Chedoke-McMaster Stroke Assessment

Purpose

The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment measures physical impairment and disability in clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and other neurological impairment. The measure consists of an Impairment Inventory and an Activity Inventory (Moreland, Gowland, Van Hullenaar, & Huijbregts, 1993). The first inventory aims to determine the presence and severity of common physical impairments, to classify or stratify patients when planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint” (Anderson, 2008, p. 17)
, selecting interventions and evaluating their effectiveness and to predict outcomes. The second inventory measures changes in physical function (Gowland, Stratford, Ward, Moreland, Torresin, Van Hullenar, Sanford, Barreca, Vanspall, & Plews, 1993). The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is a discriminative, predictive and evaluative tool.

In-Depth Review

Purpose of the measure

The Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment measures physical impairment and disability in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and other neurological impairment. The measure consists of an Impairment Inventory and an Activity Inventory (Moreland, Gowland, Van Hullenaar, & Huijbregts, 1993). The first inventory aims to determine the presence and severity of common physical impairments, to classify or stratify patients when planningPlanning ability involves anticipating future events, formulating a goal or endpoint, and devising a sequence of steps or actions that will achieve the goal or endpoint" (Anderson, 2008, p. 17)
, selecting interventions and evaluating their effectiveness and to predict outcomes. The second inventory measures changes in physical function (Gowland, Stratford, Ward, Moreland, Torresin, Van Hullenar, Sanford, Barreca, Vanspall, & Plews, 1993). The Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is a discriminative, predictive and evaluative tool. It is recommended that measures of motor impairmentLoss of strength and coordination, decrease in arm or leg movement
, such as the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment, be accompanied by a measure of functional disability such as the Barthel Index (BI) or Functional Independence Measure (FIM) (Poole & Whitney, 2001).

Available versions

There is only one version of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment, which was developed by Gowland, Van Hullenar, Moreland, Vanspall, Barreca, Ward, Huijbregts, Stratford and Barclay-Goddard from the original work by Brunnstrom.

A complimentary measure for the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment, the Chedoke Arm and Hand Inventory (CAHAI), was developed by Barreca, Gowland, Stratford, Huijbregts, Griffiths, Torresin, Dunkley, Miller and Masters, in 2004, to assess, exclusively, the recovery of the paretic upper limb. To date, there are three different versions of the CAHAI. The original version comprehends 13 items, which was then shortened to a version with 9 and 7 items. This CAHAI is summarized in its own module.

Features of the measure

Items:
The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is a performance-based measure that consists of two inventories: the Impairment Inventory and the Activity Inventory.
The Impairment Inventory is used to determine the presence and severity of common physical impairments. It has six dimensions (recovery stage of the arm, hand, leg, foot, postural control, and shoulder pain). Each dimension is measured on a 7-point scale (Gowland et al., 1993). The 7-point scale corresponds to seven stages of motor recovery. The 7-point scale for shoulder pain is based on pain severity. The Impairment Inventory is considered to be a discriminative and predictive tool (Huijbregts, Gowland, & Gruber, 2000; Moreland et al., 1993).

The Activity Inventory was originally called the Disability Inventory. Its name changed in 1999, in accordance with the World Health Organization (WHO) terminology (Huijbregts et al., 2000). The aim of this inventory is to measure clinically important changes in the client’s functional ability. This Activity Inventory is made up of the gross motor function and walking indexes.

The gross motor function index consists of the 10 following items: 1 – supine to side lying on strong side; 2 – supine to side lying on weak side; 3 – side lying to long sitting through strong side; 4 – side lying to sitting on side of the bed through strong side; 5 – side lying to sitting on side of the bed through weak side; 6 – standing; 7 – transfer to and from bed toward strong side; 8 – transfer to and from bed toward weak side; 9 – transfer up and down from floor to chair; 10 – transfer up and down from floor and standing. The walking index consists of the 5 following items: 11 – walking indoors; 12 – walking outdoors, over rough ground, ramps, and curbs; 13 – walking outdoors several blocks; 14 – stairs; 15 – age and sex appropriate walking distance in meters for 2 minutes. (Finch et al., 2002; Gowland et al., 1993; Huijbregts at al., 2000). The Activity Inventory is considered an evaluative tool (Huijbregts at al., 2000; Moreland et al., 1993).

