IOS PressBalasch I Bernat, M.; Balasch Parisi, S.; Noe Sebastian, E.; Dueñas Moscardo, L.; Ferri Campos, J.; Lopez Bueno, L. (2015). Determining cut-off points in functional assessment scales in stroke. NeuroRehabilitation. 37(2):165-172. doi:10.3233/NRE-151249.2 "Determining cut-off points in/for functional poststroke assessment scales"
INTRODUCTIONAppropriate assessment of post-stroke patients is an important element for quality of care and is a constant recommendation in all the International Guidelines for the management of these patients. Use of a standardized assessment helps identify and quantify the degree of neurological deficits, facilitate communication between clinicians, provides outcome information, and helps treatment selection to increase efectiveness in rehabilitation. A wide variety of well-validated instruments for the assessment of functioning and disability have been developed [1][2][3][4][5], which enable the extent of the sequelae of a stroke, and subsequent recovery, to be determined [6].
The Barthel Index (BI), Functional Independence Measurement (FIM) and FunctionalAssessment Measurement (FAM) scales have been validated and globally used for functional assessment in this population. Although these scales can capture minimal changes in physical functioning, they have limitations in their application. Because these scales yield ordinal values, researchers or practitioners may have difficulties in understanding and interpreting the clinical meaning of total scores or score changes when these occur. Interpretation of each instrument's raw score is limited to numeric increases or decreases in total score. In order to provide more interpretable information on post-stroke outcomes, several assessment scales have been stratified or divided into categories, which distinguish different levels of recovery [4,5,[7][8][9].Several cut-off points have been suggested for the categorization of some of these instruments. The assessment scales most commonly used in order to establish such cut-off points are the BI and the Modified Rankin Scale (mRS) [2,9,10]. Less frequently, the FIM has also been used in a variety of such studies [5,11]. While the cut-off points used in the functional assessment scales such as the BI [2,9,[12][13][14][15][16]] and the FIM [11] are highly variable, 3 a more consistent stratification of recovery levels has been determined for the mRS [9,16].. However, mRS represents a unidimensional scale heavily weighted toward global disability (in particular physical disability), so other instruments have been developed in an effort to reflect nonphysical attributes essential to a person's self-maintenance and well-being, such as cognition, behavior and social functioning. The Differential Outcome Scale (DOS) is one of these multidimensional tools listed within the functioning and disability component of the International Classification of Functioning, Disability and Health (ICF) framework [Tate et al., 2013]. Since the use of multidimensional scales is not generalized, the categoriza...
