Development of a Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke: A Simulation and Validation Study

Objective

The authors aimed to develop and validate the Computerized Adaptive Testing System for Assessing 5 Functions in Patients with Stroke (CAT-5F) based on the Barthel Index (BI), Postural Assessment Scale for Stroke patients (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) to improve the efficiency of assessment. The purposes of the CAT-5F assessment are to describe patients’ levels of impairments or disabilities in the 5 functions and to serve as an outcome measure in patients with stroke.

Interrater and Intrarater Reliability of the Balance Computerized Adaptive Test in Patients With Stroke

Objective

To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions.

Reliability and Responsiveness of the Activities of Daily Living Computerized Adaptive Testing System in Patients With Stroke

Objective

To examine the intrarater reliability, interrater reliability, and responsiveness of the Activities of Daily Living Computerized Adaptive Testing system (ADL CAT) in patients with stroke.

Design

One repeated-measures design (at an interval of 7d) was used to examine the intrarater reliability and interrater reliability of the ADL CAT. For the responsiveness study, participants were assessed with the ADL CAT at admission to the rehabilitation ward and at discharge from the hospital.

Setting

Eight rehabilitation units.

Participants

Three different (nonoverlapping) groups of patients (N=157) were recruited. Fifty-five and 42 outpatients with chronic stroke participated in the intrarater and interrater reliability studies, respectively; 60 inpatients who had recently had a stroke participated in the responsiveness study.

Interventions

Not applicable.

Main Outcome Measure

ADL CAT.

Results

The intraclass correlation coefficient values were .94 and .80 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The classical test theory–based minimal detectable change values were 6.5 and 9.5 for the ADL CAT in the intrarater reliability and interrater reliability studies, respectively. The Kazis' effect size and standardized response mean of the ADL CAT were moderate (.62–.73).

Conclusions

The ADL CAT has good intrarater reliability and interrater reliability in outpatients with chronic stroke, and sufficient responsiveness in inpatients with stroke undergoing inpatient rehabilitation. Further investigations on the responsiveness of the ADL CAT in outpatients are needed to obtain more evidence on the utility of the ADL CAT.     

Development of a Social Functioning Assessment Using Computerized Adaptive Testing for Patients With Stroke

Objective

To develop a computerized adaptive test of social functioning (Social-CAT) for patients with stroke.

Comparison of the Test-Retest Reliability of the Balance Computerized Adaptive Test and a Computerized Posturography Instrument in Patients With Stroke

Objective

To compare the test-retest reliabilities of the scores of the Balance Computerized Adaptive Test (CAT) and the Biodex Balance System in patients with stroke.

Design

A repeated-measures design (at a 1-wk interval) was used to examine the test-retest reliabilities of the scores of the Balance CAT and the Biodex Balance System.

Setting

One rehabilitation unit in a local hospital.

Participants

Patients (N=50) with stroke for more than 6 months and undergoing outpatient rehabilitation completed the Balance CAT and the eyes open (EO)/closed (EC) tests, but only 17 patients finished the Limit of Stability (LOS) test because they were unable to reach all the targets.

Interventions

Not applicable.

Main Outcome Measures

The Balance CAT and 2 computerized tests of the Biodex Balance System, namely the EO/EC test and the LOS, were used to evaluate balance function.

Results

The test-retest reliabilities of the scores of the Balance CAT (Pearson r=.92, minimal detectable change [MDC] percent=12.8%) was excellent. Those of the EO/EC and LOS tests were poor to good (Pearson r=.56–.85, MDC%=50.8%–126.9%).

Conclusions

The test-retest reliabilities of the scores of the Balance CAT were sufficient for assessing balance function in patients with stroke. Moreover, the test-retest reliabilities of the scores of the Balance CAT, one of the functional balance measures, were superior to those of the Biodex Balance System, 1 type of computerized posturography instrument. Therefore, the Balance CAT may be a more reliable measure for clinicians and researchers to use in assessing the balance function of patients with stroke for more than 6 months.     

Group- and Individual-Level Responsiveness of the 3-Point Berg Balance Scale and 3-Point Postural Assessment Scale for Stroke Patients

Objectives

To examine both group- and individual-level responsiveness of the 3-point Berg Balance Scale (BBS-3P) and 3-point Postural Assessment Scale for Stroke Patients (PASS-3P) in patients with stroke, and to compare the responsiveness of both 3-point measures versus their original measures (Berg Balance Scale [BBS] and Postural Assessment Scale for Stroke Patients [PASS]) and their short forms (short-form Berg Balance Scale [SFBBS] and short-form Postural Assessment Scale for Stroke Patients [SFPASS]) and between the BBS-3P and PASS-3P.

