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
    • "Participation allows an individual to build relationships and develops skills to meet social demands, allowing individuals to find purpose and meaning in life, which has a positive impact on both physical and mental health.[8]Among the ICF components, participation has been considered the most complex to classify based on existing measures.[9,10]Thus, to classify the participation component, the use of previously developed assessment tools designed to measure health-related quality of life (HRQoL) has been suggested.91011121314However, while different aspects of participation require a multidimensional evaluation that encompasses HRQoL, it is possible that some of its concepts exhibit constructs that are not evaluated with the use of HRQoL assessment tools, such as depressive symptoms. "
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    ABSTRACT: Purpose: To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF). Method: Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann-Whitney test was used to compare the participation scores between the two groups. Spearman's correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance. Results: The group with depression had low participation scores (p = 0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r = -0.6; p = 0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r(2) = 0.51; p = 0.001). Conclusions: Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke. Implications for Rehabilitation Individuals with post-stroke depression experience a lower degree of social participation. Depression explains 51% of the decline in participation following a stroke. The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.
    No preview · Article · Jan 2016 · Disability and Rehabilitation
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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.
    Full-text · Article · Dec 2014 · Research in Developmental Disabilities
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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.
    Full-text · Article · Jul 2014 · Journal of Physical Therapy Science
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