The development of an instrument to match individuals with disabilities and service animals

Purpose : There has been an increase in the use of service animals assisting persons with disabilities in the past decade. However many of the service dog agencies do not utilize an assessment that is designed to match the person to the animal in the rehabilitation and psycho-social domains. The purpose of this study was to develop the Service Animal Adaptive Intervention Assessment (SAAIA) and to measure the content validity, inter-rater reliability and clinical utility of the assessment. Method : Two subject groups were used. Subject group one had 43 subjects who measured the content validity and clinical utility of the SAAIA Survey. Subject group two had 12 subjects who measured the inter-rater reliability by completing the SAAIA using information obtained through a video-taped client case scenario. Results : Content validity results indicated a good to high percentage of agreement and a fair percentage of agreement for clinical utility. Inter-rater reliability results indicate good to high agreement on six of the eight variables of the SAAIA. However, the Kappa score indicates low inter-rater reliability. Conclusion : Results indicate the SAAIA has good content validity and inter-rater reliability and fair clinical utility based on percent agreement. However, further research is needed on the reliability of the SAAIA.     

The development of an instrument to match individuals with disabilities and service animals

PURPOSE: There has been an increase in the use of service animals assisting persons with disabilities in the past decade. However many of the service dog agencies do not utilize an assessment that is designed to match the person to the animal in the rehabilitation and psycho-social domains. The purpose of this study was to develop the Service Animal Adaptive Intervention Assessment (SAAIA) and to measure the content validity, inter-rater reliability and clinical utility of the assessment. METHOD: Two subject groups were used. Subject group one had 43 subjects who measured the content validity and clinical utility of the SAAIA Survey. Subject group two had 12 subjects who measured the inter-rater reliability by completing the SAAIA using information obtained through a video-taped client case scenario. RESULTS: Content validity results indicated a good to high percentage of agreement and a fair percentage of agreement for clinical utility. Inter-rater reliability results indicate good to high agreement on six of the eight variables of the SAAIA. However, the Kappa score indicates low inter-rater reliability. CONCLUSION: Results indicate the SAAIA has good content validity and inter-rater reliability and fair clinical utility based on percent agreement. However, further research is needed on the reliability of the SAAIA.     

Reliability and validity of the Northwick Park Dependency Score (NPDS) Swedish version 6.0

OBJECTIVE: To translate, to test inter-rater and intra-rater reliability and concurrent validity of the Basic Care Needs (BCN) section of the Northwick Park Dependency Score (NPDS). DESIGN: Test-retest reliability and validity testing. Observed data were collected by the staff (nursing staff, occupational therapists). SETTING: Three rehabilitation units. SUBJECTS: Forty inpatients between 16 and 65 years of age with brain injury were included. MAIN MEASURES: Inter-rater and intra-rater reliability was calculated by percentage agreement (PA) and unweighted kappa measure. Concurrent validity was examined by computing Goodman-Kruskal's gamma, a nonparametric statistic for degree of association between the BCN score and the total score of the Functional Independence Measure (FIM). RESULTS: Inter-rater reliability showed a good percentage agreement between nursing staff. Between nursing staff and occupational therapists the percentage agreement was lower especially in one item. Intra-rater reliability showed a good percentage agreement for all assessors. Concordance was good with a gamma--0.83 and an asymptotic error (ase) of 0.04, for nursing staff and for occupational therapists -0.87, ase 0.04. CONCLUSION: The BCN section of NPDS was found to be inter-rater and intra-rater reliable, to have concurrent validity. Further studies are needed on clinical utility. The instrument can be used for assessment of dependency for individual patients with brain injury, and information when transferring between different caregivers. Further studies need to investigate the sensitivity of the instrument.     

