Post on 12-Feb-2017
Compendium of clinical measures for community rehabilitation Page 72 of 101
SUMMARY OF METHODOLOGY
Systematic
literature review
for outcome
measures
A systematic literature review was undertaken utilising a rigorous step-by-step approach
to provide Queensland Health with transparency of the process underpinning the
literature search. As there is no one standard approach recommended for systematic
review or critical appraisal, the CAHE team has developed a framework which uses the
best available approaches.
Preliminary
search
A preliminary search for this project was conducted using search terms of health
outcomes, neurological, rehabilitation, stroke and related terms in an initial sweep of the
library databases. The CAHE team accessed the mainstream research journals via an
examination of the major electronic databases (Amed, Australian Education Index,
Cinahl, Cochrane Library, Current Contents, Eric, Embase, Medline, Psych Info,
Pubmed). These sources were then used for the ongoing search. Over 1500 outcome
measures were identified from this initial search which could be relevant to the review,
and about which CAHE needed to take advice from the steering group.
Search proper Step 1. This involved developing and confirming the search topics/ questions at a face-
to-face meeting with QH and the reference group. The initial search strategy (deliverable
1) included:
Step 2. The preliminary search strategy and library resources were expanded to
incorporate additional search terms and literature sources identified both via CAHE
investigations, and from discussion with the reference group. No time limits were
imposed as it was clear from the initial searches that there were older but useful
measures. The following table outlines the revised search strategy reflecting the inclusion
of coping measures:
1 (outcome$ or measure$ or tool$ or instrument$ or index$ or questionnaire$ or
survey$ or evaluation$ or assessment$ or scale$ or score$ or test$ or inventor$ or
checklist$ or profile$ or protocol$).mp.
2 (activit$ or ADL$ or quality of life or QOL or participation or function or mobility
or psychological or depression or impair$ or health status).mp.
3 rehabilitation/ or physical mobility/ or physical therapy/ or occupational therapy/
or speech therapy/
4 cerebrovascular accident/ or cerebrovascular disease/ or stroke.tw.
5 or/3-4
6 (psychometric$ or valid$ or reliab$ or responsive$ or sensitiv$ or specific$ or
feasibil$ or accura$ or scalab$ or dimensiona$ or factor analysis).ti.
7 and/1-2,5-6
8 limit 7 to english
Compendium of clinical measures for community rehabilitation Page 73 of 101
The search was limited to only the published literature, to provide the requisite leads to
determine the psychometric properties of the outcome instruments. It was considered
vital that the development of an instrument had been subjected to peer review rather than
simply its authors’ (unpublished) claims of validity.
Step 3. This revised search yielded over 1300 titles. The CAHE team analysed text
contained in the title and abstract of retrieved citations, and in the index terms (MESH
headings) used to describe the identified articles. This step formally involved an
integrated validation search using all identified key words and index terms, through the
same electronic databases to ensure that all relevant literature had been identified.
Step 4. This step entailed scrutinising the reference lists and bibliographies of all
retrieved literature for additional studies potentially relevant to the topic. In order to
avoid the possibility of publication bias, hand searching was also undertaken in key
journals relevant to the area (advice taken from our own clinical team members and from
the reference group).
1 (outcome$ or measure$ or tool$ or instrument$ or index$ or questionnaire$ or
survey$ or evaluation$ or assessment$ or scale$ or score$ or test$ or inventor$ or
checklist$ or profile$ or protocol$).mp.
2 (activit$ or ADL$ or quality of life or QOL or participation or function or mobility
or psychological or depression or impair$ or health status or coping or cope).mp.
3 rehabilitation/ or physical mobility/ or physical therapy/ or occupational therapy/
or speech therapy/
4 cerebrovascular accident/ or cerebrovascular disease/ or stroke.tw.
5 or/3-4
6 (psychometric$ or valid$ or reliab$ or responsive$ or sensitiv$ or specific$ or
feasibil$ or accura$ or scalab$ or dimensiona$ or factor analysis).ti.
7 and/1-2,5-6
8 limit 7 to english
Inclusion and
exclusion of
measures
Only peer-reviewed literature on outcome measures which were available in full
text and written in English were considered for retrieval.
The measure had to be relevant to the intended population i.e. demonstrated use
in adult community rehabilitation settings.
Any measure that had a specific diagnostic grouping (other than stroke) was
automatically excluded.
All measures were grouped (in a preliminary fashion) into the ICF domains.
Application of these criteria led to an initial list of some 500 measures. Further
examination by the reference group reduced this list to around 300 measures – this list
with a relevant reference for each measure formed the basis of Deliverable 2.
Evaluation of
psychometric
properties
This step involved an evaluation of the clinical utility of the 300 identified outcome
measures with respect to evidence of psychometric properties. By undertaking this step,
outcome measures with good evidence of robustness and applicability to Queensland
Health settings were identified for the final Compendium (Deliverable 3).
To evaluate the quality of the eligible outcome measures, each measure was critically
reviewed with a critical appraisal system uniquely developed for this research. This
Compendium of clinical measures for community rehabilitation Page 74 of 101
approach was based on criteria developed by the United Kingdom’s Clearing House on
Health Outcomes (UKCHHO)1. The key criteria underpinning the measurement of the
quality of rehabilitation outcome measures were:
Purpose of the measure
-- What does the measure aim to do?
