Issues for selection of outcome measures in stroke rehabilitation: ICF Participation

Department of Physical Medicine and Rehabilitation, St. Joseph's Health Care London, London, Ontario, Canada.
Disability and Rehabilitation (Impact Factor: 1.99). 06/2005; 27(9):507-28. DOI: 10.1080/0963828040008552
Source: PubMed


To evaluate the psychometric and administrative properties of outcome measures in the ICF Participation category, which are used in stroke rehabilitation research and reported in the published literature.
Critical review and synthesis of measurement properties for six commonly reported instruments in the stroke rehabilitation literature. Each instrument was rated using the eight evaluation criteria proposed by the UK Health Technology Assessment (HTA) programme. The instruments were also assessed for the rigour with which their reliability, validity and responsiveness were reported in the published literature.
Validity has been well reported for at least half of the measures reviewed. However, methods for reporting specific measurement qualities of outcome instruments were inconsistent. Responsiveness of measures has not been well documented. Of the three ICF categories, Participation seems to be most problematic with respect to: (a) lack of consensus on the range of domains required for measurement in stroke; (b) much greater emphasis on health-related quality of life, relative to subjective quality of life in general; (c) the inclusion of a mixture of measurements from all three ICF categories.
The reader is encouraged to examine carefully the nature and scope of outcome measurement used in reporting the strength of evidence for improved participation associated with stroke rehabilitation. There is no consensus regarding the most important indicators of successful involvement in a life situation and which ones best represent the societal perspective of functioning. In particular, quality of life outcomes lack adequate conceptual frameworks to guide the process of development and validation of measures.

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Available from: Jeffrey Jutai, Mar 17, 2014
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    • "Internal consistency and test-retest reliability of the CASE-C total and factor subscale scores were examined by Cronbach's a coefficient and intra-class correlation coefficients (ICC). Alphas ranging between .70–.90 and ICC values of .70 are considered adequate (Salter et al., 2005). "
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    ABSTRACT: Measurement of children's participation and environmental factors is a key component of the assessment in the new Disability Evaluation System (DES) in Taiwan. The Child and Adolescent Scale of Environment (CASE) was translated into Traditional Chinese (CASE-C) and used for assessing environmental factors affecting the participation of children and youth with disabilities in the DES. The aim of this study was to validate the CASE-C. Participants were 614 children and youth aged 6.0-17.9 years with disabilities, with the largest condition group comprised of children with intellectual disability (61%). Internal structure, internal consistency, test-retest reliability, convergent validity, and discriminant (known group) validity were examined using exploratory factor analyses, Cronbach's α coefficient, intra-class correlation coefficients (ICC), correlation analyses, and univariate ANOVAs. A three-factor structure (Family/Community Resources, Assistance/Attitude Supports, and Physical Design Access) of the CASE-C was produced with 38% variance explained. The CASE-C had adequate internal consistency (Cronbach's α=.74-.86) and test-retest reliability (ICCs=.73-.90). Children and youth with disabilities who had higher levels of severity of impairment encountered more environmental barriers and those experiencing more environmental problems also had greater restrictions in participation. The CASE-C scores were found to distinguish children on the basis of disability condition and impairment severity, but not on the basis of age or sex. The CASE-C is valid for assessing environmental problems experienced by children and youth with disabilities in Taiwan. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Research in Developmental Disabilities 12/2014; 38C:64-74. DOI:10.1016/j.ridd.2014.12.019 · 3.40 Impact Factor
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    • "As mentioned above, in the International Classification of Functioning model, a large gap exists between functional improvement and actual participation in physical activities16). Studies using accelerometers to monitor real life physical activities strongly support this ICF concept, and will lead the efforts to enhance performance in rehabilitation treatment. "
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    ABSTRACT: [Purpose] This study compared the upper extremity recovery of stroke patients with the amount of their upper extremity use in real life as measured by accelerometers. [Subjects] Forty inpatients who had had a stroke were recruited. [Methods] The subjects were divided into two groups by the Fugl-Meyer Assessment of Motor Function (FMA) score, a moderately recovered group and a well recovered group. The amount of upper extremity physical activity and its ratio in daily time periods were analyzed for the affected and unaffected sides. [Results] The well recovered group showed significantly higher affected arm use and use ratio than the moderately recovered group in all time periods. [Conclusion] The upper extremity recovery level of the affected side is similar to the physical activity level according to the amount of upper extremity physical activity in actual life measured with an accelerometer. Overuse of the normal side regardless of the recovery level of upper extremity proves the International Classification of Functioning (ICF) concept of differentiating between capacity and performance, and rehabilitation treatments should focus on improving performance.
    Journal of Physical Therapy Science 07/2014; 26(7):1009-11. DOI:10.1589/jpts.26.1009 · 0.39 Impact Factor
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    • "Although participation is beginning to be considered in outcome studies after stroke, Salter et al. (2005) reported in their review that no clinical or scientific consensus exists regarding important indicators of successful participation . Participation as it is described in the ICF is complex to measure because it is related to quality of life, autonomy, and doing with others and depends on environmental influences (Salter et al., 2005). Participation is also subjectively determined because it is a person's report of his or her own perceptions of fulfillment of personal and societal goals (Perenboom & Chorus, 2003). "
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    ABSTRACT: Objective: We sought to determine the extent to which perceptions of participation in everyday occupations were affected in a sample of people with predominantly mild stroke. Demographic variables, stroke severity, community integration, participation in everyday occupations, and perceptions of recovery were examined as potential contributors to their perceptions of participation. Method: We conducted a cross-sectional study with 116 people with mild to moderate first stroke assessed approximately 6 mo after stroke. Results: Perceptions of participation assessed using the Stroke Impact Scale varied (range = 19-100), with a mean score of 82. Regression analyses revealed three factors that contributed to perceptions of participation: retention of previous activities, reintegration in home and community, and perception of stroke recovery. Conclusion: Although the majority of participants reported a high level of perceived participation, more than a third failed to report successful participation.
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