Registry of Outcome Measures With MDC 2010
Registry of Outcome Measures With MDC 2010
Registry of Outcome Measures With MDC 2010
Registry of Selected Functional Physical Therapy Outcome Measures With Minimal Detectable Change Scores
Jeffrey S. DeRenzo, DPT Candidate Research Project Advisor: Stacy Fritz, PhD, PT
Doctor of Physical Therapy Program Department of Exercise Science Arnold School of Public Health University of South Carolina 2010
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Outcome Measure Quebec Back Pain Disability Scale Roland-Morris Questionnaire Romberg Test SF 36 (36-Item Short-Form Health Survey) Six Minute Walk Test SPADI (Shoulder Pain and Disability Index) SPPB (Short Physical Performance Battery) Stroke Impact Scale TUG (Timed Up and Go Test) UPDRS (Unified Parkinson Disease Rating Scale) Wolf Motor Function Test WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index)
page number 73 74 75 76 78 80 81 82 84 85 86 88
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ACL injuries Lysholm Score Alzheimers Gait Speed Six Minute Walk Test Timed Up and Go Test
Elderly (>65 y.o.) Berg Balance Test Gait Speed POMA Six Minute Walk Test SPPB TUG
Low Back Pain, Chronic or Acute FABQ Oswestry Disability Index Quebec Back Pain Disability Scale Roland Morris Questionnaire
Multiple Sclerosis Six Minute Walk Test Hip Fracture with Surgical Repair Gait Speed SF-36 Six Minute Walk SPPB
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Pain
NPRS PI-NRS
Parkinsonism ABC Scale Berg Balance Test Functional Reach Test Gait Speed GUG Romberg Test SF-36 Six Minute Walk Test TUG UPDRS
Stroke ABC Scale Berg Balance Test Fugl-Meyer Assessment Gait Speed Six Minute Walk Test Stroke Impact Scale Wolf Motor Function Test
ABC
Activities-specific Balance Confidence Scale The ABC Scale is a 16-item questionnaire used to measure balance confidence in specific situations ranging from walking inside the home to walking on icy sidewalks. Subjects are asked to rate their confidence level on an 11-point scale that ranges from 0% (no confidence) to 100% (complete confidence) in performing each activity without losing balance or becoming unsteady. Scores range from 0% to 100% with a higher percentage indicating a higher degree of confidence in ones ability to perform the activity. (Salbach, et al., 2006; Steffan and Seney, 2008).
Diagnosis Parkinsonism
Study Sample Population 37 community dwelling persons with parkinsonism Mean age: 71
Year 2008
Stroke
13.99 %*
91 community dwelling persons with residual walking deficit post stroke Mean time from stroke: 227 days Mean age: 72
Salbach, et al.
2006
49
ASES
American Shoulder and Elbow Surgeons Score The patient self-report section of the ASES is a condition specific scale intended to measure functional limitations and pain of the shoulder. The original ASES consists of two portions, a medical professional assessment section and a patient self report section. The patient self-report section is a patient self-evaluation questionnaire consisting of two dimensions: pain and activities of daily living. The pain score is calculated from the single pain question and the function score from the sum of the 10 questions addressing function. The pain score and function composite score are weighted equally (50 points each) and combined for a total score out of a possible 100 points. A lower function score is equal decreased function. (Michener, 2002). Diagnosis Shoulder dysfunction including the following: (# of patients in study with dx) impingement syndrome 25 Instability/dislocation 2 Rotator cuff syndrome 2 Adhesive capsulitis 5 Hemiarthroplasty 1 Shoulder weakness 2 Humeral fracture 5 Rotator cuff and adhesive capsulitis 6 Statuspost surgery 15 MDC (CI) 9.7 points (90%) Study Sample Population 63 patients with shoulder dysfunction receiving outpatient PT Mean age: 51.7 Author Year
Michener
2002
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BBT Scoring (points): 0-14 15-32 33-49 50-56 severe balance impairment moderate balance impairment mild balance impairment normal balance
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Parkinsonism
Lim, et al.
2005
Stevenson
2001
Score ranges (95%): 0-24 5 points 25-34 7 points 35-44 5 points 45-56 4 points
Donoghue et al.
2009
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DASH
Disabilities of Arm, Shoulder, and Hand The DASH is a 30 item questionnaire with each item rated between 1-5 with higher scores equating to increased difficulty, pain or lower function. Scores range from 0 to 100, with 0 reflecting no disability. The DASH is region-specific and so allows comparisons across diagnoses of the upper extremity. The DASH is used for discriminative and evaluative purposes. It contains two optional modules for work and sports/performing arts (Schmitt and Di Fabio, 2004; www.dash.iwh.on.ca). DASH Score calculation: [(sum of n responses) 1] x 25 n where n is equal to the number of completed responses
A DASH score may not be calculated if there are greater than 3 missing items. Scoring of optional modules: Add up assigned values for each response; divide by 4 (number of items); subtract 1; multiply by 25. An optional module score may not be calculated if there are any missing items.
