Concepts of capacity and performance in assessment of functioning amongst stroke survivors: A comparison of the Functional Independence Measure and the International Classification of Functioning, Disability and Health

Tarvonen-Schröder, Sinikka; Laimi, Katri; Kauko, Tommi; Saltychev, Mikhail

doi:10.2340/16501977-1974

Cited by 12 publications

(4 citation statements)

References 14 publications

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“…Also, other ICF-based disease-specific functioning tools can be used in stroke patients, but other measures are usually more timeconsuming (ICF checklist, ICF Comprehensive and Brief Core Sets for Stroke). In the current study, the 12-item WHODAS had a strong inverse relationship with the dependence measure FIM in the same way as in a previous stroke study comparing ICF Brief Core Set for stroke with FIM scores (37). In previous studies with different diagnostic patient populations a similar positive correlation has been found between WHODAS 2.0 and other measures of dependence (19).…”

Section: Discussionsupporting

confidence: 87%

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

Tarvonen-Schröder

Hurme²,

Laimi³

2019

J Rehabil Med

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LAY ABSTRACTThis study compared short generic International Classification of Functioning, Disability and Health (ICF)based measures of functioning, the patient-and proxyreported 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item WHO Minimal Generic Set of domains of functioning and health assessed by a neurologist, with traditionally used measures of stroke in the subacute phase. Although proxies rated 6 out of 12 separate WHODAS functions more impaired than did the patients, the scores of patient-and proxy-reported WHODAS 2.0 and the WHO Minimal Generic Set correlated well with each other and with older measures of stroke severity (National Institutes of Health Stroke Scale) and dependence (modified Rankin Scale and Functional Independence Measure). Both ICF-based tools, despite their brevity, were useful in finding disabilities for patient-and family-centred goal-setting and service-planning after subacute stroke rehabilitation. Objective: To compare short generic International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with traditional measures of stroke severity and dependence in subacute stroke. Methods: In this cross-sectional study patients with stroke (n = 195) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) at discharge from rehabilitation. A neurologist assessed functioning with the 7-item World Health Organization (WHO) Minimal Generic Set of domains of functioning and health. These scores were compared with assessments of severity of stroke (National Institutes of Health Stroke Scale; NIHSS) and dependence (modified Rankin Scale; mRS; and Functional Independence Measure; FIM).Results: From mild to severe stroke, increasing disability was found in single items and sum scores of WHODAS and the WHO Minimal Generic Set. Although proxies rated 6 out of the 12 separate WHO-DAS functions more impaired than did the patients, correlations between the different measures (proxyand patient-WHODAS, the WHO Minimal Generic Set, mRS, NIHSS and FIM total and sub-scores) were strong to very strong, except for moderate correlations between patient-WHODAS, and NIHSS or FIM cognitive sub-score. Conclusion: Despite their brevity, both generic ICFbased tools were useful in finding disabilities for patient-and family-centred goal-setting and serviceplanning after subacute rehabilitation.

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Section: Discussionsupporting

confidence: 87%

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

Tarvonen-Schröder

Hurme²,

Laimi³

2019

J Rehabil Med

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“…The subgroup analyses of upper extremity Fugl-Meyer Assessment scores were performed using baseline data, namely, the mean patient age (older or younger than 60 years), mean stroke duration (acute (<one month), subacute (one-six months), or chronic (>six months) phase), and stroke severity. Stroke severity was classified according to mean upper extremity Fugl-Meyer Assessment scores as severe (0-28), moderate (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42), and mild . 15 Individual subscales of upper extremity Fugl-Meyer Assessment score (shoulder, wrist, hand, and coordination) were also collected.…”

Section: Methodsmentioning

confidence: 99%

“…37 The Functional Independence Measure was reported to be highly correlated with activity in the ICF Brief Core Set for stroke. 38 No statistical differences were detected in any paired comparison immediately after treatment and at follow-up (Supplemental Table S9).…”

