Felmérések

3. sz. függelék a Stroke rehabilitációs ellátás c. klinikai irányelvhez: Felmérőeszközök (angolul)                          (az eredeti US anyag ‘D’ appendixe)
Standard Instruments for Post-Stroke Assessment

Preferred Standard Instruments for Patient Assessment in Stroke1

Type

Name and Source

Approximate Time to Administer

Strengths

Weaknesses

Level-of-consciousness scale

Glasgow Coma Scale]2, 3

2 min

Simple, valid, reliable

None observed

Stroke deficit scales

NIH Stroke Scale4

2 min

Brief, reliable; Can be administered by non-neurologists

Low sensitivity

Canadian Neurological Scale5

5 min

Brief, valid, reliable

Some useful measures omitted

Global disability scale

Rankin Scale6-8

5 min

Good for overall assessment of disability

Walking is the only explicit assessment criterion; Low sensitivity

Measures of disability/ activities of daily living (ADLs)

Barthel Index9, 10

5-10 min

Widely used for stroke; Excellent validity and reliability

Low sensitivity for high-level functioning

Functional Independence Measure (FIM™) [g]11-13

40 min

Widely used for stroke; Measures mobility, ADLs, cognition, functional communication

"Ceiling" and "floor" effects

Mental status screening

Folstein Mini-Mental State Examination14

10 min

Widely used for screening

Several functions with summed score—May misclassify patients with aphasia

Neurobehavioral Cognition Status Exam (NCSE)15

10 min

Predicts gain in Barthel Index scores; Unrelated to age

Does not distinguish right from left hemisphere; No reliability studies in stroke; No studies of factorial structure; Correlates with education

Assessment of motor function

Fugl-Meyer16

30-40 min

Extensively evaluated measure; Good validity and reliability for assessing sensorimotor function and balance

Considered too complex and time-consuming by many.

Motor Assessment Scale17, 18

15 min

Good, brief assessment of movement and physical mobility

Reliability assessed only in stable patients; Sensitivity not tested

Motricity Index19, 20

5 min

Brief assessment of motor function of arm, le.g.,e.g.,e.g., and trunk

Sensitivity not tested

Balance assessment

Berg Balance Assessment21, 22

10 min

Simple, well established with stroke patients; sensitive to change

None observed

Mobility assessment

Rivermead Mobility Index23, 24

5 min

Valid, brief, reliable test of physical mobility

Sensitivity not tested

Assessment of speech and language functions

Boston Diagnostic Aphasia Examination25, 26

1-4 h

Widely used; Comprehensive, good standardization data; Sound theoretical rationale

Time to administer long; Half of patients cannot be classified

Porch Index of Communicative Ability (PICA)27

1/2-2 h

Widely used; Comprehensive, careful test development and standardization

Time to administer long; Special training required to administer; Inadequate sampling of language other than 1 word and single sentences

Western Aphasia Battery28

1-4 h

Widely used. Comprehensive

Time to administer long; "Aphasia quotients" and "taxonomy" of aphasia not well validated

Depression scales

Beck Depression Inventory (BDI)29, 30

10 min

Widely used; Easily administered; Norms available; Good with somatic symptoms

Less useful in elderly and in patients with aphasia or neglect; High rate of false positives; Somatic items may not be due to depression

Center for Epidemiologic Studies Depression (CES-D)31

< 15 min

Brief, easily administered, useful in elderly; Effective for screening in stroke population

Not appropriate for aphasic patients

Geriatric Depression Scale (GDS)32

10 min

Brief, easy to use with elderly, cognitively impaired, and those with visual or physical problems or low motivation

High false-negative rates in minor depression

Hamilton Depression Scale33, 34

< 30 min

Observer rated; Frequently used in stroke patients

Multiple differing versions compromise interobserver reliability

Measures of instrumental ADLs

PGC Instrumental Activities of Daily Living35

5-10 min

Measures broad base of information necessary for independent living

Has not been tested in stroke patients

Frenchay Activities Index36

10-15 min

Developed specifically for stroke patients; Assesses broad array of activities

Sensitivity and interobserver reliability not tested; sensitivity probably limited

Family assessment

Family Assessment Device (FAD)37

30 min

Widely used in stroke; Computer scoring available; Excellent validity and reliability; Available in multiple languages

Assessment subjective; sensitivity not tested; "ceiling" and "floor" effects

Health status/quality of life measures

Medical Outcomes Study (MOS) 36-Item Short-Form Health Survey38

10-15 min

Generic health status scale SF36 is improved version of SF20; Brief, can be self-administered or administered by phone or interview; Widely used in the United States

Possible "floor" effect in seriously ill patients (especially for physical functioning), suggests it should be supplemented by an ADL scale in stroke patients

Sickness Impact Profile (SIP)39*

20-30 min

Comprehensive and well-evaluated; Broad range of items reduces "floor" or "ceiling" effects

Time to administer somewhat long; Evaluates behavior rather than subjective health; needs questions on well-being, happiness, and satisfaction

[

 

ADLs indicates activities of daily living. IADLs, instrumental activities of daily living.

