Outcome Measures Flashcards
5 times sit to stand
Cut off scores for CVA-12 sec and for PD-16 sec; >13 sec indicates balance dysfunction
Activity limitation
6 minute walk test
Activity limitation
Cut off scores not established
9-hole peg test
Normal values based on age group
20-30s- 17 sec 30-40s- 18 sec 40-50s- 19 sec 50-60s-19-21 sec 60-70s- 21-22 sec \+70-25 sec
10 MWT
6th vital sign <0.4 m/sec- household ambulation 0.4-0.8 m/sec- limited community 0.8 m/sec- community >1.2- cross walks
<1.0 m/sec- intervention to reduce fall risk
>1.0 m/sec- INDEP w/ ADLs, less likely to be hospitalized
<0.6 m/sec- DEP in ADLs, more likely to be hospitalized
Activities Specific Balance Confidence Scale
Cut off score 67% in elderly adults
Cut off score of 81% in chronic stroke
Higher scores indicate increased confidence in one’s balance
Agitated Behavior Scale
<21 WNL
22-28- Mild
29-35-Moderate
>35- Severe
Score 14-56
>22= presence of agitation
Berg Balance Scale
Cut off score for fall 45/56
Activity limitation
Chedoke-McMaster Stroke Assessment
> 9 on the leg and postural control scores indicate independent ambulation
Clinical Test of Sensory Interaction and Balance
1- firm surface, EO
2- firm surface, EC
3- compliant surface- EO
4- compliant surface- EC
Measures up to 30 sec, average across 3 trials
Coma Recovery Scale
Score from 0-23; lower scores= brainstem/reflex activity
Functional Independence Measure
FIM
18-126; higher scores= higher level of functioning
Training required, used in IP rehab
Functional Gait Assessment
FGA
Cut off score <23/30
Disability Rating Scale
0-29;
Lower scores indicates greater ability
TBI/ABI
Dizziness Handicap Inventory
0-100
Higher score= increased severity
>59 = increased risk for falls in individuals with MS
>61= severe perception of handicap for vestibular dysfunction
Dynamic Gait Index
DGI
0-24
<19 indicates fall risk
Timed Up and Go
Increased risk for falls
CVA- >14 sec
Elderly->13.5 sec indicates increased risk for falls
> 14.5 sec on TUG manual or difference of 4.5 sec or greater between TUG and TUG manual indicates falls risk
> 15 sec indicates falls risk for TUG Cognitive
Tinetti Performance Oriented Mobility Assessment
25-28- low fall risk
19-24- medium fall risk
<19 = high falls risk
On a scale of 0-28
United Parkinson Disease Rating Scale
UPDRS
0-260 (lower scores suggests decreased impact of disease)
Walking Index for Spinal Cord Injury II
WISCI
0-20 (higher scores indicates less severe impairment)
Stroke Impact Scale
Score from 0-100
Higher scores= less impairment
Retropulsive Pull Test
0-4
0: recovers independently with 1-2 steps or ankle strategies
1: recovers INDEP with 3+ steps
2: requires assistance to prevent fall
3: very unstable; loses balance spontaneously
4: unable to stand w/o assistance
Orpington Prognostic Scale
Where a patient will DC
3.2-5.2= IP rehab
>5.2= SNF
<3.2= home
Postural Assessment Scale for Stroke Patients
PASS
0-36 (higher score indicates higher ability)
Score of 14= INDEP ambulation
National Institutes of Health Stroke Scale
NIHSS
Mild: 1-5
Mild/Moderate: 5-14
Severe: 15-25
Very severe >25
0 (no impairment)- 42 (highest impairment)
Montreal Cognitive Assessment
MoCA
0-30
<26 suggests cognitive dysfunction
Moss Attention Rating Scale
22-110
Higher score indicates better attention
Functional Reach Test
Cut off scores <6’’ or <15 cm indicates fall risk
Hand held myometry
Normal values
Male- 100 lbs
Female- 65 lbs
High level Mobility Assessment Tool
HiMat 0-54 (higher score indicates better performance) Normative values Men- 50-54 Female-44-54
Mini-Best Test
0-28
Higher score indicates less impairment
<23 suggests increased risk for falling
Mini Mental State Exam
MMSE
0-30
<24= presence of cog impairment
Modified Ashworth Scale
MAS 0-4 Higher score=increased spasticity 0-None 1- slight catch/release, at end of ROM 2- Increase muscle tone throughout most ROM 3- Passive movement difficult 4-Unable to move/rigid
What are the highly recommended OMs used in acute CVA?
- Orpington prognostic scale
- Functional reach test
- PASS
- 6MWT
- 10MWT
- TUG
What are the highly recommended OMs using in IP rehab and OP post CVA?
