compendium of clinical measures for community rehabilitation

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


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


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).

http://www.leeds.ac.uk/nuffield/infoservices/UKCH/home.html


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.


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)


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


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


Name Assessment of Quality of Life (AQoL)


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


Name Canadian Occupational Performance Measure

(COPM)


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


Name Chedoke Arm and Hand Activity Inventory (CAHAI)


Compendium of clinical measures for community rehabilitation 8 of 101

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


Y

User centredness Bilateral functional tasks derived from stroke patients


Y

Utility Shorter versions as reliable as longer Y

Feasibility Inventory easily administered (Barecca et al. 2006) Y


Name Coping Strategy Indicator (CSI)


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


Name Frenchay Activities Index


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


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


Name Frenchay Dysarthria Assessment


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


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


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


Name Goal Attainment Scale


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


Name Hand Active Sensation Test (HASTe)


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


Name Hand Grip Strength Test


Purpose specific Measure maximum isometric grip strength +/- sustained Y

Background/rationale Impairment – physical (grip) strength Y


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


Name Home and Community Environment Instrument

(HACE)


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


Name Manual Muscle Testing


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


Utility Subjective, requires expertise but widely used (Broniecki

et al. 2002)

Y

Feasibility Inexpensive, easy (Broniecki et al. 2002) Y


Name Motor Assessment Scale


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


Name Neuropsychology Behaviour and Affect Profile


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


Name Nine Hole Peg Test


Purpose specific Assess dexterity in upper limb Y



Validity U


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


Name Postural assessment scale for stroke patients (PASS)


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


Name Rivermead Behavioural Memory Test


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


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


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


Name Short Orientation-Memory-Concentration Test


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


Name Step Test

Clinical environment

for adult community?

Y

Purpose specific Measure simple balance task Y

Background/rationale Activity - balance 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


0.97 post stroke (Hill et al. 1996)

Responsiveness U

Precision U

User centredness U

Utility Acceptable interpretation Y

Feasibility Easy to administer Y


Name Tardieu Scale


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


Name Timed up and go test


Purpose specific Measure simple mobility task requiring postural control Y

Background/rationale Activity - mobility 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


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


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


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


Name

Voice Handicap Index (VHI)


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


Name Western Aphasia Battery


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


Name Wolf Motor Function Test


Purpose specific Quantifies upper extremity ability Y


Description adequate Timed standardised activities Y


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


Name World Health Organisation Quality of Life – Brief

version (WHOQoL BREF)


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



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


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


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


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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

compendium of clinical measures for community rehabilitation

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