* Instrument is available from the Health Services Research and Development Center, The Johns Hopkins School of Hygiene and Public Health, 624 North Broadway, Baltimore, MD 21205.

 

 

Disability/ADL Assessment

Katz Index of ADL40

 

Kenny Self-Care Evaluation41 

 

LORS/LAD42

 

PECS43

 

Mental Status Assessment44

The Stroke Center at http://www.strokecenter.org/trials/scales/index.htm

 

Depression Assessment

The Zung Scale45 

 

IADL Assessment

OARS: Instrumental ADL46 

Functional Health Status47

 

Stroke Impact Assessment48-50

The Stroke Impact Scale (SIS) - Web site: www2.kumc.edu/coa/Pepper/pepper.htm.

 

Assessment of Communication:

Websites:

American Speech-Language-Hearing Association: http://www.asha.org
National Aphasia Association: http://www.aphasia.org
Academy of Neurological Communication Disorders and Sciences: http://www.ancds.duq.edu/
University of Minnesota Duluth: http://www.d.umn.edu/~mmizuko/3411/may11.htm
Neuropsychology Central: http://www.neuropsychologycentral.com/interface/content/resources/page_
material/resources_general_materials_pages/resources_document_pages/aphasia_assessment.pdf

 

 

 

REFERENCES

 

 

 

1.         Agency for Health Care Policy and Research (AHCPR), Gresham GE, Duncan PW, et al. Post-Stroke Rehabilitation (Clinical Practice Guideline, no. 16). Rockville, MD: U.S. Department of Health and Human Services, Public Health Service; 1995.

2.         dale G, Murray G, Parker L, et al. Assessment of coma and impaired consciousness: a practical scale. Lancet. 1974;2:81-83.

3.         dale G, Murray G, Parker L, et al. Adding up the Glasgow Coma Scale. Acta Neurochir. 1979;Suppl 28:13-16.

4.         Brott T, Adams HP, Jr., Olinger CP, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. Jul 1989;20(7):864-870.

5.         Cote R, Hachinski VC, Shurvell BL, et al. The Canadian Neurological Scale: a preliminary study in acute stroke. Stroke. Jul-Aug 1986;17(4):731-737.

6.         Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. May 1957;2(5):200-215.

7.         Bonita R, Beaglehole R. Recovery of motor function after stroke. Stroke. Dec 1988;19(12):1497-1500.

8.         van Swieten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. May 1988;19(5):604-607.

9.         Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. Feb 1965;14:61-65.

10.       Wade DT, Collin C. The Barthel ADL Index: a standard measure of physical disability? Int Disabil Stud. 1988;10(2):64-67.

11.       Granger CV, Hamilton BB, Keith RA, et al. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil. 1986;1(3):59-74.

12.       Granger CV, Hamilton BB, Sherwin FS. Guide for the use of the uniform data set for medical rehabilitation. Buffalo, NY: Uniform Data System for Medical Rehabilitation Project Office, Buffalo General Hospital, NY; 1986.

13.       Keith RA, Granger CV, Hamilton BB, et al. The functional [a] Teasindependence measure: a new tool for rehabilitation. In: Eisenberg MG, Grzesiak RC, eds. Advances in clinical rehabilitation. Vol 1. New York: Springer-Verlag; 1987:6-18.

14.       Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. Nov 1975;12(3):189-198.

15.       Kiernan RJ, Mueller J, Langston JW, et al. The Neurobehavioral Cognitive Status Examination: a brief but quantitative approach to cognitive assessment. Ann Intern Med. Oct 1987;107(4):481-485.

16.       Fugl-Meyer AR, Jaasko L, Leyman I, et al. The post-stroke hemiplegic patient. 1. a method for evaluation of physical performance. Scand J Rehabil Med. 1975;7(1):13-31.

17.       Carr JH, Shepherd RB, Nordholm L, et al. Investigation of a new motor assessment scale for stroke patients. Phys Ther. Feb 1985;65(2):175-180.