-- What does it aim to measure?
Background of the measure
-- Why was this particular measure needed?
-- What were the rationale and the developmental processes behind the
measure?
Description of the measure
-- Description of the domains covered, number of items and subscales,
response format, references period and method of administration and
scoring
User centeredness
-- Which stakeholder’s perspective does it capture?
-- To what extent does the measure capture stakeholder’s desired
outcomes?
-- Is it faithful to the content and form of stakeholder’s views?
Psychometrics
-- Is the measure psychometrically sound? This includes an assessment of
evidence of content and construct validity, reliability of administration,
sensitivity to change etc
Feasibility
-- How feasible is the measure to use within routine practice?
-- Consideration for ease of administration, scoring, interpretation of the
information
Utility
-- Can the information provided by the measure being integral part of
treatment and care decision making?
-- Does the measure involve the stakeholder in the process?
-- Does the measure provide additional information not already available to
the care provider?
A team of reviewers then appraised each of the measures using the identified literature.
For rigour, two independent reviewers critically appraised the quality of a sample of the
included measures, achieving satisfactory agreement. A copy of the critical appraisal tool
is included in Appendix One. The full Glossary of Psychometric Terms considered in
the critical appraisal is also included after this section.
Critical appraisals were then sent to the reference group in ICF domain bundles. Relevant
group members then reviewed the measures individually, and made the final decision
collectively, for a possible final set of some 40 measures. Further consultation between
the CAHE review team and the reference group reduced this to the final 29 measures in
the Outcomes Compendium. Decisions were based on:
the collective consideration of the critical appraisals,
1 http://www.leeds.ac.uk/nuffield/infoservices/UKCH/home.html).
Compendium of clinical measures for community rehabilitation Page 75 of 101
the ability of the measures to provide a comprehensive picture of capacity
across ICF domains (including core measures and discipline specific
measures)
that were relevant to each rehabilitation unit’s target client population,
that met the needs of the rehabilitation teams collectively and of individual
disciplines within the teams and
met the information needs of Queensland Health.
Final deliverable:
outcomes
compendium
On agreement of the final content of the Compendium, the CAHE team contacted all
developers of the included measures, where relevant, for permission to reproduce the
measure, scoring procedures and any appropriate normative data. This resulted in further
exclusions for measures out of print or those requiring specific training from the
developers (Salford Object Recognition Test – out of print, and AusTOMs – partial
inclusion only as requires specific training from the developers).
The final Compendium was constructed, with several drafts being reviewed by
Queensland Health to ensure appropriateness. The penultimate format was used in a
training and orientation session with all relevant staff.
Compendium of clinical measures for community rehabilitation Page 76 of 101
CRITICAL APPRAISAL: SUMMARY OF PSYCHOMETRIC
SCORES (alphabetical order)
Name Activities-specific Balance Confidence Scale (ABC
Scale)
Yes/No/
unknown
For adult community? Y
Purpose specific Objectify fear of falling Y
Background/rationale Activity – standing balance Y
Description adequate questionnaire Y
Validity Construct: moderate correlation with BBS (Spearmans =
0.36); gait speed (0.48) (Botner et al. 2005); with BBS
(Pearsons r=0.5); multi-directional reach test (r=0.41-
0.59) (Pal et al. 2005).
Factor analysis: two components – perceived high and low
risk activities (Botner et al. 2005).
Concurrent: Spearman =0.52) between ABC and BBS
baseline (Pal et al. 2005)
Y
Reliability Test-retest: ICC 0.85 (Botner et al. 2005); ICC 0.7
(Holbein-Jenny et al. 2005); ICC 0.92 (Pal et al. 2005);
Spearman values 0.30-0.60 (Salbach et al. 2006); total
ABC score r=0.92 (Powell and Myers, 1995).
Internal consistency: Cronbachs α 0.94 (Botner et al.
2005); Cronbachs α 0.94 (Salbach et al. 2006); Cronbachs
α 0.96 (Powell and Myers 1995).
Absolute reliability: SEM 5.05 ie true value of a rating
would be expected to be within 5 pts of that observed 68%
of the time if evaluations are repeated (Salbach et al.
2006).
Y
Responsiveness Minimal floor or ceiling effects (Botner et al. 2005)
Percentage of subjects with total score between 20-80% is
75% (Salbach et al. 2006).
Effect size 1.5 (Powell and Myers 1995).