Scoring:
The Impairment Inventory is scored on a 7-point scale, where 1 – is flaccid paralysis; 2 – spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
is present and felt as a resistance to passive movement; 3 – marked spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
but voluntary movement present within synergistic patterns; 4 – spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
decreases; 5 – spasticityInvoluntary muscle tightness and stiffness that can occur after a stroke. It is characterized by exaggerated deep tendon reflexes that interfere with muscular activity, gait, movement, or speech. Spasticity can increase initially but wane down later on, after stroke.
wanes but is evident with rapid movement at the extremes of range; 6 – coordination and patterns of movement are near normal; and 7 – normal movement. The 7-point scale corresponds to seven stages of motor recovery. The 7-point scale for shoulder pain is based on pain severity. The minimum score for the Impairment Inventory is 6 and the maximum score is 42 (Gowland et al., 1993).

The Activity Inventory is also scored on a 7-point scale, based on the amount of assistance the individual with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. requires. It is categorized by the need for assistance from another person, the need for equipment, or the need for extra time to accomplish a task (Huijbregts at al., 2000). For the Activity Inventory, the scoring key from the Functional Independence Measure (Keith, Granger, Hamilton & Sherwin, 1987) is used, where 1 – the client needs total assistance; 2 – maximal assistance; 3 – moderate assistance, 4 – minimal assistance, 5 – clients needs supervision; 6 – client is modified independent (needs assistance from devices); 7 – client is timely and safely independent (Gowland et al., 1993).

The maximum score is 100, where higher scores reflect normal function (Finch et al., 2002; Gowland et al., 1993). More specifically, the maximum score for the gross motor function index is 70 and for the walking index is 30 (Gowland et al., 1993). Additionally, a 2-point bonus should be assigned for those who walk, appropriate distances, in meters, accordingly to the norms for their age and sex, on item 15 (the 2-Minute Walk Test) (Huijbregts at al., 2000).

Detailed administration guidelines and scoring are in the development manual that can be obtained by emailing to the following address: djohnstn@mcmaster.ca at a cost of $50.00 CAD.

Time:
The time to administer the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment typically varies from 45 to 60 minutes depending on the client’s ability to complete the required task (Finch et al., 2002; Gowland et al., 1993; Poole & Whitney, 2001). Clients with severe strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. will typically take longer to accomplish all tasks when compared to clients with mild strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..

Subscales:
The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is divided into two inventories: Impairment and Activity. The Activity Inventory, initially called the Disability Inventory, subdivides into gross motor and walking indexes (Finch et al., 2002; Gowland et al., 1993; Huijbregts at al., 2000).

Equipment:

• An adjustable table (Finch et al., 2002)
• A chair with armrests (Finch et al., 2002)
• A floor mat (Finch et al., 2002)
• Pillows (Finch et al., 2002)
• Pitcher with water (Finch et al., 2002)
• Measuring cup (Finch et al., 2002)
• A ball 2.5 inches in diameter (Finch et al., 2002)
• A footstool (Finch et al., 2002)
• 2m line marked on the floor (Finch et al., 2002)
• A stopwatch (Finch et al., 2002)

Training:
Training is provided by the authors at McMaster University in Hamilton, Ontario. Further information about training can be obtained by emailing: pmiller@mcmaster.ca

Alternative forms of the Chedoke-McMaster Stroke Assessment

None.

Client suitability

Can be used with:

• Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
• Clients with other neurological impairment

Should not be used with:

• Clients younger than 19 years old (Finch et al., 2002), as the measure was developed with adults and its psychometrics properties were tested only for this population.
• It is not suited to proxy use.

