Orpington Prognostic Score (OPS)

Purpose

The Orpington Prognostic Score (OPS), also known as Orpington Prognostic Scale, was developed from the Edinburgh Prognostic Score (Prescott, Garraway, & Akhtar, 1982) and the Hodkinson’s Mental Test Score (Qureshi & Hodkinson, 1974) as a means to evaluate 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. severity. The OPS enables clinicians and researchers to stratify clients into a good, intermediate or poor prognosis group by using established cut-offs. The OPS is also very effective in predicting functional outcomes (Kalra & Crome, 1993).

In-Depth Review

Purpose of the measure

The Orpington Prognostic Score (OPS), also known as Orpington Prognostic Scale, was developed from the Edinburgh Prognostic Score (Prescott, Garraway, & Akhtar, 1982) and the Hodkinson’s Mental Test Score (Qureshi & Hodkinson, 1974) as a means to evaluate 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. severity. The OPS enables clinicians and researchers to stratify clients into a good, intermediate or poor prognosis group by using established cut-offs. The OPS is also very effective in predicting functional outcomes (Kalra & Crome, 1993).

Available versions

The OPS was published by Kalra and Crome in 1993.

Features of the measure

Items:
The OPS is comprised of four subscales: Motor deficit in the arm, Proprioception, Balance and Cognition.

Motor deficit in the arm: The client is positioned lying in supine. The therapist asks the client to flex the shoulder of the most affected arm to 90 degrees against therapist’s manual resistance. If the client is not able to perform the movement, manual resistance is then removed and the therapist observes how the client flexes the shoulder only against gravity. Muscle power is then scored. In the presence of shoulder pain, the elbow extensors may be tested instead of the shoulder flexor (Kalra & Crome, 1993; Rieck & Moreland, 2005).

Proprioception: The client is instructed to close his/her eyes and locate the affected thumb by touching it with the other hand. The degree of difficulty in finding the affected thumb is scored (Kalra & Crome, 1993; Rieck & Moreland, 2005).

Balance: The therapist observes whether the client can successfully complete 3 balance tasks in the following order: 1) sit with feet unsupported for 20 seconds; 2) stand unsupported for 1 minute; 3) walk 10 feet without assistance. The client only attempts the next task after successful completion of a previous one. The highest balance-related ability is scored (Kalra & Crome, 1993; Rieck & Moreland, 2005).

Cognition: The clients are asked to verbally respond to the following 10 questions. In the presence of aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada) or dysarthria questions can be answered in writing (Kalra & Crome, 1993; Rieck & Moreland, 2005). A score of 1 point is given for each correct answer:

1. Age of the client;
2. Time (to the nearest hour);
3. At this point the therapist instructs the client to memorize an address (42, West Street) that will be asked afterwards.
4. Name of the hospital;
5. Current year;
6. Client’s date of birth;
7. Current month;
8. Year of the First World War;
9. Name of the Monarch;
10. Count backwards from 20 to 1;
11. Recall previous address.

Note: Some studies have been adapting items 7 and 8 to Year of the Second World War and Name of the President, respectively.

It is recommended that the OPS be performed from day 2 post 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.. However, some authors advocate that outcomes are better predicted when administering the OPS in the second week (Kalra & Crome, 1993; Rieck & Moreland, 2005; Studenski, Wallace, Duncan, Rymer and Lai, 2001).

Scoring:
OPS scores range from 1.6 to 6.8. Higher scores indicate a more 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. and a worse prognosis. The OPS is scored as follows:

Subscales	Score
Motor Deficit in arm: Normal power (MRC grade 5) Diminished power (MRC grade 4) Movement against gravity (MRC grade 3) Movement with gravity eliminated or flicker when attempted movement (MRC grade 1-2) No movement (MRC grade 0) Note: MRC = Medical Research Council for grading power	0 0.4 0.8 1.2 1.6
Proprioception (eyes closed) Locates affected thumb accurately Locates affected thumb with slight difficulty Locates affected thumb via arm Unable to locate affected thumb	0 0.4 0.8 1.2
Balance Walks 10 feet without help Maintains standing position Maintains sitting position No sitting balance	0 0.4 0.8 1.2
Cognition (one point for each corrected answer) Mental Test Score 10 out of 10 Mental Test Score 8-9 out of 10 Mental Test Score 5-7 out of 10 Mental Test Score 0-4 out of 10	0 0.4 0.8 1.2
TOTAL SCORE = 1.6 + Motor deficit score + Proprioception score + Balance score + Cognition score

