Outcome measures used to assess disability post stroke within the framework of the ICF: a literature review

BACKGROUND: The use of outcome measures has been associated with good practice among clinicians and as a research instrument. These measures can be utilized to assess- and manage patients, observe progress, determine the effects of certain intervention and for research purposes. This scholarly paper investigates the most commonly used outcome measures along the continuum of care, and further provides additional information that will assist researchers and clinicians to decide on the most appropriate outcome measure in a South African Healthcare. METHODS: Literature of the past 10 years dealing with outcome measures was reviewed for this study. The types of papers in this review were systematic reviews, narrative reviews, scholarly papers, longitudinal and cross sectional. RESULTS AND DISCUSSION: Included in this review are four impairment, five activity/disability, two participation restriction and four quality of life outcome measures. Although a number of these measures have been used in the South African setting, it is not clear whether they have been validated for the local context. Few translated versions relevant to South Africa are available and not all measures are freely available, which could limit the use thereof. CONCLUSION: This paper successfully describes the commonly used outcome measures and aspects that should be taken into account when deciding on the appropriate measure

Activity limitations and factors influencing functional outcome of patients with stroke following rehabilitation at a specialised facility in the Western Cape

BACKGROUND: Determining the functional abilities and factors influencing outcome of patients with stroke following rehabilitation are essential for the planning of future interventions and services in order to optimise recovery. OBJECTIVES: To determine the activity limitations and factors influencing functional outcome of patients with stroke managed at a specialised rehabilitation centre. METHODOLOGY: A longitudinal study design was used to determine the functional outcomes of patients admitted to the centre on admission and discharge. A data gathering sheet was developed to collect information pertaining to the demographicand medical profile and process of rehabilitation, whereas the Barthel Index was used to collect data relating to functional abilities. For analysis, descriptive statistics as well as inferential statistics (Student t test) were utilised to determine the paired differences. Six prognostic factors influencing functional outcome were selected and tested using linear (bivariate) regression. RESULTS: The mean Barthel Index scores on admission and at discharge were 58.85 and 81.59 respectively. A significant improvement was noted in the execution of functional task of patients with stroke (p< 0.01) between the data collection points. Despite the significant overall improvement, results show a high prevalence of dependence with walking and stair climbing at discharge. Only functional ability on admission (r=0.49) predicted a favourable functional outcome at discharge. CONCLUSION: This study highlights the limitations of younger stroke survivors and the need for continued rehabilitation following in-patient care. It further underscores the administration of a functional rating scale on admission in order to aggressively manage activity limitations.Department of HE and Training approved lis

Characteristics and outcomes of gunshot-acquired spinal cord injury in South Africa

Background. Spinal cord injuries (SCIs) caused by assault present a unique challenge facing the healthcare system, in that very little is known about how these injuries manifest compared with other causes of injury. Understanding the nuances of gunshot SCIs could contribute towards better care provision. Objective. To determine the characteristics of gunshot SCI and compare both injury characteristics and outcomes between gunshot SCI and all other traumatic causes taken together. Methods. The gunshot SCI sub-cohort was derived from a 1-year prospective, population-based study, including both tertiary-level hospitals providing SCI care in the Cape Metropolitan area of South Africa (SA). All consenting 145 survivors, after a window period of 7 days, were included, and their demographic and injury characteristics were captured according to the International SCI Core Basic Data Set. Further, selected secondary medical complications (outcomes) were prospectively and routinely assessed throughout acute care. Both descriptive and inferential statistics were used to describe and compare characteristics and outcomes, respectively. Results. Of the 145 survivors of traumatic SCIs, 45 (31%) injuries were caused by gunshots. The gunshot SCI group consisted mainly of males (n=43, 96%), and the average age of injury onset was 26 years. Most survivors of the gunshot SCI group were paraplegic (69%), had complete lesions (69%) and vertebral injuries (96%), and presented with significant associated injuries (84%). When comparing gunshot SCI with all other traumatic causes, significant differences were found in relation to demographic and injury characteristics and adverse outcomes, indicating that those survivors with gunshot SCI were typically younger males with complete paraplegia, had more frequent secondary medical complications, and a longer hospital stay. Conclusion. This study contributes to the knowledge base of survivors with gunshot SCIs in a region of SA. Efforts should be made to reduce the occurrence of all gunshot SCIs, since those injuries affect survivors negatively in terms of injury characteristics and adverse outcomes

Determining the process of rehabilitation and the outcomes of patients at a specialised in-patient centre in the Western Cape

