Translating measurement findings into rehabilitation practice: an example using Fugl-Meyer Assessment-Upper Extremity with patients following stroke. Poor functional recovery after a critical illness: a longitudinal study. Relationships between upper-limb functional limitation and self-reported disability 3 months after stroke. The relation between impairments and functional outcomes poststroke. Restrictions of the Mini-Mental State Examination in acute stroke. Development and validation of a physical performance instrument for the functionally impaired elderly: the Physical Disability Index (PDI). Berg Balance Scale and Functional Reach: determining the best clinical tool for individuals post acute stroke Evaluation of a comprehensive rehabilitation program for post-treatment patients with cancer. Development and validation of a muscular dystrophy-specific functional rating scale Assessing the functional status of older patients with chronic illness. Analysis and Comparison of the Psychometric Properties of Three Balance Measures for Stroke Patients Variables Explaining Functional Recovery Following Motor Stroke A community-based group exercise program for persons with chronic stroke. Examining the factor structure of the recovery assessment scale. Validity of a brief outpatient functional assessment measure. A Multidimensional Measure of Caregiving Appraisal: Validation of the Caregiver Appraisal Scale in Traumatic Brain Injury Outcomes among older people in a post-acute inpatient rehabilitation unit
St and ardized assessment s are critical for advancing clinical rehabilitation , yet assessment scores often provide little information for rehabilitation treatment planning . A keyform recovery map is an innovative way for a therapist to record patient responses to st and ardized assessment items . The form enables a therapist to view the specific items that a patient can or can not perform . This information can assist a therapist in tailoring treatments to a patient 's individual ability level . We demonstrate how a keyform recovery map can be used to inform clinical treatment planning for individuals with stroke-related upper-limb motor impairment . A keyform map of poststroke upper-limb recovery defined by items of the Fugl-Meyer Assessment -Upper Extremity ( FMA-UE ) was generated by a previously published Rasch analysis . Three individuals with stroke enrolled in a separate research study were r and omly selected from each of the three impairment strata of the FMA-UE . Their performance on each item was displayed on the FMA-UE keyform . The forms directly connected qualitative descriptions of patients ' motor ability to assessment measures , thereby suggesting appropriate shorter and longer term rehabilitation goals . This study demonstrates how measurement theory can be used to translate a st and ardized assessment into a useful , evidence -based tool for making clinical practice decisions OBJECTIVE To determine the time course of functional health status , and to inventory impairments in body functions , limitations in activities , and restrictions in participation after critical illness . DESIGN Prospect i ve observational cohort study . SETTING Mixed medical and surgical closed format ; intensive care unit of an academic medical hospital . PATIENTS Consecutive patients over a period of 3 months who were ventilated in the intensive care unit for more than 48 h ( n = 116 ) . METHODS Functional health status was assessed 3 , 6 and 12 months after discharge from the intensive care unit using the Sickness Impact Profile 68 . Impairments in function , limitations in activities , and restrictions in participation , classified according to the International Classification of Functioning , Disability , and Health ( ICF ) , were evaluated after 3 and 12 months . RESULTS Due to a high mortality rate ( 48 % ) and poor health conditions , data could not be obtained from all participants at all measurement points . Physical functioning and social behaviour improved predominantly within the first 6 months , while impaired psychological functioning remained unchanged within one year after discharge from the intensive care unit . After one year , 69 % of patients were still restricted in performing daily activities and only 50 % had resumed work . CONCLUSION The extent and severity of lasting intensive care unit-related disability necessitates the development of multidisciplinary after-care to improve health status , functional independence and return to work This study explored relationships between upper-limb ( UL ) functional limitations and self-reported disability in stroke patients with relatively pure motor hemiparesis who were enrolled in an acute rehabilitation treatment trial . All participants were enrolled in the VECTORS ( Very Early Constraint Treatment for Recovery from Stroke ) study . VECTORS is a single-center pilot clinical trial of early application of constraint-induced movement therapy ( CIMT ) . All 39 subjects who completed 90 days of VECTORS  were included in this analysis . Trained study personnel who were blinded to the treatment type performed all evaluations . Data in this article examine relationships between assessment s performed 90 days after stroke . Functional limitation measures