MDC (CI) All diagnoses (90%): 12.5 points Subdivisions by diagnosis (90%): Proximal dx 12.2 points Distal dx 13.7 points
Study Sample Population 211 patients with musculoskeletal upper extremity problems receiving outpatient rehabilitation Mean age: 47.5
Year 2004
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FABQ
Fear Avoidance Beliefs Questionnaire The FABQ is used to quantify fear-avoidance beliefs specific to low back pain and can help predict those who have a high pain avoidance behavior. The FABQ consists of 2 subscales. The first subscale (items 1-5) is the Physical Activity subscale (FABQ-PA) with a score range of 0 24 points; and the second subscale (items 6-16) is the Work subscale (FABQ-W) with a score range of 0 42 points. Patients must complete all items in the questionnaire, as there is no procedure to adjust for incomplete/unanswered items. Higher scores indicate higher levels of fear-avoidance beliefs for both FABQ scales (George, 2010). Each subscale is graded separately by summing the responses of each scale item (0-6 for each item). For scoring purposes, only 4 of the physical activity scale items are scored (24 possible points) and only 7 of the work items (42 possible points) (George, 2010 and Waddell, et al., 1993). FABQ Subscale Scoring: FABQ Physical Activity (FABQ-PA): Sum items 2, 3, 4, and 5 (the score circled by the patient for these items) FABQ Work (FABQ-W): Sum items 6, 7, 9, 10, 11, 12, and 15 (the score circled by the patient for these items) Diagnosis MDC (CI) FABQ PA (physical activity): 5.4 points (95%) FABQ W (work): 6.8 points (95%) Study Sample Population 53 patients with chronic LBP receiving PT in outpatient setting Mean age: 44.3 Author Year
George
2010
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Fugl-Meyer Assessment
The FM consists of a 33-item upper-extremity subscale (UE-FM) and a 17-item lower-extremity subscale. The UE-FM items are related to movements of the proximal and distal parts of the upper extremities and include reflex testing, movement observation, grasp testing and assessment of coordination. The items of the FM are mainly scored on a 3-point scale from 0 to 2. Scoring ranges from 0 to a maximum of 66 for the UE-FM. Higher scores indicate a higher level function (i.e. a lower level of impairment) (Deakin, et al., 2003 ; Jau-Hong Lin, et al., 2009).
UE-FM Scoring (points): 0 1 2 Unable to perform Able to perform in part Able to perform.
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Fugl-Meyer Assessment
Diagnosis UE-FM Chronic Stroke LE-FM Motor FM MDC (CI) 7.2 points (95%) 3.8 8.4 Study Sample Population 60 patients receiving outpatient therapy following stroke (> 1 year since stroke onset) Mean age: 57.9 Author Year
2008
*Short FM (S-FM) UE-S-FM 12.2 points (95%) LE-S-FM 8.6 Motor-S-FM 16.0
Chronic Stroke
UE-FM
30 patients with chronic stroke undergoing outpatient therapy Mean time since stroke onset: 693.2 days Mean age: 56.6
2009
*The S-FM (SHORT FM) also includes both subscales (i.e. the UE-SFM and the LE-S-FM). Each of the subscales has 6 items retrieved from the FM. The raw scores of each subscale of the S-FM can be transformed to Rasch interval scores ranging from 0 to 100. The total motor SFM score ranges from 0 to 200 (I-Ping Hsueh, et al., 2008).
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Diagnosis Parkinsonism
Study Sample Population 37 community dwelling persons with Parkinsonism Mean age: 71 26 community dwelling with Parkinsons (Hoehn and Yahr stage ranging from 1 -3) Mean age: 62.5
Year 2008
Parkinsonism
11.5 cm (95%)
Lim, et al.
2005
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Gait Speed
Gait speed is a measure of overall walking performance, but does not include an endurance component. Both fast and comfortable gait speeds are often measured to ensure that patients have the ability to change walking speed. For the test of comfortable gait speed, subjects walk 10 meters and are instructed to walk at your own comfortable walking speed and stop when you reach the far line. For the test of fast gait speed, subjects walk the 10 meters with the instructions to walk as fast as you can safely walk and to stop at the far line. Time to complete the central 6 meters is measured to the nearest 100th of a second. Time starts when any part of the foot crosses the plane of the first tapeline and ends when any part of the foot crosses the plane of the 6 meter mark. Gait speeds are generally calculated in meters per second (Steffan and Seney, 2008).
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Gait Speed
Diagnosis Elderly (> 65 y.o.) MDC (CI) Free gait speed Fast gait speed Alzheimers .19m/s (90%) .21 m/s (90%) Study Sample Population 52 ambulatory participants recruited from Senior Day Centers Mean age: 78 51 patients with Alzheimers from inpatient and day care facilities Mean age: 80.71 Author Year
Mangione, et al.
2010
Ries, et al.
2009
108 community dwelling patients s/p hip fracture with surgical repair (within last 17 days); Age: >65 years
Latham, et al.
2008
Stroke
All patients (90%) (with or without physical assist) .30 m/s With physical assist No physical assist .07 m/s (90%) .36 m/s (90%)
35 patients post stroke receiving rehabilitation in inpatient facility Mean age: 67.4 Mean time post stroke: 34.5 days
2008
Parkinsonism
2008
GUG
Get Up and Go Test To perform the GUG test, subject is seated on a standard-height chair with armrests in front of a 20 meter unobstructed corridor. The finish line is marked with a strip of tape placed 15.2 m away from the front edge of the chair. Subject is instructed to sit with their back touching the back of the chair. On the command go, the subject stands and walked as fast as possible along the level corridor. The subject is instructed not to slow down before crossing the finish line. Time is measured in seconds from the command go until the subject crosses the finish line. The examiner stands at the finish line during the test. Subjects who use canes or other assistive devices are permitted to use them during the test. GUG Scoring: 1 2 3 4 5 Normal Very slightly abnormal Mildly abnormal Moderately abnormal Severely abnormal
"Normal" indicates that the patient gave no evidence of being at risk of falling during the test or at any other time. "Severely abnormal" indicates that the patient appeared at risk of falling during the test. Intermediate grades reflect the presence of any of the following as indicators of the possibility of falling: undue slowness, hesitancy, abnormal movements of the trunk or upper limbs, staggering, stumbling. A patient with a score of 3 or more on the Get-up and Go Test is considered at risk of falling (Mathias, et al., 1986; Piva, et al., 2004).
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GUG
Get Up and Go Test
Study Sample Population Convenience sample of 130 participants of a larger study; n=105 with knee OA Mean age: 62 n=25 controls Mean age 57 26 community dwelling with Parkinsons (Hoehn and Yahr stage ranging from 1 -3) Mean age: 62.5
Author
Year
Piva, et al.