In what languages is the measure available?

English, French and German

Summary

What does the tool measure?	The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment measures specific changes in limb function among individuals who sustained cortical damage resulting in hemiplegiaComplete paralysis of the arm, leg, and trunk on one side of the body that results from damage to the parts of the brain that control muscle movements. Hemiplegia is not a progressive condition, nor is it a disease..
What types of clients can the tool be used for?	The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment can be used with, but is not limited to clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	ScreeningTesting for disease in people without symptoms. and assessment.
Time to administer	An average of 45 to 60 minutes.
Versions	There are no alternative versions.
Other Languages	French.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.: No studies have examined the internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment. Test-retest: One study has examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). using ICC. Intra-rater: One study has examined the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported excellent intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings. using ICC. Inter-rater: Three studies have examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported excellent inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept. using ICC.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: Two studies have examined the content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment. Criterion: Concurrent: One study has examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment total score and the Fugl-Meyer Assessment total score and the Functional Independence Measure (FIM) total score, using Pearson correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. . Predictive: One study has examined the predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported it is a predictor of functional ability and sensorimotor recovery after strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Construct: Convergent: Two studies examined convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment, 1 reported excellent correlations between similar impairments from the Impairment Inventory and the Fugl-Meyer Assessment and between similar activity limitations from the Activity Inventory and the Functional Independence Measure, using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. . The other reported excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between totals scores on the Activity Inventory (AI) of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and the Clinical Outcomes Variable Scale at admission, discharge and change from admission to discharge. Known Groups: One study examined known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured. of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported that it is able to distinguish between subjects who changed little (<20 on FIM), and those who change more (>20 on FIM), using student t-test.
Floor/Ceiling Effects	No studies have examined floor/ceiling effects of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment.
SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” / SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).	No studies have examined the sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.” /specificity of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment.
Does the tool detect change in patients?	Two studies have examined the responsivenessThe ability of an instrument to detect clinically important change over time. of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and reported that it has a large variance ratio and a minimal clinically-important change is expressed by a change of 8 units in the Activity Inventory.
Acceptability	Administration of the entire Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is lengthy. The test is scored by direct observation.
Feasibility	The Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment must be administered by a trained physical or occupational therapistIn charge of the “assessment of personal and domestic care activities; evaluation and treatment of functional impairments related to change in sensorimotor, cognitive and perceptual abilities; prescription of wheelchairs and bathroom appliances; home visits; patient and family education.”(Suggested by Philips et al, 2002) . It does not require any specialized equipment.
How to obtain the tool?	The Chedoke-McMaster can be ordered by email: djohnstn@mcmaster.ca

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in individuals with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. We identified six studies. The Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment appears to be responsive in clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

Floor/Ceiling Effects

No studies have examined the floor/ceiling effects of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment.

Reliability

Test-retest:
Gowland, Stratford, Ward, Moreland, Torresin, Van Hullenar, et al. (1993) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the Activity Inventory section of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in 32 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., at a mean age of 64 years. Participants were re-assessed with a 5-day interval. The test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
for the Activity Inventory, as calculated using Intraclass Correlation Coefficient (ICC)Intraclass correlation (ICC) is used to measure inter-rater reliability for two or more raters. It may also be used to assess test-retest reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance., was excellent (ICC = 0.98), as were the gross motor function (ICC = 0.96) and walking (ICC = 0.98) indexes.

Intra-rater:
Gowland et al. (1993) estimated the intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the Impairment Inventory section of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in 32 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain., at a mean age of 64 years. Participants were assessed at admission to the rehabilitation center, and their performances were videotaped. Scoring on the second evaluation was based on the videotape recorded previously. The intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
, as calculated using ICC was excellent for both Impairment Inventory evaluations (ICC = 0.98), as well as for the dimension’s shoulder pain (ICC = 0.96), postural control (ICC = 0.96), arm (ICC = 0.95), hand (ICC = 0.93), leg (ICC = 0.98) and foot (ICC = 0.94).