Y
Precision Y
User centredness U
Utility Scoring clear Y
Feasibility Quick to administer, no training Y
Total CA score: 10/11
Name Assessment of Life Habits (LIFE-H)
(excluded due to prohibitive cost – Dec 07)
For adult community? Y
Purpose specific Measure of person-perceived social participation Y
Background/rationale ICF – participation restrictions Y
Description adequate Questionnaire, self administered, 77 items covering 12
categories of life habits, scored on 9-point
accomplishment scale
Y
Validity Pearson’s: 0.7 with CIQ; SMAF; FIM (Desrosiers, 2003) Y
Reliability ICCs: 0.76-0.92 for test-retest & inter-rater reliability for
total scores and categories
Y
Responsiveness Currently undergoing testing (Switzerland) U
Compendium of clinical measures for community rehabilitation Page 77 of 101
Precision Y
User centredness Person perceived, demonstrated relationship with QOL
(Levasseur et al. 2004)
Utility Scoring formula clear Y
Feasibility Quick and easy to answer Y
Total CA score: 10/11
Name Assessment of Quality of Life (AQoL)
For adult community? Y
Purpose specific Measure Health Related QoL Y
Background/rationale HRQoL (WHO health definition) Y
Description adequate Questionnaire Y
Validity Construct validity: r=0.74 to 0.85 compared to other
scales like BI, SF36 (Sturm et al. 2002)
Y
Reliability Internal consistency: α + 0.81and comparative fit
index=0.90 (Sturm et al. 2002)
Y
Responsiveness ROC analyses – is sensitive, responsive and predictive (cf
SF-36) (Osborne et al. 2002)
Y
Precision Likert scale Y
User centredness Developed with strong psychometrics and consumer
participation
Y
Utility Complete package for analysis Y
Feasibility assessed Y
Total CA score: 11/11
Name Canadian Occupational Performance Measure
(COPM)
For adult community? Y
Purpose specific Measures change in (self perceived) occupational
performance
Y
Background/rationale Activity – multidimensional (client-centred) Y
Description adequate Individualised, criterion referenced scale Y
Validity Construct: significantly related to Satisfaction with
Performance Scaled Questionnaire; Reintegration to
Normal Living Index; Life satisfaction Scale (McColl
2000).
Criterion: common reference to ADL problems 53%
(McColl, 2000)
Y
Reliability Test- retest: 0.63 for satisfaction scale and 0.84 for
performance scale (McColl, 2000)
Y
Responsiveness Mean change scores 1.5x sd in scores (Law et al. 1994) Y
Precision U
User centredness Reported easy to use by clients, 75% reported it to be
helpful (McColl 2000)
Y
Utility Easy to interpret Y
Feasibility Requires practice (Toomey et al. 1997) Y
Total CA score: 10/11
Name Chedoke Arm and Hand Activity Inventory (CAHAI)
For adult community? Y
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Purpose specific Measure functional ability of hemiplegic upper limb Y
Background/rationale Activity – upper limb Y
Description adequate Inventory questionnaire Y
Validity Construct: high correlations with CMSA and ARAT
(Barecca et al. 2005)
Inter-item correlations: mean r=0.641
Y
Reliability Internal consistency: 0.98
Single-item factor: loadings “high”
Inter-rater: 0.98 (Barecca et al. 2005)
Y
Responsiveness ROC curve: 0.95
“more dept at distinguishing change than the CMSA and
ARAT (Barecca et al. 2005)
Y
Precision 7 point scale more precise than comparable scales
(Barecca et al. 2005)
Y
User centredness Bilateral functional tasks derived from stroke patients
(Barecca et al. 2005)
Y
Utility Shorter versions as reliable as longer Y
Feasibility Inventory easily administered (Barecca et al. 2006) Y
Total CA score: 11/11
Name Coping Strategy Indicator (CSI)
For adult community? Y
Purpose specific Measures individual’s choice in coping strategies Y
Background/rationale Personal factors - coping Y
Description adequate Self-report questionnaire Y
Validity Convergent: supported (Amirkhan 1990)
Discriminant: absolute values 0.01-0.44 (good) (Clark et
al. 1995)
Y
Reliability Inter-rater: 86-88% (Amirkhan 1994)
Internal consistency: Cronbachs α 0.84-0.93
Test-retest: Pearsons coefficient 0.82-0.81 (Amirkhan
1990)
Y
Responsiveness U
Precision U
User centredness Allows more complex patterns to be exhibited (Amirkhan
1994)
Y
Utility U
Feasibility Practical, efficient (Amirkhan 1990) Y
Total CA score: 8/11
Name Frenchay Activities Index
For adult community? Y
Purpose specific Measures activities reflecting independence and social
survival
Y
Background/rationale Activities - general Y
Description adequate Self report or interview Y
Validity Construct: “meaningful correlations between FAI and BI
and SIP (Schuling et al. 1993).
Convergent/discriminant: Pearsons CC 0.66 with BI; 0.14-
0.73 with SIP (Schuling et al. 1993); discriminative of
Y
Compendium of clinical measures for community rehabilitation Page 79 of 101
patients pre and post stroke levels (Salter et al 2005)
Concurrent: strong with FIM (r=0.80 and MRS (r=0.80);
correlation coeff r=0.44-0.77 (Wade et al. 1985)
Reliability Internal consistency: Cronbachs α 0.78-0.87 (Schuling et
al. 1993)
Inter-rater: Kappa 0.64-0.80 (good) for 9 items; 0.26-0.52
for remaining 6 items; Spearmans rho =0.93 (Piercy 2000)
Test-retest: 0.96 (Turnbull et al. 2000)
Y
Responsiveness No ceiling effects, scores well distributed (Salter et al.