Kalra and Crome (1993) established cut-off scores to categorize patients into prognostic groups. OPS scores <3.2 represent clients with mild neurological impairments and a good prognosis; OPS scores = 3.2-5.2 are representative of clients with moderate neurological impairments and an intermediate prognosis; OPS scores >5.2 are associated with severe neurological impairments and a poor prognosis. Early stratification assists in more appropriate allocation of stroke unitStroke units are designed to provide multidisciplinary specialized care for patients who have had a stroke. In the best units, the team consists of nurses, pharmacists, social workers, medical staff, and occupational, physical and speech therapists. Stroke units can be located in a special unit in a defined location, or can used as a roving stroke specialist team. (Hill, M. Stroke Units in Canada. CMAJ. 2002:167:649-50.) resources. Patients scoring <3.2 have a high likelihood of returning home. Patients scoring between 3.2 and 5.2 tend to respond better to rehabilitation. Patients scoring >5.2 are often severely dependent with an increased risk of institutionalization. (Kalra & Crome, 1993; Kalra & Eade, 1995).

Time:
The OPS takes approximately 5 minutes to administer (Celik, Aksel and Karaoglan, 2006; Studenski et al., 2001).

Subscales:
The OPS subscales items encompass Motor deficit, Proprioception, Balance and Cognition.

Equipment:
Only a pencil and the test are needed.

Training:
No specific training is available.

Alternative forms of the OPS

Not available.

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., including those with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury.
  An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), dysarthria and dementia (Kalra, Dale and Crome, 1994).

Should not be used in:

• The OPS cannot be administered until neurological deficit and consciousness levels have stabilized (Kalra, Dale and Crome, 1994).

In what languages is the measure available?

English.

Summary

What does the tool measure?	The OPS measures 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. severity at baseline.
What types of clients can the tool be used for?	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., including those with aphasiaAphasia is an acquired disorder caused by an injury to the brain and affects a person’s ability to communicate. It is most often the result of stroke or head injury. An individual with aphasia may experience difficulty expressing themselves when speaking, difficulty understanding the speech of others, and difficulty reading and writing. Sadly, aphasia can mask a person’s intelligence and ability to communicate feelings, thoughts and emotions. (The Aphasia Institute, Canada), dysarthria and dementia.
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment and screeningTesting for disease in people without symptoms. .
Time to administer	An average of 5 minutes.
Versions	None.
Other Languages	None.
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 .	Test-retest: One study 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 OPS 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 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.. Inter-rater: Two studies 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 OPS and reported adequate to 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 and weighted kappa.
ValidityThe degree to which an assessment measures what it is supposed to measure.	Content: No 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 OPS. Criterion: Concurrent: Three studies 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 OPS and reported excellent correlations between the OPS and the National Institute of Health 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. Scale (NIHSS) as the gold standardA measurement that is widely accepted as being the best available to measure a construct. using Spearman’s Rank 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: – Ten studies 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 OPS. Nine studies reported that the OPS measured between the third and the fourteenth day 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. was able to predict activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. of daily living, length of stay, upper limb function, discharge destination, recovery rate and scores on the Barthel Index, the SF-36, the Rivermead Mobility Assessment, and the Oxford Handicap Scale either at discharge, 1, 3, 6 or 24 months 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.. One study reported that the OPS measured between the fourth and the twelfth week was able to predict Functional Independence Measure and Nottingham Extended ADL Index scores at discharge from the rehabilitation program. 2 studies reported that the OPS was not able to predict the Timed Up and Go and the number of required follow-up sessions. – Four studies 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.” , specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative). and predictive values of the OPS. Three studies reported that the OPS showed high to adequate 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.” and positive predictive values, adequate negative predictive values, and adequate to low specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative). at determining discharge destination. One study reported that the OPS showed high positive predictive values, moderate negative predictive values, and high to low 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.” and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative). at predicting independence and death at 6 months.
Floor/Ceiling Effects	No studies have examined the floor or ceiling effects of the OPS.
Does the tool detect change in patients?	No studies have examined the ability of the OPS to detect change
Acceptability	The OPS cannot be administered until neurological deficit and consciousness levels have stabilized (Kalra, Dale and Crome, 1994).
Feasibility	The administration of the OPS is quick and simple.
How to obtain the tool?	The OPS can be obtained from its original publication: Kalra and Crome 1993 (1987). The following publications also present a description of the full tool: Lai et al., (1998); Pittock et al., (2003); Rieck & Moreland (2005). Wrigth et al., (2004).

