functional Ambulation Category (MFAC) can serve as a stratification tool of patients with stroke in inpatient rehabilitation. Methods: This was a retrospective, descriptive study of the demographic, functional outcomes of patients with stroke in an inpatient rehabilitation center. A total of 2,722 patients completed a stroke rehabilitation program from 2011 to 2015 were recruited. The patients were divided into seven groups according to their admission MFAC. The between-group difference in LOS, functional outcomes at admission and discharge including Modified Rivermead Mobility Index (MRMI) and Modified Barthel Index (MBI) as well as MRMI gain, MRMI efficiency, MBI gain, and MBI efficiency were analyzed. Results: Subjects with admission categories of MFAC 2 and 3 had a highly significant ([Formula: see text]) MRMI gain (6.2 and 6.6, respectively) and subjects with admission categories of MFAC 3 to 5 had highly significant ([Formula: see text]) MRMI efficiency (0.34, 0.40, and 0.39, respectively). The subjects with admission categories of MFAC 2 to 5 had a highly significant ([Formula: see text]) MBI gain (9.7, 10.2, 9.3, and 7.0, respectively) and the subjects with admission categories of MFAC 4 to 5 had a highly significant ([Formula: see text]) MBI efficiency (0.70 and 0.72, respectively). The subjects with admission categories of MFAC 1 and 2 had a highly significant ([Formula: see text]) LOS (27.7 and 26.6, respectively). MFAC profile was also established to represent the distribution of discharge MFAC of subjects according to their admission MFAC. The chance of subjects with admission categories of MFAC 1 and MFAC 2 progress to any kind of walker (MFAC [Formula: see text] 2) is 12.7% and 58.2%, respectively. The chance of subjects with admission MFAC 3, MFAC 4 and MFAC 5 progress to independent walker (MFAC [Formula: see text] 5) is 6.7%, 14.8%, and 50.3%, respectively. Both admission MFAC and admission MBI had strong correlations with discharge MFAC ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively), discharge MRMI ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively) and discharge MBI ([Formula: see text], [Formula: see text] and [Formula: see text], [Formula: see text], respectively). Conclusion: This study showed that patients on admission with moderate disability in term of MFAC had the greatest mobility gain and basic activities of daily living (ADL) gain from inpatient stroke rehabilitation. Admission MFAC could be a stratification tool of patients with stroke in inpatient rehabilitation.

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Reliability and validity of the modified functional ambulation category scale in patients with hemiparalysis

Cited by 21 publications

References 19 publications

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Clinical risk factors associated with functional outcomes of thrombolytic therapy in stroke and non-stroke units

Brain state–dependent stimulation boosts functional recovery following stroke

Stratification of stroke rehabilitation: Five-year profiles of functional outcomes

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