2005); appropriate change scores over 12 months (Wade
et al. 1985)
Y
Precision U
User centredness Functional tasks of daily life, high response rates (Buck et
al 2000)
Y
Utility Some questions regarding scoring (Salter et al. 2005) N
Feasibility Simple, easy to administer (Salter et al. 2005) Y
Total CA score: 9/11
Name Frenchay Dysarthria Assessment
For adult community? Y
Purpose specific Rates motor speech function Y
Background/rationale Activity - speech Y
Description adequate N
Validity U
Reliability Test-retest: evaluated with p values for significant
difference between tests (p>0.05) (Wallace 1991)
Reliable between online version and face to face
(Theodoros et al. 2003)
?Y
Responsiveness U
Precision 8 point scale U
User centredness U
Utility Easy to score (Wallace 1991) Y
Feasibility Easy to administer (Wallace 1991) Y
Total CA score: 5.5/11
Name Geriatric Depression Scale
For adult community? Y
Purpose specific Assess depression in elderly persons Y
Background/rationale Impairment - psychological Y
Description adequate Questionnaire Y
Validity Interscale correlations: with DSC r=0.82, with SDS r=0.59
(Dunn et al. 1989)
Y
Reliability Internal consistency: α=0.91
Median item-total correlation 0.48 (Dunn et al. 1989)
Kappa range 0.29-0.75 (Burke et al. 1995)
Y
Responsiveness ROC curve: area under =0.84
Sensitivity of 52% and specificity 79% (Burke et al.
1995).
Y
Precision Confirmed somewhat by Burke et al 1995 Y
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User centredness Confirmed by Scogin et al 1987 Y
Utility Confirmed by Dunn et al. 1989 Y
Feasibility “less confusing” (Dunn et al. 1989) Y
Total CA score: 11/11
Name Goal Attainment Scale
For adult community? Y
Purpose specific Identification/monitoring of client goals Y
Background/rationale Activity – multidimensional, client centred Y
Description adequate Interview based rating scale Y
Validity Concurrent: with norm-referenced measures is low to
moderate due to idiosyncratic nature of GAS (Donnelly
and Carswell, 2002)
Y/N
Reliability Internal consistency and test-retest: not relevant due to
different goals set for each client and which may
changeover time (Forbes 1998)
U
Responsiveness Reported to be more sensitive to small changes than
standardised measures (Stolee et al. 1999)
Y
Precision Allows for incremental scoring Y
User centredness Client focussed - individualised Y
Utility Requires training Y
Feasibility Mixed reports: difficult (Stolee et al 1999); flexible
(Ottenbacher et al. 1990)
Y/N
Total CA score: 9/11
Name Hand Active Sensation Test (HASTe)
For adult community? Y
Purpose specific Test of haptic touch Y
Background/rationale Impairment - sensation Y
Description adequate Objects for testing under patent N
Validity “Moderate negative correlations with established
measures” (Williams et al. 2006)
Y
Reliability Test-retest: ICC 0.77, r=0.78
Internal consistency: Cronbachs α 0.82 (Williams et al.
2006)
Y
Responsiveness ROC curve: area 0.941.
Sensitivity: 0.857 using 13 as accuracy score and
specificity 1.0 (Williams et al. 2006)
Y
Precision Continuous scale provides more precision than existing
dichotomous measures (Williams et al. 2006)
Y
User centredness Functional textures and objects Y
Utility U
Feasibility U
Total CA score: 8/11
Name Hand Grip Strength Test
For adult community? Y
Purpose specific Measure maximum isometric grip strength +/- sustained Y
Background/rationale Impairment – physical (grip) strength Y
Compendium of clinical measures for community rehabilitation Page 81 of 101
Description adequate Short performance test Y
Validity Face validity U
Reliability Test-retest: ICC 0.95 (Kamimura and Ikuta 2002) Y
Responsiveness U
Precision Calibrated instrumentation Y
User centredness Focal ability Y
Utility Easy scoring from meter Y
Feasibility quick Y
Total CA score: 9/11
Name Home and Community Environment Instrument
(HACE)
For adult community? Y
Purpose specific Characterises factors in home and community
environment that may influence participation
Y
Background/rationale Participation - Environmental factors Y
Description adequate Self report questionnaire Y
Validity Reported but no data ?Y
Reliability Median Kappa range across domains 0.62-1.0 (Keysor et
al. 2005)
Y
Responsiveness U
Precision U
User centredness Captures client evaluation of environment Y
Utility U
Feasibility quick Y
Total CA score: 7.5/11
Name Manual Muscle Testing
For adult community? Y
Purpose specific Detect and grade muscle weakness Y
Background/rationale Impairment – muscle strength Y
Description adequate Clinical performance measure Y
Validity With hand held dynamometry: r=0.77-0.89 (Roberts-
Warrior 2003) and R>0.73 (Bohannon 1999)
Y
Reliability Test-retest: r=0.63-0.98 (Roberts-Warrior 2003).
Inter rater: median Cohens k coeff = 0.54 (Jepsen et al.
2004).
Intra-rater: 0.63-0.98 (Wadsworth et al. 1987)
Grades from single tester are recommended (Knepler and
Bohannon 1998)
Y
Responsiveness Decreased sensitivity for grades>3+ (Roberts-Warrior
2003, Bohannon 2002)
Sensitivity: 42.9% accurate in detecting 20% difference in
knee ext.