included the Action Research Arm ( ARA ) test and Wolf Motor Function Test ( WMFT ) , and self-reported disability measures included the Functional Independence Measure ( FIM ) and Motor Activity Log ( MAL ) ( by telephone ) . Mean plus or minus st and ard deviation time from stroke onset to r and omization was 9.4 plus or minus 4.3 days , and median time to follow-up was 99 days ( range 68 - 178 ) . Subjects with perfect or near-perfect scores on the ARA test or WMFT reported residual disability on the FIM and MAL . Quality of movement on the WMFT ( functional ability score ) was not strongly associated with self-reported frequency , and speed of movement on the WMFT ( timed score ) was not associated with self-reported frequency ( MAL amount of use ) . In this early UL intervention trial , we found that perceived disability measures captured information that was not assessed by functional limitation and impairment scales . Our results indicate that excellent motor recovery as measured by functional limitation and impairment scales did not equal restoration of everyday productive UL use and speed of task completion did not translate to actual use . Our results confirm the need for a measurement strategy that is sensitive to change , assesses a broad performance range , and detects meaningful clinical improvements in early rehabilitation intervention trials OBJECTIVE To assess the influence of initial stroke impairments on the severity of basic and higher level functional deficits over time and to determine the cumulative impact on functional deficits beyond severity of motor deficits alone . DESIGN Observational study . SETTING Twelve participating hospitals in the Greater Kansas City area , as part of the Kansas City Stroke Study ( October 1995-March 1998 ) . PARTICIPANTS Individuals ( n = 459 ) who sustained an eligible stroke were evaluated prospect ively using st and ardized assessment s at enrollment ( within 14 days of stroke onset , 8.8 + /- 3.5 days ) . MAIN OUTCOME MEASURES Mobility and activities of daily living ( ADLs ) were assessed at 1 , 3 , and 6 months poststroke using the Functional Independence Measure , Barthel index , Lawton Instrumental Activities of Daily Living ( IADL ) , and the Medical Outcomes Study Short-Form Health Survey instruments . RESULTS The cumulative probability of achieving independence with walking , a Barthel index of 60 or greater or 90 or greater , and independence in 3 or more IADL was significantly different for the following 4 impairment groups in descending order : motor ; motor and somatosensory ; motor and hemianopia ; and motor , sensory , and hemianopia . Although motor severity was a strong predictor of outcome ( p < .0001 ) , the additional somatosensory and hemianopia deficits significantly ( p < .05 ) affected time and likelihood of achieving these levels of function . CONCLUSION Cumulative deficits poststroke affect patients ' functional outcome in the first 6 months poststroke beyond the effect of motor severity alone While the Mini-Mental State Examination ( MMSE ) was originally developed to screen for dementia and delirium , many neurologists use this measure as a screening instrument for ' cognitive impairment ' in hospitalized stroke patients . However , the validity of the MMSE as such has never been evaluated in acute stroke . We administered the MMSE in addition to a neuropsychological examination covering six cognitive domains to 34 stroke patients ( mean interval between stroke and examination , 6.5+/-2.9 days ) and 34 healthy controls . The area under the receiver operating characteristic curve ( AUC ) was calculated in addition to the sensitivity and specificity for various cut-off points on the MMSE . Seventy percent of the patients were impaired in at least one cognitive domain . The accuracy of the MMSE  in detecting cognitive impairment was no better than chance ( AUC = 0.67 ; p = 0.13 ) . No optimum MMSE cut-off value could be identified . The MMSE is particularly insensitive to impairments in abstract reasoning , executive functioning , and visual perception/construction Article describes development of the Physical Disability Index ( PDI ) , an observer-administered , performance-based instrument measuring physical disability in frail-elderly persons without severe cognitive impairment . Sixty-five items in four subscales encompassing Range of Motion ( ROM ) , Strength ( STR ) , Balance ( BAL ) , and Mobility ( MOB ) were measured . Subjects were r and omly selected frail nursing home residents ( N = 103 ) with a Folstein Mini-Mental State Exam ( MMSE ) score of > or = 11 . Using correlation matrices , cluster analysis , and regression techniques , the scale was reduced to 54 items . All individual item values were st and ardized and aggregated into subscale and summary PDI scores , each with a range of 0 - 100 . Test-retest and interrater reliability were evaluated . Discriminant and convergent validity were established using MMSE , Physical Self-Maintenance Scale ( PSMS ) , and Sickness Impact Profile-Physical Dimension ( SIP-PD ) . PDI is a performance-based instrument that appears to discriminate among frail individuals with differing levels of physical function . Further testing is warranted in other population s of frail-elderly persons