Comparison of the Responsiveness of the Long-Form and Simplified Stroke Rehabilitation Assessment of Movement: Group- and Individual-Level Analysis.
BACKGROUND
The group-level responsiveness of the original, 30-item Stroke Rehabilitation Assessment of Movement measure (STREAM-30) is similar to that of the simplified STREAM (STREAM-15), even though the STREAM-30 has twice as many items as those of the STREAM-15.


OBJECTIVE
The purpose of this study was to compare the responsiveness of the STREAM-30 and STREAM-15 at both group and individual levels in patients with stroke. For the latter level, the Rasch-calibrated 27-item STREAM (STREAM-27) was used because the individual-level indexes of the STREAM-30 could not be estimated.


METHODS
A repeated-measurements design was used. In total, 195 patients were assessed with the STREAM-30 at both admission and discharge.


METHODS
The Rasch scores of the STREAM-27 and STREAM-15 were estimated from the participants' responses on the STREAM-30. We calculated the paired t-test value, effect size, and standardized response mean as the indexes of group-level responsiveness. The significance of change for each participant was estimated as the individual-level responsiveness index, and the paired t test and test of marginal homogeneity were used for individual-level comparisons between the STREAM-27 and STREAM-15.


RESULTS
At the group level, the STREAM-30, STREAM-27, and STREAM-15 showed sufficient and comparable responsiveness. At the individual level, the STREAM-27 detected significantly more participants with significant improvement and fewer participants with no change or deterioration compared with the STREAM-15.


CONCLUSIONS
Few patients with subacute stroke showed deterioration at discharge, so the abilities of the 2 measures to detect deterioration remain inconclusive.


CONCLUSIONS
The STREAM-27 detected more participants with significant recovery compared with the STREAM-15, although the group-level responsiveness of the 2 measures was the same. The STREAM-27 is recommended as an outcome measure to demonstrate the treatment effects of movement and mobility for patients with stroke.
Y-J. Huang, BS, School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Yi-Jing
YJ
Huang
K-L. Chen, PhD, Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Kuan-Lin
KL
Chen
Y-T. Chou, MS, Department of Psychology, National Chung Cheng University, Chiayi, Taiwan, and Research Center for Psychological and Educational Testing, National Taiwan Normal University, Taipei, Taiwan.
Yeh-Tai
YT
Chou
I-P. Hsueh, MA, School of Occupational Therapy, College of Medicine, National Taiwan University, 4F, No. 17, Xuzhou Road, Taipei 100, Taiwan, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital. iping@ntu.edu.tw.
I-Ping
IP
Hsueh
C-Y. Hou, MS, Department of Physical Medicine and Rehabilitation, E-Da Hospital/I-Shou University, Kaohsiung, Taiwan.
Chieh-Yi
CY
Hou
C-L. Hsieh, PhD, School of Occupational Therapy, College of Medicine, National Taiwan University, and Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital.
Ching-Lin
CL
Hsieh
D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology*; D011594:Psychometrics; D020127:Recovery of Function; D015203:Reproducibility of Results; D020521:Stroke / Q000503:physiopathology*; D000071939:Stroke Rehabilitation