2004
Parkinsonism
Lim, et al.
2005
61
LEFS
Lower Extremity Functional Scale
The LEFS is a 20-item condition-specific questionnaire designed for use with individuals who have musculoskeletal conditions of the lower extremity. Each item of the LEFS is scored on a 5-point scale ranging from 0 (unable to perform/extreme difficulty) to 4 (no difficulty). LEFS scores range from 0 to 80 points, with higher scores representing higher functional levels (Y.H Pua, 2009).
Study Sample Population 107 patients in outpatient physical therapy clinic Mean age: 44
Author
Year
Binkley
1999
Hip Osteoarthritis
2009
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Lysholm score
The Lysholm score is used as a comprehensive outcome assessment for patients with ACL injuries. This scale is often used at six, nine, and twelve months to document early return to function. This scale evaluates instability (25 points), pain (25 points), locking (15 points), swelling (10 points), stair climbing (10 points), limp (5 points), support, such as use of assistive device (5 points), and squatting (5 points). The maximum score is 100 points with a higher score denoting better function. The Lysholm Score is generally not interpreted on the basis of its individual items (Briggs, 2009). Lysholm Scoring: <65 65-83 84-90 >90 Poor Fair Good Excellent
Study Sample Population 712 patients s/p ACL reconstruction surgery Mean age: 37
Author Briggs
Year 2009
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NDI
Neck Disability Index
The NDI is a questionnaire containing 10 items of which seven are related to activities of daily living, two related to pain, and one item related to concentration. Each item is scored from 0 to 5 with a total possible score of 50 points. The total score is expressed as a percentage (by multiplying the numerical raw score by two to obtain percentage), with higher scores corresponding to greater disability (Cleland, 2006; Vernon and Mior, 1991).
NDI scoring (points and percentage): 0-4 points 5-14 15-24 25-34 > 34 0-8% 10-28% 30-48% 50-68% >72% no disability mild disability moderate disability severe disability complete disability
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NDI
Neck Disability Index
Study Sample Population 38 patients undergoing outpatient PT treatment Mean age: 51.2
Author
Year
Cleland
2006
Young
2009
Pool
2007
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NPRS
Numeric Pain Rating Scale
The NPRS is based on an 11-point numerical rating scale for determining pain intensity, ranging from 0 (no pain) to 10 (worst pain imaginable). The questions associated with the NPRSs are as follows: Over the past 24-hours, how bad has your pain been? and On average over the past 2-days, how bad has your pain been? (Spadoni, 2004).
Diagnosis Pain (non-chronic) in one of following sites: Upper extremity Head, neck, thorax Low back, pelvis Lower extremity
MDC (CI) 3 points (90%) for pain over last 2 days 3.5 points (90%) for pain over last 24 hours
Study Sample Population 220 patients receiving outpatient treatment for musculoskeletal condition Age: > 16 years old
Author
Year
Spadoni
2004
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Oswestry Scoring: Total possible score for each section: 5 points; if the first statement is marked then the section score = 0; if the last statement is marked the section score = 5. If all ten sections are completed the score is calculated as follows: Total points scored divided by 50 (total possible score) x 100 = %
If one section is not applicable or is missed, then the total possible score is reduced by 5 points (thus, 45 x 100 = %
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Maughan
2010
2002
Back pain previous year (n= 214) Back pain on day of study (n = 82)
Dawson
2010
68
69
Leggin
2006
70
PI-NRS
Pain Intensity Numerical Rating Scale The Pain Intensity Numerical Rating Scale uses an 11-point numerical rating scale for determining pain intensity, ranging from 0 (no pain) to 10 (very severe pain). When used as a graphic rating scale, a 10cm baseline is used. (van der Roer, 2006).
MDC (CI) 4.0 points (95%) Categories (95%): Neck pain only 4.2 points Pain referred to arm 6.2 points
Study Sample Population 658 patients receiving treatment for neck pain and/or referred pain Mean age 54.1
Author
Year
Kovacs
2008
Categories (95%): LBP only 3.7 points Pain referred to leg 5.4 points
1067 patients receiving treatment for acute or chronic LBP Mean age: 54.3
Kovacs
2007
442 patients with LBP (304 acute LBP and 138 chronic LBP) Mean age: 46
2006
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POMA
Performance Oriented Mobility Assessement, Tinetti The Performance-Oriented Mobility Assessment (POMA) is an instrument used to provide an evaluation of balance and gait. The POMA consists of 8 balance items and 8 gait items scored on a three point ordinal scale with a range of 0 to 2. A score of 0 represents the most impairment, while a 2 represents independence of the patient. The balance items include sitting balance, rising from a chair and sitting down again, standing balance (eyes open and eyes closed), and turning balance. The balance items add up to a maximum score of 12 points (POMA-B). The gait items include gait initiation, step length, step height, step length symmetry and continuity, path direction, and trunk sway, adding up to a maximum score of 16 points (POMA-G). The total score (POMA-T) ranges from 0 to 28 points. Lower scores indicate poorer performance. In general, patients who score below 19 are at a high risk for falls. Patients who score in the range of 19-24 indicate that the patient has a risk for falls. Patients scoring above 24 are considered at low risk for falls (Faber, et al. 2006; Tinetti, 1986). POMA Scoring (points): < 19 19-24 >24 Diagnosis None specified (elderly: >65 y.o.) high risk for falls at risk for falls low risk for falls. MDC (CI) Study Sample Population 245 residents of either independent or nursing home facility Mean age: 84.9 Author Year
5 points (95%)
Faber, et al.