Assessment of neonatal resuscitation skills: a reliable and valid scoring system

OBJECTIVE: To study the reliability and validity of a scoring instrument for the assessment of neonatal resuscitation skills in a training setting. METHODS: Fourteen paediatric residents performed a neonatal resuscitation on a manikin, while being recorded with a video camera. The videotapes were analysed using an existing scoring instrument with an established face and content validity, adjusted for use in a training setting. Intra- and inter-rater reliability were assessed by comparing the ratings of the videotapes of three raters, one of who rated the videotapes twice. Intra-class coefficients (ICC) were calculated for the sum score, percentages of agreement and kappa coefficients for the individual items. To study construct validity, the performance of a second resuscitation of by residents was assessed after they had received feedback on their first performance. RESULTS: The ICC were 0.95 and 0.77 for intra- and inter-rater reliability, respectively. The median percentage of intra-rater agreement was 100%; inter-rater agreement 78.6-84.0%. The median kappa was 0.85 for intra-rater reliability, and 0.42-0.59 for inter-rater reliability. Residents showed a 10% improvement (95% confidence interval -4; 23%) on performance of a second resuscitation, which supports the instrument's construct validity. CONCLUSION: A useful and valid instrument with good intra-rater and reasonable inter-rater reliability is now available for the assessment of neonatal resuscitation skills in a training setting. Its reliability can be improved by using a more advanced manikin and by training of the raters.     

Venous access in oncology and haematology patients: Part two

AIM: To assess the validity and inter-rater reliability of two tools, Venous Assessment Tool (VAT) and Deciding on IntraVenous Access (DIVA), using thematic analysis of feedback from nurses who used the tools, METHOD: Analysis methods used in grounded theory were employed to investigate the written feedback provided by nurses. Inter-rater reliability was tested statistically using percentage agreement and the kappa (K) statistic. FINDINGS: Thematic analysis of the nurses' feedback generated themes concerning the role of clinical judgement, how theory translates to practice and the role of patient preference when using VAT and DIVA. Exploring these themes confirmed the validity of the tools and highlighted the importance of these considerations when evaluating the usefulness of assessment tools in the clinical environment. When VAT was used by a group of nurses to assess patients, the strength of agreement statistically was 'moderate'. When using DIVA, the tool demonstrated 'very good' agreement statistically. CONCLUSION: When used with oncology and haematology patients, VAT and DIVA have been shown to generate agreement among the nurses who used them beyond that which would be expected by chance. As the only tools of this kind with evidence of inter-rater reliability, they provide clinicians with a useful resource which can be used in practice or research. However, the use of assessment tools cannot replace clinical judgement or override the preferences of patients.     

Reproducibility of physiological track-and-trigger warning systems for identifying at-risk patients on the ward

OBJECTIVE: Physiological track-and-trigger warning systems are used to identify patients on acute wards at risk of deterioration, as early as possible. The objective of this study was to assess the inter-rater and intra-rater reliability of the physiological measurements, aggregate scores and triggering events of three such systems. DESIGN: Prospective cohort study. SETTING: General medical and surgical wards in one non-university acute hospital. PATIENTS AND PARTICIPANTS: Unselected ward patients: 114 patients in the inter-rater study and 45 patients in the intra-rater study were examined by four raters. MEASUREMENTS AND RESULTS: Physiological observations obtained at the bedside were evaluated using three systems: the medical emergency team call-out criteria (MET); the modified early warning score (MEWS); and the assessment score of sick-patient identification and step-up in treatment (ASSIST). Inter-rater and intra-rater reliability were assessed by intra-class correlation coefficients, kappa statistics and percentage agreement. There was fair to moderate agreement on most physiological parameters, and fair agreement on the scores, but better levels of agreement on triggers. Reliability was partially a function of simplicity: MET achieved a higher percentage of agreement than ASSIST, and ASSIST higher than MEWS. Intra-rater reliability was better then inter-rater reliability. Using corrected calculations improved the level of inter-rater agreement but not intra-rater agreement. CONCLUSION: There was significant variation in the reproducibility of different track-and-trigger warning systems. The systems examined showed better levels of agreement on triggers than on aggregate scores. Simpler systems had better reliability. Inter-rater agreement might improve by using electronic calculations of scores.     

Intra- and inter-rater reliability of the assessment of capacity for myoelectric control.

