Newly developed short behavior scale for use in stroke outcome research

Is the Korean Mini-Mental State Examination (K-MMSE) Useful in Evaluating the Cognitive Function of Brain Injury Patients?: Through Correlation Analysis With Computerized Neurocognitive Test (CNT)

Patients with brain injury often experience accompanying disabilities that can make it challenging for them to use tools or perform complex tests. Therefore, Korean Mini-Mental State Examination (K-MMSE) is widely used in clinical practice as an alternative to the computerized neurocognitive test (CNT) or Wechsler Adult Intelligence Scale tests to assess cognitive function in these individuals. This study aimed to investigate the correlation between the K-MMSE and CNT in brain injury patients to evaluate the and clinical usefulness of K-MMSE. A total of 120 patients were assessed using both tests, and a significant correlation was observed between the total scores of K-MMSE and CNT. The orientation component of K-MMSE was significantly correlated with CNT components, indicating that individuals who perform well on orientation tasks are likely to have better cognitive abilities overall. While K-MMSE has limitations in evaluating specific cognitive domains, it is a useful tool in clinical practice for evaluating cognitive impairment, especially in patients who have difficulty using more complex cognitive tests.

Measurement properties of performance-based instruments for assessing mental function during activity and participation in persons with stroke: A systematic review

BACKGROUND

Various performance-based instruments exist to assess mental function after stroke and users have to select one for research or clinical practice.

OBJECTIVES

To evaluate the measurement properties of performance-based instruments to assess (any aspect of) mental function during activity and participation in persons after stroke.

MATERIAL AND METHODS

We searched in five electronic databases. COSMIN methodology was used to conduct the review. The strength of evidence was assessed using a modified GRADE approach.

RESULTS

Fifty articles were included reporting on 20 instruments assessing (1) multiple mental functions including ≥ four subdomains (2) attention, memory and executive functions, or single subdomains (3) executive functions, (4) perception, and (5) mental function of language. Highest quality evidence for sufficient results was found for some measurement properties in seven instruments. These instruments included: FIM + FAM, MPAI-4 and EFPT, MET, CBS/KF-NAP, BIT and the Scenario Test.

CONCLUSIONS

Further studies of high methodological quality are needed that evaluate the measurement properties of instruments to allow clinicians and researchers to select the most suitable performance-based measures for purpose.

SIGNIFICANCE

Results may be used to select the most suitable performance-based instrument to measure mental function during activity and participation in persons with stroke.

TRIAL REGISTRATION NUMBER

PROSPERO CRD42018086744.

The Current State of Stroke Rehabilitation in Japan

This paper presents the current state of stroke rehabilitation in Japan. The Japanese rehabilitation system is much different from those in other countries, mainly because of the Japanese insurance system, which covers from acute to chronic conditions. In this situation, a Japanese inpatient stroke rehabilitation program treats patients until they reach a plateau in impairment and disability. Thus we can evaluate the true func tional prognosis because of longer periods of observation for assessing the recovery pat tern of impairment and disability. As a result, we can predict stroke outcome much more precisely. We recently developed a new evaluation methods for stroke patients called the Stroke Impairment Assessment Set (SIAS) based on work from the Sym posium on Methodologic Issues in Stroke Outcome Research in 1989. Using the SIAS and the Functional Independence Measure, we have successfully predicted stroke out come using regression analysis.

Results of stroke rehabilitation in Thailand

OBJECTIVE

The purpose of this study is to identify predictors of functional outcome after acute to sub-acute stroke rehabilitation using raw FIM score and results of stroke rehabilitation in Thailand.

DESIGN

Descriptive and multivariate analysis was performed on data collected prospectively from 50 patients who were on stroke rehabilitation at Thai Red Cross Rehabilitation Center from October 1, 2000 to September 30, 2001. Six independent variables were obtained from patients' medical records.

RESULTS

The total FIM scores at the time of discharge and total FIM scores gain are strongly correlated with the total FIM scores at the time of admission to the hospital and correlated negatively with age using multiple linear regression analysis, significant at p < 0.05. The equation for all cases were: (discharge total FIM scores) = 82.856 + 0.708 x (admission total FIM scores) - 0.408 x (age) and (total FIM scores gain) = 82.85 - 0.292 x (admission total FIM scores) - 0.408 x (age). The models explained 76.48% of variation for total FIM scores at the time of discharge and 45.66% of variation for total FIM scores gain. The total FIM scores at the time of admission and age were the best predictors of the total FIM score at the time of discharge and the total FIM scores gain. However, the nature of stroke, gender, onset to admission interval (OAI), and length of rehabilitation stay (LOS) were not statistically significantly correlated with the total FIM scores at the time of discharge and the total FIM scores gain.