to ascertain its applicability and generalizability Objective : To begin the process of determining the best clinical tool for measuring balance in individuals post stroke . Design : Prospect i ve with descriptive and relational analyses . Setting : Rehabilitation centres and stroke support group meetings . Subjects : Seventy-five subjects who had suffered a stroke were divided into four groups based on the Duncan classification for stroke severity . Main outcome measures : The motor section of the Fugl-Meyer Assessment of Physical Performance was completed for each person to classify the motor deficit . Subjects performed  Functional Reach  twice with the nonparetic arm and the average was recorded . Subjects performed the Berg Balance Scale and the total score on the first attempt was recorded . Results : As motor impairment increased , balance ability declined and both the Functional Reach and Berg Balance Scale proved sensitive to this decline . Spearman rank correlation coefficient was excellent among the entire sample ( rs-0.78 ) . Conclusion : Subjects ' performance on the Berg Balance Scale was closely associated with performance on the Functional Reach . Therefore , the clinician may elect to use the shorter Functional Reach as a measure of balance where efficient use of time is the primary goal PURPOSE / OBJECTIVES To evaluate the effects of a rehabilitation program on quality of life , fatigue , fear of movement ( kinesiophobia ) , distress , anxiety , depression , and physical condition . DESIGN Pretest/post-test . SETTING An outpatient rehabilitation setting in the Oncology Centre at the University Hospital Brussels in Belgium . SAMPLE 36 patients who had completed cancer treatment with a curative potential . METHODS Participants completed a question naire and underwent a physical test at baseline and at the end of the program . The measurement instruments used included the European Organisation for Research and Treatment of Cancer Quality -of-Life Question naire-Core 30 , Functional Assessment of Cancer Therapy-Fatigue , Hospital Anxiety and Depression Scale , R AND -36 , Tampa Scale for Kinesiophobia , Distress Barometer , and Tecumseh Step Test . MAIN RESEARCH VARIABLES Quality of life , fatigue , kinesiophobia , distress , anxiety , depression , and physical condition . FINDINGS Significant improvement was observed in quality of life ( p < 0.001 ) , physical condition ( p = 0.007 ) , fatigue ( p = 0.01 ) , and depression ( p = 0.012 ) . In contrast , kinesiophobia ( p = 0.229 ) , distress ( p = 0.344 ) , and anxiety ( p = 0.101 ) did not change significantly . CONCLUSIONS A general and significant improvement in all aspects affecting quality of life and rehabilitation was observed , but less so for aspects that might be influenced by prognostic concerns . The relative contribution of the program versus spontaneous recovery and long-term impact need to be determined further in a prospect i ve r and omized study . IMPLICATION S FOR NURSING Multidisciplinary rehabilitation should become part of the total care plan for patients with cancer Objective : To develop a reliable and valid new rating scale for measuring the functional impact of muscular dystrophy . Design : Prospect i ve and longitudinal investigation . Setting : Three academic medical centres in Taiwan and the Muscular Dystrophy Association of Taiwan . Measures : The Brooke Scale , the Vignos Scale , the Barthel Index , muscular strength , contracture severity , and predicted forced vital capacity ( FVC% ) . Methods : Scale development was in three stages . In stage I , a preliminary pool of 53 items was generated from patient interviews ( n-/25 ) , literature review , existing functional rating scales and expert opinion . In stage II , these items were administered to 85 patients with muscular dystrophy . The result ing data were analysed to construct a rating scale ( the Muscular Dystrophy Functional Rating Scale , MDFRS ) that encompassed four unidimensional constructs : mobility , basic activities of daily living , arm function and impairment . In stage III , the measurement properties of this rating scale were assessed in 121 muscular dystrophy patients different from those examined with the preliminary instrument . Results : Internal consistency reliability was excellent for all domains of the final 33-item scale , with values of Cronbach ’s alpha ranging from 0.84 to 0.97 . Intraclass correlation coefficients for test-retest and inter-rater reliability were 0.99 for all domains of the MDFRS . The MDFRS showed moderate to high correlations with a range of functional rating scales measuring similar aspects and impairment parameters ( Spearman ’s rho=0.65 - 0.91 ; P<0.001 , each ) . Confirmatory factor analysis supported a unitary construct of the four-dimensional MDFRS . The MDFRS had small floor and ceiling effects in the study sample s. Sensitivity to change was confirmed by large st and ardized response means for the MDFRS total score . Conclusions : The MDFRS is a reliable and valid disease-specific measure of functional status for patients with muscular dystrophy The purpose of this study was to investigate the value of using a vali date d functional assessment instrument , the  Sickness Impact Profile ( SIP )  , with older , chronically ill patients seeking care at the family physician 's office . The SIP was completed by the patient and the family physician on patients 55 years of age or older who were seen at a family practice residency clinic . The study used stratified , r and om assignment in an experimental design to compare physician and patient reaction to the SIP . Both physicians ( residents and faculty ) and patients felt the SIP was useful in detecting disabilities . Approximately half of the physicians felt the SIP was helpful in patient management . Patients reported twice as many disabilities as were reported by physicians . Half of the clinic physicians had the opportunity to review a patient 's SIP immediately prior to a visit . They recognized more disabilities and agreed more often with the patients about the presence of a disability . The physicians felt the SIP was too lengthy to assimilate easily into the clinic setting . Use of a functional assessment instrument is advocated because of its ability to increase both physician awareness and physician-patient communication regarding the presence of a functional deficit Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures Abstract : Few well‐ design ed descriptive studies focus exclusively on patients after motor stroke . This study describes a cohort of participants after motor stroke and assesses the extent to which five key variables explain the variation in functional recovery 3 months after stroke . Prospect i ve data were collected ( N = 100 ) on age , lesion volume , motor strength , cognition , and poststroke function during the acute care hospital admission . Instruments included magnetic resonance imaging ( MRI ) to provide a measure of lesion volume , the  Mini‐Mental State Examination ( MMSE ) and the Neurobehavioral Cognitive Status Examination ( NCSE )  to measure cognitive status , and the  National Institutes of Health Stroke Scale ( NIHSS ) to measure motor strength . The Functional Independence Measure ( FIMTM ) was used to measure baseline function and functional recovery 3 months after stroke . Descriptive and hierarchical multiple regression analyses were used to describe the cohort and predict functional recovery . The means for key variables during acute care were 65 ( ±15 ) years of age , lesion volume  21.5 ( ±44.7 ) cm3 , NIHSS 6.34 ( ±3.55 ) , MMSE 24.38 ( ±4.82 ) , NCSE 64.33 ( ±13 ) , and FIMTM 94.05 ( ±19.31 ) . Age , cognitive status , and initial function accounted for 42 % of the variance in functional recovery 3 months after stroke . Results indicate that neuroscience nurses need to add cognition to their focus during the fast‐paced acute phase of care following motor stroke PURPOSE The purpose of this study was to evaluate the physical and psychosocial effects of an 8-wk community-based functional exercise program in a group of individuals with chronic stroke . METHODS Twenty-five subjects ( mean age 63 yr ) participated in a repeated measures design that evaluated the subjects with two baseline assessment s 1 month apart , one postintervention assessment , and one retention assessment 1 month postintervention . Physical outcome measures assessed were the Berg Balance Test , 12-Minute Walk Test distance , gait speed , and stair climbing speed . Psychosocial measures assessed were the Reintegration to Normal Living Index ( RNL ) and Canadian Occupational Performance Measure ( COPM ) . The 8-wk training consisted of a 60-min , 3 x wk-1 group program that focused on balance , mobility , functional strength , and functional capacity . The program was design ed to be accessible by reducing the need for costly one-on-one supervision , specialized setting s , and expensive equipment . RESULTS Improvements from the exercise program were found for all physical measures and these effects were retained 1-month postintervention . Subjects with lower function improved the most relative to their initial physical status . Significant effects were found for the COPM , but not the RNL Index ; however , subjects with lower RNL improved the most relative to their initial RNL Score . CONCLUSION A short-term community-based exercise program can improve and retain mobility , functional capacity , and balance and result in a demonstrable impact upon the performance of activities and abilities that were considered meaningful to the subjects . Implementation of such community-based programs has potential for improving activity tolerance and reducing the risk for secondary complications common to stroke ( e.g. , falls result ing in fractures and cardiac events ) This article follows up on earlier research examining the factor structure of a measure of recovery from serious mental illness . Exactly 1,824 persons with serious mental illness who were participating in the baseline interview for a multistate study on consumer-operated services completed the  Recovery Assessment Scale ( RAS ) plus measures representing hope , meaning of life , quality of life , symptoms , and empowerment . Results of exploratory and subsequent confirmatory factor analyses of the RAS for r and om halves of the sample yielded five factors : personal confidence and hope , willingness to ask for help , goal and success orientation , reliance on others , and no domination by