OBJECTIVE: To examine the reliability of the Assessment of Capacity for Myoelectric Control (ACMC) in children and adults with a myoelectric prosthetic hand. DESIGN: Intra-rater and inter-rater reliability estimated from reported assessments by 3 different raters. PATIENTS: A sample of convenience of 26 subjects (11 males, 15 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands were video-taped during a regular clinical visit for ACMC. Participants' ages ranged from 2 to 40 years. METHODS: After instruction, 3 occupational therapists with no, 10 weeks' and 15 years' clinical experience of myoelectric prosthesis training and follow-up independently rated the 30 ACMC items for each patient. The ratings were repeated after 2-4 weeks. Inter- and intra-rater reliability in items was examined by using weighted kappa statistics and Rasch-measurement analyses. RESULTS: The mean intra-rater agreement in items was excellent (kappa 0.81) in the more experienced raters. Fit statistics showed too much variation in the least experienced rater, who also had only good (kappa 0.65) agreement in items. The stability of rater calibrations between first and second assessment showed that no rater varied beyond chance (>0.50 logit) in severity. The mean inter-rater agreement in items was fair; kappa 0.60, between the experienced raters and kappa 0.47 between raters with no and 10 weeks' experience. CONCLUSION: Overall, the agreement was higher in the more experienced raters, indicating that reliable measures of the ACMC require clinical experience from myoelectric prosthesis training.     

Reliability of postural measures in elite badminton players using Posture Pro 8

The Posture Pro software is used for photogrammetry assessment of posture and has been commercially available for several years. Along with symmetry-related measures, a Posture Number® is calculated to reflect the sum of postural deviations. Our aim was to investigate the intra- and inter-rater reliability of measures extracted using the Posture Pro 8 software without using reference markers on subjects. Four raters assessed the standing posture of 40 badminton players (20 males, 20 females) from anterior, lateral, and posterior photographs. Thirty-three postural measures were extracted using visual landmarks as guide. Reliability was quantified using intra-class correlation coefficient (ICC) and typical error of measurement (TEM). Overall, the intra-rater reliability was considered good to excellent for nearly all measures. However, only two measures had excellent inter-rater reliability, with 13 and 18 measures exhibiting good and fair inter-rater reliability, respectively. Posture Pro specific measures (n = 9) exhibited good-to-excellent intra-rater and fair-to-excellent inter-rater reliability, with small-to-moderate and small-to-large TEM, respectively. Overall, the Posture Pro 8 software can be considered a reliable tool for assessing a range of posture-relevant measures from photographs, particularly when performed by the same examiner. The Posture Number® demonstrated generally acceptable intra- and inter-rater reliability. Nonetheless, investigations on the validity, sensitivity, and interpretation of this measure are essential to confirm its clinical relevance.     

康复护理日常生活活动评定量表的信度和效度研究

背景在康复医学中有许多种日常生活活动(ADL)能力评定量表,但符合康复护理程序的评定量表甚少.为此,浙江省康复中心从2000年开始研究设计了康复护理ADL(rehabilitative nursing ADL,RNADL)评定量表,并制定了评定内容和评定标准.目的探讨康复护理ADL评定量表在患者日常生活活动功能评测中的重测信度、内部一致性及量表的有效信度.设计重复测量设计.单位浙江省望江山疗养院,浙江省康复中心.对象2001-04/2003-04浙江省望江山疗养院康复医学科进行康复治疗的ADL功能障碍的40例患者.方法对40例住院康复患者用RNADL量表进行评测者内部、评测者之间的信度分析;内部一致性用Cronbach α计算;并分别用RNADL和改良的Barthel指数(MBI)进行出、入院各项目评定,用Pearson分析入院、出院及出入院之间的相关性.主要观察指标RNADL评定量表的信度和效度检测结果.结果RNADL评测者内部和评测者之间的信度良好,各项组内相关系数(ICC)范围为0.966～0.998,r=0.996～0.997;内部一致性信度系数α=0.822,各项之间α=0.925,RNADL内部一致性较好.RNADL和MBI的比较研究得出出、入院RNADL与MBI改变值间相关性良好(r=0.89,P＜0.001).结论RNADL具有很高的重测信度,内部一致性较好,与MBI有良好的关联效度,是康复护理日常生活活动能力可信、有效的评测量表.     

Inter-rater reliability of a modified version of Delitto et al.’s classification-based system for low back pain: a pilot study

Study design:: Observational inter-rater reliability study.

Objectives: To examine: (1) the inter-rater reliability of a modified version of Delitto et al.’s classification-based algorithm for patients with low back pain; (2) the influence of different levels of familiarity with the system; and (3) the inter-rater reliability of algorithm decisions in patients who clearly fit into a subgroup (clear classifications) and those who do not (unclear classifications).

