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Prakash V1, Ganesan M2
1Charotar University of Science &Technology, Ashok & Rita Patel Institute of Physiotherapy, Anand, India, 2Clarke University, Department of Physiotherapy, Dubuque, United States
Background: In India, the choice of outcome measures (OM) both for research and clinical practice is often guided by convention, convenience and feasibility. Conceptual understanding of the construct of daily functioning of patients with stroke in India is often overlooked. Value of commonly used functional outcome measures in adequately representing post stroke concerns of patients' living in India may be questionable due to the inherent socio-cultural and demographic differences. Outcome measures measuring post stroke functioning within Indian context, however, are currently not available.
Purpose: Objective of this study was to develop and evaluate the psychometric properties of the Indian Stroke Scale
Methods: A cross-sectional study design was conducted for development and validation of The Indian Stroke Scale (ISS). The items for the ISS and the preliminary version of the ISS were generated based on the conceptual framework including the literature review and through integration of views of patients, content experts and clinicians. A total of 294 patients participated in the final psychometric evaluation phase of the ISS, which included evaluation of internal consistency, factor analysis, construct and convergent validity, test-retest reliability and measurement error of the Indian Stroke Scale. To investigate known group validity (construct validity) we used modified Rankin Scale (mRs); convergent validity (construct validity) was tested through comparing the ISS total mean scores with physical and instrumental activities of daily living and social participation domains of stroke impact scale (SIS version 3.0) and Barthel Index (BI)
Results: The scale demonstrated good internal consistency. Cronbach alpha score for ISS total score is 0.94. Test-retest reliability estimates for the total score was good (R= 0.80, 95% confidence interval 0.74 to 0.89). Standard error of measurement (SEM) and smallest detectable change (SDC) were calculated as 4.8 and 13.4, respectively. There was a significant difference in ISS total scores between low and severe stroke as categorized by modified Rankin score scores (p=0.000). Mean difference of ISS total scores were significantly higher in low severity group (mean difference 33.3, 95% CI 27.4 to 39.1). We found moderate to low correlation between ISS total score and SIS 3.0 physical and instrumental activities of daily living (R = 0.64, p=0.00) and social participation domains of stroke impact scale (R = 0.44, p=0.00) and Barthel Index (R = 0.59, p=0.00)
Conclusion(s): The Indian stroke scale is an acceptable, reliable, and valid measure with good psychometric properties of an evaluative measure of functional status amongst patients with stroke in India.
Implications: Developed as an interviewer administered questionnaire and taking an average of 5-8 minutes to complete, the Indian Stroke scale is suitable for use in populations of mixed literacy levels and short enough to keep respondent burden to a minimum. Therefore, has potential to become a useful clinical and a research tool measuring post stroke functional outcomes of patients with stroke in India.
Keywords: Indian Stroke Scale, Patient reported outcome measure
Funding acknowledgements: The author(s) received no specific funding for this work.
Purpose: Objective of this study was to develop and evaluate the psychometric properties of the Indian Stroke Scale
Methods: A cross-sectional study design was conducted for development and validation of The Indian Stroke Scale (ISS). The items for the ISS and the preliminary version of the ISS were generated based on the conceptual framework including the literature review and through integration of views of patients, content experts and clinicians. A total of 294 patients participated in the final psychometric evaluation phase of the ISS, which included evaluation of internal consistency, factor analysis, construct and convergent validity, test-retest reliability and measurement error of the Indian Stroke Scale. To investigate known group validity (construct validity) we used modified Rankin Scale (mRs); convergent validity (construct validity) was tested through comparing the ISS total mean scores with physical and instrumental activities of daily living and social participation domains of stroke impact scale (SIS version 3.0) and Barthel Index (BI)
Results: The scale demonstrated good internal consistency. Cronbach alpha score for ISS total score is 0.94. Test-retest reliability estimates for the total score was good (R= 0.80, 95% confidence interval 0.74 to 0.89). Standard error of measurement (SEM) and smallest detectable change (SDC) were calculated as 4.8 and 13.4, respectively. There was a significant difference in ISS total scores between low and severe stroke as categorized by modified Rankin score scores (p=0.000). Mean difference of ISS total scores were significantly higher in low severity group (mean difference 33.3, 95% CI 27.4 to 39.1). We found moderate to low correlation between ISS total score and SIS 3.0 physical and instrumental activities of daily living (R = 0.64, p=0.00) and social participation domains of stroke impact scale (R = 0.44, p=0.00) and Barthel Index (R = 0.59, p=0.00)
Conclusion(s): The Indian stroke scale is an acceptable, reliable, and valid measure with good psychometric properties of an evaluative measure of functional status amongst patients with stroke in India.
Implications: Developed as an interviewer administered questionnaire and taking an average of 5-8 minutes to complete, the Indian Stroke scale is suitable for use in populations of mixed literacy levels and short enough to keep respondent burden to a minimum. Therefore, has potential to become a useful clinical and a research tool measuring post stroke functional outcomes of patients with stroke in India.
Keywords: Indian Stroke Scale, Patient reported outcome measure
Funding acknowledgements: The author(s) received no specific funding for this work.
Topic: Outcome measurement; Neurology: stroke
Ethics approval required: Yes
Institution: Ashok & Rita Patel Institute of Physiotherapy
Ethics committee: Institutional Review Board
Ethics number: ARIP/IRB/15/43
All authors, affiliations and abstracts have been published as submitted.