Inter-rater:
Gowland et al. (1993) estimated the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the Activity Inventory section of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in 32 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., at a mean age of 64 years. Participants were assessed simultaneously by two raters. The ICC for the total score showed excellent agreement (ICC = 0.97), as well as for the dimension’s shoulder pain (ICC = 0.95), postural control (ICC = 0.92), arm (ICC = 0.88), hand (ICC = 0.93), leg (ICC = 0.85) and foot (ICC = 0.96).

Gowland et al. (1993) examined the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the Impairment Inventory section of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in 32 clients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain., at a mean age of 64 years. Participants were re-assessed within 5 days by a second rater. The inter-rater reliabilities as calculated using ICC were excellent for the Impairment Inventory (ICC = 0.99), as well as for the gross motor function (ICC = 0.98) and walking (ICC = 0.98) indexes.

Crowe, Harmer, and Sharp (1996) assessed the inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the Impairment Inventory section of the Chedoke-McMaster StrokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. Assessment in 28 participants with Acquired Brain Injury. Participants were assessed with a 2-week interval by two therapists. Agreement between raters for the Impairment Inventory, as calculated using ICC, was excellent (r = 0.99).
Note: The severity of the Acquired Brain Injury and the reason for the 2 weeks delay when measuring inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
were not specified by the authors.

Validity

Content:
Moreland, Gowland, Van Hullenar, and Huijbregts (1993) performed a literature review to gather evidence for a theoretical basis of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment. All items from both inventories had enough scientific evidence supporting its assumptions. Thus, the authors were able to establish a theoretical basis underlying the content of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment.

Huijbregts, Gowland, and Gruber (2000) carried out a survey in 34 clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and 27 caregivers to verify whether the content in the Activity Inventory is representative of skills that are important to that population. On a scale where 1 is not at all important and 7 is extremely important, all items received a 7 from at least one person in each group. For most items, the mean level was above 5, except for the 2-Minute Walk Test, which had the lowest score from both clients (1.78) and caregivers (3.52). The two most important items according to clients’ and caregivers’ perspective was standing and transferring from and to bed towards the strong side.

Criterion:
Concurrent:
Gowland et al. (1993) compared the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment with the Fugl-Meyer Assessment –FMA (Fugl-Meyer, Jääskö, Leyman, Olsson, & Steglind, 1975) and the Functional Independence Measure (FIM) (Keith, Granger, Hamilton & Sherwin, 1987) in 32 participants with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients, the correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
between the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment total score and the FMA total score (r = 0.95) and the FIM total score (r = 0.79) were excellent.

Predictive:
Gowland (1984) examined whether the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment was able to predict sensorimotor recovery at discharge from an active rehabilitation program. Predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment was examined in 335 active strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. rehabilitation inpatients. Assessments were performed at admission to and at discharge from the rehabilitation center. The length of stay varied from 1 to 49 weeks with an average of seven weeks. At discharge, the 23 independent variables selected were able to predict 11 out of 14 outcomes. Among these independent variables, stage of recovery of the leg was found to be the most important predictive variable, followed by weeks’ post-stroke and gross motor performance.

Valach, Singer, Hartmeier, Hofer & Cox Steck (2003) examined whether scores from the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment (CMSA) were predictive of scores on the Barthel Index (BI) and vice versa, in 127 patients with vascular brain-damage. Regression analysis revealed that as few as 3 items on the CMSA disability index were needed to predict BI scores, however 6 to 8 items on the BI were needed to predict CMSA scores. Although only a few items on the CMSA were required to predict BI scores, there was still a large portion of unexplained variance and thus, it is recommended that both the BI and CMSA be performed in situations where a comprehensive evaluation of patients is desired.

