Description

OUTCOME MEASURES- ICF DOMAINS

https://www.neuropt.org/practice-resources/neurology-section-outcome-measures-recommendations

Search | Shirley Ryan AbilityLab (sralab.org)

Abbreviation:

Pt = patient

T/F = transfers

Ax = assessment

ADLs = activities of daily living

STROKE

BODY FUNCTIONS/STUCTURES

Fugl-Meyer Assessment (of Motor Recovery after Stroke)- (FMA)

Functional Ax: kitchen tasks, dressing, showering, writing/ typing, (balance).
Used to evaluate & measure recovery in post-stroke hemiplegic patients by assessing motor & sensory functioning(of upper & lower limb), balance, & ROM/pain in 8 joints.
5 domains, each with several items. Max score = 226.

Each item scores between 0-2 points. (0= can’t perform, 1= performs partially or 2= performs fully).

Focuses specifically on grasping & releasing ability in upper extremity, ability to move arm & ability to perform ADLs. Max score UE motor = 66, LE motor = 34.
Equipment- tennis ball, small spherical shaped container, reflex hammer, pen, paper.
Takes 30 mins
Highly recommended

Modified Ashworth Scale (MAS) Stroke (gold standard) , SCI, MS , non-specific

this outcome measure is used to assess spasticity within a limb
used on the main muscles which flexes or extends a joint, muscle is put in its maximum position for flex/ext and then flex/ext in the amount of time it takes to say ("one thousand one”)
this is graded 0-4 graded by the amount of stiffness felt in the muscles. 0 none-4 rigid
ICF body structures and function (exam pt looks like they spasticity in vid which could effect upper and lower limb movements)
Around 5 mins depending on how many joints tested. Pen and paper

Motricity Index Stroke but can be used across the board

ICF domain: Body Structure and Function
Functional Ax: eating, cooking, dressing and gait
Lower and upper limb strength
6 sections altogether; 3 of which are joints of the upper limb and 3 of which are joints of the lower limb.
Equipment needed: 2.5cm cube (used to test grip strength)
Scores are measured using the MRC/Oxford grading scale.
0-100 score (100 being the best score)
15 minutes
Highly recommended

ACTIVITY

6 min walk test- (6MWT)-can be used across the board.

Functional Ax: Gait
Measures distance walked over 6 minutes as a sub-maximal test of aerobic capacity/ endurance.
Standing rests throughout 6 mins permitted (although all resting time’s recorded).
Mobility aids may be used & minimum required assistance to complete task should be provided.
An ↑ in distance walked indicates improvement in basic mobility. Changes in performance capacity are compared.
Equipment- stop watch, measuring tape, ~12m long hallway, markings to indicate turning points.
Less than 10 mins.
Highly recommended.

Modified Barthel Index- can be used for Stroke & PD.

This is a performance scaled used to assess pt level of completing ADLS from observationor self-report.
It assesses grooming, feeding, T/Fs (wheelchair, bed, chair), toileting, continence bowel and bladder, dressing, stairs, bathing self, walking (10 activity’s).
The pts scores out of 3-4 depending on if (modified) Barthel index used, on how independent they are with each task 0 the less independent 3 or 4 independent, this will be added from each task to make a final score.
20 mins to administer depending on pt, self-report 2-3 mins.
ICF-activity- upper limb feeding, Dressing, grooming. T/Fs, stairs, and walking
Stroke, Parkinson’s, non-specific
Evidence good reliability and consistency, not enough evidence

Berg BalanceCan be used across the board

ICF domain: Activity
Functional assessments: balance, transfers
Conditions it can be used for: All conditions
Highly recommended
14 items
Sitting, sit to stand, transfers, tandem standing, eyes closed, retrieving objects from the floor, turning 360 degrees, stool stepping, reaching, standing on one leg
Each item is scored 0-4 with a total score of 0-56
0= lowest function, 4= highest function
The higher the score, the better the balance.

