A Cognitive-Augmented Mobility Program (CAMP): Combining Cognitive Strategy Training And Best Evidence Mobility Training To Optimize Long-Term Meaningful Living For People With Stroke
Phase: NA
Conditions: Stroke
Sponsor: Sunnybrook Health Sciences Centre

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A Cognitive-Augmented Mobility Program (CAMP): Combining 
Cognitive Strategy Training And Best Evidence Mobility 
Training To Optimize Long-Term Meaningful Living For People 
With Stroke 
 
PRINCIPAL INVESTIGATOR 
Sara McEwen, BSc (PT), MSc, PhD 
Scientist, Sunnybrook Research Institute 
Assistant Professor, Dept of Physical Therapy and Rehabilitation Sciences Institute, University 
of Toronto 
 
CO-INVESTIGATORS 
Joyce Chen, PT, PhD, Scientist, Sunnybrook Research Institute 
 
Elizabeth Inness, PT, PhD, Clinic Lead, Balance, Mobility & Falls Clinic, UHN - Toronto Rehab  
 
Elizabeth Linkewich, MPA, OT Reg (Ont), Director, Regional Stroke Centre and North and East 
Greater Toronto Area Stroke Network, Sunnybrook Health Sciences Centre (SHSC) 
 
Jennifer Shaffer, PT,MSc, Physiotherapy Professional Practice Leader, SHSC-St. John’s Rehab  
 
Ada Tang, PT, PhD, Assistant Professor, McMaster University 
 
RESEARCH STAFF 
 
Katherine Dittmann, PT, MSc, Clinical Research Coordinator, Sunnybrook Research Institute 
Kay-Ann Allen, BSc, Research Assistant, Sunnybrook Research Institute 
Jorge Rios, BSc, Lab Manager, McEwen Lab, Sunnybrook Research Institute 
 
 

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RESEARCH PROTOCOL 
1.0 OBJECTIVE 
This project will combine best-evidence gait and mobility training with best evidence 
cognitive strategy training to produce a new cognitive-augmented mobility intervention that 
is expected to optimize long-term functional mobility outcomes for those living with stroke. 
More importantly, the new cognitive-augmented mobility program (CAMP) will address two 
crucial outcomes that do not occur with current approaches: 1. Maintenance of mobility 
gains after discharge from formal rehabilitation and 2. Transfer of skills learned in 
rehabilitation to real-world community living. This project will result in a new, fully defined 
intervention, and will provide effect size and cost estimates to design a future appropriately 
powered randomized controlled trial (RCT). 
2.0 RATIONALE 
After a stroke, two-thirds of survivors do not participate meaningfully in their 
communities.1 Approximately half are dependent in activities of daily living;1,2 most 
experience restrictions in physical exercise, housekeeping, and outdoor activities;3 and they 
are significantly less active than age-matched controls.4 While reasons for these poor 
outcomes are multi- factorial, dysfunctional gait is recognized as the most important factor 
associated with ongoing restrictions in activity and participation.5 Two recent meta analyses 
concluded that physical rehabilitation interventions do improve function and mobility after a 
stroke, but only during the intervention period.6,7 To have a sustained, meaningful impact on 
activity and community participation, two intervention outcomes are crucial: 1. Gains made 
during a formal rehabilitation program must be maintained after discharge to the 
community; and 2. The finite number of skills learned in a formal rehabilitation program must 
be transferred to new contexts and situations that the person encounters after discharge. 
Evidence suggests that current gait and mobility interventions do not usually impact 
maintenance and transfer of skills learned. Cognitive strategy training has demonstrated a 
large effect on skill transfer in people with stroke compared to dose-matched controls, and 
the large effect is maintained at follow-up.8,9 
In an extensive meta-analysis, Veerbeek et al. concluded that several physiotherapy 

