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  Saturday, November 18, 2017   
 
Overview of the Measure
 
   

Population

Time to Complete

Cost

Training

Clients with stroke and other neurological conditions

Approximately 1 hour

Test manual $15

Training Workshop proven effective


INSTRUCTIONS

The detailed test manual 3 provides instructions for administering and scoring. The manual describes the development and validation work to date and, as well, gives suggestions for therapeutic activities.


SCALING

Format

Task performance.

Subscales

The assessment consists of (1) an Impairment Inventory with 6 subscales: the stage of recovery of postural control, the arm, hand, leg, foot and shoulder pain. (2) a Disability Inventory with 2 subscales: gross motor function (10 items evaluating rolling, sitting, transferring and standing) and walking (5 items).

Scoring

Scoring of the physical Impairment Inventory is based on a 7-point ordinal scale corresponding to the stages of motor recovery. For each stage of motor recovery beyond stage 1, 3 activities are given, If the person is able to achieve 2 of these 3 activities, they are considered to be in this stage of recovery. The Disability Inventory has a maximum score of 100; 7 points for each of the first 14 items, and 2 points for item 15 (2 minute walk test). Minimum score is 14. Eight points change on the Disability Inventory equates to clinically important change as judged by client and caregiver.

 


RELIABILITY

Internal consistency - The correlation alpha for the DI scores of 68 clients with stroke revealed high internal consistency (.9649) 4

Test-retest Reliability - Clients were assessed on the Disability Inventory upon admission and again within five days. ICCs ranged from 0.96 - 0.98 for the subscales and total score was 0.98. 1

Intrarater Reliability - The physical impairment assessments of 32 stroke clients, (mean age of 64) were videotaped during the first week of admission. The treating therapist scored the admission evaluation and then the videotape after a minimum interval of 2 weeks. ICCs for 6 dimensions were 0.93 - 0.98 total score was 0.98. 1

Interrater Reliability - The 32 clients were scored on the physical impairment scale and the Disability Inventory by two physical therapists during week 1 of admission. The physical Impairment Inventory ICCs were 0.85 - 0.96 and total score 0.97. ICCs for Disability Inventory were 0.98 for individual items and 0.99 for total score. 1


VALIDITY

Content (domain or face) Not reported

Construct - Construct validity assessed for the 32 clients. Specific items on the Impairment and Disability Inventories were compared with similar attributes on other measures: impairment with Fugl-Meyer, and disability with FIM. The correlations were:

Chedoke Fugl-Meyer r p
shoulder
postural control
leg and foot
arm and hand
upper limb pain
balance
balance
shoulder, elbow, forearm, wrist and hand
0.76
0.84
0.84
0.95
<0.01
<0.01
<0.001
<0.001

Chedoke=s gross motor function index correlated with mobility on the FIM (r = 0.990, p<0.001); walking index correlated with locomotion (r=0.85, p<.01). 1

Concurrent - The same 32 clients were evaluated on admission and discharge on the Chedoke and the Fugl-Meyer and FIM scales. The Impairment Inventory of the Chedoke correlated highly with the Fugl-Meyer (r=0.95, p<.001), however, the Disability Inventory and the FIM only showed a moderate correlation (r=0.79, p<0.05). 1

Predictive - Predictive equations, suitable for use when determining treatment and discharge plans, are available for patients in both the acute 5 and rehabilitation settings. 3 Clients with leg and postural control scores >9 are able to ambulate independently (FAC >3.) 6

Responsiveness - The Disability Inventory was compared to the FIM on ability to detect clinical important change. The variance ratio (variance due to change/variance due to change + error) 1 for the results of the change between admission and discharge scores was 0.53 for the Disability Inventory and 0.39 for the FIM suggesting that the Disability Inventory is more responsive to change than the FIM. The relative efficiency was 1.92 times greater, hence a smaller sample size is needed to detect similar degrees of change with Chedoke. 1

The minimal clinically important difference (MCID) is 8 points as determined by clients and 7 points as determined by therapists. 7, 8, 9, 10

 


ADDITIONAL INFORMATION ABOUT THE DISABILITY INVENTORY

1. Acute Neurological Patients 10, 14

Reliability - The inter-rater test-retest reliability was high and similar to that in the rehabilitation setting (ICC = 0.97).