18.       Poole JL, Whitney SL. Motor assessment scale for stroke patients: concurrent validity and interrater reliability. Arch Phys Med Rehabil. Mar 1988;69(3 Pt 1):195-197.

19.       Collin C, Wade D. Assessing motor impairment after stroke: a pilot reliability study. J Neurol Neurosurg Psychiatry. Jul 1990;53(7):576-579.

20.       Demeurisse G, Demol O, Robaye E. Motor evaluation in vascular hemiplegia. Eur Neurol. 1980;19(6):382-389.

21.       Berg KO, Maki BE, Williams JI, et al. Clinical and laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil. Nov 1992;73(11):1073-1080.

22.       Berg K, Wood- Dauphinee S, Williams JI, et al. Measuring balance in the elderly: preliminary development of an instrument. Physiother Can. 1989:304-311.

23.       Collen FM, Wade DT, Robb GF, et al. The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud. Apr-Jun 1991;13(2):50-54.

24.       Wade DT, Collen FM, Robb GF, et al. Physiotherapy intervention late after stroke and mobility. Bmj. Mar 7 1992;304(6827):609-613.

25.       Goodglass H, Kaplan E. Test procedures and rationale. The assessment of aphasia and related disorders. Philadelphia: Lea and Febiger; 1972.

26.       Goodglass H, Kaplan E. Manual for the Boston Diagnostic Aphasia Examination (BDAE). Philadelphia: Lea and Febiger; 1983.

27.       Porch B. Porch Index of Communicative Ability (PICA). Palo Alto: Consulting Psychologists Press; 1981.

28.       Kertesz A. Western Aphasia Battery. New York: Grune & Stratton; 1982.

29.       Beck AT, Ward CH, Mendelson M, et al. An inventory for measuring depression. Arch Gen Psychiatry. Jun 1961;4:561-571.

30.       Beck AT, Steer RA. Beck Depression Inventory: manual (revised edition). New York: NY Psychological Corporation; 1987.

31.       Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. J Appl Psychol Meas. 1977;1:385-401.

32.       Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1982;17(1):37-49.

33.       Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry. Feb 1960;23:56-62.

34.       Hamilton M. Development of a rating scale for primary depressive illness. Br J Soc Clin Psychol. Dec 1967;6(4):278-296.

35.       Lawton MP. Assessing the competence of older people. In: Kent D, Kastenbaum R, Sherwood S, eds. Research planning and action for the elderly. New York: Behavioral Publications; 1972.

36.       Holbrook M, Skilbeck CE. An activities index for use with stroke patients. Age Ageing. May 1983;12(2):166-170.

37.       Epstein NB, Baldwin LM, Bishop DS. The McMaster Family Assessment Device. J Marital and Fam Ther. 1983;9(2):171-180.

38.       Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. Jun 1992;30(6):473-483.

39.       Bergner M, Bobbitt RA, Carter WB, et al. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. Aug 1981;19(8):787-805.

40.       Katz S, Ford AB, Moskowitz RW, et al. Studies Of Illness In The Aged. The Index Of Adl: A Standardized Measure Of Biological And Psychosocial Function. JAMA. Sep 21 1963;185:914-919.

41.       Schoening HA, Iversen IA. Numerical scoring of self-care status: a study of the Kenny self-care evaluation. Arch Phys Med Rehabil. Apr 1968;49(4):221-229.

42.       Carey RG, Posavac EJ. Program evaluation of a physical medicine and rehabilitation unit: a new approach. Arch Phys Med Rehabil. Jul 1978;59(7):330-337.

43.       Harvey RF, Jellinek HM. Functional performance assessment: a program approach. Arch Phys Med Rehabil. Sep 1981;62(9):456-460.

44.       Ben-Yishay Y, Diller L, Gerstman L, et al. The relationship between impersistence, intellectual function and outcome of rehabilitation in patients with left hemiplegia. Neurology. Sep 1968;18(9):852-861.

45.       Zung WW. A Self-Rating Depression Scale. Arch Gen Psychiatry. Jan 1965;12:63-70.

46.       Duke University Center for the Study of Aging and Human Development. Multidimensional functional assessment: the OARS methodology. Durham, NC: Duke University; 1978.

47.       Rosow I, Breslau N. A Guttman health scale for the aged. J Gerontol. Oct 1966;21(4):556-559.

48.       Duncan PW, Bode RK, Min Lai S, et al. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Arch Phys Med Rehabil. Jul 2003;84(7):950-963.