2006
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Study Sample Population 442 total patients with LBP Subdivided into: 304 acute LBP 138 chronic LBP Mean age: 46
Author
Year
2006
15 points (90%)
2002
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Roland-Morris Questionnaire
The Roland Morris Disability Questionnaire is a self-administered disability measure that consists of 24 statements regarding activity limitations due to back pain, such as walking, lying and self-care. Patients are asked to answer yes or no to each statement. Each positive answer is worth one point with scores ranging from 0 (no disability) to 24 (severely disabled). (Maughan, 2010 and Stratford, 1996). Diagnosis Chronic LBP MDC (CI) 4.9 (95%) Study Sample Population 63 patients with chronic LBP receiving physical therapy treatment Mean age: 52 60 patients receiving PT in outpatient setting Mean age: 41 Author Maughan Year 2010
Stratford
1996
*According to Stratford, the MDC for the Roland Morris varies according to the location of scores on the scale. MDC of 4 points needed to detect improvement when: Initial score is between 4-11 points Initial score is > 16 points MDC of 4 points needed to detect deterioration when Initial score is < 7 points Initial score is between 13-20 points Additionally, improvement in patients with initial score of < 4 points or deterioration in patients with initial scores >20 points cannot be detected with high degree of confidence. 74
Romberg Test
The Romberg Test and Sharpened Romberg Test are tests of static balance that measure the ability to maintain balance with a narrowed base of support. The Romberg Test is performed with feet together and eyes open for 60 seconds and with feet together and eyes closed for 60 seconds. The Sharpened Romberg Test is performed in a tandem standing position, with the dominant foot behind the non-dominant foot for 60 seconds with eyes open and for 60 seconds with eyes closed. Timing starts after the subject has assumed the proper position and is stopped if the subject moves his or her feet from the proper position, opens his or her eyes on the eyes-closed trials, or when the maximum balance time of 60 seconds is reached. Subjects may be given assistance to assume the test position. Up to three trials may be performed if the maximum balance time is not reached in either of the first 2 trials. Upper-extremity use is not controlled during testing (Steffan and Seney, 2008).
Diagnosis
MDC (CI) Standard Romberg (95%) Eyes open 10 seconds Eyes closed 19 seconds Sharpened Romberg (95%) (Tandem stance) Eyes open 39 seconds Eyes closed 19 seconds
Author
Year
Parkinsonism
2008
75
SF 36
36-Item Short-Form Health Survey The SF-36 is a quality-of-life questionnaire used to assess physical and mental health concepts from the respondents point of view. These concepts are: (1) limitations in physical activities because of health problems (Physical Functioning), (2) limitations in social activities because of physical or emotional problems (Social Functioning), (3) limitations in usual role activities because of physical health problems (RolePhysical), (4) bodily pain (Bodily Pain), (5) psychological distress and well-being (Mental Health), (6) limitations in usual role activities because of emotional problems (RoleEmotional), (7) energy and fatigue (Vitality), and (8) general health perceptions (General Health). These 8 domains are relevant to general functional status and well-being. For each scale, item scores are coded, summed, and transformed, with final values (expressed as a percentage) ranging from 0 (worst health) to 100 (best health) (Steffan and Seney, 2008).
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Parkinsons
2008
469 patients s/p THA in Spanish hospital system Mean age: 69.4 Quintana 2005
108 community dwelling patients s/p hip fracture and surgical repair (within last 17 days); Age: >65 years 516 patient s/p TKA in Spanish hospital system Mean age: 71.6
Latham, et al.
2008
Escobar
2007
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Parkinsonism Alzheimers
2008
2009
post Stroke
54.1 m (90%)
Fulk, et al.
2008
53.51 m (90%)
Latham, et al.
2008
Multiple Sclerosis
92.16 m (95%)
Paltamaa, et al.
2008
79
SPADI
Shoulder Pain and Disability Index The SPADI is a 13-item self-administered questionnaire relating to pain and functional status of the shoulder region. It includes a fiveitem pain scale and an eight-item disability scale. Each item is scored from 0 to 10, with total scores ranging from 0 to 100 for both the pain and disability sections and higher scores indicate greater disability. The total SPADI is calculated as the mean of the pain and disability scales (Schmitt and DiFabio, 2004). SPADI scoring: Disability score: _____/ 80 x 100 = % Note: If not all questions are answered, divide by the total possible score (thus if 1 question is missed then divide by 70) Total SPADI score: _____ 130 x 100 = % Note: If not all questions are answered, divide by the total possible score (thus if 1 question is missed then divide by 120)
MDC (CI)
Study Sample Population 211 patients with musculoskeletal upper extremity problems receiving outpatient rehabilitation Mean age: 47.5
Author
Year
2004
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SPPB
Short Physical Performance Battery The Short Physical Performance Battery is a composite of three timed tests: (1) chair rise for five repetitions without the use of arms; (2) standing balance in positions of side-by side stance, semi-tandem stance, and full tandem stance; and (3) walking speed over a 2.44-m (8-ft) course. Each test is scored on a scale of 0 to 4, with a total score range of 0-12 points. Higher scores indicate better function (Mangione, et al., 2010).
Study Sample Population 108 community dwelling patients s/p hip fracture with surgical repair (within last 17 days); Age: >65 years
Author
Year
Latham, et al.
2008
Mangione, et al.
2010
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82
Stroke
Carod-Artal, et al.
2008
13.23 points
Stroke
74 patients with stroke receiving rehabilitation at a medical center Mean time since stroke onset: 17.5 months Mean age: 54.1
2010
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TUG
Timed Up and Go Test The TUG is a mobility test generally used for the geriatric population. It tests basic functional mobility and is scored as the minimum time needed to stand up from a standard armchair, walk across a distance of 3 meters (10ft), turn around, walk back to the chair, and sit down again. Subjects are instructed to independently rise on the word go, comfortably walk a clearly marked distance of 3 meters, turn around a cone, walk back to the chair, and sit down with their back against the chair. Time is started once the subjects back leaves the chair and ends when the subjects back touches the back of the chair. Time to complete the course is measured to the nearest 100th of a second. Subjects may complete the measure twice with the average of the two trials used (Faber, et al., 2006; Mangione, et al., 2010; Seffan and Seney, 2008).