Concurrent validity - When results of the Disability Inventory and the COVS 11 were compared, the totals and corresponding subscale correlations were high. The Pearson r was 0.97 for total scores and 0.98 and 0.90 respectively for gross motor function and walking subscales.

Responsiveness - The MCID for the DI was determined to be 7. The relative efficiency of the Chedoke Assessment is 1.47 times greater than the COVS.

2. Individuals with Acquired Brain Injury 12

Reliability - The inter-rater reliability in this population was high (ICC = 0.99).

Concurrent Validity - The correlation with FIM 13 subscores was good (pearson r = 0.76).

Responsiveness - The DI was able to distinguish those patients who changed a little ( FIM < 20 points) and those whose FIM changed more than 20 points ( unpaired t test, p = 0.0007)

REFERENCES

  1. Gowland C, Stratford P, Ward M, Moreland J, Torresin W, Van Hullenaar S, et al. Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke 1993: 24 (1): 58-63.
  2. Moreland J, Gowland C, Van Hullenaar S, Huijbregts M. Theoretical Basis of the Chedoke-McMaster Stroke Assessment. Physiotherapy Canada 1993, 45(4) 231-238.
  3. Gowland C et al. Chedoke-McMaster Stroke Assessment - Development, Validation, and Administration Manual. 1995. Available from the School of Rehabilitation Sciences, McMaster University, Building T-16, 1280 Main Street West, Hamilton, Ontario.
  4. Robarts SF, Kane-Haas D, Miller P. An Examination of Item 15 of the Chedoke-McMaster Stroke Assessment. Physiotherapy Canada 1998:50(S):5, Abstracts of scientific presentations at the Annual Congress.
  5. Miller P. Predicting Impairment and Disability in Patients with Acute Stroke. 1996. McMaster University , Hamilton , Ontario : Master of Health Sciences Thesis.
  6. Stevenson, TJ. Using Impairment Inventory Scores to Determine Ambulation Status in Individuals with Stroke. Physiotherapy Canada , Summer 1999, p168-174.
  7. Huijbregts M, Gowland C. Content and Construct Validity of the Disability Inventory of the Chedoke-McMaster Stroke Assessment, Physiotherapy Canada 1993, 45(2). Abstracts of scientific presentation at the Annual Congress.
  8. Huijbregts MPJ, Gowland C, Gruber RA. Measuring clinically-important change with the activity inventory of the Chedoke-McMaster Stroke Assessment. Physiotherapy Canada 2000, 2(4):295-304.
  9. Gowland C, Huijbregts M, McClung A, McNern A. Measuring clinically important change with the Chedoke-McMaster Stroke Assessment. Canadian Journal of Rehabilitation 1993, 7, 14-16.
  10. Barclay-Goddard R. Physical Function Outcome Measurement in Acute Neurology. Physiotherapy Canada 2000, 52(2): 138-145.
  11. Seaby L and Torrance G. Reliability of a Physiotherapy Functional Assessment Used in a Rehabilitation Setting. Physiotherapy Canada 1988, 41(5) 264-271.
  12. Crowe J, Harmer D, Sharpe D. Reliability of the Chedoke-McMaster Disability Inventory in Acquired Brain Injury. Physiotherapy Canada 1996, 48(2). Abstracts of scientific presentations at the Annual Congress.
  13. State University of New York at Buffalo , Buffalo , New York . Guide for the Uniform Data Set for Medical Rehabilitation (Adult FIM MR) Version 4.0. 1993.
  14. Miller PA, Moreland J, Stevenson TJ. Measurement Properties of a Standardized Version of the Two-Minute Walk Test for Individuals with Neurological Dysfunction. Physiotherapy Canada 2002, 54(4): 241-248, 257.

ADAPTED FROM: Cole B, Finch E, Gowland C, Mayo N. Physical Rehabilitation Outcome Measures. 1994. Available from the Canadian Physiotherapy Association, 890 Yonge Street , Toronto , Ontario .

 
 


     
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