symptoms . Subsequent regression analyses showed that these five factors were uniquely related to the additional constructs assessed in the study . We compared these findings with those of other studies to summarize the factor structure that currently emerges on recovery Aspects of validity are investigated with a brief functional assessment measure among out patients undergoing rehabilitation for musculoskeletal problems . The Medical Rehabilitation Follow Along measure ( MRFA ) currently has screening , musculoskeletal , neurologic , and multiple sclerosis forms . In this study , the 31-item musculoskeletal form of the MRFA is compared with and contrasted to a measure of general health status , the Medical Outcomes Trust SF-36 . Content , construct , and criterion validity are addressed using scale scores before ( n = 94 ) and after ( n = 48 ) outpatient rehabilitation .  Scale scores are compared with therapists ' ratings of improvement . The results provide support for the validity of inferences made from scale scores of the MRFA for persons with musculoskeletal problems . Applications of the MRFA , including screening , monitoring , and outcome assessment are discussed for clinical management , measuring treatment effectiveness , and program evaluation Objective : To investigate the factor structure and concurrent validity of the Caregiver Appraisal Scale ( CAS ) in a sample of caregivers of adults with traumatic brain injury ( TBI ) . Design : Prospect i ve cohort study . Setting : Two sites : ( 1 ) Outpatient clinics associated with a comprehensive inpatient brain injury rehabilitation program and ( 2 ) a comprehensive residential postacute rehabilitation program in the Southern United States . Participants : One hundred forty-nine caregivers of adults with TBI enrolled in the TBI Model Systems Project and 92 caregivers of adults with TBI admitted to a residential postacute rehabilitation program . Most caregivers were women and either parents or spouses of the injured person . Main Outcome Measures :  Caregiver Appraisal Scale ( CAS ) ; Subjective Burden Scale ( SBS ) ; Objective Burden Scale ( OBS ) ; General Health Question naire ( GHQ ) . Results : Principal components analysis with varimax rotation yielded four factors : perceived burden ( PB ) , caregiver relationship satisfaction ( CRS ) , caregiving ideology ( CI ) , and caregiving mastery ( CM ) , which were found to be fairly stable across treatment setting s. Adequate concurrent validity was demonstrated for the perceived burden factor , and adequate internal consistency was found for three of four scales . Conclusions : Preliminary support for the use of the CAS in caregivers of adults with TBI was obtained . However , further scale development , particularly for the CM factor , will likely improve the stability and usefulness of this instrument Purpose : Design ated multidisciplinary rehabilitation units have been shown to provide several benefits for the frail older population . The aim of this research was to evaluate changes in strength , mobility , balance , endurance , frailty and quality of life ( QoL ) following a 6-week multidisciplinary inpatient rehabilitation programme . Method : This was a prospect i ve , observational study performed in a post-acute multidisciplinary geriatric inpatient rehabilitation service . A consecutive sample of heterogenous frail older adults ( n = 32 ) participated . Subjects were assessed on admission to the rehabilitation service ( T1 ) and following 6 weeks of rehabilitation ( T2 ) . A range of outcome measures were used to assess function and QoL : Berg Balance Scale ( BBS ) , Timed Up and Go ( TUG ) , 6-Minute Walk Test ( 6MWT ) , Barthel Index ( BI ) , EuroQol-Visual Analogue Scale ( EQ-VAS ) , Clinical Frailty Scale ( CFS ) , lower limb and grip dynamometry . Results : The majority were female ( n = 25 ) , the mean age was 82.9 years ( SD 6.35 ) . The median length of stay was 49 days . Patients improved significantly between T1 and T2 assessment s in the BBS ( p ≤ 0.0001 ) ; TUG ( p ≤ 0.0001 ) ; 6MWT ( p ≤ 0.0001 ) ; BI ( p ≤ 0.0001 ) ; EQ-VAS ( p = 0.002 ) ; CFS ( p ≤ 0.0001 ) ; and in some aspects of grip and lower limb strength . Conclusion : This study has demonstrated that positive outcomes occurred in a range of measures in an older , frail inpatient rehabilitation population . Implication s for Rehabilitation Elderly in patients undergoing rehabilitation programmes improve across a range of measures looking at impairment , activity , participation and quality of life . However , gains were modest and patients did not attain their baseline level of performance after a 6-week programme of inpatient rehabilitation . Using outcome measures in clinical rehabilitation practice can facilitate comparison between units and can form the basis for future research in this population
Conclusions There is considerable variability in the type of measures utilized to measure physical impairments and limitations in survivors of critical illness .
Purpose To identify measures used to evaluate the broad constructs of functional impairment and limitations in the critically ill across the continuum of recovery , and to evaluate , synthesis e and compare the clinimetric properties of the measures identified .