Advertisement

Evaluation of Stroke: A Review

  • John L. Melvin
  • John Whyte

Summary

A comprehensive review of evaluation issues related to stroke would require more than a short chapter. However, the subject is of great importance. Stroke is the most frequent cause of death in the United States. Health care and lost productivity costs associated with stroke reached an estimated 15.6 billion dollars in the United States in 1991. Despite these significant impacts, clinicians in the United States often treat similar stroke patients quite differently. This suggests that greater uniformity in evaluation and treatment could result in better clinical outcomes and economic efficiency. To accomplish these goals, evaluation of stroke patients requires the development of a patient database that includes information categorized as in the International Classification of Impairment, Disability, and Handicap. Additionally it should include medical and quality-of-life information. Information regarding these conceptually different categories permits the development of appropriate strategies for their treatment and the framework to evaluate their outcomes. These categories also permit facilities to compare their results against others. Although clinicians focus primarily on medical and functional outcomes, organizations responsible for health care increasingly include patient and family satisfaction and cost efficiency as measures of effectiveness. Those performing evaluations select their measurement instruments on the basis of sensibility, validity, reliability, and sensitivity. A number of examinations, instruments, and scales provide appropriate information regarding the pathology, impairment, disability, handicap, and quality of life of stroke patients. This will increasingly become the foundation of clinical practice as outcome analysis influences which treatments may be utilized in the treatment of stroke.

Keywords

Life Satisfaction Stroke Patient Functional Independence Measure Skilled Nursing Facility Rehabilitation Hospital 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    World Health Organization (WHO) (1980) International classification of impairments, disabilities, and handicaps (ICDIDH). WHO, Geneva, SwitzerlandGoogle Scholar
  2. 2.
    American Heart Association (1991) Heart and stroke facts. American Heart Association, Washington, DCGoogle Scholar
  3. 3.
    Hosek S, Kane R, Carney M, Hartman J, Reboussin D, Serato C, Melvin JL (1986) Charges and outcomes for rehabilitative care, implications for the prospective payment system. RAND/UCLA Center for Health Care Financing Policy Research (R-3424-HFCA), University of California, Los AngelesGoogle Scholar
  4. 4.
    ProPAC (1991) Report to Congress: U.S. Government Printing Office, WashingtonGoogle Scholar
  5. 5.
    University of Minnesota School of Public Health, Institute of Health (1993) A final report: post acute care (HFCA #17-C98891). University of Minnesota, Minneapolis, Table 24Google Scholar
  6. 6.
    Jameison DG (1991) Acute management of the stroke patient. Phys Med Rehabil Clin North Am 2:437Google Scholar
  7. 7.
    Levine S (1977) The changing terrains in medical sociology: emergent concern with quality of life. J Health Soc Behav 28:1–6CrossRefGoogle Scholar
  8. 8.
    Hamilton BB, Granger CV, Sherwin FS, Zielezny M, Tashman JS (1986) A uniform national data system for medical rehabilitation. Rehabilitation Outcomes. Paul H, Brookes Publishing, BaltimoreGoogle Scholar
  9. 9.
    Brott T, Marier JR, Olinger CP, et al (1989) Measurements of acute cerebral infarction: a clinical examination scale. Stroke 20:864–870PubMedCrossRefGoogle Scholar
  10. 10.
    Twitchell TE (1951) The restoration of motor function following hemiplegia in man. Brain 74:443–480PubMedCrossRefGoogle Scholar
  11. 11.
    Brunnstrom S (1970) Movement therapy in hemiplegia: a neuropsychological approach. Harper and Row, New YorkGoogle Scholar
  12. 12.
    Prescott RJ, Garraway WM, Ahktar AJ (1982) Predicting functional outcome following acute stroke using a standard clinical examination. Stroke 13:641–644PubMedCrossRefGoogle Scholar
  13. 13.
    Kierman RJ, Mueller J, Langston JW, VanDyke C (1987) The neurobehavioral cognitive status examination: a brief but differentiated approach to cognitive assessment. Ann Intern Med 107:481–485Google Scholar
  14. 14.
    Osman DC, Smet IC, Winegarden B, Gandhavadi B (1992) Neurobehavioral cognitive status examination: its use with unilateral stroke patients in a rehabilitation setting. Arch Phys Med Rehabil 73:414–418Google Scholar
  15. 15.
    Wade DT, Wood VA, Heller A, et al (1987) Walking after stroke: measurement and recovery over the first three months. Scand J Rehabil Med 19:25–30PubMedGoogle Scholar
  16. 16.
    Lomas J, Laura P, Bester S, Elbard H, Finlayson A, Zogheib C (1989) The communicative effectivenes index: development and psychometric evaluation of a functional communication measure for adult aphasia. J Speech Hear Disord 54:113–124PubMedGoogle Scholar
  17. 17.
    Manochiopinig S, Sheard C, Reed VA (1992) Pragmatic assessment in adult aphasia: a clinical review. Aphasiology 6:519–533CrossRefGoogle Scholar
  18. 18.
    Holbrook M, Skilbeck CE (1983) An activities index for use with stroke patients. Age Aging 12:166–170CrossRefGoogle Scholar
  19. 19.
    Whiteneck GG, Charlifue MA, Gerhart KA, Overholser JD, Richardson GN (1992) Quantifying handicaps: a new measure of long-term rehabilitation outcomes. Arch Phys Med Rehabil 73:519–526PubMedGoogle Scholar
  20. 20.
    Randloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  21. 21.
    Himmelfarb S, Murreil SA (1983) Reliability and validity of five mental health scales in older persons. J Gerentol 38:333–334Google Scholar
  22. 22.
    Robinson RG, Boldue PL, Price TR (1987) Two-year longitudinal study of post mood stroke disorders: diagnosis and outcome at one and two years. Stroke 18:837–843PubMedCrossRefGoogle Scholar
  23. 23.
    Ware JE, Sherbourne CD (1992) The MOS 36 Item Short Form Health Survey. I. Conceptual framework and item selection. Med Care 30:473–481PubMedCrossRefGoogle Scholar
  24. 24.
    DeHaan R, Aaronson N, Limburg M, Langton HR, van Crevel H (1993) Measuring quality of life in stroke. Stroke 24:320–327CrossRefGoogle Scholar
  25. 25.
    Andrews FM, Crandall R (1976) The validity of measures of self-reported well being. Soc Indicat Res 3:1–19CrossRefGoogle Scholar
  26. 26.
    McDowell I, Newell C (1987) Measuring health: a guide to rating scales and questionnaires. Oxford, New YorkGoogle Scholar
  27. 27.
    Neugarten BL, Havighurst RJ, Tobin SS (1961) The measurement of life satisfaction. J Gerontol 16:134–143PubMedGoogle Scholar
  28. 28.
    Holroyd J (1987) Questionnaire on resources and stress. Clinical Psychology Publishing, BrandonGoogle Scholar

Copyright information

© Springer-Verlag Tokyo 1996

Authors and Affiliations

  • John L. Melvin
    • 1
    • 2
  • John Whyte
    • 1
    • 2
  1. 1.MossRehab Hospital and The Moss Rehabilitation Research InstitutePhiladelphiaUSA
  2. 2.Department of Physical Medicine and RehabilitationTemple UniversityPhiladelphiaUSA

Personalised recommendations