Specificity: 82.3% accurate in identifying absence of 20%
difference in knee ext. (Bohannon 1997)
Small differences in strength less likely to be detected if
within normal limits (Broniecki et al. 2002)
Y/N
Precision 5 part scale Y
User centredness U
Compendium of clinical measures for community rehabilitation Page 82 of 101
Utility Subjective, requires expertise but widely used (Broniecki
et al. 2002)
Y
Feasibility Inexpensive, easy (Broniecki et al. 2002) Y
Total CA score: 9.5/11
Name Motor Assessment Scale
For adult community? Y
Purpose specific Functional capabilities Y
Background/rationale Activity – Global (Motor behaviour) Y
Description adequate Y
Validity Correlation with total FMA: rho=0.96 (Malouin et al.
1994); rho=0.88 (Poole et al. 2001)
With FMSA r=0.88-0.96 (Murphy et al. 2003)
Predictors of arm function at discharge post stroke: Arm
function score at 1 week (r=0.84) and 1 month (r=0.91)
(Murphy et al. 2003)
Y
Reliability Inter-rater: r=0.89-0.99; 78%-95% agreement (Murphy et
al. 2003; Poole et al. 2001)
Intra-rater: r=0.81-1.0 (Dean et al. 1992; Poole et al. 2001)
Y
Responsiveness Floor effect for pen item (too easy); no ceiling effect
(Sabari et al 2005)
Y
Precision Questioned (Malouin et al 1994) ?
User centredness functional Y
Utility Y
Feasibility Y
Total CA score: 10/11
Name Neuropsychology Behaviour and Affect Profile
For adult community? Y
Purpose specific Measure of level and type of emotional functioning and
change from pre-morbid levels
Y
Background/rationale Personal factors – behaviour and affect Y
Description adequate Questionnaire – significant other Y
Validity Discriminant: three of five scales (Nelson et al. 1993) Y
Reliability Internal consistency: 0.68-0.82
Test-retest: ICC 0.92-0.99 (Nelson et al. 1989)
Y
Responsiveness U
Precision U
User centredness U
Utility Internal stability supported (Nelson et al. 1993) Y
Feasibility Proxy report - acceptable Y
Total CA score: 8/11
Name Nine Hole Peg Test
For adult community? Y
Purpose specific Assess dexterity in upper limb Y
Background/rationale Activity – upper limb Y
Description adequate Short performance test Y
Validity U
Compendium of clinical measures for community rehabilitation Page 83 of 101
Reliability Inter-rater: high r=0.984 (right hand) and r=0.993 for left
hand
Y
Responsiveness U
Precision U
User centredness Functional task Y
Utility Confirmed by Grice et al. 2003 Y
Feasibility Confirmed by Grice et al. 2003 Y
Total CA score: 8/11
Name Postural assessment scale for stroke patients (PASS)
For adult community? Y
Purpose specific Assess/monitor postural control post stroke Y
Background/rationale Activity - balance Y
Description adequate Performance test Y
Validity Construct validity: r=0.73, with leg MI (r=0.75) (Benaim
et al. 1999, Murphy and Warrior, 2003)
Y
Reliability Internal consistency: Cronbachs α = 0.95.
Inter-rater and test-retest: average K=0.88 and 0.72
(Benaim et al. 1999, Murphy and Warrior, 2003)
Y
Responsiveness Effect size – ranges from 31 at 90-180 days post stroke,
1.12 over 14-180 days.
Floor effect <10%; ceiling <14% (Benaim et al. 1999,
Murphy and Warrior, 2003)
Y
Precision U
User centredness U
Utility U
Feasibility In regular use clinically Y
Total CA score: 8/11
Name Rivermead Behavioural Memory Test
For adult community? Y
Purpose specific Assess everyday memory Y
Background/rationale Impairment - memory Y
Description adequate Clinical assessment Y
Validity Correlation: with Everyday Memory Questionnaire
p<0.05-0.001) (Lincoln and Tinson 1989)
Y
Reliability U
Responsiveness U
Precision U
User centredness Functional everyday memory items Y
Utility Cut-off scores for ful interpretation (Cockburn et al. 1990) Y
Feasibility Van Balen et al 1996 Y
Total CA score: 8/11
Name Royal Brisbane Hospital Outcome measure for
Swallowing
For adult community? (originally for inpatients) ?
Purpose specific Measures outcomes of dysphagia in terms of oral intake Y
Background/rationale Activity – speech/oral function Y
Description adequate Clinician administered scale Y
Compendium of clinical measures for community rehabilitation Page 84 of 101
Validity Criterion: rho=0.83 (TOM Dysphagia Disability
Scale); rho= -0.61 (Westmead scale)
Content: peer review and discriminatory power –
clinically relevant, “strong”. (Ward and Conroy,
1999)
Y
Reliability Inter-rater: spearmans=0.993 (Ward and Conroy,
1999)
Y
Responsiveness Reported to be responsive to clinical change and sensitive
within acute hospital setting. Possible ceiling effects in
rehabilitation setting (Skeat and Perry, 2005).
