COSMIN database

Outcome measurement in stroke: a scale selection strategy

Baker, K., Cano, S. J., and Playford, E. D.
BACKGROUND AND PURPOSE: Evaluating the impact of new treatments requires the use of reliable, valid, and responsive outcome measures. However, given the wide range of instruments currently available, it is not always straightforward for healthcare professionals to select the most appropriate tool. In this review, we propose a potential approach to scale selection.

METHODS: In designing a new study of the impact of a robotic device in stroke rehabilitation, we developed a three-stage scale selection strategy. First, two guidance documents (Medical Outcome Trust and Food and Drug Administration PRO Guidance) were reviewed to identify key scale assessment criteria. Second, consideration was given at a theoretical level of the concepts and domains relevant to the goals our study. Third, a comprehensive literature search strategy and review were developed in conjunction with healthcare professionals and psychometricians. Identified scales were appraised regarding their psychometric properties and clinical content.

RESULTS: Forty-five measures were initially identified and appraised. From a clinical content perspective, none of the measures were considered to be sufficient on their own to capture all the important outcome domains in this study. However, 3 measures were identified that best met our review criteria: Stroke Rehabilitation Assessment of Movement, Chedoke Arm and Hand Inventory, and ABILHAND. After the final stage of scale appraisal, two further upper limb scales (Fugl-Meyer and Action Research Arm Test) were included based on clinical content and study design issues.

CONCLUSIONS: Our three-stage review process appears to be a potentially useful approach for evidence-based scale selection in stroke rehabilitation studies.
1524-4628 (Electronic)
Publication year:
Biological and physiological variables:
Biological and physiological variables
Overall quality of life:
Overall quality of life
Adults (18-65)
Seniors (65+)
Diseases of and symptoms related to the circulatory system
PRO / non-PRO:
Non-patient Reported Outcome
Patient Reported Outcome
Type of measurement instrument:
1 - Questionnaires
7 - Observations
10-s Test
AMAT - Arm Motor Ability Test
ARAT - Action Research Arm Test   
BBT - Box and Block Test
CAHAI - Chedoke Arm and Hand Activity Inventory
DHI - Dizziness Handicap Inventory
FAT - Frenchay Arm Test   
FMA - Fugl-Meyer Motor Assessment   
Functional Test
MAL - Motor Activity Log   
MESUPE - Motor Evaluation Scale for Upper Extremity
Motricity Index   
MSS - Motor Status Score
NHPT - Nine-Hole Peg Test   
RMA - Rivermead Motor Assessment
SHT - Sollerman Hand Function Test
SMES - Sodring motor evaluation for stroke patients
STREAM - Stroke Rehabilitation Assessment of Movement
UMAQS - University of Maryland Arm Questionnaire for Stroke