Magister Scientiae (Physiotherapy) - MSc(Physio)The World Health Organisation estimates that the majority of the disabled population resides in the developing world, but most of the research on outcomes of patients originates from the developed world. In the light of the differences in healthcare structures and function, especially rehabilitation between settings and countries, it is imperative to have an understanding of the functioning of patients at discharge with the objective of measuring the level at which outcomes are met. The aim of this study was therefore to determine the process of rehabilitation and the outcome of patients following in-patient rehabilitation at a facility in the Western Cape. A quantitative research design was employed to address the objectives. Self-administered questionnaires were developed to collate information pertaining to the demographic-, socioeconomic- and medical profile of patients and data extraction sheets collected information relating to the process of rehabilitation and the impairment status of patients on admission. With regards to activity and participation, a longitudinal study design was used, which utilised standardised outcomes measures. The sample consisted of all patients with stroke and spinal cord injury admitted within a three-month period, and all ethical principles relating to research on human subjects, as stipulated in the Helsinki Declaration were adhered to during data collection, with ethical clearance obtained from relevant authorities. The SAS and the Microsoft Excel Package 2007 were used to analyse the quantitative data elements. Descriptive statistics using frequencies, percentages, ranges, means, and standard deviations and inferential statistics using chi-square, student T-tests and correlation tests, for determining the predictors of functional outcome, were calculated. There were 175 patients, whereof 82 were patients with stroke and 93 with spinal cord injury, with 143 (76 presenting with spinal cord injury and 67 with stroke) meeting the inclusion criteria on admission. The mean age of those with spinal cord injury and stroke was 34.14 and 52.95 years. Most of the patients with spinal cord injuries were single (73.68%), whereas the majority (53.73%) of patients with strokes were married at the time of injury. All patients were managed by the doctor and the nurse, with most of the patients receiving physiotherapy, occupational therapy and social assistance from the social worker. With regards to recreational activities, 46.87% of patients with spinal cord injury and 39.39% of those with stroke attended the learn to swim programme, and 29.68% of patients with spinal cord injury attended the wheelchair basketball sessions. The mean length of hospital stay for patients with spinal cord injury and stroke was 73.11 and 51. 62 days, with most of the spinal cord injured patients (80.26%) and stroke patients (82.08%) discharged home without follow-up rehabilitation. The most prevalent impairments on admission of the spinal cord injury cohort were muscle weakness (75.0%), bladder incontinence (71.1%) and reduced sensation (69.7%), whereas patients with stroke presented mostly with muscle paralysis (80.6%), abnormal tone (76.1%) and aphasia (50.8%). Functional limitations experienced by the participants included, mobility, stair climbing and transfers. The participants experienced participation restrictions in the following domains, leisure activities and employment. A clinical significant improvement was noted in execution of functional task of patients with spinal cord injury (p< 0.0001) and stroke (p< 0.0001) between admission and discharge. A significant statistical change was also detected for the participation elements of both stroke and spinal cord injury cohorts. Functional ability on admission was found to be a predictor of functional outcome of the stroke diagnostic group at discharge, whereas the multiple redictor model of functional outcome of the spinal cord injured cohort at discharge was significant with remaining variables of functional outcome score on admission (p<0.0001) and bladder -and bowel impairment(s) (p=0.0247). The study findings suggest that despite the significant change in activity and participation, most of the patients were discharged home without further follow-up for rehabilitation, irrespective of the activity limitations and participation restrictions still experienced at the time of discharge. The latter finding questions the duration of the length of hospital stay, which does not allow patients to be independent in all meaningful activities and participatory actions and roles by the end of inpatient rehabilitation. The study findings could assist authorities to adapt the existing rehabilitation programme and referral process .South Afric

Characteristics and outcomes of gunshot-acquired spinal cord injury in South Africa

Background. Spinal cord injuries (SCIs) caused by assault present a unique challenge facing the healthcare system, in that very little is known about how these injuries manifest compared with other causes of injury. Understanding the nuances of gunshot SCIs could contribute towards better care provision.Objective. To determine the characteristics of gunshot SCI and compare both injury characteristics and outcomes between gunshot SCI and all other traumatic causes taken together.Methods. The gunshot SCI sub-cohort was derived from a 1-year prospective, population-based study, including both tertiary-level hospitals providing SCI care in the Cape Metropolitan area of South Africa (SA). All consenting 145 survivors, after a window period of 7 days, were included, and their demographic and injury characteristics were captured according to the International SCI Core Basic Data Set. Further, selected secondary medical complications (outcomes) were prospectively and routinely assessed throughout acute care. Both descriptive and inferential statistics were used to describe and compare characteristics and outcomes, respectively.Results. Of the 145 survivors of traumatic SCIs, 45 (31%) injuries were caused by gunshots. The gunshot SCI group consisted mainly of males (n=43, 96%), and the average age of injury onset was 26 years. Most survivors of the gunshot SCI group were paraplegic (69%), had complete lesions (69%) and vertebral injuries (96%), and presented with significant associated injuries (84%). When comparing gunshot SCI with all other traumatic causes, significant differences were found in relation to demographic and injury characteristics and adverse outcomes, indicating that those survivors with gunshot SCI were typically younger males with complete paraplegia, had more frequent secondary medical complications, and a longer hospital stay.Conclusion. This study contributes to the knowledge base of survivors with gunshot SCIs in a region of SA. Efforts should be made to reduce the occurrence of all gunshot SCIs, since those injuries affect survivors negatively in terms of injury characteristics and adverse outcomes

