Outcome Measure

8/2/2019 Outcome Measure

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OUTCOME MEASURES



OUTCOME MEASURES

The following Outcome Measures will be dealt -

►Motor Assessment Scale

►Functional Independence Measure

►Berg Balance Scale

►Dynamic Gait Index



Motor Assessment Scale (MAS)

Purpose of the measure:►The Motor Assessment Scale (MAS) is a

performance-based scale that wasdeveloped as a means of assessingeveryday motor function in patients withstroke (Carr, Shepherd, Nordholm, & Lynne, 1985).

►The MAS is based on a task-orientedapproach for evaluation that assessesperformance of functional tasks rather thanisolated patterns of movement.



MASItems of the measure:

The MAS is comprised of 8 items corresponding to 8 areasof motor function. Patients perform each task 3 times andthe best performance is recorded.

► Supine to side lying► Supine to sitting over the edge of a bed

► Balanced sitting► Sitting to standing► Walking► Upper-arm function►

Hand movements► Advanced hand activities► Also included is a single item, general tonus, intended to

provide an estimate of muscle tone on the affected side(Carr et al., 1985).



MAS

Scoring:► All items (with the exception of the general

tonus item) are assessed using a 7-point

scale from 0 - 6. A score of 6 indicatesoptimal motor behavior.

►For the general tonus item, the score is

based on continuous observationsthroughout the assessment.



MAS

Equipment: Although a number of items are required to administer the MAS, theequipment is easy to acquire. The following equipment is needed:

► Stopwatch► 8 Jellybeans► Polystyrene cup

► Rubber ball► Stool► Comb► Spoon► Pen

► 2 Teacups► Water► Prepared sheet for drawing lines► Cylindrical object like a jar► Table



Reliability

Only 1 study has examined the test-retest reliability of the MAS, reporting excellent test-retest.Out of 2 studies that examined the inter-raterreliability , both reported excellent inter-rater.

Validity

Content: Items and scoring options are based onobservations of the improvement of a large number of patients.Criterion: Excellent correlations between the MAS and

the Fugl-Meyer Assessment .

Acceptability

The MAS is a fairly simple and short measure toadminister. A proxy respondent is not appropriate for thisperformance-based measure. For severely affectedpatients or patients with aphasia, Fugl-Meyer

Assessment is used rather than the MAS.

Feasibility

A short instruction and practice period is recommendedprior to administering the test in a formal setting. A number of items are required as equipment for the MAS,however all items are readily available.

http://www.medicine.mcgill.ca/strokengine-assess/definitions-en.html


http://www.medicine.mcgill.ca/strokengine-assess/statistics-en.html






http://www.medicine.mcgill.ca/strokengine-assess/module_fma_intro-en.html




































Berg Balance Scale (BBS)

Purpose of the measure:►The BBS quantitatively assesses balance in

older adults.

Items of the measure: ►In this 14-item scale, patients must

maintain positions and complete moving

tasks of varying difficulty. In most items,patients must maintain a given position fora specified time.



BBS

Scoring:►Patients receive a score from 0-4 on their ability

to meet these balance dimensions. A global scorecan be calculated out of 56. A score of 0

represents an inability to complete the item, anda score of 56 represents the ability toindependently complete the item.

► 0-20 on the BBS represents balance impairment;► 21-40 on the BBS represents acceptable balance;

► 41-56 on the BBS represents good balance.



BBS

Equipment:

►Only simple and easily accessibleequipment is needed to complete

the BBS.

►This includes a ruler, stopwatch,

chair, and a step or stool. Also, thepatients will require enough roomto move 360 degrees.



Reliability

- Out of 3 studies examining test-retest reliability, all 3reported excellent test-retest.- Out of 4 studies examining inter-rater reliability, all 4reported excellent inter-rater reliability.

Validity

Content: The items were selected based on interviewswith 12 geriatric clients and 10 professionals.

Criterion: Predicted risk of falling over next 12 months,moderately predictive of length of stay in rehabilitation

unit, predicted motor ability 180 days after stroke.

Acceptability

This direct observation test is not suitable for severelyaffected patients as it assesses only one item related tobalance while sitting. Active individuals will find it toosimple. The scale is not suitable for use by proxy.

Feasibility

The BBS requires no specialized training to administer,but the BBS is a risky assessment where a patient couldfall if not supervised by someone with stroke expertise.Relatively little equipment or space is required.