Y
Precision U
User centredness U
Utility Not fully ordinal U
Feasibility In regular use with clinicians Y
Total CA score: 7/11
Name Short Orientation-Memory-Concentration Test
For adult community? Y
Purpose specific Assess memory and concentration Y
Background/rationale Impairment - cognition Y
Description adequate Clinical test / questions Y
Validity Concurrent: with clinician scores: 100% agreement
(Dellasega et al. 2001); with MSQ r=-0.896 and with
MMSE r=-0.926 (Dellasega et al. 2001); with RBMT
r=0.68-0.74 (Wade and Vergis 1999); with Blessed Test
r=0.941 (Katzman et al. 1983) with cortical plaque found
on autopsy significant correlation (Katzman et al. 1983);
no significant correlation with Barthel Index r=0.23
(Wade and Vergis 1999)
Y
Reliability Test-retest: Pearsons CC=0.992 (Dellasega et al. 2001);
significantly higher scores on second test (Wade and
Vergis 1999) ?practice effect
Y/N
Responsiveness Sensitivity 88%
Specificity 94% (Davous et al. 1987)
Y
Precision U
User centredness Appears to be relevant to participants Y
Utility Clear interpretive scoring Y
Feasibility Short, low cost, minimal training Y
Total CA score: 9.5/11
Name Step Test
Clinical environment
for adult community?
Y
Purpose specific Measure simple balance task Y
Background/rationale Activity - balance Y
Description adequate Short performance test Y
Validity Correlated with FRT (r=0.68-0.73), gait velocity (r=0.83)
and stride length (r=0.82-0.83) (Hill et al.1996)
Y
Reliability Test-retest: ICC 0.90 – 0.94 for healthy elderly; ICC 0.88- Y
Compendium of clinical measures for community rehabilitation Page 85 of 101
0.97 post stroke (Hill et al. 1996)
Responsiveness U
Precision U
User centredness U
Utility Acceptable interpretation Y
Feasibility Easy to administer Y
Total CA score: 8/11
Name Tardieu Scale
For adult community? Y
Purpose specific Assesses/compares response of muscles to passive
movement +/-velocity
Y
Background/rationale Impairment – muscle tone Y
Description adequate Rating scale with definitions Y
Validity With laboratory measure of spasticity: 100% agreement
(Kappa 0.24) for elbow flexors and ankle plantarflexors;
Differerentiate between spasticity and contracture (Patrick
and Ada 2006)
Reliability Inter rater: ICC 0.58-0.78
Intra rater: ICC 0.55-0.97 (Morris 2002)
Y
Responsiveness U
Precision U
User centredness U
Utility U
Feasibility Quick test with minimal subject burden Y
Total CA score: 6/11
Name Timed up and go test
For adult community? Y
Purpose specific Measure simple mobility task requiring postural control Y
Background/rationale Activity - mobility Y
Description adequate Short performance test Y
Validity Moderate correlation with Tinetti Gait Assessment (r=-
0.54); gait speed (r=0.66); ADL scale (r=-0.45) (Lin et al.
2004); with BBS (r=0.47) (Bernie et al. 2003); Frailty
Scale, Older American resources and services ADL scales
(0.6-0.7 (Rockwood et al. 2000).
High inverse correlation with 6MWT (Spearman cc -0.96)
and ankle plantarflexion peak torque (-0.86) (Ng and Hui-
Chan 2005).
Strong correlation with comfortable gait speed, fast gait
speed and 6MWT (-0.86 to -0.92) (Flansbjer et al. 2005)
Y
Reliability Intra and inter rater: ICC≥0.93 (Lin et al. 2004)
Test-retest: ICC > 0.95 (Ng and Hui-Chan 2005);
ICC>0.96 (Flansbjer et al. 2005); ICC=0.56 (Rockwood et
al. 2000)
Y
Responsiveness Responsiveness to falls: effect size 0.12 (Lin et al.2004)
Sensitivity to predict falls using a cut off point of 13.5s
=).80; specificity 1.00 (Shumway-Cook cited in Hayes
and Johnson 2003).
Y
Compendium of clinical measures for community rehabilitation Page 86 of 101
Standardised response mean (Mean change/SD of change)
= 0.73 (Salbach et al. 2001).
95% smallest real difference = 23% (Flansbjer et al.
2005).
Possible floor effects in persons with cognitive
impairment (Rockwood et al. 2000)
Precision Continuous data - precise Y
User centredness Functional/meaningfulness reported (Flasnbjer et al. 2005
and Salter et al. 2005)
Y
Utility Y
Feasibility Simple etc (Ng and Hui-Chan 2005) Y
Total CA score: 11/11
Name Six Minute Walk Test
Clinical environment
for adult community?
Y
Purpose specific Physical mobility function and cardio-vascular function Y
Background/rationale Activity - mobility Y
Description adequate Clinical performance test Y
Validity Convergent: moderate correlation with lower limb
strength (r+0.53), tandem balance 9r=0.39), gait speed
(r=0.45), SF-36 physical functioning subset (r=0.53 and
general health perception subset (r=0.24) (Harada et al
1999)
High correlation with TUG (CC -0.83to 0.95) (Flansbjer
et al 2005); maximal step length (0.732)(Cho et al. 2004).
No relation to VO2Max (Eng et al 2002).
Significant correlation with BBS (p<0.0001) and Lower
limb Motor Score (p<0.05) (Pohl et al. 2002).