Psychometric Properties

Overview

We conducted a literature search to identify all relevant publications on the psychometric properties of the Orpington Prognostic Score (OPS) 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 13 studies.

Floor/Ceiling Effects

No studies have examined the floor or ceiling effects of the OPS.

Reliability

Test-retest:
Note: From the descriptions provided of the following study it appears that the authors called the testing ‘test-retest reliability’ while others would call the same analysis ‘inter-rater reliability’.
Rieck and Moreland (2005) evaluated 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 OPS in 27 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.. Participants were tested separately by 2 different raters within the same day. 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).
, as calculated using Intraclass 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.
Coefficient, was excellent (ICC = 0.95).

Inter-rater:
Weir, Counsell, McDowall, Gunkel and Dennis (2003) 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 OPS items in 92 clients with acute 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.. Two examiners administered the OPS within 4 hours of each other. Examiners were blinded to each other’s scores. 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.
on individual items was calculated using weighted kappa. Adequate 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.
was found on Proprioception (weighted kappa = 0.53), Cognition (weighted kappa = 0.64) and Arm motor deficit (weighted kappa = 0.72). Balance was the only item with 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.
(weighted kappa = 0.84).

Rieck and Moreland (2005) evaluated 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 OPS in 65 clients with stroke. Two different raters following a 1-week interval tested participants separately. 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.
, as calculated using Intraclass 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.
Coefficient, was excellent (ICC = 0.99).[/su_spoiler]

Validity

Content:
No 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 OPS

Criterion:
Concurrent:
In a study by Lai, Duncan, and Keighley (1998) 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 OPS was verified against the National Institute of Health 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. Scale (NIHSS), considered as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
(Brott, Adams, Olinger, Marler, Barsan, Biller et al., 1989), in 184 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.. 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 OPS and the NIHSS, as calculated using Spearman’s Rank 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.
, was excellent (rho = 0.83).

Wright, Swinton and Green (2004) assessed 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 OPS by comparing it with the NIHSS, which is considered as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
(Brott et al., 1989), in 277 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.. 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.
between the OPS and the NIHSS was found (rho = 0.60).

Celik, Aksel and Karaoglan (2006) 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 OPS against the NIHSS, considered as the gold standardA measurement that is widely accepted as being the best available to measure a construct.
(Brott et al., 1989), in 25 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.. 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.
using Spearman’s Rank 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.
was excellent between the OPS and the NIHSS (rho = 0.76).

Predictive:
Kalra and Crome (1993) estimated the ability of the OPS and the Edinburgh Prognostic Score (Prescott, Garraway, & Akhtar, 1982), measured at 1 and 2 weeks 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., to predict Barthel Index ADL scores (Mahoney & Barthel, 1965) at discharge from hospital. 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.
was calculated using linear regression in 64 patients at week 1 and in 47 patients at week 2. The OPS measured at week 2 was a better predictor of Barthel Index scores (R² = 0.89), when compared to the Edinburgh Prognostic Score (R² = 0.57).

Kalra, Dale and Crome (1994) compared 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.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the OPS versus the presence of urinary incontinence, measured 2 weeks 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., in determining independent living at discharge. Both measures, calculated on 217 patients, showed high 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.”
but low specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
. The OPS was more sensitive (96%) but slightly less specific (36%) than urinary incontinence (90% 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.”
, 39% specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
). Additionally, the authors analyzed the predictive values of the OPS categories (OPS <3.2; OPS >5.2) and continence status (continence versus incontinence). The positive predictive value of OPS scores <3.2 was 100% for discharge home and for OPS scores >5.2 was 82% for discharge to an institutional center. Continence status showed lower predictive values.

Lai et al. (1998) examined, in 184 individuals, whether the OPS and the National Institute of Health 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. Scale – NIHSS (Brot et al., 1989) measured at admission to hospital were able to predict SF-36 (Ware & Sherbourne, 1992) and the Barthel Index (Mahoney & Barthel, 1965) scores at 1, 3 and 6 months post 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.. 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.
was analyzed using linear regression. The OPS, compared with the NIHSS, explained more variance for both measures at all times taken, suggesting that the OPS was a better predictor of physical function as measured by the SF-36 and ADL as measured by the Barthel Index.