Section: Comparisons Between Emg-triggered Cyclic and Sensory Electmentioning

confidence: 96%

Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

et al. 2019

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Objective: The aim of this study is to investigate the effectiveness of electrical stimulation in arm function recovery after stroke. Methods: Data were obtained from the PubMed, Cochrane Library, Embase, and Scopus databases from their inception until 12 January 2019. Only randomized controlled trials (RCTs) reporting the effects of electrical stimulation on the recovery of arm function after stroke were selected. Results: Forty-eight RCTs with a total of 1712 patients were included in the analysis. The body function assessment, Upper-Extremity Fugl-Meyer Assessment, indicated more favorable outcomes in the electrical stimulation group than in the placebo group immediately after treatment (23 RCTs ( n = 794): standard mean difference (SMD) = 0.67, 95% confidence interval (CI) = 0.51–0.84) and at follow-up (12 RCTs ( n = 391): SMD = 0.66, 95% CI = 0.35–0.97). The activity assessment, Action Research Arm Test, revealed superior outcomes in the electrical stimulation group than those in the placebo group immediately after treatment (10 RCTs ( n = 411): SMD = 0.70, 95% CI = 0.39–1.02) and at follow-up (8 RCTs ( n = 289): SMD = 0.93, 95% CI = 0.34–1.52). Other activity assessments, including Wolf Motor Function Test, Box and Block Test, and Motor Activity Log, also revealed superior outcomes in the electrical stimulation group than those in the placebo group. Comparisons between three types of electrical stimulation (sensory, cyclic, and electromyography-triggered electrical stimulation) groups revealed no significant differences in the body function and activity. Conclusion: Electrical stimulation therapy can effectively improve the arm function in stroke patients.

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“…Moreover, these in-lab gait analyses were limited to few gait cycles performed over a short distance. Such standard clinical assessments give information on the capacity level of individuals after a stroke ( Tarvonen-Schroder et al, 2015 ). New tools for gait analysis overcoming some of these limitations are so-called “wearables”: portable, more practicable and affordable sensor-based systems that can provide useful and objective information regarding gait measures also in unsupervised real-life performance ( Silva et al, 2015 ; Chen et al, 2016 ; Del Din et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Agreement, Reliability, and Concurrent Validity of an Outdoor, Wearable-Based Walk Ratio Assessment in Healthy Adults and Chronic Stroke Survivors

Huber

Knols²,

Held³

et al. 2022

Front. Physiol.

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Purpose: The walk ratio (WR)—the step-length/cadence relation—is a promising measure for gait control. GPS-running watches deliver clinically relevant outcomes including the WR. The aim of this study was to determine test-retest agreement, reliability and concurrent validity of an outdoor WR assessment using a GPS-running watch.Methods: Healthy adults and moderate—high functioning stroke survivors (≥6 months), performed the 1 km-outdoor walk twice using a GPS-running watch (Garmin Forerunner 35, GFR35) and a Step Activity Monitor (SAM 3). Global cognition was assessed using the Montreal Cognitive Assessment. Test-retest agreement and reliability were assessed using Bland-Altman plots, standard error of measurement (SEM), intraclass correlation coefficients (ICCs) and smallest detectable changes (SDCs). Concurrent validity was determined by the mean difference (MD), standard error (SE), mean absolute percentage errors (MAPEs) and Spearman’s Rho between GFR35 and SAM3. WR values of the two groups were compared by a Welch’s test. A hierarchical multiple regression was performed with the WR as dependent variable and possible predictors as independent variables.Results: Fifty-one healthy adults [median: 60.0 (47.0, 67.0) years) and 20 stroke survivors [mean: 63.1 (12.4) years, median: 76 (30, 146) months post-stroke] were included. Test-retest agreement and reliability were excellent (SEM% ≤ 2.2, ICCs > 0.9, SDC% ≤ 6.1) and concurrent validity was high (MAPE < 5, ρ > 0.7) for those walking ≥ 1 m/s. Walking < 1 m/s impaired accurate step counting and reduced agreement, reliability, and validity. The WR differed between healthy adults and stroke survivors (t = −2.126, p = 0.045). The hierarchical regression model including stroke and global cognition (Montreal Cognitive Assessment, 0—30) explained 25% of the WR variance (ΔR2 = 0.246, p < 0.001). Stroke had no effect (β = −0.05, p = 0.682), but global cognition was a predictor for an altered WR (β = 0.44, p = 0.001).Discussion: The outdoor WR assessment using the GFR35 showed excellent test-retest agreement, reliability and concurrent validity in healthy adults and chronic stroke survivors walking at least 1 m/s. As the WR seems relevant in chronic stroke, future studies should further investigate this parameter.

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Concepts of capacity and performance in assessment of functioning amongst stroke survivors: A comparison of the Functional Independence Measure and the International Classification of Functioning, Disability and Health

Abstract: Even though the FIM and an ICF-based scale may describe limitation of functioning of stroke survivors similarly, ICF is probably more comprehensive in describing both capacity and performance.

Cited by 12 publications

References 14 publications

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of Domains of Functioning and Health versus Conventional Instruments in subacute stroke

Effectiveness of electrical stimulation therapy in improving arm function after stroke: a systematic review and a meta-analysis of randomised controlled trials

Agreement, Reliability, and Concurrent Validity of an Outdoor, Wearable-Based Walk Ratio Assessment in Healthy Adults and Chronic Stroke Survivors

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