- 6MWT
- 10MWT
- TUG
- Functional reach test
- FIM (IP only)
- PASS
- Goal attainment scale
- Motor activity log
- Stroke impact scale (OP only)
Tinetti Falls Efficacy Scale
Self report for rating balance confidence
Lower score=better
On a scale of 1 (very confident)- 10 (not confident)
> 70 points= FOF
80 points= risk of falling
Fugl-Meyer
GRASP (Graded repetitive Arm Supplementary Progrma
- Level 1 Fugyl Meyer score 10-25 (fine motor skills not required)
- Level 2 Fugyl Meyer score 26-45; more graded control of hand grasp/release
- Level 3 Fugyl Meyer score 46-58; requires fine motor skills
Modified Rankin Scale
Looks at assistance level required for self care, ADLs, and overall function
- Mix of self report and observation measure
- 0= no symptoms
- 5 = bed ridden
- Initially moderately disabled (score of 3) achieved INDEP state within 96 days
- Severely disabled (score of 4)= 585 days
- Very severely disabled (score of 5)= >600 days
Barthel index
Functional limitation measure
- Shows individuals ability to care for self
- 10 ADL items rated based on level of assist the patient requires
Functional ambulation categories
0= non functional 6= independent
Trunk impairment scale for non-ambulatory patients
- Can score 0-23
- Average score for non-ambulatory patients is 8
- Average score for ambulatory patients is 14
- looks at static sitting, balance, dynamic sitting balance, and coordination
What score on the BBS indicates a more likely DC to home?
20/56
Functional reach cutoff score for fall risk
<6 inches or 15 cm
Postural Assessment Scale for Stroke
able to predict functional ability and DC destination better than the trunk impairment scale
What range of FIM scores demonstrates higher gains with rehab?
score between 37-72
What are the STREAM score categories for DC home?
<63 has 0% chance
63-95 has 55% chance
95-100 has 86% chance
What are the mini-mental state exam categories?
None 24-30
Mild- 18-24
Severe- 0-7
Motor activity log
Self rating of quality and amount of hemiparetic arm use
Activity level
IP and OP setting only
What is the Action Research Arm Test
Provides more information on grasp, grip, and pinch
Activity level measure
What is the SIP-30?
Assess perceived health status
Self report
0-100% where higher score is worse health status
What are the highly recommended outcome measures in the acute care setting for TBI?
- RLAS
- CRS
- ABS
- Moss attention rating scale
What are the highly recommended outcome measures in the IP rehab setting for TBI?
- CRS
- MARS
What are the highly recommended outcome measures in OP setting for TBI
- 6MWT
- Functional Assessment Measure
Based on the CRS, what indicates emergence from minimally conscious state?
Score of 0-23 (lower scores indicate reflexive and brainstem level activity)
- Motor score of 6 or communication score of 2 indicates emergence from minimally conscious state
- functional object use and functional/accurate communication
- appropriate for P’s rancho levels I-IV
Disability rating scale scoring
higher scores indicate higher level of disability
What is the cutoff score for the Functional Assessment Measure?
- FAM score <65 indicative of risk for long-term unemployment
- Activity level measure
Dizziness handicap inventory (DHI)
Self report measure where higher score indicates greater handicap due to dizziness
Glasgow Coma Scale
Mild- 13-15
Moderate- 9-12
Severe: <8
Vegitative: <3
Motor response (1-6), Verbal response (1-5), and eye opening (1-4)
Eye opening
- no eye opening
- eyes open to pain
- eyes open to speech
- spontaneous eye opening
Verbal response
- no sounds
- Incomprehensible sounds
- Inappropriate words and jumbled phrases of workds
- Confused, yet coherent speech
- Alert and oriented
Motor response
- No response
- Decerebrate posturing
- Decorticate posturing
- Withdraws from noxious stimuli
- Localizes to noxious stimuli
- Obeys command fully
What are highly recommended OMs in PD?
- UPDRS
- MOCA
- 6MWT
- 10MWT
- Mini BESTest
- FGA
- 5XSTS
- Participation- PDQ 8 or 39
What is the only validated measure of freezing of gait?
- FOG questionnaire
- Higher scores=greater severity of FOG
- self reported measure
- completed during “on” medication time
ABC cutoff scores for PD
67% indicates risk of falling
<69% predictive of recurrent falls
What stages of PD is the TUG recommended for?