Studenski, Wallace, Duncan, Rymer and Lai (2001) assessed the ability of the OPS, measured in 413 clients, 3-to-14 days post 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., to predict functional recovery rate at 3 and 6 months. Functional recovery rate was measured by independence levels in personal care, meal preparation, medication administration and mobility in the community. 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 OPS cut-offs <2.4 and >4.4 was calculated using Receiver Operating Characteristic (ROC) curvesA ROC curve is a graph that plots true positive rates against false positive rates for a series of cutoff values, or in other words, graphically displays the trade-off between sensitivity and specificity for each cutoff value. An ideal cutoff might give the test the highest possible sensitivity with the lowest possible false positive rate (i.e., highest specificity). This is the point lying geometrically closest to the top-left corner of the graph (where the ideal cutoff value with 100% sensitivity and specificity would be plotted). Picking the ideal cutoff score is, to some extent, dependent on the clinical context, that is the purpose for which the tool will be used. The area under an ROC curve can be used as an overall estimate of its discriminating ability and sometimes is expressed as accuracy. The area under the ROC curve is equal to the probability that a test correctly classifies patients as true positives or true negatives. Greater areas under the curve indicate higher accuracy. To further clarify, a discriminant test might have an area under the curve of 0.7 while a nondiscriminant test has an area under the curve of 0.5.Rosenberg, L., Joseph, L., & Barkun, A. (2000). Surgical Arithmetic: Epidemiological, Statistical and Outcome-Based Approach to Surgical Practice. Georgetown, Texas: Landes Bioscience.. At 3 months the percentage of patients correctly classified according to their functional recovery rate was adequate (AUC = 0.80-0.86). At 6 months 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.
was adequate but the percentage of patients correctly classified according to their functional recovery rate was slightly lower. At six months the area under the ROC curve for the 4 outcomes ranged from 0.74 to 0.80.

Pittock, Meldrum, Ni Dhuill, Hardiman and Moroney (2003) evaluated 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 OPS in 117 individuals by comparing the results of the OPS at 2 and 14 days 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. with that of the Rivermead Motor Assessment (Lincoln & Leadbitter, 1979); the Oxford Handicap Scale (Bamford, Sandercock, Warlow, & Slattery, 1989); Barthel Index (Mahoney & Barthel, 1965) and length of stay at 6 and at 24 months by use of Spearman’s Rank 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.
. Correlations between both scores of the OPS (day 2 and day 14) and all outcome measures were excellent at 6 months and adequate at 24 months. These results suggest that the OPS measured within the first 2 weeks 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. is able to predict motor performance, disability level, ADL and length of stay, especially at 6 months. This study also examined the predictive values, 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.”
and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
for OPS scores <3.2 and >5.2 in predicting independence and death at 6 months. Scores <3.2 measured at day 2 showed a positive predictive value of 87%, 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.”
of 85%, specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of 85%, and negative predictive value of 84%. This same cut-off (<3.2) when measured at 2 weeks showed very high positive predictive value (92%) and 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.”
(92%), adequate negative predictive value (84%) and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
(63%). OPS scores >5.2 at day 2 and day 14 demonstrated high positive predictive values (93%; 100%) and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
(97%; 100%), adequate negative predictive values (68%; 68%) and low 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.”
(48%; 35%).

Meldrum, Pittock, Hardiman, Ni Dhuill, O’Regan and Moroney (2004) examined, in 114 patients, whether the OPS, Rivermead Motor Assessment arm scores to measure upper limb function (Lincoln & Leadbitter, 1979), Grip Strength (Mathiowetz, Kashman, Volland, Weber, Dowe, & Rogers, 1985), age, and arm sensation, measured at day 2 post-stroke were adequate predictors of upper limb function at 6 and 24 months. 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 OPS was calculated using Spearman’s Rank 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.
and logistic regression analyses. The highest 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.
was found between the OPS and upper limb function at 6 months (rho = -0.73) and 24 months (rho = -0.71). Logistic regression analyses revealed that the best predictor of upper limb function at 6 months was the OPS and arm sensation. The only predictor of upper limb function at 24 months was arm sensation.