CONCLUSIONS

Because the total FIM score at the time of discharge and the total FIM scores gain are highly correlated with the total FIM scores at the time of admission and age, we can inform the patient and their family about the possibility of recovery, and assess the amount and quality of care needed at home or placement after discharge.

Psychometric properties of the Stroke Impairment Assessment Set (SIAS)

OBJECTIVE

To review the psychometric properties of the Stroke Impairment Assessment Set (SAS), which was developed in 1990 as a comprehensive instrument to assess stroke impairment.

METHOD

Articles related to the SIAS were retrieved from the MEDLINE and the Folia Centro Japonica.

RESULTS

Thirty-five articles were retrieved and analyzed. 1) Scale quality: Rasch analysis demonstrated the unidimensionality of the SIAS. Factor analysis produced factors corresponding to the 6 SIAS subscales. 2) Interrater reliability: The weighted kappas were high except for the unaffected side quadriceps item for which the score distribution was skewed. 3) Concurrent validity: Significant correlations were found between a) SIAS motor items and the Motricity Index or the Brunnstrom stage, b) SIAS lower extremity scores and the Functional Independence Measure (FIMSM) locomotion scores, c) trunk scores and abdominal manual muscle testing, d) visuospatial scores and line bisection and copying task scores, and e) speech scores and the FIMSM communication scores. 4) Predictive validity: Three studies attempting to predict discharge functional status demonstrated that adding the SIAS as one of the predictors enhanced the predictive power 5) Responsiveness: The SIAS was more responsive to changes than the Motricity Index, the Brunnstrom stage, or the National Institutes of Health Stroke Scale.

CONCLUSION

The SIAS is a useful measure of stroke impairment with well-established psychometric properties.

Mini-Mental State Examination, cognitive FIM instrument, and the Loewenstein Occupational Therapy Cognitive Assessment: relation to functional outcome of stroke patients

OBJECTIVES

To compare 3 cognitive tests, used on admission, for predicting discharge functional outcome and to assess the efficacy of these tests in predicting functional outcome at discharge in stroke patients undergoing rehabilitation.

DESIGN

Cohort study.

SETTING

Geriatric rehabilitation department of a tertiary care hospital in Israel.

PATIENTS

Sixty-six patients undergoing acute inpatient comprehensive rehabilitation after first clinical stroke.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASUREMENTS

Cognitive status was assessed with the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA), the Mini-Mental State Examination (MMSE), and the cognitive subscale of the FIM instrument. The FIM motor subscale was used to assess functional outcome status. Functional gain was determined by the motor FIM gain (efficacy), and the relative (to potential) functional gain was determined by the Montebello Rehabilitation Factor Score. Efficiency was calculated by efficacy divided by the length of hospital stay.

RESULTS

A significant increase in total FIM scores (34.8 points) occurred during rehabilitation mainly because of improvement in motor functioning (31.5 points). Significant improvement in global cognitive status was documented by all 3 tests. Intertest correlation coefficients ranged between.47 and.67. The LOTCA showed somewhat higher correlation coefficients with most of the parameters of functional motor outcomes. Correlation between the MMSE and FIM cognitive subscale and these outcome parameters were nearly identical.

CONCLUSION

The LOTCA is slightly better than the MMSE and the FIM cognitive subscale in predicting functional status change after stroke rehabilitation but it is a time-consuming and exhausting instrument to use. The FIM cognitive subscale requires a better overall understanding of the patient's situation at time of administration and therefore is less convenient for the initial assessment. The similar correlation of all 3 tests with functional outcomes and the simplicity of administration of the MMSE suggests its use in the initial assessment of stroke patients.

Prediction of functional outcome after stroke rehabilitation

OBJECTIVE

The purpose of this study is to identify predictors of functional outcome after acute stroke inpatient rehabilitation using raw Functional Independence Measure (FIM) total scores.

DESIGN

Multivariate analysis was performed on data collected retrospectively from stroke rehabilitation patients. Six independent variables were obtained from patients' medical records.

RESULTS

The FIM total scores at the time of discharge from the hospital correlated strongly with FIM total scores at the time of admission to the hospital and correlated negatively with age and OAI using the Spearman's rank correlation method. The FIM total scores at the time of hospital admission were the best predictor of FIM total scores at the time of discharge from the hospital. However, the nature of the stroke, gender, and LOHS did not correlate with FIM total scores at the time of discharge from the hospital.

CONCLUSIONS

Because FIM total scores at the time of hospital admission and discharge are highly correlated, FIM total scores at the time of hospital admission can be used to establish a rehabilitation program, to inform the patient and family about the possibility of recovery, and to assess the amount and quality of care given in the home or discharge placement.