Functional Independence Measure (FIM)

Purpose of the measure:

► It was developed to address the issues of sensitivityand comprehensiveness that were criticized asbeing problematic with the Barthel Index.

► The FIM was also developed to offer a uniformsystem of measurement for disability based on theInternational Classification of Impairment,Disabilities and Handicaps for use in the medicalsystem in the United States (McDowell & Newell,1996).

► The level of a patient's disability indicates theburden of caring for them and items are scored onthe basis of how much assistance is required for theindividual to carry out activities of daily living.



FIM

Items of the measure: ► The FIM assesses six areas of function (Self-care,

Sphincter control, Mobility, Locomotion, Communicationand Social cognition), which fall under two dimensions(Motor and Cognitive). It has been tested for use in

patients with stroke, traumatic brain injury, spinal cordinjury, multiple sclerosis, and elderly individualsundergoing inpatient rehabilitation and has been usedwith children as young as 7 years old.

► The FIM was developed between 1984 and 1987 by anational task force sponsored by the American Academyof Physical Medicine and Rehabilitation and the

American Congress of Rehabilitation Medicine and waspublished by Keith, Granger, Hamilton, and Sherwin in

1987.



FIM

Scoring:►Each item on the FIM is scored on a 7-point scale,

and the score indicates the amount of assistancerequired to perform each item

(1=total assistance in all areas, 7=totalindependence in all areas). A final summed scoreis created and ranges from 18 - 126, where 18

represents complete dependence/total assistanceand 126 represents complete independence.Subscale scores for the Motor and Cognitivedomains can also be calculated.



FIM

Equipment:► Any items that the patient uses to carry out their

activities of daily living.

►The FIM consists of 18 items assessing 6 areas of function. The items fall into two domains: Motor(13 items) and Cognitive (5 items).

►The motor items are based on the items of theBarthel Index. These domains are referred to asthe Motor-FIM and the Cognitive-FIM.



Reliability

- Out of 5 studies examining test-retest reliability, all5 reported excellent test-retest.- Out of 10 studies examining inter-rater reliability, 8studies reported excellent ; 1 reported adequate to

excellent

Validity

Content: The FIM was created based on the results of aliterature review of published and unpublished measuresand expert panels and was then piloted in 11 centers.Criterion: Excellent correlations with the Barthel

Index. FIM scores predict amount of home carerequired.

Acceptability

The FIM is typically administered by interview. Inpatients with stroke, it can be well administered to proxyrespondents.

Feasibility

Training and education of persons to administer the FIMmay represent significant cost. Use of interview formatsmay make the FIM more feasible for longitudinalassessment.








http://www.medicine.mcgill.ca/strokengine-assess/module_bi_intro-en.html



















FIM



Dynamic Gait Index (DGI)

Purpose of the measure:

►Developed to assess the likelihood of fallingin older adults. Tests 8 facets of gait whileperforming level walking exercises and

more complex tasks.

►Tasks reflect everyday experiences aswalking around objects, turning and

stopping quickly, and movement of thehead are all added to the DGI.



DGI

Items of the measure: The DGI assesses 8 facets of gait –

► Gait Level Surface

► Changes in gait Speed

► Gait with horizontal head turns► Gait with vertical head turns

► Gait and pivot turn

► Step over obstacle

► Step around obstacles► Steps



DGI

Scoring:► Each facet of gait is assigned a level of function

such as normal, mild impairment, moderateimpairment, and severe impairment for different

walking activities.

► A scale ranging from 0-3 is used to determinescore. 0 indicates a low level of function and 3

indicates a high level of functioning.► In total, a score of less than 19/24 is predictive

of falls in the elderly. A score of >22 signifies asafe ambulator.



DGI

Equipment:►Box (Shoebox)

►Cones (2 Nos.)

►Stairs

►20’ walkway 15” wide



Reliability

- Out of 3 studies examining test-retest reliability, all3 reported excellent test-retest.- Out of 6 studies examining inter-rater reliability, allstudies reported excellent inter-rater reliability.

Validity

Content: The DGI was created based on the results of literature review of published and unpublished measuresand expert panels.

Criterion: Excellent correlations with the RivermeadMobility Index.

Acceptability

The DGI is typically administered to patients withimprovement in their gait & not suitable for severelyaffected patients.

Feasibility

Training and education of persons is required toadminister the DGI, also there are chances that a patientcould fall if not supervised properly.

























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