Cerebrovascular Accident, Stroke, Stroke, Acute, Stroke Hemorrhagic
Conditions
Keywords
stroke, PASS, AM-PAC 6-Clicks, MSAS, acute care hospital, physical therapy outcome measures
Brief summary
Physical therapy assessments assist in discharge planning along with demographic and social factors for patients with stroke in acute care. Understanding where a patient can be discharged to, based on the patient's functional status post stroke is important to be able to use resources effectively, decrease length of stay, and facilitate early initiation of rehabilitation services if needed. Standardized outcome measures can help quantify functional deficits and the scores on the standardized outcome measures can in turn guide the discharge planning process. The Activity Measure for Post Acute Care 6-Clicks (AM-PAC 6-Clicks) has been used in the acute care setting to guide discharge planning. Based on its cutoff scores, it also can assist in predicting discharge destination. The Mobility Scale for Acute Stroke (MSAS) has been used to determine discharge to home versus not home in patients with stroke. Understanding the validity of the MSAS in comparison with the Postural Assessment Scale for Stroke (PASS) and the AM-PAC 6-Clicks can be beneficial as the MSAS is a stroke specific outcome measure which is mainly used in acute care and is easy to administer. It can be administered in a short duration and consists of mobility and balance assessments which can help determine functional deficits.
Interventions
OTHEROne time Physical Therapy Evaluation
A physical therapist will perform an evaluation which will consist of history taking and assessing the following: strength, endurance, range of motion, sitting/standing balance, sensory testing, and skin integrity. Following these assessments, the physical therapist will assess participant's functional mobility which involves assessing how you get out of bed, standing up, and walking. The physical therapist will also assess the participant on three tests which help determine your balance and assistance required with functional mobility. The tests that will be performed in no particular order are PASS, MSAS, AM-PAC 6-Clicks, OPS, MRS, and FCI. Data for the AM-PAC daily activity and applied cognition domains will be obtained from the patient's chart from the Occupational Therapy evaluation. Discharge destination information will be obtained from the PT evaluation and the discharge destinations will be acute/inpatient rehab, SAR, SNF, Home with or without home PT, and outpatient PT.
Sponsors
Nova Southeastern University
New York Presbyterian Brooklyn Methodist Hospital
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
1. Individuals who have a confirmed diagnosis of a first acute, single or multiple infarct, ischemic or hemorrhagic in nature by imaging. 2. Individuals who are 18 years of age or older. 3. Individuals must be non-institutionalized prior to hospital admission. 4. Individuals whose primary spoken and written language is English. 5. Individuals who are referred for physical therapy in acute care.
Exclusion criteria
1. Individuals who are non-ambulatory prior to hospital admission. 2. Individuals having a diagnosis of secondary major trauma or subarachnoid hemorrhage. 3. Individuals with any comorbidity that prevents him/her from completing the tests such as a previous neurological injury or recent orthopedic diagnoses.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Mobility Scale for Acute Stroke (MSAS) | Baseline | The MSAS is a six-item scale which consists of components that are routinely assessed in patients by physical therapists. The components are bridging, sit from supine and then return to supine, sitting balance to be held for 3 minutes, sit to stand from a chair without using arms, standing balance for 1 minute, and gait testing for 10 m with or without an assistive device. The scores for each domain range from 6 to 36. The cut off score is 26 with scores above 26 indicating possible discharge to home and below 26 indicating need for institutionalization. |
| Postural Assessment Scale for Stroke (PASS) | Baseline | The PASS consists of 12-items assessing balance ability to maintain postures or while changing postures. The score range for the PASS is 0 to 36 with lower scores indicating greater balance impairments. The 12 items consist of sitting without support, standing with support, standing without support, standing on nonparetic leg, standing on paretic leg, supine to paretic side lateral, supine to nonparetic side lateral, supine to sitting up on edge of the mat, sitting on the edge of the mat to supine, sitting to standing up, standing up to sitting down, and standing - picking up a pencil from the floor. |
| Activity Measure for Post-Acute Care 6-Clicks (AM-PAC 6-Clicks) | Baseline | The AM-PAC was developed to assess activity level post-acute care. It consists of three domains - basic mobility, daily activity, and applied cognition and each of the three domains consists of six items. The raw scores for each domain range from 6 to 24. A higher raw score indicates less functional limitations. The cutoff score for medically complex patients is 42.9 for the basic mobility domain and 39.4 for the daily activity domain. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Orpington Prognostic Scale (OPS) | Baseline | The OPS consists of four domains namely deficits in upper extremity strength, upper extremity proprioception, balance, and cognition. The total score consists of adding all four domains together along with 1.6. The total score can range from 1.6 to 6.8. The cutoff scores range from \< 3.2 to \> 5.2, where \< 3.2 indicates a high likelihood of discharge home; a score between 3.2 and 5.2 respond better to inpatient rehabilitation; and a score of \> 5.2 indicates increased risk of institutionalization as patients are typically dependent. |
| Modified Rankin Scale (MRS) | Baseline | The MRS is a global outcomes rating scale which ranges from 0 (no impairment) to 5 (severe disability- patient is bedridden, incontinent, and requires constant nursing care and attention) and 6 (death). A higher score indicates greater impairment. |
| Functional Comorbidity Index (FCI) | Baseline | The FCI was developed to assess comorbidity and used physical function as the outcome. It consists of an 18-item list of diagnoses. The scores range from 0 to 18 which is the cumulative sum of the comorbidities present. |
Countries
United States
Contacts
Primary ContactAniketh M Chavan, DPT
Outcome results
None listed