Diagnosis Parkinsonism
Study Sample Population 37 community dwelling persons with Parkinsonism Mean age: 71 51 patients with Alzheimers from inpatient and day care facilities Mean age: 80.71 52 ambulatory participants recruited from Senior Day Centers Mean age: 78
Year 2008
Alzheimers
Ries, et al.
2009
Mangione, et al.
2010
84
UPDRS
Unified Parkinson Disease Rating Scale The UPDRS is the gold standard instrument used to measure disease severity in Parkinsons Disease. It contains 3 subscales: I - Mentation, Behavior, and Mood (range_016), II - Activities of Daily Living (ADL) (range_052), and III - Motor Examination (range_0 108). A total score (range_0176) can be derived by summating the 3 subscales. Lower scores indicate a less involved disease process (Steffan and Seney, 2008).
Diagnosis
MDC (CI) Subscales (95%): Mentation, Behavior and Mood 2 points Activities of Daily Living 4 points Motor Examination 11 points Total Score (all scales) 13 points
Study Sample Population 37 community dwelling persons with parkinsonism Mean age: 71
Author
Year
Parkinsonism
2008
15 points 15 points
26 community dwelling with Parkinsons (Hoehn and Yahr stage ranging from 1 -3) Mean age: 62.5
Lim, et al.
2005
85
86
Fritz, et al.
2009
1.8 1.4 1.4 2.0 1.3 1.6 4.3 2.8 1.6 2.5 1.8 2.6 1.0 0.1 0.8 1.0 1.7 0.1
2.1 1.6 1.7 2.4 1.5 1.9 5.2 3.4 2.0 3.0 2.2 3.2 1.2 0.1 1.0 1.2 2.0 0.1 4.36 seconds (90%)
57 patients post stroke (> 6 months) Mean time since stroke: 12.98 Lin, et al. 2009 *WMFT FAS .37 seconds (90%) months Mean age: 54.6 *Indicates that when the change scores of an individual stroke patient between 2 measurements reach 4.36 seconds and 0.37 points on the WMFT time and WMFT FAS respectively, the clinician may interpret the changes as true and reliable (i.e., beyond measurement error), given the 90% confidence level (Lin, et al., 2009). Stroke
87
WOMAC
Western Ontario and McMaster Universities Osteoarthritis Index
The WOMAC is a disease-specific, self-administered questionnaire used with patients who have hip or knee osteoarthritis. It contains a multi-dimensional scale made up of 24 items grouped into three dimensions: pain (five items), stiffness (two items), and physical function (17 items). Each item has five response levels representing different degrees of intensity (none, mild, moderate, severe, or extreme) that are scored from 0 to 4. The final score for the WOMAC is determined by adding the aggregate scores for pain, stiffness, and function. The data is standardized to a range of values from 0 to 100, where 0 represents the best health status and 100 the worst possible status. An improvement is achieved by reducing the overall score (Escobar, 2007).
88
WOMAC
Western Ontario and McMaster Universities Osteoarthritis Index
Study Sample Population 100 community dwelling adults with systemic hip OA Mean age: 62
Author
Year
2009
WOMAC Categories (95%): Pain 22.39 points Functional Limitation 13.1 points Stiffness 29.12 points
516 patient s/p TKA in Spanish hospital system Mean age: 71.6
Escobar
2007
WOMAC Categories (95%): Pain 21.38 points Functional Limitation 11.93 points Stiffness 27.98 points
469 patients s/p THA in Spanish hospital system Mean age: 69.4
Quintana
2005
89
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10. Duncan PW, Weiner DK, Chandler J, Studenski S. Functional Reach: a New Clinical Measure of Balance. Journal of Gerontology, 1990; 45(6):M192M197. 11. Escobar, A., et al., Responsiveness and Clinically Important Differences for the WOMAC and SF-36 After total Knee Replacement; OsteoArthritis and Cartilage (2007) 15, 273e280. 12. Faber, Marjan J., et al., Clinimetric Properties of the Performance-Oriented Mobility Assessment; Physical Therapy. Volume 86. Number 7. July 2006. 13. Fritz, Stacy L., et al., Minimal Detectable Change Scores for the Wolf Motor Function Test; Neurorehabilitation and Neural Repair, 2009 Sep;23(7):662-7. 14. Fulk, GD, et al., Clinometric properties of the six-minute walk test in individuals undergoing rehabilitation poststroke; Physiotherapy Theory and Practice. 2008 May-Jun; 24(3):195-204. 15. Fulk, GD and Echternach, John, Test-Retest Reliability and Minimal Detectable Change of Gait Speed in Individuals Undergoing Rehabilitation After Stroke; Journal of Neurologic Physical Therapy, Volume 32, March 2008. 16. George, Steven Z., et al., A Psychometric Investigation of Fear-Avoidance Model Measures in Patients With Chronic Low Back Pain; Journal of Orthopaedic & Sports Physical Therapy, volume 40, number 4, April 2010. 17. Glaab, Thomas, et al., Outcome Measures in Chronic Obstructive Pulmonary Disease (COPD): Strengths and Limitations; Respiratory Research 2010, 11:79. 18. I-Ping Hsueh, et al., Psychometric Comparisons of 2 Versions of the Fugl-Meyer Motor Scale and 2 Versions of the Stroke Rehabilitation Assessment of Movement; Neurorehabilitation and Neural Repair 22(6); 2008. 19. Jau-Hong Lin, et al., Psychometric Comparisons of 4 Measures for Assessing Upper Extremity Function in People With Stroke; Physical Therapy Volume 89 Number 8 August 2009.
