Evaluating the effectiveness of stroke rehabilitation: choosing a discriminative measure.
OBJECTIVE
To evaluate the discriminative ability of several measures of physical disability used to determine quality of outcome for poststroke rehabilitation.


METHODS
A comparative study, using Rasch analysis, of the discriminative ability of functional status and mobility measures in rehabilitation patients with stroke.


METHODS
A 26-bed rehabilitation unit, on site of a tertiary teaching hospital in Melbourne, Australia.


METHODS
A consecutive sample of 106 patients with acute stroke admitted for rehabilitation.


METHODS
Not applicable.


METHODS
Rasch analysis of the motor subscale of the FIM instrument, Motor Assessment Scale, Functional Ambulation Classification, gait velocity, and gait endurance.


RESULTS
The more difficult items of the FIM motor scale adequately discriminated among higher functioning patients. The gait velocity measure further distinguished 9% of the sample, who functioned at a higher level than could be indicated by FIM motor subscale. The other measures did not add levels of discrimination to that provided by the FIM motor. Ability estimates provided by Rasch analysis of the FIM motor scale were a more accurate indication of ability than raw scores. Raw scores underestimated change in ability observed at higher levels of ability.


CONCLUSIONS
Rasch estimates of the FIM motor subscale provide a discriminative measure for evaluating outcomes and change in ability achieved in stroke rehabilitation.
Brock
Kim A
KA
Physiotherapy Department, St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia. brockka@svhm.org.au
Goldie
Patricia A
PA
Greenwood
Kenneth M
KM
D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D005260:Female; D005684:Gait / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills; D020127:Recovery of Function; D020521:Stroke / Q000503:physiopathology; D000071939:Stroke Rehabilitation