Characteristics and outcomes of gunshot-acquired spinal cord injury in South Africa

Background. Spinal cord injuries (SCIs) caused by assault present a unique challenge facing the healthcare system, in that very little is known about how these injuries manifest compared with other causes of injury. Understanding the nuances of gunshot SCIs could contribute towards better care provision. Objective. To determine the characteristics of gunshot SCI and compare both injury characteristics and outcomes between gunshot SCI and all other traumatic causes taken together. Methods. The gunshot SCI sub-cohort was derived from a 1-year prospective, population-based study, including both tertiary-level hospitals providing SCI care in the Cape Metropolitan area of South Africa (SA). All consenting 145 survivors, after a window period of 7 days, were included, and their demographic and injury characteristics were captured according to the International SCI Core Basic Data Set. Further, selected secondary medical complications (outcomes) were prospectively and routinely assessed throughout acute care. Both descriptive and inferential statistics were used to describe and compare characteristics and outcomes, respectively. Results. Of the 145 survivors of traumatic SCIs, 45 (31%) injuries were caused by gunshots. The gunshot SCI group consisted mainly of males (n=43, 96%), and the average age of injury onset was 26 years. Most survivors of the gunshot SCI group were paraplegic (69%), had complete lesions (69%) and vertebral injuries (96%), and presented with significant associated injuries (84%). When comparing gunshot SCI with all other traumatic causes, significant differences were found in relation to demographic and injury characteristics and adverse outcomes, indicating that those survivors with gunshot SCI were typically younger males with complete paraplegia, had more frequent secondary medical complications, and a longer hospital stay. Conclusion. This study contributes to the knowledge base of survivors with gunshot SCIs in a region of SA. Efforts should be made to reduce the occurrence of all gunshot SCIs, since those injuries affect survivors negatively in terms of injury characteristics and adverse outcomes

Exploring the key performance areas and assessment criteria for the evaluation of students' clinical performance: a Delphi study

BACKGROUND: Evaluating students’ clinical performance is an integral part of the quality assurance in a physiotherapy curriculum, however, the objectivity during clinical examination have been questioned on numerous occasions. The aim of this study was to explore the essential key clinical performance areas and the associated assessment criteria in order to develop a reliable clinical assessment form. METHODS: A Delphi study was used to obtain consensus on the development of a reliable clinical performance assessment tool. The study population consisted of purposively selected academic physiotherapy staff from the University of Western Cape as well as supervisors and clinicians involved in the examination of physiotherapy students from the three Universities in the Western Cape. Findings from the Delphi rounds were analysed descriptively. Fifty percent or higher agreement on an element was interpreted as an acceptable level of consensus. RESULTS: Eight key performance areas were identified with five assessment criteria per key performance area as well as the weighting per area. It was evident that evaluators differed on the expectations of physiotherapy students as well as the criteria used to assess them.CONCLUSIONS: The Delphi panel contributed to the formulation of a clinical assessment form through the identification of relevant key performance areas and assessment criteria as they relate to undergraduate physiotherapy training. Consensus on both aspects was reached following discussion and calculation of mean ranking sores. IMPLICATIONS: This process of reaching consensus in determining clear criteria for measuring key performance areas contributes to the objectivity of the process of cilia examinations.Web of Scienc

Evaluation of a new clinical performance assessment tool: a reliability study

Clinical practice is an essential requirement of any graduate physiotherapy programme. For this purpose, valid and reliable assessment tools are paramount for the measurement of key competencies in the real-world setting. This study aims to determine the internal consistency and inter-rater reliability of a newly developed and validated clinical performance assessment form. A cross-sectional quantitative research design was used, which included paired evaluations of 32 (17 treatment and 15 assessment) student examinations performed by two independent clinical educators. Chronbachs alpha was computed to assess internal consistency and intraclass correlation coefficient (ICC’s) with confidence intervals of 95% were computed to determine the percentage agreement between paired examiners. The degree of internal consistency was substantial for all key performance areas of both examinations, except for time and organisational management (0.21) and professionalism (0.42) in the treatment and evaluation examinations respectively. The overall internal consistency was 0.89 and 0.73 for both treatment and assessment examinations, indicating substantial agreement. With regard to agreement between raters, the ICC’s for the overall marks were 0.90 and 0.97 for both treatment and assessment examinations. Clinical educators demonstrated a high level of reliability in the assessment of students’ competence using the newly developed clinical performance assessment form. These findings greatly underscore the reliability of results obtained through observation of student examinations, and add another tool to the basket of ensuring quality assurance in physiotherapy clinical practice assessment.Department of HE and Training approved lis