PARTICIPATION

Stroke Impact Scale

ICF domain: Activity and Participation
Functional assessments: eating, dressing, washing, balance, writing and typing, transfers, gait, stairs (Covers all of the functional assessments apart from posture)
Highly recommended
It’s a Questionnaire which includes mental health, cognition and participation.
Rates strength upper & lower extremities in affected limbs, functional daily activities & functional tasks of the hand.
59 items
Scored 1-5
1= unable to perform, 5= normal. The higher the score, the better.

MS

BODY FUNCTIONS/STUCTURES

Multiple Sclerosis Functional Composite (MSFC)

Functional Ax: Gait, upper limb tasks.
Assesses cognition, gait & upper limb motor function.
It consists of 3 component parts- Timed 25 foot Walk Test, 9-Hole Peg Test(see below)& Paced Auditory Serial Addition Test (PASAT).
2x trials for 25 foot walk, 2x trials (for both dominant & non-dominant hand) 9-HPT & 1x PASAT trial.
A statistical formula is used to combine test scores into a single score. This score is used to detect changes over time (deterioration/ improvement in the MS patient).
Equipment: measured 25 foot walkway, 9 hole peg test kit, PASAT audiocassette/ CD, stopwatch, calculator & forms to record data.
10-20 mins
Recommended for inpatient rehab & highly recommended for outpatient rehab.

9-Hole Peg Test (9HPT)- can also be used for stroke.
Functional Ax: Finger dexterity in kitchen tasks, cooking, dressing, typing/ writing.
Measures upper extremity (arm & hand) function. - Focuses on co-ordination.
Both the dominant & non-dominant hand are tested twice -> 2 consecutive dominant hand trials then 2 consecutive non-dominant hand trials.
Needs to be administered on a solid table.
Apparatus set-up: Side with the pegs is in front of the hand being tested & the side with empty pegboard is in front of hand not being tested.
Pt is told to pick up the pegs one at a time, using one hand only, and put them into the holes as quickly as can in any order until all holes filled. Then, without pausing, remove the pegs one at a time & return them to container as quickly as can. = TRIAL 1.
Timer started as soon as pt touches the 1^stpeg & stopped when last peg hits the container.
Time limit per trial = 5 minutes. 4 trials in total.
Timed 25 Foot Walk Test
Functional Ax: Gait
Measure of lower extremity function.
Pt is instructed to walk a clearly marked 25-foot course as quickly as possible, but safely= trial 1. Timer started when lead foot crosses the starting line & stopped when lead foot crosses finish line.
Pt walks back the same distance immediately after= Trial 2.
Assistive devices allowed. No additional (e.g. wall support) allowed.
Time limit per trial = 3 minutes. Reset stopwatch between trials.

ACTIVITY

Function in sitting. - Stroke, MS

Test which measures sitting balance
Pt marked 0-4 depending how independent they were with each task. 0-dependnat 4-independent, marked out of 56
Reaching out of BOS, nudged, and shuffling
Completed on standard hospital bed, 15 mins, stopwatch
Pt positioned½ femur on surface; hips & knees flexed to 90°□Used step/stool for positioning & foot support
Unable to recommend not enough research/ excellent reliability and consistency (stroke)

Activities-Specific Balance Confidence Scale - Can be used across the board

Also known as ABC scale
ICF domain: Activity
Functional assessments: stairs, bath/showering, cooking, transfers, dressing, gait
Recommended
Questionnaire
In the first section each answer is answered with a percentage of how confident you are at doing that specific activity e.g. “I feel 90% confident when meal prepping”
In the second section to score 1-10 how confident you feel doing specific activities. 1 being extremely confident and 10 being not confident at all
5-10 minutes

12-Item MS Walking Scale (MSWS-12)

Functional Ax: Gait, (stairs, balance).
Self-reported measure of walking ability.
12 items