Methods:: Patients were examined twice on the same day by two of three participating physical therapists with different levels of familiarity with the system. Patients were classified into one of four classification groups. Raters were blind to the others’ classification decision. In order to quantify the inter-rater reliability, percentages of agreement and Cohen’s Kappa were calculated.

Results:: A total of 36 patients were included (clear classification n?=?23; unclear classification n?=?13). The overall rate of agreement was 53% and the Kappa value was 0·34 [95% confidence interval (CI): 0·11–0·57], which indicated only fair inter-rater reliability. Inter-rater reliability for patients with a clear classification (agreement 52%, Kappa value 0·29) was not higher than for patients with an unclear classification (agreement 54%, Kappa value 0·33). Familiarity with the system (i.e. trained with written instructions and previous research experience with the algorithm) did not improve the inter-rater reliability.

Conclusion:: Our pilot study challenges the inter-rater reliability of the classification procedure in clinical practice. Therefore, more knowledge is needed about factors that affect the inter-rater reliability, in order to improve the clinical applicability of the classification scheme.     

Reliability of measuring the passive range of shoulder horizontal adduction using a smartphone in the supine versus the side-lying position

[Purpose] The purpose of this study was to compare the reliability of the measurement of the passive range of motion (PROM) of shoulder horizontal adduction (SHA) measurements using a smartphone for the assessment posterior shoulder tightness (PST) between the side-lying and supine test positions. [Subjects and Methods] Forty-seven subjects (mean ± age, 24.9 ± 3.5 years) without shoulder pathology were included in this study. Intra-rater and inter-rater reliabilities were determined using intraclass correlation coefficients. The SHA PROM of each subject’s dominant shoulder was measured using a smartphone by two investigators in two positions: the standard supine position, and a side-lying position on the tested side. [Results] The intra-rater reliability of the supine measurements was fair to good (ICC_3,1 = 0.72–0.89), and for the side-lying measurements was excellent (ICC_3,1 = 0.95–0.97). The inter-rater reliability of the supine measurements was fair (ICC_2,2 = 0.79) and for the side-lying measurements was excellent (ICC_2,2 = 0.94). [Conclusion] These results suggest that for healthy subjects, measurements of SHA using smartphones in the side-lying position has superior intra-rater and inter-rater reliabilities compared to the standard supine position.Key words: Reliability, Horizontal adduction, Smartphone     

Inter-rater reliability in disability assessment based on a semi-structured interview report

Purpose. To investigate whether physicians are able to perform a disability assessment based on a written report and to assess the inter-rater reliability between physicians in the assessment of work limitations.

Method. In total, 12 insurance physicians used written reports to assess work limitations in 12 patients. The reports involved a semi-structured interview executed by a nurse practitioner. The insurance physicians were asked whether they could make reliable assessments based on these reports. In addition, inter-rater reliability was measured by computing their percentage agreement with respect to the mental and physical items of two Dutch disability lists (the Functional Information System and the Mental Ability List).

Results. The quality of the reports was evaluated as reasonable to good. Half the physicians found the assessment based on the reports to be reasonably reliable, 25% found the opposite and 25% was indecisive. The overall agreement between the insurance physicians was reasonable to good, with a mean agreement of 76% (range 64 – 88%). Agreement between the physicians concerning the number of hours a patient could function daily was low.

Conclusions. Half the physicians thought that a reliable assessment based on the written information was possible. The quality of written patient reports made by nurse practitioners trained in conducting a semi-structured interview was considered reasonable to good by insurance physicians. The inter-rater reliability between insurance physicians of physical-disability and mental-disability assessment based on the written reports was reasonable to good. The assessment of the number hours patients could function daily had low inter-rater reliability.     

Inter- and intra-rater reliability of the manual handling component of the WorkHab Functional Capacity Evaluation

The WorkHab Functional Capacity Evaluation (FCE) is widely used in Australian workplace injury management and occupational rehabilitation arenas; however, there is a lack of published literature regarding its reliability and validity.

Purpose.?This study investigated the intra- and inter-rater reliability of the manual handling component of this FCE.

