Prognostic accuracy of the Stroke Rehabilitation Assessment of Movement (STREAM) scores on admission for walking independence in stroke patients at discharge and one-month follow-up

 

I don't consider any prediction of recovery useful at all. You're supposed to deliver EXACT RECOVERY PROTOCOLS AS SURVIVORS NEED! This is fucking useless for survivors! You're fired!

Prognostic accuracy of the Stroke Rehabilitation Assessment of Movement (STREAM) scores on admission for walking independence in stroke patients at discharge and one-month follow-up

•  Thamonwan Kirdthongkham,
• Maria Justine,
• Akkradate Siriphorn

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• Published: March 7, 2025
• https://doi.org/10.1371/journal.pone.0319682

Abstract

Gait prediction is critical in optimizing rehabilitation strategies for stroke survivors. This study evaluates the prognostic utility of the Stroke Rehabilitation Assessment of Movement (STREAM) scores, recorded at admission, for predicting walking ability at discharge and one-month follow-up. We assessed 47 stroke patients using STREAM at admission; walking independence was defined using two criteria: a Functional Ambulation Category (FAC) score >  3 and a 10-Meter Walk Test (10-MWT) speed ≥  0.4 m/s. The predictive validity of STREAM scores was analyzed using the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and cut-off values were computed. The analysis revealed that a STREAM score above 38 at admission significantly predicted independent gait by discharge, evidenced by a high AUC of 0.897. At the one-month follow-up, a cut-off score of 29 continued to predict walking independence, with an AUC of 0.987. The subscores further enhanced predictive accuracy and highlighted the effectiveness of the STREAM assessment as a robust predictor of independent walking in stroke patients. These findings suggest the practicality of using STREAM scores to predict walking independence, which can guide the planning of more effective rehabilitation interventions. Trial registration TCTR20240323004 at www.thaiclinicaltrials.org.

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Citation: Kirdthongkham T, Justine M, Siriphorn A (2025) Prognostic accuracy of the Stroke Rehabilitation Assessment of Movement (STREAM) scores on admission for walking independence in stroke patients at discharge and one-month follow-up. PLoS ONE 20(3): e0319682. https://doi.org/10.1371/journal.pone.0319682

Editor: Jyotindra Narayan, Imperial College London, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND

Received: October 10, 2024; Accepted: February 6, 2025; Published: March 7, 2025

Copyright: © 2025 Kirdthongkham et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Measurement characteristics and clinical utility of the stroke rehabilitation assessment of movement among stroke patients

The only way I can see any usefulness of this is if the results lead directly to a stroke protocol that will fix the problems. Testing like this is usually useless, it does nothing to bring more recovery to the survivor.  I remember complete therapy sessions only doing testing, no therapy at all. 

Measurement characteristics and clinical utility of the stroke rehabilitation assessment of movement among stroke patients

Archives of Physical Medicine and Rehabilitation , Volume 95(1) , Pgs. 207-208.

NARIC Accession Number: J67792.  What's this?
ISSN: 0003-9993.
Author(s): Sullivan, Jane E.
Project Number: H133B090024.
Publication Year: 2014.
Number of Pages: 2.
Abstract: Article reviews the psychometric properties of the Stroke Rehabilitation Assessment of Movement (STREAM), an outcome measure that examines voluntary limb movement of the arm and leg and basic mobility after stroke. The 2 limb subscales are scored on a 3-point ordinal scale. Scoring considers the excursion and quality of limb movement compared with the less-impaired side. The mobility subscale is scored on a 4-point ordinal considering the quality of movement, whole versus part completion of the task, use of a device, and assistance required. A total of 20 points is available for each limb scale, and 30 points are available for the mobility scale. Scores are converted to percentages to allow for items that were not tested. The measure can be completed in 15 minutes with equipment typically found in the clinic. Excellent reliability, concurrent validity with other commonly used clinical tests, minimal detectable change data, and normative values have been established. The STREAM has been reported to be responsive to change in acute stroke. A full review of the STREAM, as well as reviews of nearly 200 other instruments, can be found at www.rehabmeasures.org.
Descriptor Terms: BODY MOVEMENT, LIMBS, MEASUREMENTS, MOBILITY, MOTOR SKILLS, OUTCOMES, PERFORMANCE STANDARDS, STROKE.

Can this document be ordered through NARIC's document delivery service*?: Y.

Citation: Sullivan, Jane E. (2014). Measurement characteristics and clinical utility of the stroke rehabilitation assessment of movement among stroke patients. Archives of Physical Medicine and Rehabilitation, 95(1), Pgs. 207-208. Retrieved 4/11/2014, from REHABDATA database.

Validity of the Stroke Rehabilitation Assessment of Movement Scale in Acute Rehabilitation:

Neither one is valid because they aren't looking at the reason for the impairment, Is it dead brain impaired or penumbra impaired?
Validity of the Stroke Rehabilitation Assessment of Movement Scale in Acute Rehabilitation:

Objective

To demonstrate sensitivity to change of the Stroke Rehabilitation Assessment of Movement (STREAM) as well as the concurrent and predictive validity of the STREAM in an acute rehabilitation setting.

Design

Prospective cohort study.

Setting

Acute, in-patient rehabilitation department within a tertiary-care teaching hospital in the United States.

Participants

Thirty adults with a newly diagnosed, first ischemic stroke.

Methods

Clinical assessments were conducted on admission and then again on discharge from the rehabilitation hospital with the STREAM (total STREAM and upper extremity, lower extremity, and mobility subscales), Functional Independence Measure (FIM), and Stroke Impact Scale-16 (SIS-16). Sensitivity to change was determined with the Wilcoxon signed rank test and by the calculation of standardized response means. Spearman correlations were used to assess concurrent validity of the total STREAM and STREAM subscales with the FIM and SIS-16 on admission and discharge. We determined predictive validity for all instruments by correlating admission scores with actual and predicted length of stay and by testing associations between admission scores and discharge destination (home vs subacute facility).

Main Outcomes

Not applicable.

Results

For all instruments, there was statistically significant improvement from admission to discharge. The standardized response means for the total STREAM and STREAM subscales were large. Spearman correlations between the total STREAM and STREAM subscales and the FIM and SIS-16 were moderate to excellent, both on admission and discharge. Among change scores, only the SIS-16 correlated with the total STREAM. All 3 instruments were significantly associated with discharge destination; however, the associations were strongest for the total STREAM and STREAM subscales. All instruments showed moderate-to-excellent correlations with predicted and actual length of stay.

Conclusions

The STREAM is sensitive to change and demonstrates good concurrent and predictive validity as compared with the FIM and SIS-16 in the acute inpatient rehabilitation population.