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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 was developed as a means of assessing everyday motor function in patients with stroke (Carr, Shepherd, Nordholm, & Lynne, 1985). The MAS is based on a task-oriented approach for evaluation that assesses performance of functional tasks rather than isolated patterns of movement.

MAS
Items of the measure: The MAS is comprised of 8 items corresponding to 8 areas of motor function. Patients perform each task 3 times and the 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 indicates optimal motor behavior. For the general tonus item, the score is based on continuous observations throughout the assessment.

MAS
Equipment: Although a number of items are required to administer the MAS, the equipment 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-rater reliability , both reported excellent inter-rater. Content: Items and scoring options are based on observations of the improvement of a large number of patients. Criterion: Excellent correlations between the MAS and the Fugl-Meyer Assessment . The MAS is a fairly simple and short measure to administer. A proxy respondent is not appropriate for this performance-based measure. For severely affected patients or patients with aphasia, Fugl-Meyer Assessment is used rather than the MAS.

Validity

Acceptability

Feasibility

A short instruction and practice period is recommended prior 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.

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 for a specified time.

BBS
Scoring: Patients receive a score from 0-4 on their ability to meet these balance dimensions. A global score can be calculated out of 56. A score of 0 represents an inability to complete the item, and a score of 56 represents the ability to independently 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 accessible equipment is needed to complete the BBS. This includes a ruler, stopwatch, chair, and a step or stool. Also, the patients will require enough room to move 360 degrees.

Reliability

- Out of 3 studies examining test-retest reliability, all 3 reported excellent test-retest. - Out of 4 studies examining inter-rater reliability, all 4 reported excellent inter-rater reliability. Content: The items were selected based on interviews with 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. This direct observation test is not suitable for severely affected patients as it assesses only one item related to balance while sitting. Active individuals will find it too simple. The scale is not suitable for use by proxy. The BBS requires no specialized training to administer, but the BBS is a risky assessment where a patient could fall if not supervised by someone with stroke expertise. Relatively little equipment or space is required.

Validity

Acceptability

Feasibility

Functional Independence Measure (FIM)


Purpose of the measure: It was developed to address the issues of sensitivity and comprehensiveness that were criticized as being problematic with the Barthel Index. The FIM was also developed to offer a uniform system of measurement for disability based on the International Classification of Impairment, Disabilities and Handicaps for use in the medical system in the United States (McDowell & Newell, 1996). The level of a patient's disability indicates the burden of caring for them and items are scored on the basis of how much assistance is required for the individual 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, Communication and Social cognition), which fall under two dimensions (Motor and Cognitive). It has been tested for use in patients with stroke, traumatic brain injury, spinal cord injury, multiple sclerosis, and elderly individuals undergoing inpatient rehabilitation and has been used with children as young as 7 years old. The FIM was developed between 1984 and 1987 by a national task force sponsored by the American Academy of Physical Medicine and Rehabilitation and the American Congress of Rehabilitation Medicine and was published 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 assistance required to perform each item (1=total assistance in all areas, 7=total independence in all areas). A final summed score is created and ranges from 18 - 126, where 18 represents complete dependence/total assistance and 126 represents complete independence. Subscale scores for the Motor and Cognitive domains 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 the Barthel Index. These domains are referred to as the Motor-FIM and the Cognitive-FIM.

Reliability

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

Validity

Content: The FIM was created based on the results of a literature review of published and unpublished measures and expert panels and was then piloted in 11 centers. Criterion: Excellent correlations with the Barthel Index. FIM scores predict amount of home care required.
The FIM is typically administered by interview. In patients with stroke, it can be well administered to proxy respondents. Training and education of persons to administer the FIM may represent significant cost. Use of interview formats may make the FIM more feasible for longitudinal assessment.

Acceptability

Feasibility

FIM

Dynamic Gait Index (DGI)


Purpose of the measure: Developed to assess the likelihood of falling in older adults. Tests 8 facets of gait while performing level walking exercises and more complex tasks. Tasks reflect everyday experiences as walking around objects, turning and stopping quickly, and movement of the head 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, moderate impairment, and severe impairment for different walking activities. A scale ranging from 0-3 is used to determine score. 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 a safe ambulator.

DGI
Equipment: Box (Shoebox) Cones (2 Nos.) Stairs 20 walkway 15 wide

Reliability

- Out of 3 studies examining test-retest reliability, all 3 reported excellent test-retest. - Out of 6 studies examining inter-rater reliability, all studies reported excellent inter-rater reliability. Content: The DGI was created based on the results of literature review of published and unpublished measures and expert panels. Criterion: Excellent correlations with the Rivermead Mobility Index. The DGI is typically administered to patients with improvement in their gait & not suitable for severely affected patients. Training and education of persons is required to administer the DGI, also there are chances that a patient could fall if not supervised properly.

Validity

Acceptability

Feasibility

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