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20. Kovacs, Francisco M. et al., Minimal Clinically Important Change for Pain Intensity and Disability in Patients With Nonspecific Low Back Pain; SPINE (2007) Volume 32, Number 25, pp 29152920. 21. Kovacs, Francisco M., et al., Minimum Detectable and Minimal Clinically Important Changes for Pain in Patients with Nonspecific Neck Pain; BMC Musculoskeletal Disorders 2008, 9:43. 22. Latham, Nancy K., et al., Performance-Based or Self-Report Measures of Physical Function: Which Should Be Used in Clinical Trials of Hip Fracture Patients? Archives of Physical Medicine and Rehabilitation Vol 89, November 2008. 23. Leggin, Brian G., et al., The Penn Shoulder Score: Reliability and Validity; Journal of Orthopaedic & Sports Physical Therapy; Volume 36, Number 3, March 2006. 24. Lim, L.I.I.K, et al., Measuring Gait and Gait-Related Activities in Parkinsons Patients Own Home Environment: a Reliability, Responsiveness and Feasibility Study; Parkinsonism and Related Disorders 11 (2005) 1924. 25. Lin, KC, et al., Minimal Detectable Change and Clinically Important Difference of the Wolf Motor Function Test in Stroke Patients; Neurorehabilitation and Neural Repair, 2009. Jun; 23(5): 429-434. 26. Lin, KC, et al., Minimal detectable change and clinically important difference of the Stroke Impact Scale in stroke patients; Neurorehabilitation and Neural Repair. 2010 Jun; 24(5):486-92. 27. Mangione, Kathleen Kline, et al., Detectable Changes in Physical Performance Measures in Elderly African Americans; Physical Therapy; June 2010 Volume 90 Number 6. 28. Mathias S, Nayak USL, Isaacs B. Balance in Elderly Patients: the Get-up and Go Test. Archives of Physical Medicine and Rehabilitation. 1986; 67:387-389. 29. Maughan, Elaine F, and Lewis, Jeremy S., Outcome Measures in Chronic Low Back Pain; European Spine Journal (2010); DOI 10.1007/s00586-010-1353-6.
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30. Michener, Lori A., et al., American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form, Patient SelfReport Section: Reliability, Validity, and Responsiveness; Journal of Shoulder and Elbow Surgery; Volume 11, Number 6 November/December 2002. 31. Ottenbacher, Kenneth J., et al., The Reliability of the Functional Independence Measure: A Quantitative Review. Archives of Physical Medicine and Rehabilitation, Vol 77, December 1996. 32. Paltamaa, Jaana, et al., Measuring Deterioration in International Classification of Functioning Domains of People With Multiple Sclerosis Who Are Ambulatory; Physical Therapy Volume 88 Number 2 February 2008. 33. Piva, Sara, et al., Get Up and Go Test in Patients With Knee Osteoarthritis. Archives of Physical Medicine and Rehabilitation, Vol. 85, February 2004. 34. Pool, Jan J., et al. Minimal Clinically Important Change of the Neck Disability Index and the Numerical Rating Scale for Patients With Neck Pain. SPINE (2007) Volume 32, Number 26, pp 30473051. 35. Puthoff, Michael, L., Outcome Measures in Cardiopulmonary Physical Therapy: Short Physical Performance Battery; Cardiopulmonary Physical Therapy Journal; Vol 19, No 1, March 2008. 36. Quintana, J.M., et al., Responsiveness and Clinically Important Differences for the WOMAC and SF-36 After Hip Joint Replacement; OsteoArthritis and Cartilage (2005) 13, 1076e1083. 37. Ries, Julie D., et al., Test-Retest Reliability and Minimal Detectable Change Scores for the Timed Up & Go Test, the SixMinute Walk Test, and Gait Speed in People With Alzheimer Disease; Physical Therapy; June 2009 Volume 89 Number 6. 38. Roy, Jean-Sebastien, et al., Measuring Shoulder Function: A Systematic Review of Four Questionnaires; Arthritis & Rheumatism (Arthritis Care & Research); Vol. 61, No. 5, May 15, 2009, pp 623632 39. Salbach, Nancy M., et al., Psychometric Evaluation of the Original and Canadian French Version of the Activities-Specific Balance Confidence Scale Among People With Stroke; Archives of Physical Medicine and Rehabilitation Vol 87, December 2006. 93
40. Schmitt, John S., and Di Fabio, Richard P. Reliable Change and Minimum Important Difference (MID) Proportions Facilitated Group Responsiveness Comparisons Using Individual Threshold Criteria; Journal of Clinical Epidemiology 57 (2004) 10081018. 41. Spadoni, Gregory, F., et al., The Evaluation of Change in Pain Intensity: A Comparison of the P4 and Single-Item Numeric Pain Rating Scales; Journal of Orthopaedic & Sports Physical Therapy; Volume 34, Number 4 April 2004. 42. Steffen, Teresa and Seney, Megan. Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism Physical Therapy, Volume 88 Number 6 June 2008. 43. Stevenson, TJ. Detecting Change in Patients with Stroke Using the Berg Balance Scale. Australian Journal of Physiotherapy. 2001; 47:29 38. 44. Tinetti ME, Williams TF, Mayewski R, Fall Risk Index for Elderly Patients Based on Number of Chronic Disabilities. American Journal of Medicine, 1986:80:429-434. 45. Tinetti ME. Performance-Oriented Assessment of Mobility Problems in Elderly Patients; Journal of the American Geriatrics Society, 1986; 34:119-126. 46. van der Roer, Nicole, et al., Minimal Clinically Important Change for Pain Intensity, Functional Status, and General Health Status in Patients With Nonspecific Low Back Pain; SPINE (2006) Volume 31, Number 5, pp 578582. 47. Vernon H., and Mior S. The Neck Disability Index: A Study of Reliability and Validity; Journal of Manipulative and Physiological Therapeutics, 1991;14:409-415. 48. Waddell G, et al., A Fear-Avoidance Beliefs Questionnaire (FABQ) and the Role of Fear-Avoidance Beliefs in Chronic Low Back Pain and Disability; Pain 1993; 52:157-168.
