Mokken scale for functional assessment of patients with subacute stroke based on the ICF

To develop the Mokken scale for functional assessment of patients in the non-acute phase of stroke based on the International Classification of Functioning, Disability and Health (ICF), and to validate its reliability and validity. 

A cross-sectional study involved subacute stroke patients who visited the First Rehabilitation Hospital of Shanghai from July to December 2023. They were assessed by Mini-Mental State Examination (MMSE), Functional Independence Measure (FIM), Stroke social network analysis (SSNS), and ICF Rehabilitation Set (ICF-RS). Based on the Mokken assumptions of non-parametric Item Response Theory (IRT), Mokken Scale Analysis (MSA) was performed on the items of the ICF-RS.

Following the principle of maximum variation, a convenience sample of 100 subacute stroke patients (males = 70, females = 30) was included. A double monotonic model (DMM) was constructed through MSA, leading to the development of a Mokken scale containing 22 items, with a latent trait reliability coefficient (LCRC) of 0.959. The top three difficult items included “b455 Exercise intolerance”, “d660 Assisting others”, and “d640 Doing housework”. The least difficult item was “d550 eating”. The dichotomized Mokken scale scores showed a significant correlation with FIM scores (p 0.001), with a strong correlation (Spearman ρ = 0.887).

The Mokken scale developed based on the ICF-RS can be used for functional assessment of subacute stroke patients and demonstrates good reliability and validity. Additionally, the item difficulties calculated by the DMM can also be used to guide the setting of rehabilitation goals.

Compared with a solely summarized score of the ICF qualifier scale, the International Classification of Functioning, Disability and Health (ICF)-based health-oriented personal evaluation integrates using the non-parametric item response theory modelling, which offers more functioning information for person-centred care for adults with subacute stroke. Moreover, this ICF-derived scale allows for comprehensive and detailed functional evaluation among patients with subacute stroke under the lens of the biopsychosocial model of the ICF classification, thereby facilitating rehabilitation care and multidisciplinary medical management.