Method.?A DVD was produced containing footage of the manual handling components of the WorkHab conducted with four injured workers. Therapist raters (n == 17) who were trained and accredited in use of the WorkHab FCE scored these components and 14 raters re-evaluated them after approximately 2 weeks. Ratings were compared using intraclass correlation coefficients (ICCs), paired sample t-tests (intra-rater), chi-squared (inter-rater) and percentage agreement.

Results.?Intra-rater agreement was high with ICCs for the manual handling components and manual handling score showing excellent reliability (0.94–0.98) and good reliability for identification of the safe maximal lift (ICC: 0.81). Overall inter-rater agreement ranged from good to excellent for the manual handling components and safe maximal lift determination (ICC > 0.9). Agreement for safe maximal lift identification was good.

Conclusions.?Ratings demonstrated substantial levels of intra-rater and inter-rater reliability for the lifting components of the WorkHab FCEs.     

The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients

Abstract

Valid, reliable, responsive and practical outcome measures are essential for treatment planning and outcome assessment. This study aimed to examine the measurement properties of Modified Rivermead Mobility Index (MRMI) and Modified Functional Ambulation Classification (MFAC) in Chinese stroke patients. The content validity, responsiveness, predictive validity, test–retest reliability, internal consistency and factor structure of the MRMI were examined. The content validity, discriminative power and inter-rater agreement of the MFAC were investigated. A total of 456 Chinese stroke patients were recruited. Evidence of good content validity, high responsiveness, adequate predictive validity, excellent test–retest reliability with 1.3-point as minimum detectable change in 95% confidence interval, high internal consistency and unidimensionality was obtained for the MRMI. Good content validity, sufficient discriminative power and excellent inter-rater agreement were demonstrated for the MFAC. Both the MRMI and MFAC have good to excellent measurement properties and are recommended as routine outcome measures for Chinese stroke patients.     

Generalizability and clinical utility of a practice-based infant pain assessment instrument

The purpose of this study was to determine the clinical usefulness and generalizability of an infant pain assessment instrument. Earlier work showed that this instrument--an algorithm derived from a model of infant pain assessment-possessed excellent content validity, criterion-like validity, and 3-month stability (test-retest reliability). In this study, generalizability was determined by comparing the percentage agreement between inexperienced pediatric nurses and one author, both using the tool to assess pain of infants in various clinical settings, and by comparing the percentage agreement between one author who used the tool to assess pain and the infant's pediatric nurse caretaker who used his or her clinical expertise, not the tool, to assess pain across various clinical settings. The results show excellent generalizability.     

Measurement properties of existing clinical assessment methods evaluating scapular positioning and function. A systematic review

Abstract

The aims were to compile a schematic overview of clinical scapular assessment methods and critically appraise the methodological quality of the involved studies. A systematic, computer-assisted literature search using Medline, CINAHL, SportDiscus and EMBASE was performed from inception to October 2013. Reference lists in articles were also screened for publications. From 50 articles, 54 method names were identified and categorized into three groups: (1) Static positioning assessment (n?=?19); (2) Semi-dynamic (n?=?13); and (3) Dynamic functional assessment (n?=?22). Fifteen studies were excluded for evaluation due to no/few clinimetric results, leaving 35 studies for evaluation. Graded according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN checklist), the methodological quality in the reliability and validity domains was “fair” (57%) to “poor” (43%), with only one study rated as “good”. The reliability domain was most often investigated. Few of the assessment methods in the included studies that had “fair” or “good” measurement property ratings demonstrated acceptable results for both reliability and validity. We found a substantially larger number of clinical scapular assessment methods than previously reported. Using the COSMIN checklist the methodological quality of the included measurement properties in the reliability and validity domains were in general “fair” to “poor”. None were examined for all three domains: (1) reliability; (2) validity; and (3) responsiveness. Observational evaluation systems and assessment of scapular upward rotation seem suitably evidence-based for clinical use. Future studies should test and improve the clinimetric properties, and especially diagnostic accuracy and responsiveness, to increase utility for clinical practice.     

The reliability and validity of visual rating of dynamic alignment during lower extremity functional screening tests: a review of the literature

Abstract

Background:

Musculoskeletal assessment of lower extremity dynamic alignment during functional screening tests is important. Clinicians must consider the reliability and validity of visual assessment and the reliability of kinematics during the tests.

Aim:

To review studies reporting on the reliability and validity of visual and kinematic assessments of dynamic alignment during lower extremity functional screening tests.

