Deans' stroke musings: The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, October 26, 2016

The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index

No fucking clue what use this is. No measurement of actual changes in the brain, just secondary changes.which are not objective.
http://journal.frontiersin.org/article/10.3389/fneur.2016.00152/full?

Tim Vanbellingen^1,2*,

Beatrice Ottiger¹,

Tobias Pflugshaupt¹,

Jan Mehrholz³,

Stephan Bohlhalter¹,

Tobias Nef^2,4 and

Thomas Nyffeler^1,2

¹Neurology and Neurorehabilitation Center, Luzerner Kantonsspital, Luzern, Switzerland
²Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland
³Wissenschaftliches Institut, Klinik Bavaria in Kreischa GmbH, Kreischa, Germany
⁴ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland

Background: Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients.

Methods: One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses.

Results: The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness.

Conclusion: We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.

Introduction

Several measures for activities of daily living (ADL) have been published for patients with stroke. Among those, the Barthel index (BI) (1) and the functional independence measure (FIM) (2) are most widely used (3–5). The FIM covers two main aspects of functional outcome, by including a motor and cognitive subscale, while the BI includes motor items only. Previous studies have explored floor and ceiling effects, and responsiveness of both FIM subscales, often comparing the FIM motor subscale with the BI. No clear advantage of the FIM motor subscale over the BI has been found (6, 7). In addition, floor and ceiling effects have been suggested for both FIM motor subscale (7–9) and BI (10, 11). An attempt to overcome ceiling effects and to extend the range of the FIM has been the adding of 12 additional items of the functional assessment measure (FAM) to the FIM, so-called FIM + FAM (12). However, the added value of the FAM can be questioned, since ceiling effects still remained (12, 13). Consequently, the FIM is still most commonly used as a reference functional outcome measurement and this, in particular, in stroke rehabilitation centers (5).

Recently, the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) has been developed (14). In this study, it was found that the scale covers four components, which can be defined as LIMOS motor, LIMOS cognition, LIMOS communication, and LIMOS domestic life subscales. These LIMOS subscales have several advantages. First, the composition and rating of the scales are based on the International Classification of Functioning, Disability, and Health (ICF) (15–18). In fact, the selection of the items of the LIMOS is based on the comprehensive ICF core sets for stroke (17). Second, the scales are used by a multidisciplinary team (nurses, physical and occupational therapists, speech therapists, neurologists). Finally, with respect to the LIMOS motor and LIMOS cognition, for example, these include detailed motor items, such as carrying objects (d430), and cognitive items, such as focusing attention (d160). Therefore, the more comprehensive LIMOS subscales are expected to be more sensitive to change over time than the other measures.

The test–retest, inter-rater reliability and construct validity of the total LIMOS and its subscales has been previously confirmed (14). However, the internal and external responsiveness, which are important psychometric properties, still remains to be established. The internal responsiveness is defined as the ability of a measure to change over a specific time frame, and the external responsiveness is reflected by the extent to which changes in a measure relate to corresponding changes in a reference measure (19). The advantage of having more sensitive measures is that even subtle changes can be measured in stroke patients with already good sensory–motor functions. These patients may still have impaired cognitive functions associated with difficulties in extended ADL tasks (e.g., cooking, using public transport services).

The aim of this single center, prospective cohort study was to explore the internal and external responsiveness, floor and ceiling effects, of the LIMOS motor, and LIMOS cognition and communication subscales – relative to the widely used FIM motor and FIM cognition subscales and the BI – in a large cohort of inpatients with stroke, who received multidisciplinary neurorehabilitation.