- ability to walk (effort, distance, speed, fluidity, concentration, mobility aids use indoors/outdoors), run, stairs, stand when doing things, balance when standing/walking,

Scored 1-5 on each item. 1= no limitation, 5= extreme limitation.
Scores on the 12 items summed. Max score= 60.
The ↑ the score, the more walking has been impacted/ limited.
Equipment: 12-Item Walking Scale record form & pen.
Less than 10 mins.
Highly recommended

PARTICPATION

Fatigue severity scale (FSS). Can be used across the board

A questionnaire about how fatigue effects a person’s life
Rated out of 1-7. 1 strongly disagree, 7 strongly agree. Total score 69, higher score greater fatigue
Takes 5 min’s, paper and pen
ICFParticipation, activities
Evidence- recommended in Parkinson’s

MS Quality of life questionnaire

a questionnaire asses pt quality of life compiles 3 questionnaire into 1, MSQOL-54 Scoring Form, MSQOL-54 Physical Health Composite Score, MSQOL-54 Mental Health Composite Score
a formula is made to find out pt total score for each section
ADLs, health in general, health distress, physical health, mental health cognitive function, sexual function, pain, quality of life
Rating from sections ranges through questionnaire mainly 1-5
Good reliability/ consistency
Pen and paper
https://www.nationalmssociety.org/For-Professionals/Researchers/Resources-for-MS-Researchers/Research-Tools/Clinical-Study-Measures/Multiple-Sclerosis-Quality-of-Life-54-(MSQOL-54)

MS impact scale

ICF domain: Participation
Functional assessments: balance, writing and typing, cooking and eating (reach and grasp), muscle tone/spasticity
Recommended
It’s a questionnaire (answer how your MS has been affecting you in the last two weeks)
Questions are scored 1-5. 1 being not at all affect by MS and 5 being MS is extremely affecting that specific activity
10-15 minutes

PARKINSON’S DISEASE

BODY FUNCTIONS/STUCTURES

Push and release test

Test to measure balance and postural stability
Pt leans back on hands of the examiner, examiner removes hands, to test the pt balance reaction
They get scored 1-4 on their balance reaction depending on how many steps taken backwards to regain balance. 0- takes one step to regain balance. 4- falls without attempting to step/ unable to stand without A01. (1-2 how many 3 to 4 steps taken to not fall, 3-AO1 not to fall)
Lower score better they did
Pen and pencil
Takes 5 mins
Recommended use not for students to learn

PD Rapid Turns Test

Also called: ‘360 Degree Turn Test’
Functional Ax: Balance, gait, (freezing, turning).
Measures dynamic balance.
The pt turns in a complete circle (360 degrees) while time to complete or number of steps to complete the turn are recorded.
Both directions at high speed.
Look to see if freezing evoked. If not trial dual tasking to evoke freezing.
Administering test: Mark starting position, start from standing still- feet comfortably apart.
Start timer from word ‘GO’ & stop when pt’s shoulders are facing you again (i.e. 360 turn complete).
Pt has 2 trials & average of both trials is final score.
Equipment: Stopwatch.
Less than 5 mins.

Tragus to wall measure

ICF domain: Body structure and function
Functional assessments: Posture
Recommended
Equipment: Measured with a tape measure
Instructions: As the TWD (tragus to wall distance) measures the horizontal distance between the right tragus and the wall, instruct the person being measured to stand with their heels and buttocks against the wall, knees extended, shoulders back and chin tucked in.
Measure the distance from tragus to wall.
A larger distance between measures as the condition progresses indicates worse spinal/ upper cervical posture.

