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The development of an objective functional outcome measure for the evaluation of physiotherapy in stroke; a scoring system to quantify the movement patterns of stroke subjects derived from video reports

Salisbury, L.G. and Durward, B. and Rowe, P.J. (2003) The development of an objective functional outcome measure for the evaluation of physiotherapy in stroke; a scoring system to quantify the movement patterns of stroke subjects derived from video reports. In: 14th International WCPT congress, 2003-06-07 - 2003-06-12. (Unpublished)

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PURPOSE: Following a literature review it was identified there was a need for a sensitive objective outcome measure for the assessment of stroke patients receiving physiotherapy. RELEVANCE: It was anticipated that the development of such an outcome measure could help to produce good quality research for the evaluation of the efficacy of physiotherapy in stroke. DESCRIPTION:Initial development work was carried out which was concerned with the construct and content validity of the new outcome measure. Videoing from above combined with digitisation of the video records provided movement trajectories visually representative of movement changes addressed by physiotherapists across a range of functional activities. However a method of quantifying the movement patterns was required to allow the production of numerical values. To provide numerical values the maximum displacement of the marker in an anterior, posterior and lateral direction was identified from the movement trajectory. Equations were formed from the marker positions to represent 4 parameters of movement these were termed centrality, lateral dynamic control, anterior-posterior position and anterior-posterior dynamic control. Time was also measured. Each parameter of movement developed was assessed during each functional activity leading to 39 different parameters of measurement for each use of the outcome measure. Due to this large amount of data a method was required to provide a total score. A scoring system was developed which was based on the results of a normal cohort of 100 people. Ordinal scores of 0 to 5 were assigned to each measurement parameter dependent on the normal values. If a patient value fell within the interquartile range of the normals they were assigned a score of 5. The next scoring band, a score of 4, was any value one interquartile box length from the 25th percentile or one box length from the 75th percentile. Subsequent bands were one interquartile box from the upper and lower edges of the previous limits. A percentage score was calculated for each of the 5 parameters of movement and a total overall score was obtained by averaging the percentage scores of these 5 subscores. OBSERVATIONS: The measurement parameters reflected in numerical values the visual differences seen in the movement trajectories. The scoring system presents a sensitive objective method of reflecting movement. CONCLUSIONS: The scoring system provided a method of quantifying movement of stroke patients from video records. Validation of the method is required through studies of validity and reliability.