Convergent Validity and Responsiveness of the SULCS

Objective

To evaluate the convergent validity and responsiveness of the Stroke Upper Limb Capacity Scale (SULCS) in comparison to the Arm Motor Ability Test (AMAT), the Box and Blocks Test (BBT), and the upper limb Fugl-Meyer Assessment (FMA). The SULCS is a relatively new measure that was designed to be easier to score and less time consuming than some existing measures.

Virtual Reality Rehabilitation With Functional Electrical Stimulation Improves Upper Extremity Function in Patients With Chronic Stroke: A Pilot Randomized Controlled Study

Objective

To compare virtual reality (VR) combined with functional electrical stimulation (FES) with cyclic FES for improving upper extremity function and health-related quality of life in patients with chronic stroke.

Psychometric Evaluation of the Improved Work-Disability Functional Assessment Battery

ObjectiveTo assess psychometric properties of the improved Work Disability Functional Assessment Battery (WD-FAB 2.0).DesignLongitudinal study.SettingCommunity.ParticipantsThree samples of working-age (21-66) adults (N=1006): (1) unable to work because of a physical condition (n=375); (2) unable to work because of a mental health condition (n=296); (3) general United States working age sample (n=335).InterventionNA.Main Outcome MeasuresAll samples completed the WD-FAB 2.0; the second administration came 5 days after the first. Construct validity was examined by convergent and divergent correlational analysis using legacy measures. Test-retest reliability was assessed by intraclass correlation coefficients (ICC_3,1). Standard error of the mean (SEM) and minimal detectable change (MDC₉₀) were calculated to measure scale precision and sensitivity.ResultsPhysical function ICCs ranged from 0.69 to 0.77 in the general sample, and 0.66 to 0.86 in the disability sample. Mental health function scales ICCs ranged from 0.62 to 0.73 in the general sample, and 0.74 to 0.76 in the disability sample. SEMs for all scales indicated good discrimination; those for the physical function scales were generally lower than those for the mental health scales. MDC₉₀ values ranged from 3.41 to 10.55. Correlations between all WD-FAB 2.0 scales and legacy measures were in the expected direction.ConclusionsThe study provides substantial support for the reliability and construct validity of the WD-FAB 2.0 among 3 diverse samples. Although initially developed for use within the Social Security Administration (SSA), these results suggest that the WD-FAB 2.0 could be used for assessment and measurement of work-related physical and mental health function in other contexts as well.     

Unilateral Strength Training of the Less Affected Hand Improves Cortical Excitability and Clinical Outcomes in Patients With Subacute Stroke: A Randomized Controlled Trial

ObjectivesTo investigate whether unilateral strength training helps improve cortical excitability and clinical outcomes after stroke.DesignRandomized controlled trial.SettingRehabilitation sciences research center.ParticipantsPatients with subacute stroke (N=26) were randomly assigned to a control group (n=13) or the experimental group (n=13).InterventionsParticipants in both groups received conventional physiotherapy. The experimental group also received unilateral strength training of the less affected wrist extensors. Interventions were applied for 4 weeks (12 sessions, 3 d/wk).Main Outcome MeasuresCortical excitability in both the ipsilesional hemisphere (ipsiH) and contralesional hemisphere (contraH) was assessed by measuring resting motor threshold (RMT), active motor threshold (AMT), motor evoked potential (MEP), and cortical silent period (CSP) at baseline and after the 4-week intervention period. Clinical outcomes were obtained by evaluating wrist extension strength in both the more affected and less affected hands, upper extremity motor function, activities of daily living (ADL), and spasticity.ResultsThe experimental group showed greater MEP amplitude (P=.001) in the ipsiH and shorter CSP duration in both the ipsiH (P=.042) and contraH (P=.038) compared with the control group. However, the reductions in RMT and AMT in both hemispheres were not significantly different between groups. Improvements in wrist extension strength in the more affected (P=.029) and less affected (P=.001) hand, upper extremity motor function (P=.04), and spasticity (P=.014) were greater in the experimental group. No significant difference in ADLs was detected between groups.ConclusionsA combination of unilateral strength training and conventional physiotherapy appears to be a beneficial therapeutic modality for improving cortical excitability and some clinical outcomes in patients with stroke.