Methods:

One relevant book and 39 journal articles were reviewed after searches of electronic databases.

Findings:

Reliability of lower extremity joint kinematics during functional tests ranged from fair to excellent [intraclass correlation coefficient (ICC)?=?0.46–1.0]. The best evidence of reliable kinematics from 3D motion analysis exists for the single leg squat, small knee bend and drop jump/land. Intra-rater and inter-rater agreement with visual rating of functional tests ranged from slight to excellent (AC1?=?0.01–0.96; κ?=?0.00–0.92). Visual assessment can differentiate groups with kinematics and hip muscle function that may place them at increased risk of injury. Clinician's visual ratings agreed sufficiently with those of an expert consensus panel. Reliability and validity of visual assessment may improve with clinical experience, training, simple dichotomous rating methods and slower velocity tests.

Conclusion:

The most valid clinical assessment of lower extremity dynamic alignment will be achieved with the use of a single leg squat, single or double leg small knee bend or drop jump, rating knee position relative to the foot on a dichotomous scale. If using more complex rating methods, example ratings and/or additional rater training are needed to gain acceptable agreement.     

Is there a difference in response to manual cranial bone tissue assessment techniques between participants with cervical and/or temporomandibular complaints versus a control group?

AimManual cranial bone tissue techniques (CBTT) are used by physiotherapists as a tool for assessment and treatment of complaints in the craniocervical, face, and head regions. The goal of this study was to determine whether CBTT were able to discriminate between subjects with cervical and/or temporomandibular disorders (TMD) and a healthy group. In addition, the inter-rater reliability when applying CBTT was also investigated.MethodsA cross-sectional study was conducted and included 60 participants. Six standardized passive techniques were applied and judged for resistance, compliance, and sensory answer. In order to evaluate the inter-rater reliability of these techniques a cohort of participants was measured twice (by two evaluators) prospectively. A logistic regression model and Receiver Operating Curve (ROC) analyses were used to determining the discriminative validity of these techniques.ResultsLogistic regression identified a significant difference for five techniques for resistance and/or compliance and/or the sensory answer between the groups. Based on the Area Under the Curve (AUC) analysis, the discriminative ability of the temporal rotation to distinguish between the groups was fair to good (for resistance AUC = 0.7775 and for compliance AUC = 0.8065). The highest agreement between the two assessors was for the resistance with occipital compression (73%) technique.ConclusionThis study highlights that some of the CBTT could be potentially useful in distinguishing subjects with cervical and/or TMD from healthy subjects. Inter-rater reliability was moderate. CBTT could be potentially integrated in the examination of participants with complaints in the craniofacial region.     

Defining the content of individual physiotherapy and occupational therapy sessions for stroke patients in an inpatient rehabilitation setting. Development, validation and inter-rater reliability of a scoring list

OBJECTIVE: To develop a valid and reliable scoring list to define the content of individual physiotherapy and occupational therapy sessions for stroke patients in inpatient rehabilitation. DESIGN: A list was developed based on previous lists, neurological textbooks and recorded therapy sessions. Content validity was verified and inter-rater reliability evaluated on videos of treatment sessions. In each of four rehabilitation centres, a researcher recorded and scored five physiotherapy and five occupational therapy sessions. These 40 treatment sessions were also scored by the first author. The scores of the researchers and first author were statistically compared. Settings and subjects : Forty stroke patients in four European rehabilitation centres. RESULTS: The scoring list consists of 49 subcategories, divided into 12 categories: mobilization; selective movements; lying (balance); sitting (balance); standing (balance); sensory and visual perceptual training and cognition; transfers; ambulatory activities; personal activities of daily living; domestic activities of daily living; leisure- and work-related activities; and miscellaneous. Comparing the frequency of occurrence of the categories resulted in intraclass correlation coefficients, indicating high reliability for eight categories, good for one, and fair for two. One category was not observed. Spearman rank correlation coefficients were high to very high for 24 subcategories and moderate for four. Twenty-one subcategories contained too few observations to enable calculation of Spearman rank correlation coefficients. Average point-to-point percentage of agreement in time of the treatment sessions equalled 76.6 +/- 16.2%. CONCLUSIONS: The list is a valid and reliable tool for describing the content of physiotherapy and occupational therapy for stroke patients.