Traumatic spinal cord injury in South Africa and Sweden : epidemiologic features and functioning

Background: Trauma to the human spinal cord typically strikes out of the blue, leaving those surviving the initial ordeal with permanent or temporary deficits in health and functioning. Because of this, traumatic spinal cord injuries (TSCI) impose a significant burden on society. While these facts are well known for certain countries, the International Perspectives on Spinal Cord Injury Report highlights the need for the remaining countries to establish a foundation upon which injuries could be prevented and functioning problems addressed. In South Africa, the foundation for primary prevention and knowledge of the unmet needs of persons with TSCI are not yet established. Aim: To develop an evidence-based foundation for TSCI in South Africa that addresses prevention both in terms of injury occurrence and problems with functioning. Methods: This thesis utilised a mixed-method approach to answer epidemiologic and functioning questions. A prospective, population-based design was used in Study I and II to determine the incidence, aetiology and injury profiles of newly-injured adults with TSCI in Cape Town, South Africa and Stockholm, Sweden. In the Functioning section of the thesis (Study III), a comparative content validity design was used to define the nature of functioning categories in a generic outcome measure currently used in the South African SCI rehabilitation field, and a standardised measure not yet adopted in the local context, against the International Classification of Functioning, Disability and Health and the brief ICF core sets for SCI in the post-acute context. In Study IV, qualitative description was used to explore the experiences of reclaiming participation in 17 chronic survivors of TSCI by emphasising their met and unmet needs as well as the conditions influencing them. Findings: One-hundred and forty-seven and 49 incident cases, resulting in an annual crude incidence rate of 75.6 and 19.0 per million population, were registered for the region of South Africa (study I) and Sweden (study II), respectively. The leading cause of injury in South Africa was assault, accounting for approximately 60% of all incident cases, compared with the leading cause in Sweden, where falls was responsible for 58% of all cases. The two cohorts differed significantly with respect to demographic and aetiologic characteristics. Concerning functioning, Study III found that the generic rehabilitation outcome measure was not fully conceptualised within the ICF and did not cover all the essential functioning aspects as contained in the brief core set. In contrast, the standardised outcome measure was fully conceptualised within the ICF and covered, in its entirety, the activity and participation categories contained in the brief core set. In Study IV, clients’ perspectives confirmed 'participation' as a desirable and possible goal by effectively dealing with the new self, negotiating obstacles, identifying facilitators of participation, and becoming an agent. These critical aspects − also categories − were essential for reconstructing meaning and prioritising important life situations. Conclusions: The incidence of TSCI in South Africa is among the highest in the world and is mainly caused by assault, while the incidence in Sweden appeared consistent to what is proposed for Western Europe. Furthermore, there is a need to raise awareness and facilitate the use of standardised outcome measures in TSCI rehabilitation, since the current operational measure in the South African SCI rehabilitation field presented some shortcomings. It is remarkable to conclude that while participation is indeed a reality after injury, the dimensionality of challenges remains an issue for further discourse. The insights gained from these studies provide an evidence-based foundation for impacting primary prevention action plans and the alignment of rehabilitation practices towards addressing the unmet needs of survivors

Changes in activity limitations and predictors of functional outcome of patients with spinal cord injury following in-patient rehabilitation

The purpose of this study was to investigate the changes in the activity limitations of patients following in-patient rehabilitation and the factors influencing functional ability as measured by the Spinal Cord Independence Measure III (SCIM III). A longitudinal study design was utilised to study the change in functional abilities of patients with spinal cord injury between admission and discharge. A convenient sampling strategy was employed, in which every consecutive patient admitted to the rehabilitation centre within a three month period was eligible for the study. Demographic-, medical, and process of rehabilitation data were collected and collated from the patients' medical records using a data gathering sheet that was validated and tested for reliability. Functional abilities were measured by the SCIM III. Seventy-six patients met the inclusion criteria, consisting of 58 paraplegics and 18 tetraplegics. The mean age of this cohort was 34.14 years. A significant difference (p<0.001) in functional ability was detected for the total sample, with only12.5% of patients independent in walking ability and 28.12% in stair management. Four (4) factors were found to be predictors of functional outcomes on bivariate analysis, but when considered together in a multiple regression model, only functional status on admission remained correlated to functional outcomes. Conclusion and implication for practice: Significant improvement in functional abilities of persons with spinal cord injury following in-patient rehabilitation was observed. However, mobility and stair-management limitations were the most prevalent at discharge. Lastly, a lower functional status should be better targeted to optimise functional ability in the future. Future research should be directed towards illuminating whether personal factors or rehabilitation inefficiencies are responsible for the limitations observed at discharge.Department of HE and Training approved lis