Construct:
Convergent/Discriminant:
Gowland et al. (1993) evaluated the convergent validityA type of validity that is determined by hypothesizing and examining the overlap between two or more tests that presumably measure the same construct. In other words, convergent validity is used to evaluate the degree to which two or more measures that theoretically should be related to each other are, in fact, observed to be related to each other.
of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment by comparing similar impairments between the Impairment Inventory and the Fugl-Meyer Assessment (FMA) (Fugl-Meyer et al., 1975). Correlations, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients, were excellent between postural control (Impairment Inventory) and balance (FMA) (r = 0.84); arm and hand (Impairment Inventory) and shoulder, elbow, forearm, wrist and hand (FMA) (r = 0.95); leg and foot (Impairment Inventory) and hip, knee, foot and ankle (FMA) (r = 0.93); shoulder pain (Impairment Inventory) and upper limb joint pain (FMA) (r = 0.76). Furthermore, the authors compared similar activity limitations between the Activity Inventory and the Functional Independence Measure (FIM) (Keith et al., 1987). Correlations, as calculated using Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients were excellent between the gross motor function index (Activity Inventory) and the Mobility subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the FIM (r = 0.90) and between the walking index (Activity Inventory) and the Locomotion subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
of the FIM (r = 0.85).

Sacks et al. (2010) evaluated the construct validityReflects the ability of an instrument to measure an abstract concept, or construct. For some attributes, no gold standard exists. In the absence of a gold standard , construct validation occurs, where theories about the attribute of interest are formed, and then the extent to which the measure under investigation provides results that are consistent with these theories are assessed.
of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment Activity Inventory (AI) and the Clinical Outcomes Variable Scale (COVS) (Seaby & Torrance, 1989) in 24 geriatric inpatients (mean age 83 years) receiving care in a rehabilitation unit. Correlations between AI and COVS total scores at admission and discharge, and change in total scores from admission to discharge, as calculated by Pearson CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficients, were excellent (r=0.92, r=0.91 and r=0.84 respectively). All subscales of the AI and COVS demonstrated excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
at admission, discharge and change from admission to discharge, except for the walking subscaleMany measurement instruments are multidimensional and are designed to measure more than one construct or more than one domain of a single construct. In such instances subscales can be constructed in which the various items from a scale are grouped into subscales. Although a subscale could consist of a single item, in most cases subscales consist of multiple individual items that have been combined into a composite score (National Multiple Sclerosis Society).
, which was found to have adequate correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
for change from admission to discharge (r=0.59).

Known groups:
Crowe at al. (1996) analyzed whether the Activity Inventory was able to distinguish between subjects who changed little (<20) and those who change more (>20) on the Functional Independence Measure (FIM) (Keith et al., 1987) in 28 clients with Acquired Brain Injury. Known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
, as calculated using a student t-test, showed that the Activity Inventory is able to distinguish between clients with lower and higher scores on FIM.

Responsiveness

Gowland et al. (1993) estimated the responsivenessThe ability of an instrument to detect clinically important change over time.
of the Activity Inventory and the Functional Independence Measure (FIM) (Keith et al., 1987) in 32 participants with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. Participants were assessed at two points in time: at admission and discharge from the rehabilitation centre. Variance ratios were calculated. Compared to the FIM, the Activity Inventory had a greater variance ratio (0.53 for Activity Inventory vs. 0.30 for FIM) suggesting that the Activity Inventory of Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment is a more sensitive measure to detecting change.

Huijbregts et al. (2000) assessed clinically-important changes based on a global rating of change for the Activity Inventory, gross motor function index, and walking index in 34 clients. For the Activity Inventory, no change was represented by a mean change in score of 0, small changes by a mean change in score of 8, and moderate to large changes by a mean change in score of 20. For the gross motor function index, no change was represented by a mean change in score of 1, small changes by a mean change in score of 7, and moderate to large changes by a mean change in score of 7. For the walking index, no change was represented by a mean change in score of 1, small changes by a mean change in score of 5, and moderate to large changes by a mean change in score of 13. All this information suggests that for the client, a minimum change of 20 points in the Activity Inventory score is required for him to perceive a moderate to large change. Furthermore, important change as perceived by the client and the real change score of the measure have an excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
(r = 0.74).