49.       Duncan PW, Lai SM, Tyler D, et al. Evaluation of proxy responses to the Stroke Impact Scale. Stroke. Nov 2002c;33(11):2593-2599.

50.       Lai SM, Studenski S, Duncan PW, et al. Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke. Jul 2002;33(7):1840-1844.

 

 

Czimbalmos Á és mtsai (1999): Páciens megelégedettségi vizsgálat SF-36 kérdőívvel, a magyarországi normálértékek meghatározása. Népegészségügy 80 (1):4-19

 

Kálmán János, Maglóczky Erzsébet, Janka Zoltán (1995):  Óra rajzolási teszt: gyors és egyszerű demencia szűrőmódszer. Psychiatr Hung 10 (1):11-18

 

Osmanné Sági Judit (1991): Az afázia klasszifikációja és diagnosztikája I-II. Ideggy Szle 44 (8): 339-362

 

Szél I: Állapotfelmérés és tervkészítés a rehabilitáció folyamatában. In: Huszár I, Kullmann L, Tringer L (szerk): A rehabilitáció gyakorlata. Medicina, Bp., 2000. 78-90

 

Molnár G, Molnár I (1999): A Beck- és Zung-féle depresszió önértékelő tesztek faktoranalízise. Pszichoterápia 8 (3):175-180

 

Tariska P, Paksy A (2003): Mini-Cog: a mentális hanyatlás "ultrarövid" és egyszerű szűrésének lehetősége. Orv Hetil 144 (17):803-9

 

Tariska P és mtsai (1990): A módosított Mini Mental State vizsgálat. Ideggy Szle 43 (10):443-9

 

        FIM (functional independence measure,    "funkcionális függetlenség mérés")

           

NÉV: ........................................................ 

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                                                               felvétel után   |  távozás előtt    |   kontroll

                                                                                                                 

                                         DÅTUM:        ..... ... ...               ..... ... ...            ..... ... ...    

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                önellátás

A. ÉTKEZÉS                                                               ...                                         ...                     ...

B. SZEMÉLYI HIGIÉNE                  ...                                 ...                     ...

C. FÜRDÉS                                                                        ...                                 ...                     ...

D. ÖLTÖZKÖDÉS (felsô testfél)                                    ...                                 ...                     ...

E. ÖLTÖZKÖDÉS (alsó testfél)                                      ...                                 ...                     ...

F. WC HASZNÅLAT                                     ...                                                  ...                     ...

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                szfinkter‑irányìtás

G. SZÉKLETTARTÅS                    ...                                  ...                     ...

H. VIZELETTARTÅS                      ...                                  ...                     ...

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                mozgékonyság

I. ÅGY‑SZÉK, KEREKESSZÉK ÅTÜLÉSEK (transzferek, átszállások)

                                                                           ...                                   ...                     ...

J. WC TRANSZFER                                               ...                                           ...                     ...               

K. KÅD vagy ZUHANY TRANSZFER       ...                  ...                     ...

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                helyváltoztatás

L. JÅRÅS vagy KEREKESSZÉK‑HASZNÅLAT

                                                                           ...                                   ...                     ...

M. LÉPCSő                                                                       ...                                   ...                     ...

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                kommunikáció

N. MEGÉRTÉS                                                                 ...                                   ...                     ...

O. ÖNKIFEJEZÉS                                                            ...                                   ...                     ...

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                szociális képességek

P. SZOCIÅLIS EGYÜTTMűKÖDÉS          ...                     ...                     ...                        

Q. PROBLÉMAMEGOLDÅS                                        ...                                   ...                     ...

R. EMLÉKEZÉS                                                               ...                                   ...                     ...    

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Pontozás:

I. SEGITô SZEMÉLYRE NINCS SZÜKSÉG  -- Önellátó

7 =Teljes függetlenség (idôben, biztonságosan)             6=Módosìtott függetlenség (segédeszköz)

 

II. SZEMÉLYES SEGITSÉG SZÜKSÉGES

                Részleges függôség

5=Felügyet     4=Minimális segìtség (75%‑nál nagyobb önállóság)          3=Közepes segìtség (50%‑nál nagyobb önállóság)

 

                Teljes függôség

2=Maximális segìtség (a vizsgált személy 25‑50%‑os részvételével)      1=Teljes segìtség (a vizsgált személy 25% alatti

                                                                                                                       részvételével)

Ha egy tevékenység nem tesztelhetô, a szint: 1

 

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