Wright et al. (2004) studied 277 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. to identify whether the OPS and the National Institute of Health 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. Scale – NIHSS (Brott et al., 1989) were able to predict discharge destination. The NIHSS was measured day 1 post-stroke and the OPS at day 7. 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.
was calculated by use of logistic regression and Receiver Operating Characteristic (ROC) curvesA ROC curve is a graph that plots true positive rates against false positive rates for a series of cutoff values, or in other words, graphically displays the trade-off between sensitivity and specificity for each cutoff value. An ideal cutoff might give the test the highest possible sensitivity with the lowest possible false positive rate (i.e., highest specificity). This is the point lying geometrically closest to the top-left corner of the graph (where the ideal cutoff value with 100% sensitivity and specificity would be plotted). Picking the ideal cutoff score is, to some extent, dependent on the clinical context, that is the purpose for which the tool will be used. The area under an ROC curve can be used as an overall estimate of its discriminating ability and sometimes is expressed as accuracy. The area under the ROC curve is equal to the probability that a test correctly classifies patients as true positives or true negatives. Greater areas under the curve indicate higher accuracy. To further clarify, a discriminant test might have an area under the curve of 0.7 while a nondiscriminant test has an area under the curve of 0.5.Rosenberg, L., Joseph, L., & Barkun, A. (2000). Surgical Arithmetic: Epidemiological, Statistical and Outcome-Based Approach to Surgical Practice. Georgetown, Texas: Landes Bioscience.. In the regression model, both prognostic measures were significant predictors of place of discharge. When analyzing the area under the ROC curve (AUC) the percentage of patients correctly classified according to their discharge destination was adequate using OPS cut-offs <3 and >5 (AUC = 77%) and NIHSS cut-offs (<5; 6-10; 11-15; 16-20; >20) (AUC = 0.81). The specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the OPS for the outcome discharge destination was high at 87.7% and even higher for the NIHSS at 97.7%.

Rieck and Moreland (2005) examined, in 81 clients, whether the OPS, measured at 7 and 14 days post-stroke, was able to predict the number of follow-up services at discharge. When analyzing the OPS as a predictor of discharge destination (home versus institution) the OPS score at day 14 showed higher 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.”
(84%) and specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
(42%) than scores at day 7 (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.”
= 82%; specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
= 25%). The positive predictive value of the OPS scores <3.0 and =3.0-5.0 at predicting discharge home was 81% and 50%, respectively. The positive predictive value of the OPS cut-off >5.0 at predicting discharge to an institution was 68%.

Hershkovitz, Gottlieb, Beloosesky and Brill (2006) assessed 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 OPS in 103 individuals by comparing the results of the OPS measured at admission to a rehabilitation program (4-to-12 weeks post-stroke) with discharge scores (on average, 6 weeks after admission) on the Functional Independence Measure (Keith, Granger, Hamilton, & Sherwin, 1987); the Nottingham Extended ADL Index (Nouri & Lincoln, 1987) and the Timed Up and Go (Podsiadlo & Richardson, 1991). Correlations were calculated using Spearman’s Rank 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.
. Excellent correlations were found between the OPS and the Functional Independence Measure (rho = -0.73) and the Nottingham Extended ADL Index (rho = -0.67). 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 OPS and the Timed Up and Go was adequate (rho = -0.44). These results indicated that the OPS, measured 4-to-12 weeks post-stroke, was able to predict function six weeks later as measured by the Functional Independence Measure and the Nottingham Extended ADL Index scores.

Celik, Aksel and Karaoglan (2006) analyzed whether the OPS and the National Institute of Health 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. Scale – NIHSS (Brott et al., 1989) measured on the seventh day post-stroke predicted Barthel Index (Mahoney & Barthel, 1965) scores at 1,3 and 6 months. 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.
was calculated using logistic regression analyses. The OPS (R²1 month=0.58; R²3months = 0.41; R²6months = 0.38) compared to the NIHSS (R²1month = 0.50; R²3months = 0.23; R²6months = 0.20), explained more variance in the regression model at all times. Thus, the OPS was found to be a better predictor of function as measured using the Barthel Index than the NIHSS at all 3 points.