1-4
MDS-UPDRS
Measure of burden and extend of PD, disease severity
- lower score indicates less impact of PD symptoms
- part 1: mentation, behavior, and mood
- part 2: assessment of ADLs
- part 3: motor exam
- part : motor complications
Mean score in PD population= 68 (highest score is 108)
Montreal Cognitive Assessment (MoCA) cuttoff scores for PD
cutoff score for PD-mild cognitive impairment <26/30
cutoff score for PD dementia: 22/30
MiniBesTest
cutt off score for propsective fallers- 16/32
Assessment of dynamic balance
FGA cutoff score to identify fallers in PD population
15/30
What stages of PD is the BBS recommended for?
Stage 2 and 3 (ceiling effect in stage 1, floor effect in stage 4)
PDQ 9 or PDQ 39
Self reported measure
Assess PD specific health related QOL
lower score= better QOL
ALS-Functional Rating Scale
Higher score= better functioning
out of 40 points
Unified Huntington Disease Rating Scale
Lower score=better functioning
Cutoff score for increased fall risk in HD on the BBS?
40/56
Highly recommended OMs used in MS?
MSWS-12 (for EDSS up to 7.5) 6MWT DHI (OP only) MS Functional Composite (OP only) MS Quality of Life MSIS-29
What type of measure is the MSWS-12 walking scale?
Self report measure of impact of MS on walking ability
sore 1-5 with 1 as no limitation and 5 as extremely limited
lower score is better
activity level measure
Average score on the MSWS-12 for falls= 75/100
What comprises the MS Functional composite?
- Timed 25-foot walk test
- 9 hole peg test
- paced auditory serial addition test
- OP setting
MSQOL-54
contains items from SF 36 with 18 new items added
activity and participation level
self report
Normative value for 6MWT in MS?
1260ft (385 meters)
What is the cutoff score on the DHI?
less than or equal to 59
use in OP setting
What score on the DGI is indicative of fall risk in MS?
<12/24 points
Expanded Disability Status Scale (EDSS) scoring
- No disability, minimal signs
- Minimal disability
- Moderate disability
- Ambulatory w/o aid or rest 500 m
- Ambulatory w/o aid or rest 200 m
- intermittent or unilateral constant assistance required for 100 m
- unable to ambulate 5 meters with aid, wheels self in WC, transfers alone
- restricted to WC, OOB most of day
- helpless in bed, can communicate and eat
- Death due to MS
Fatigue Scale for Motor and Cognitive functions (FSMC)
only fatigue measure researched in MS
recommended in all treatment settings
MSIS-29
Self report measure asking impact of MS on day to day life
- Score of 1 is not at all and 5 is extremely
- Max score of 100 meaning greater impact of MS on your life
- Participation level measure
What are the normative values for Box and Blocks test (MS)?
- range from 83-61
- 83 blocks for people in their 40s
- 61 blocks for people in their 70s
What are the 5xSTS cutoff scores in MS?
<20 sec= INDEP for basic transfers
>30= dependent on transfers, do not go out alone
What are the highly recommended OMs for AIS A/B?
AISA impairment Scale
World Health organization QOL-BREF (recommended at chronic stage >6 months)
What are the highly recommended OMs for AIS C/D?
- AISA Impairment Scale
- World Health organization QOL-BREF (>6 months)
- 6MWT
- 10MWT
- TUG
- WISCI II (not > 6 months; recommended for acute <3 months)
What are the mean TUG times for paraplegia and tetraplegia?
Para- 20 sec
Tetra- 15 sec
How is the WISCI II scored?
- 0-20
- 0 is unable to stand/participate in walking
- 20 is ambulation with no AD or assist
- gives more information on bracing and ADs
- Activity level measure
What is the SCIM?
Spinal cord independence measure
- activity level measure, similar to the FIM
- out of 100 points
What is the SCI FAI?
Spinal Cord Injury Functional Ambulation Inventory
-looks at 3 domains of walking function (gait parameters, assistive device, and temporal distance)
What is the WUSPI?
Wheelchair users shoulder pain index
- score ranges from 0-150
- higher score=more pain with activity
What time period post injury has the 6MWT shown the greatest responsiveness?
3-6 months post injury
What MMT score indicate use of specific strength testing measures?
Greater than 3/5= hand held myometry
Less than 2+/5= MMT
What is the cutoff score for fall risk on the 5xSTS in the vestibular population?
<15 sec
What are the cutoff scores on the DHI?
Mild- 0-30
Moderate- 31-60
Severe- 61-100
What is the cutoff score for falls risk on the miniBEST for vestibular patients?
<19= recurrent fallers
What is the cutoff for falls risk on the four square step test? (vestibular)
> 12 sec
What is the cutoff for fall risk on the FGA? (vestibular)
22/30
15/30 in PD population
What is the cutoff for fall risk on the TUG in the vestibular population?
> 11 sec
What is considered a positive result on the Dynamic Visual Acuity test?
> 1 line loss of vision (is it 2??)