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Appendix B
Table of Contents
ABC (Activities-specific Balance Confidence Scale) ASES (American Shoulder and Elbow Surgeons Score) Berg Balance Test DASH (Disabilities of Arm Shoulder and Hand) FABQ (Fear Avoidance Beliefs Questionnaire) Fugl-Meyer Assessment Functional Reach Test Gait Speed GUG (Get Up and Go Test) LEFS (Lower Extremity Functional Scale) Lysholm Score NDI (Neck Disability Index) NPRS (Numeric Pain Rating Scale) and PI-NRS (Pain Intensity Numerical Rating Scale) Oswestry Disability Questionnaire Penn Shoulder Score POMA (Performance Oriented Mobility Assessment, Tinetti) Quebec Back Pain Disability Scale Roland-Morris Questionnaire Romberg Test SF 36 (36-Item Short-Form Health Survey) Six Minute Walk Test SPADI (Shoulder Pain and Disability Index) SPPB (Short Physical Performance Battery) Stroke Impact Scale TUG (Timed Up and Go Test) UPDRS (Unified Parkinson Disease Rating Scale) Wolf Motor Function Test WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) 121 122 124 126 129 130 132 133 146 147 148 151 157 158 164 167 98 100 101 105 108 110 115 116 117 118 119 120
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How confident are you that you will not lose your balance or become unsteady when you 1. walk around the house? ____% 2. walk up or down stairs? ____% 3. bend over and pick up a slipper from the front of a closet floor ____% 4. reach for a small can off a shelf at eye level? ____% 5. stand on your tiptoes and reach for something above your head? ____% 6. stand on a chair and reach for something? ____% 7. sweep the floor? ____% 8. walk outside the house to a car parked in the driveway? ____% 9. get into or out of a car? ____% 10. walk across a parking lot to the mall? ____% 11. walk up or down a ramp? ____% 12. walk in a crowded mall where people rapidly walk past you? ____%
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13. are bumped into by people as you walk through the mall?____% 14. step onto or off an escalator while you are holding onto a railing?____% 15. step onto or off an escalator while holding onto parcels such that you cannot hold onto the railing? ____% 16. walk outside on icy sidewalks? ____%
*Powell, LE & Myers AM. The Activities-specific Balance Confidence (ABC) Scale. J Gerontol Med Sci 1995; 50(1): M28-34.
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Function: Circle the number in the box that indicates your ability to do the following activities: 0= Unable to do; Activity 1. Put on a coat 2. Sleep on your painful or affected side 3. Wash back/do up bra in back 4. Manage toileting 5. Comb hair 6. Reach a high shelf 7. Lift 10 lbs above shoulder 8. Throw a ball overhead 9. Do usual work List:________________ 10. Do usual sport List:________________ 1= Very Difficult to do; 2= Somewhat difficult; Right Arm 0123 0123 0123 0123 0123 0123 0123 0123 0123 0123 3= Not difficult Left Arm 0123 0123 0123 0123 0123 0123 0123 0123 0123 0123
(Michener, 2002)
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Sitting unsupported
Standing to sitting Transfers Standing with eyes closed Standing with feet together Reaching forward with outstretched arm Retrieving object from floor Turning to look behind Turning 360 degrees Placing alternate foot on stool Standing with one foot in front Standing on one foot Total
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________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________
GENERAL INSTRUCTIONS Please document each task and/or give instructions as written. When scoring, please record the lowest response category that applies for each item. In most items, the subject is asked to maintain a given position for a specific time. Progressively more points are deducted if:
Subject should understand that they must maintain their balance while attempting the tasks. The choices of which leg to stand on or how far to reach are left to the subject. Poor judgment will adversely influence the performance and the scoring. Equipment required for testing is a stopwatch or watch with a second hand, and a ruler or other indicator of 2, 5, and 10 inches. Chairs used during testing should be a reasonable height. Either a step or a stool of average step height may be used for item # 12.
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STANDING UNSUPPORTED WITH FEET TOGETHER INSTRUCTIONS: Place your feet together and stand without holding on. ( ) 4 able to place feet together independently and stand 1 minute safely ( ) 3 able to place feet together independently and stand 1 minute with supervision ( ) 2 able to place feet together independently but unable to hold for 30 seconds ( ) 1 needs help to attain position but able to stand 15 seconds feet together ( ) 0 needs help to attain position and unable to hold for 15 seconds REACHING FORWARD WITH OUTSTRETCHED ARM WHILE STANDING INSTRUCTIONS: Lift arm to 90 degrees. Stretch out your fingers and reach forward as far as you can. (Examiner places a ruler at the end of fingertips when arm is at 90 degrees. Fingers should not touch the ruler while reaching forward. The recorded measure is the distance forward that the fingers reach while the subject is in the most forward lean position. When possible, ask subject to use both arms when reaching to avoid rotation of the trunk.) ( ) 4 can reach forward confidently 25 cm (10 inches) ( ) 3 can reach forward 12 cm (5 inches) ( ) 2 can reach forward 5 cm (2 inches) ( ) 1 reaches forward but needs supervision ( ) 0 loses balance while trying/requires external support PICK UP OBJECT FROM THE FLOOR FROM A STANDING POSITION INSTRUCTIONS: Pick up the shoe/slipper, which is in front of your feet. ( ) 4 able to pick up slipper safely and easily ( ) 3 able to pick up slipper but needs supervision ( ) 2 unable to pick up but reaches 2-5 cm(1-2 inches) from slipper and keeps balance independently ( ) 1 unable to pick up and needs supervision while trying ( ) 0 unable to try/needs assist to keep from losing balance or falling TURNING TO LOOK BEHIND OVER LEFT AND RIGHT SHOULDERS WHILE STANDING INSTRUCTIONS: Turn to look directly behind you over toward the left shoulder. Repeat to the right. (Examiner may pick an object to look at directly behind the subject to encourage a better twist turn.) ( ) 4 looks behind from both sides