References

• Bamford, J. M., Sandercock, A. G., Warlow, C. P., Slattery, J. (1989). Interobserver agreement for the assessment of handicap in stroke patients (letter). Stroke, 20, 828.
• Brott, T. G., Adams, H. P., Olinger, C. P., Marler, J. R., Barsan, W. G., Biller, J., Spilker, J., Holleran, R., Eberle, R., Hertzberg, V., Rorick, M., Moomaw, C. J., Walker, M. (1989). Measurements of acute cerebral infarction: a clinical examination scale. Stroke, 20, 864 -70.
• Celik, C., Aksel, J., & Karaoglan, B. (2006). Comparison of the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke. Disability and Rehabilitation, 28(10), 609-612.
• Hershkovitz A., Gottlieb, D., Beloosesky, Y., & Brill, S. (2006). Assessing the potential for functional improvement of stroke patients attending a geriatric day hospital. Archives of Gerontology and Geriatrics, 43, 243-248.
• Kalra, L. & Crome, P. (1993). The Role of Prognostic Scores in Targeting Stroke Rehabilitation in Elderly Patients. JAGS, 41, 396-400.
• Kalra, L., Dale, P., & Crome, P. (1994). Evaluation of a Clinical Score for Prognostic Stratification of Elderly Stroke Patients. Age and Ageing, 23, 492-498.
• Kalra, L., & Eade, J. (1995). Role of Stroke Rehabilitation Units in Managing Severe Disability After Stroke. Stroke, 26, 2031-2034.
• Keith, R. A., Granger, C. V., Hamilton, B. B., Sherwin, F. S. (1987). The functional independence measure: A new tool for rehabilitation. Adv Clin Rehabil, 1, 6-18.
• Lai, S.M., Duncan, P.W., & Keighley, J. (1998). Prediction of Functional Outcome After Stroke: Comparison of the Orpington Prognostic Scale and the NIH Stroke Scale. Stroke, 29, 1838-1842.
• Lincoln, N. B., Leadbitter, D. (1979). Assessment of motor function in stroke patients. Physiotherapy, 65, 48-51.
• Mahoney, F. I., Barthel, D. W. (1965). Functional evaluation: The Barthel Index. Md State Med J, 14, 61-65.
• Mathiowetz, V., Kashman, N., Volland, G., Weber, K., Dowe, M., & Rogers, S. (1985). Grip and pinch strength: normative data for adults. Archives of Physical and Medicine and Rehabilitation, 66, 69-72.
• Meldrum, D., Pittock, S.J., Hardiman, O., Ni Dhuill, C., O’Regan M., & Moroney, J.Y. (2004). Recovery of the upper limb post ischemic stroke and the predictive value of the Orpington Prognostic Score. Clin Rehabil, 18, 694-702.
• Nouri, F. M., Lincoln, N. B. (1987). An extended activities of daily living scale for stroke patients. Clin Rehab, 1, 301-305.
• Pittock, S.J., Meldrum, D., Ni Dhuill, C., Hardiman, O., & Moroney, J.T. (2003). The Orpington Prognostic Scale within the First 48 hours of Admission as a Predictor of Outcome in Ischemic Stroke. Journal of Stroke and Cerebrovascular Diseases, 12(4), 175-181.
• Podsiadlo, E., Richardson, S. (1991). The Timed ‘Up & Go’: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc, 39, 142-148.
• Prescott, R.J., Garraway, W.M., & Akhtar, A.J. (1982). Predicting functional outcome following acute stroke using a standard clinical evaluation. Stroke, 13 (5), 641-647.
• Qureshi, K.N. & Hodkinson, H.M. (1974). Evaluation of a ten-question mental test in the institutionalized elderly. Age Ageing, 3, 152-157.
• Rieck, M., & Moreland, J. (2005). The Orpington Prognostic Scale for patients with stroke: Reliability and pilot predictive data for discharge destination and therapeutic services. Disability and Rehabilitation, 27(23), 1425-1433.
• Studenski, S.A., Wallace, D., Duncan, P.W., Rymer, M., & Lai, S.M. (2001). Predicting Stroke Recovery: Three- and Six- Month Rates of Patient Centered Functional Outcomes Based on the Orpington Prognostic Scale. JAGS, 49, 308-312.
• Teasdale, G., Jennett, B. (1974). Assessment of coma and impaired consciousness. A practical scale. The Lancet, 2(7872), 81-84.
• Ware, J. E. Jr. & Sherbourne, C. D. (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care, 30, 473-483.
• Weir, N.U., Counsell, C.E., McDowall, M.,Gunkel, A.,& Dennis, M.S. (2003). Reliability of the variables in a new set of models that predict outcome after stroke. J Neurol Neurosurg Psychiatry, 74, 447 – 451.
• Wright, C.J., Swinton, L.C., Green, H.. (2004). Predicting Final Disposition after Stroke using the Orpington Prognostic Score. Can. J. Neurol. Sci., 31, 494-498.

See the measure

How to obtain the OPS?

The OPS can be obtained from its original publication: Kalra and Crome (1993). The following publications also present a description of the full tool : Lai et al., (1998); Pittock et al., (2003); Rieck & Moreland (2005); Wright et al., (2004). It is also available on the Internet Stroke Center website.