ACTIVITY

Modified Parkinson’s activity scale

This is a test to assess pts ADLS, functional mobility, gait and strength, upper limb function
It has 14 tasks in 3 domains which are bed mobility, gait akinesia and chair T/F
Each section is scored 0-4 on quality of movement when performing activity each scoring factor changes in each domains. Total score is out of 56, HIGHER SCORE BETTER
Chair most similar to what they have at home, plastic cup ¾ water, bed & duvet, pillow etc., tap. takes 10 to 15 mins
ICF- all domains
Not enough evidence to recommend
Balance not using hands, festinations, turning

Or (explained in a different way)

ICF domain: Activity, body structure and function and participation
Functional assessments: transfers, gait, bed mobility
Reasonable to use
Consists of 14 items arranged into 3 domains; chair transfer, gait akinesia and bed mobility
Observer scores quality of movements while patient performs these activities
Scores range from 0 (dependant) to 4 (normal)
Exception: if patient is unable to stand without using hands, then the patient is retested with use of hand a scoring changes to a 0 (dependant) to 2 (normal range)
Total possible score= 56

10 metre walk test –used across the board

Time is measured while pt independently walks 10 metres, 1/ 2 metres either side to allow patient to get to comfortable speed. Assistive devices can be used need to be documented.
Need stopwatch, cones and tape measure.
2 comfortable walks, 2 fast paced walks. Both are then averaged and speed measures (speed) m/s.
Can correlate to ADL’s, dependence and mobility, can compare interventions.
Pt needs to be able to walk at least 80 metres in total and walks unaided preferably.
Recommended for 3^rd-4^thstage PD, highly recommended for stroke and SCI.

Dynamic Gait Index (DGI)- can be used across the board.

Functional Ax: Gait, balance (vestibular & non-vestibular), stairs & falls risk.
Assesses ability to modify balance while walking in presence of external demands.
Evaluates usual steady-state walking & walking during more challenging tasks.
Tests 8 items of gait.
Can be performed with a marked distance of 20 feet & with/without assistive devices.
0-3 score;

0= severe impairment, 1= moderate impairment, 2= minimal impairment, 3= no gait dysfunction.

Max score = 24. The higher the score, the better the gait function.
Tasks include: normal speed walking, walking with changing speeds, walking with head turns both horizontally & vertically, walking whilst stepping over & around obstacles, pivoting while walking & stair climbing.
Equipment: box, 2 cones, stairs, 20 foot walkway.
10-15 mins. Dependent on pt’s abilities.
Highly recommended in Stroke + PD, recommended in MS & reasonable to use in SCI.

New freezing of Gait Questionnaire

ICF domain: Activity
Functional assessments: Freezing and gait
Recommended
4 items assess freezing in gait and 2 items assess gait
Responses to each item use a 5-point interval scale ranging from 0 (absence of symptoms) to 4 (most severe stage)
Total score ranges from 0-24
Higher scores= more severe freezing in gait
Complete the questionnaire during “on” or best stage
Physio should administer test

Five Times Sit to Stand Test Can be used across the board (apart from SCI)

ICF domain: Activity
Functional assessments: Freezing and gait
Highly Recommended of PD and recommended across the board
The patient needs to stand up and sit down 5 times as quickly as possible
The quicker the time, the better the score.
Chair must be 43-45cm, timer

PARTICPATION

Falls and Efficacy Scale –used across the board

Is a patient reported questionnaire, 10-15 mins, no equipment needed.
10 questions. On a scale from 1-10 - 1 is confident, 10 is not confident. A score of 70 or more indicates a fear of falling. Lower scores = higher confidence.
Scale measures perception of balance + stability during ADL’s and motor tasks. E.g. Washing, dressing, meals, reaching cupboards, walking in house, STS, bed mobility, answering phone/door.
It has limited study, so unable to be recommended. Unable to distinguish between fallers and non-fallers but in a holistic view it could be nice for pts to see how they progress in confidence.
Excellent internal consistency, adequate test retest, excellent correlation for balance and gait mobility.
Excellent validity with Berg Balance test, 10m walk test, dynamic gait index, functional reach test.