Sacks et al. (2010) evaluated the responsivenessThe ability of an instrument to detect clinically important change over time.
of the Activity Inventory (AI) of the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment and the Clinical Outcomes Variable Scale (COVS) (Seaby & Torrance, 1989) in 24 geriatric inpatients (mean age 83 years) receiving care on a rehabilitation unit. Large effect sizes were found for both the AI and COVS (1.53 and 1.43); and a stronger standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
(SRM) was found for the COVS compared to that of the AI (2.30 and 1.83). Results from this study suggest that both measures are responsive to change in geriatric patients but the COVS is more responsive than the AI in this population.

References

• Crowe, J., Harmer, D., & Sharpe, D. (1996). Reliability of the Chedoke-McMaster Disability Inventory in acquired brain injury. Physiotherapy Canada, 48(1), 25.
• Finch, E., Brooks, D., Stratford, P.W, & Mayo, N.E. (2002). Physical Outcome Measures: A guide to enhance physical outcome measures. Ontario, Canada: Lippincott, Williams & Wilkins.
• Fugl-Meyer, A.R., Jääskö, L., Leyman, I., Olsson, S., & Steglind, S. (1975). The post-stroke hemiplegic patient 1. A method for evaluation of physical performance. Scandinavian Journal of Rehabilitation Medicine, 7, 13-31.
• Gowland, C., Stratford, P., Ward, M., Moreland, J., Torresin, W., Van Hullenaar, S. et al. (1993). Measuring physical impairment and disability with the Chedoke-McMaster Stroke Assessment. Stroke, 24, 58-63.
• Gowland, C., Van Hullenaar, S., Torresin, W., et al. (1995). Chedoke-McMaster Stroke Assessment: development, validation, and administration manual. Hamilton, ON, Canada: School of Rehabilitation Science, McMaster University.
• Gowland, C. (1984). Predicting sensorimotor recovery following stroke rehabilitation. Physiotherapy Canada, 36, 313-320.
• Gowland, C. (1982). Recovery of motor function following stroke: profile and predictors. Physiotherapy Canada, 34, 77-84.
• Huijbregts, M.P., Gowland, C., Gruber, R. (2000). Measuring clinically important change with the Activity Inventory of the Chedoke-McMaster Stroke Assessment. Physiotherapy Canada, 52, 295-304.
• Keith, R.A, Granger, C.V., Hamilton, B.B., & Sherwin, F.S. (1987). The Functional Independence Measure: a new tool for rehabilitation. In: Eisenberg, M.G. & Grzesiak, R.C. (Ed.), Advances in clinical rehabilitation (pp. 6-18). New York: Springer Publishing Company.
• Moreland, J., Gowland, C., Van Hullenar, S., Huijbregts, M. (1993). Theoretical basis of the Chedoke-McMaster Stroke Assessment. Physiotherapy Canada, 45, 231-238.
• Poole, J.L. & Whitney, S.L. (2001). Assessment of motor function post stroke: A review. Physical and Occupational Therapy in Geriatrics, 19, 1-22.
• Sacks, L., Yee, K., Huijbregts, M., Miller, P.A., Aggett, T. & Salbach, N.M. (2010). Validation of the activity inventory of the Chedoke-McMaster Stroke Assessment and the Clinical Outcome Variables Scale to evaluate mobility in geriatric clients. Journal of Rehabilitation Medicine, 42, 90-92.
• Valach, L., Signer, S., Hartmeier, A., Hofer, K. & Cox Steck, G. (2003). Chedoke-McMaster Stroke Assessment and modified Barthel Index self-assessment in patients with vascular brain damage. International Journal of Rehabilitation Research, 26, 93-99.

See the measure

How to obtain the Chedoke-McMaster StrokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. Assessment

The Chedoke-McMaster can be ordered by email: djohnstn@mcmaster.ca