Significant correlations with Chedoke McMaster Stroke
Assessment, gait speed and 12m walk test (0.754-0.966)
(Eng et al. 2002).
Moderate correlation with Ashworth score (Inverse) (-
0.534) (Eng et al. 2002).
Other variables that reduce distance are greater age,
shorter height, female, waist circumference, weight,
diastolic BP >69mmHg, lower MMSE score, ACE
inhibitors, grip strength, co-morbidities (all p<0.001)
(Enright 2003a, 2003b).
Y
Reliability Test-retest: r=0.87 (Harada et al 1999); most recent ICC
0.99 (Flansbjer et al. 2005).
For multiple re-tests may be modest learning (training)
effect ie average increase of 30m (4.5%) (Gibbons et
al.2001) and significant differences between tests 1 and 3-
5 (Kervio 2003).
Y
Responsiveness 95% smallest real difference = 13% change in scores
(Flansbjer et al. 2005)
Estimate of smallest meaningful change = 20m distance
(Perera et al. 2006)
Y
Precision Modest training effect as above Y
Compendium of clinical measures for community rehabilitation Page 87 of 101
Distance measure considered precise
User centredness Walking speed is important for participants Y
Utility Easy to interpret scores Y
Feasibility Simple and easy to conduct, no training required (Pohl et
al 2002).
Y
Total CA score: 11/11
Name
Voice Handicap Index (VHI)
For adult community? Y
Purpose specific Self reported measure of vocal function Y
Background/rationale Activity – speech (voice) Y
Description adequate Client administered questionnaire Y
Validity Construct: correlation = 0.82 with VPQ (Deary et al.
2004)
Suggestion of repetitiveness (Wilson et al. 2004)
Y/N
Reliability Internal consistency: Cronbachs α 0.88-0.90 (Wilson et al.
2004, Deary et al. 2004). Franic et al. 2005 disagree.
Test-retest: r=0.92; Pearson product moment correlation
r=0.70-0.79 (Jacobson 1997); strongest of all voice
disorder measures (Wheeler et al. 2006)
Y/N
Responsiveness Responsive with 18 point change (Franic et al. 2005) Y
Precision As above Y
User centredness Patients identify with responses (Hogikyan et al. 2002) Y
Utility Easy to score (Franic et al. 2005) Y
Feasibility Quick (Deary et al. 2004) Y
Total CA score: 10/11
Name Western Aphasia Battery
For adult community? Y
Purpose specific Measures severity of aphasia Y
Background/rationale Activity - speech Y
Description adequate Clinician administered tests N
Validity U
Reliability Internal consistency: α=0.91
Test-retest: Pearsons 0.88-0.97
(Schewan 1986)
Y
Responsiveness U
Precision U
User centredness U
Utility U
Feasibility Simple and quantifiable in short administration time
compared to other tools (Crary et al. 1989)
Y
Total CA score: 5/11
Name Wolf Motor Function Test
For adult community? Y
Purpose specific Quantifies upper extremity ability Y
Background/rationale Activity – upper limb Y
Description adequate Timed standardised activities Y
Compendium of clinical measures for community rehabilitation Page 88 of 101
Validity Construct: differentiates between stroke versus non-stroke
(Wolf et al. 2001).
Discriminant: discriminates between high and low
functioning participants (Wolf et al. 2005)
Y
Reliability Inter rater: 0.97-0.99
Internal consistency: 92.4% (Wolf et al. 2001)
Y
Responsiveness U
Precision Continuous scale (timed) Y
User centredness Functional tasks Y
Utility Easy to interpret continuous (timed)scale Y
Feasibility Simple and easy Y
Total CA score: 10/11
Name World Health Organisation Quality of Life – Brief
version (WHOQoL BREF)
For adult community? Y
Purpose specific considers domain level profiles which assess quality of
life
Y
Background/rationale Subjective quality of life Y
Description adequate questionnaire Y
Validity Construct: R² 0.41-0.52 Y
Reliability Internal consistency: Cronbachs α 0.66-0.82
Test-retest: Correlation coeff. 0.66-0.87
(WHOQoL 1998)
Y
Responsiveness U
Precision Likert scale Y
User centredness Well tested Y
Utility Used readily internationally Y
Feasibility Cheap, easy to administer Y
Total CA score: 10/11
Compendium of clinical measures for community rehabilitation Page 89 of 101
Glossary for Psychometric Terms
PROPERTY DEFINITION
ACCEPTED VALUES
Reliability
Concerned with the reproducibility and internal consistency of a
measuring instrument. It is essential to establish that any
changes observed in a trial are due to the intervention and not to
problems in the measuring instrument.
Internal consistency
Within an outcome measure, several items will be related to a
single construct within that measurement tool, eg receptive
communication. Internal consistency is the homogeneity of each
item.
Reproducibility or test-retest reliability
Directly evaluates whether an instrument yields the same results
on repeated
applications, when respondents have not changed on the domain
being measured.
Inter-rater reliability
Agreement between individuals recording baseline information
and change in performance
Split half or Cronbachs alpha:
Excellent>0.80
Adequate 0.70-0.79
Poor<0.70
Note: >0.90 may indicate redundancy
Varies widely, but minimum of 0.7
suggested for correlation coefficients
(ICC, kappa).