and weight shifts well ( ) 3 looks behind one side only other side shows less weight shift ( ) 2 turns sideways only but maintains balance ( ) 1 needs supervision when turning ( ) 0 needs assist to keep from losing balance or falling TURN 360 DEGREES INSTRUCTIONS: Turn completely around in a full circle. Pause. Then turn a full circle in the other direction. ( ) 4 able to turn 360 degrees safely in 4 seconds or less ( ) 3 able to turn 360 degrees safely one side only 4 seconds or less ( ) 2 able to turn 360 degrees safely but slowly ( ) 1 needs close supervision or verbal cuing ( ) 0 needs assistance while turning PLACE ALTERNATE FOOT ON STEP OR STOOL WHILE STANDING UNSUPPORTED INSTRUCTIONS: Place each foot alternately on the step/stool. Continue until each foot has touched the step/stool four times. ( ) 4 able to stand independently and safely and complete 8 steps in 20 seconds ( ) 3 able to stand independently and complete 8 steps in > 20 seconds ( ) 2 able to complete 4 steps without aid with supervision ( ) 1 able to complete > 2 steps needs minimal assist ( ) 0 needs assistance to keep from falling/unable to try
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STANDING UNSUPPORTED ONE FOOT IN FRONT INSTRUCTIONS: (DEMONSTRATE TO SUBJECT) Place one foot directly in front of the other. If you feel that you cannot place your foot directly in front, try to step far enough ahead that the heel of your forward foot is ahead of the toes of the other foot. (To score 3 points, the length of the step should exceed the length of the other foot and the width of the stance should approximate the subjects normal stride width.) ( ) 4 able to place foot tandem independently and hold 30 seconds ( ) 3 able to place foot ahead independently and hold 30 seconds ( ) 2 able to take small step independently and hold 30 seconds ( ) 1 needs help to step but can hold 15 seconds ( ) 0 loses balance while stepping or standing STANDING ON ONE LEG INSTRUCTIONS: Stand on one leg as long as you can without holding on. ( ) 4 able to lift leg independently and hold > 10 seconds ( ) 3 able to lift leg independently and hold 5-10 seconds ( ) 2 able to lift leg independently and hold L 3 seconds ( ) 1 tries to lift leg unable to hold 3 seconds but remains standing independently. ( ) 0 unable to try of needs assist to prevent fall
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Gait Speed
Figure 3 displays a suggested reliable, inexpensive method to collect WS by using the 10 meter (m) walk test. It requires a 20m straight path, with 5m for acceleration, 10m for steady-state walking, and 5m for deceleration. Markers are placed at the 5 and 15m positions along the path. The patient begins to walk at a comfortable pace at one end of the path, and continues walking until he or she reaches the other end. The Physical Therapist uses a stopwatch to determine how much time it takes for the patient to traverse the 10m center of the path, starting the stopwatch as soon as the patients limb crosses the first marker and stopping the stopwatch as soon as the patients limb crosses the second marker. If a full 20m walkway is not available, shorter distances can be used, as long as there is adequate room for acceleration and deceleration (e.g., 5ft acceleration, 10ft. steady state, 5ft. deceleration).
Fritz, Stacy and Lusardi, Michelle; White Paper: Walking Speed: the Sixth Vital Sign; Journal of Geriatric Physical Therapy; Vol. 32;2:09
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ROLAND-MORRIS QUESTIONNAIRE
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ROMBERG TEST
The Romberg Test and Sharpened Romberg Test are tests of static balance that measure the ability to maintain balance with a narrowed base of support. The Romberg Test is performed with feet together and eyes open for 60 seconds and with feet together and eyes closed for 60 seconds. The Sharpened Romberg Test is performed in a tandem standing position, with the dominant foot behind the non-dominant foot for 60 seconds with eyes open and for 60 seconds with eyes closed. Timing starts after the subject has assumed the proper position and is stopped if the subject moves his or her feet from the proper position, opens his or her eyes on the eyes-closed trials, or when the maximum balance time of 60 seconds is reached. Subjects may be given assistance to assume the test position. Up to three trials may be performed if the maximum balance time is not reached in either of the first 2 trials. Upper-extremity use is not controlled during testing.
(Steffan and Seney, 2008).
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SF 36 Scoring Tool
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15. Lift basket (standing): Subject picks up basket by grasping the handles and placing it on bedside table.
FMA: Upper Extremity Portion I. Reflex activity 1. Biceps 2. Triceps II. Flexor synergy 3. Shoulder retraction 4. Shoulder elevation 5. Shoulder abduction 6. Shoulder outward rotation 7. Elbow flexion 8. Forearm supination III. Extensor synergy 9. Shoulder adduction/inward rotation 10. Elbow extension 11. Forearm pronation IV. Movements combining synergies 12. Hand move to lumbar spine 13. Shoulder flexion 0 to 90 14. Elbow 90, pronation/supination V. Movements out of synergy 15. Shoulder abduction 0 to 90 16. Shoulder flexion 90 to 180 17. Elbow 0, pronation/supination VI. Reflex activity 18. Normal reflex activity, biceps and triceps VII. Wrist 19. Elbow 90, wrist stability 20. Elbow 90, wrist flexion/extension range of motion 21. Elbow 0, wrist stability 22. Elbow 0, wrist flexion/extension range of motion 23. Wrist circumduction VIII. Hand 24. Fingers, mass flexion 25. Fingers, mass extension
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26. Grasp a: First and radial surface of second digit pinch paper. 27. Grasp b: First and second digit pinch paper. 28. Grasp c: First and third digit pinch pencil. 29. Grasp d: First, second, and third digit grip coke can. 30. Grasp e: All digits grip tennis ball. IX. Coordination/speed 31. Tremor 32. Dysmetria 33. Speed
*Wolf, Steven L., et al., Assessing Wolf Motor Function Test as Outcome Measure for Research in Patients After Stroke; Stroke 2001;32;1635-1639
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(WOMAC)
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