SPINAL CORD INJURY (SCI)

BODY FUNCTIONS/STUCTURES

ASIA Impairment Scale

Functional Ax:

Functional mobility, UL & LL strength, upper extremity function, UL & LL sensory function.

Universal classification tool for SCIs.
Should be completed within 72 hours of the SCI to reliably predict recovery.
Pt can be reclassified in follow-up testing, showing recovery of some functions.
Classifies motor & sensory impairment that results from SCI.
Tests dermatomes & myotomes to determine the sensory + motor level for each side of the body (L and R), the single neurological level of injury & if injury is complete or incomplete.
Dermatomes tested bilaterally using light touch & pin-prick (i.e. sharp-dull discrimination).Graded 0-2;

0= Absent, 1= Altered, 2= Normal/Intact.

10 myotomes tested bilaterally (C5 àT1, L2 àS1) & scored on a 6-point scale.

0 = Total Paralysis à5= Normal active movement, full ROM & full resistance.

Using the above it determines the grade of the SCI impairment from A to E.

A= Complete, B= Sensory Incomplete, C & D= Motor Incomplete, E= Normal.

Equipment: Cotton ball & neuro-tip.
10- 60mins
Highly recommended

International Standards for Neurological Classification of Spinal Cord Injury (ASIA Impairment Scale) | RehabMeasures Database (sralab.org)

American Spinal Cord Injury Association (ASIA) Impairment Scale - Physiopedia (physio-pedia.com)

ACTIVITY

Spinal Cord Independence Scale

Functional assessments: Feeding, bathing, dressing, grooming, respiratory, bed mobility, transfers, gait/mobility, stairs
Recommended
Assessment type: patient reported outcomes
The SCIM is composed of 19 items that assess 3 domains: self-care, respiratory and sphincter management, mobility
Total score ranges from 0 to 100 (higher score = independent)

Walking index for spinal cord injury

This assesses how much physical assistance or devices required to help a pt with need for walking
Most often ASIA A below T10 and ASIA B, C, and D subjects may qualify.
Pt walks 10 meters, in their own time.
Marked out of 0-20 0= cannot participate in walking. 20=walks with no devices, braces or A01. Between these marks is amount of assistants needed or devices. Pt is marked on which score they would be the safest. HIGHER SCORE THE BETTER
Recommended measure

PARTICPATION

Reintegration to Normal Living Index – SCI and stroke

11 questions patient reported, all VAS scale, 1 is “minimal integration doesn’t apply to me”, 10 “fully describes my situation”. Total score= /110. The higher the score the better perceived integration an individual has.
Assess’ quantitatively to the degree an individual has been affected by traumatic or incapacitated illness for normal social activities.
Free, no equipment, takes 10 mins.
Questions asked e.g. dressing, mobility, hobbies, social activities, family role, life events.
Limited study in SCI, variable test-retest reliability, excellent internal consistency.
SCI – excellent correlation to QOL index
Stroke - excellent correlation to frenchay activity index

Assessment of life habits– Recommended for MS, SCI and stroke recovery.

Assesses pts on 77 life habits, self-reported on perception of difficulty and assistance needed.
Scale 0-9. 0 – not accomplished, 9 – accomplished with no difficulty no assistance. Second scale measures satisfaction 1-5. 5 being highly satisfied.
Needs a lot of time and lots of equipment over 200 on long one, can be condensed into smaller question sections.
Recommended for all stroke settings but not acute.
Has considerations such as low ceiling effects, limited use in clinical practise.
Elderly with disabilities has shown excellent test-retest, excellent inter/intra-rater reliability.
Stroke: test-retest excellent and responsive.
SCI: test-retest was adequate, internal consistency was excellent or adequate, construct validity suggested the assessment was different for different groups of people, as expert opinion was high in agreement but not correlated for different groups.

Neuro outcome measures incorporated into the ICF domains This page is part of the collection 'E-Portfolio 2021'.

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