Excellent>0.75
Adequate 0.4-0.74
Poor<0.4
Cohen’s kappa coefficient
Less than 0.4=poor
agreement
0.4-0.59 =fair agreement
0.6-0.74=good agreement
0.75-1= excellent agreement
Validity
The extent to which an outcome measurement tool measures
what it purports to measure
Criterion validity
Criterion validity is involved when a proposed new measure
correlates with another measure generally accepted as a more
accurate or criterion variable. It is ideally measured against a
“gold standard” if one is available.
Face validity
Examines whether an instrument appears to be measuring what
it is intended to measure. This is achieved by a qualitative
assessment.
Content validity
Correlation coefficient>0.75
Qualitative
Qualitative
Compendium of clinical measures for community rehabilitation Page 90 of 101
Content validity examines the extent to which the domain of
interest is comprehensively sampled by the items, or questions,
within the instrument. Again, assessed qualitatively.
Construct validity
Outcome measures usually aim to assess functional issues,
rather than directly observable occurrences. Construct validity
assesses the tools appropriateness in the items within the
measure to give an accurate picture of the outcome to be
measured, eg no. of carer visits per day as a measure of
functional status.
Factor Analysis
Within the field of construct validity, factor analysis is the
analysis of patterns of, items that go together to assess single
underlying constructs, eg physical ability or emotional well
being.
Correlation coefficient>0.6
Adequate 0.31-0.59
Poor<0.0.30
ROC analysis-AUC
Excellent>0.90
Adequate 0.70-.089
Poor<0.70
Responsiveness
The ability of an instrument to detect clinically important
change over time. Many different ways of measuring
Sensitivity
Ability to detect true change within a clinical setting (ie true
positive)
Specificity
Ability to detect true stability (ie true negative)
Floor and Ceiling effects
A measure may be too easy for some subjects, thus not truly
assessing higher levels of function, or too difficult, not truly
assessing the lower end of the scale.
Effect size: High>0.8
Mod 0.4-0.8
Low<0.4
Area under receiver operating
characteristic (ROC) curve:
High>0.75
Mod0.5-0.75
Low<0.5
<20% of subjects receiving scores of
either 100% or 0%
Precision
Similar to sensitivity and refers to the degree a tool can measure
an outcome, eg a tool that measures a subjects either being in
pain or not in pain is not as precise as a tool that can measure
the degree to which someone is in pain. Influenced by the nature
of responses, eg dichotomous vs ordinal
For the purposes of appraisal, a paper is deemed to have
sufficient precision if it uses a minimum of 5point Likert scale
(eg very satisfied, satisfied, unsure, unsatisfied, very
unsatisfied), or a continuous scale, eg Visual Analog Scale
7 response categories considered to
give the most precise measure
Interpretability
How clinically meaningful scores from an instrument are. cf normative data.
Acceptability How acceptable an instrument is to patients/subjects. Shorter Varies, may include reporting of
Compendium of clinical measures for community rehabilitation Page 91 of 101
questionnaires/tools considered more acceptable. Should be
addressed/assessed at the design stage of an instrument
For the purposes of appraisal, a judgement by the appraiser
should be made as to how acceptable a measure is with
reference to their justification. Eg the tool only takes 5 minutes.
speed of completion, proportion of
non respondents, proportion of
incorrectly completed questionnaires
Feasibility
How easy an instrument is to administer and process. Issues
include level of supervision or training, time and cost,
Again, a judgement may be required if sufficient information is
available as to the feasibility of a measure.
Appropriateness
Whether the instrument to be used is going to effectively
measure the characteristic(s) of interest
A philosophical issue. Refer to
Fitzpatrick et al p20
Compendium of clinical measures for community rehabilitation Page 92 of 101
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APPENDIX ONE: CRITICAL APPRAISAL TOOL
Full name of the outcome measure Abbreviated name
Author of the outcome measure
Clinical Environment
Is it commonly used in the community, if no, for immediate exclusion
Y / N / not stated
Objective of the outcome measure Purpose: does it have a specific aim? Y / N / not stated
Background
Need for this particular measure reported?
Is there a rationale behind the design?
Y / N / not stated
Population investigated
Pathology
ICF component(s) and domain(s) Type of outcome measure Eg. questionnaire, survey Mode of administration Eg. patient administered
Number of items Type of scale Eg. Likert scale
Description
Are the previous 4 characteristics appropriately satisfied?
Y / N / not stated Equipment required
Time required to perform
Normative data/scores
Reliability
Validity
Responsiveness
Precision
Validity
Is the validity of the outcome measure sound?
Y / N / not stated Reliability
Is the reliability of the outcome measure sound? Y / N / not stated
Responsiveness
Is the responsiveness of the outcome measure sound? Y / N / not stated
Precision
Is the precision of the outcome measure sound? Y / N / not stated
Appropriateness
User Centeredness
Does this measure adequately capture user or carer desired outcomes?
Is it faithful to the form of user and carer views?
Y / N / not stated
Acceptability
Interpretability
Utility
Has the measure adequate interpretability, acceptability and relevance?
Y / N / not stated Feasibility
Feasibility
Has the measure adequate feasibility?
Y / N / not stated
Critical appraisal score (total “yes”) /11
Reference
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