Determining cut-off points in functional assessment scales in stroke

• Published in: NeuroRehabilitation (Reading, Mass.) Vol. 37; no. 2; pp. 165 - 172
• Main Authors: Balasch i Bernat, Mercè, Balasch i Parisi, Sebastiá, Sebastián, Enrique Noé, Moscardó, Lirios Dueñas, Ferri Campos, Joan, López Bueno, Laura
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 14.10.2015
• Subjects: Activities of Daily Living; Aged; Disability Evaluation; Female; Humans; Male; Stroke - diagnosis; Stroke Rehabilitation; Stroke; rehabilitation; clinical evaluation; activities of daily living; disability
• ISSN: 1053-8135; 1878-6448
• DOI: 10.3233/NRE-151249

BACKGROUND: A wide variety of well-validated assessment scales of functioning and disability have been developed for stroke population. However, these instruments have limitations in their interpretation. Therefore, determining cut-off points for their categorization becomes necessary. OBJECTIVES: To determine cut-off points for the BI, FIM and FAM scales to differentiate clinical disability categories and to establish the relationship between mRS and DOS scales. METHODS: One hundred and six adults with ischemic or haemorrhagic stroke were mainly recruited from a rehabilitation facility (Hospitales Nisa, Valencia, Spain). RESULTS: A high correlation was observed between the DOS and mRS scales (Kendall’s tau-b = 0.475; p = 0.000) although a certain amount of disagreement between the two scales was detected. The cut-off points were 62.90 (95% CI, 57.26–69.29) and 21.30 (95% CI, 16.34–26.03) for the BI; 70.62 (95% CI, 66.65–75.22) and 38.29 (95% CI, 34.07–42.25) for the FIM; and 116.07 (95% CI, 110.30–122.68) and 66.02 (95% CI, 59.20–72.35) for the FAM. CONCLUSION(S): DOS was observed to be more demanding than the mRS, in terms of patient independence. Additionally, the lower cut-off points separating the levels of severe and moderate disability in the BI, FIM and FAM were determined. These findings would facilitate practitioners clinical interpretation of disability levels in post-stroke patients.