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interventions are associated with statistically significant effects, but the magnitude of 
differences between treatment and control groups was small to moderate, improvements 
were restricted only to the intervention period, and changes were limited to those activities 
specifically trained in the intervention.7 Task-specific training (TST) and combined 
cardiorespiratory and  strength exercises (CSE) were identified among the most efficacious 
interventions. TST is training or therapy where patients practice specific functional motor 
tasks and receive feedback.10 TST approaches, such as treadmill-based training, activity-based 
balance training, and functional activity-based circuit training showed significant positive 
effects on walking speed and distance and general physical activity, but not on health-related 
quality of life (HRQoL) or participation and only during the intervention phases.7 
Cardiorespiratory and strength exercises (CSE) are those that specifically target aerobic 
fitness and muscle strength. CSE approaches have largely similar benefits and limitations as 
TST.7 While some CSE studies have shown an effect on aspects of HRQoL (see for example 
Stroke. 2005;36[8]:1764-1770), results are not maintained and whether there is a true effect 
is inconclusive.11 
Cognitive strategy training approaches, such as Cognitive Orientation to daily 
Occupational Performance (CO-OP),12 are performance-based approaches that teach clients 
to independently use global cognitive strategies to solve performance problems, supported 
by therapists’ use of guided discovery. Global cognitive strategies provide a consciously 
applied problem-solving structure to support goal-directed learning, and include a self-
evaluation component. Guided discovery is a means of providing instruction and feedback in 
which a knowledgeable therapist guides the client to self-discover solutions to functional 
problems through a process of questioning, hinting and cueing rather than more typically 
applied direct and explicit instruction.13 When combined with TST of activities of daily living 
(largely upper-extremity-based), cognitive strategy training programs have a large and 
maintained effect compared to controls on transfer to untrained transfer goals8,9,14 and 
functional independence9 in people with stroke. Compared to controls, cognitive strategy 
training has also demonstrated an effect on apathy, self-efficacy, participation, aspects of 
HRQoL, cognitive flexibility and upper extremity function.8,9,14-16 These positive results have 

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been observed with an average 9 hours of treatment,8 far less than the 20-75 hours 
estimated for pure TST approaches for similar effects, suggesting the approach may also be 
cost-effective.17 Despite these successes, the effect on mobility has been small. In recent 
work focused on activities of daily living, participants in the cognitive strategy group reported 
an average 7 point change on the Stroke Impact Scale mobility domain, which is not 
considered to be clinically important.15 
We postulate that using a global cognitive strategy together with therapist use of 
guided discovery teaches participants a simple and effective problem-solving framework that 
leads to success with their functional performance issues. Having success builds self-efficacy 
to re-learn skills, which then leads to motivation to practice independently in new contexts 
(leading to maintenance) and the confidence to attempt new skills as the need arises (leading 
to transfer). We further postulate that adding cognitive strategy training to best evidence 
task-specific gait and mobility training and CSE will ensure good mobility outcomes while 
simultaneously addressing the shortcomings related to maintenance and transfer of 
improvements. This project will answer four specific research questions: 
1. 
Based on literature review and expert opinion, what best evidence 
components and processes should be included in a preliminary model for a new 
cognitive augmented mobility program (CAMP) for survivors of stroke? 
2. 
Is CAMP feasible to implement with survivors of stroke who have been 
discharged from outpatient rehabilitation? Feasibility criteria include practicality (no 
adverse events, non-medical withdrawal rate <20%, attendance rate >80%), and 
acceptability to patients and therapists (satisfaction and intent to continue to use). 
3. 
What is the estimated effect of CAMP post-intervention and at 1-month 
follow-up (maintenance) on gait speed, endurance, balance, activity and mobility 
self-efficacy, mobility goal attainment, mobility skill transfer, functional 
independence, HRQoL, and participation? 
4. 
What is the preliminary estimated cost and cost effectiveness of CAMP? 
3.0 METHODOLOGY 
The Medical Research Council (MRC) in the United Kingdom established a framework 

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for development and evaluation of complex interventions.18 CAMP is a complex intervention 
in that it has several interacting components along with additional dimensions of complexity 
such as heterogeneity of patients, numerous and variable outcomes, and permits a significant 
degree of individual tailoring.18 The MRC framework consists of development, feasibility/pilot 
testing, evaluation, and implementation stages. The current project will address the first two 
of these stages, intervention development and feasibility/pilot testing. 
3.1 Intervention Development 
This stage consists of identifying the evidence base, identifying relevant theory, and 
intervention model development. Theoretical foundations for all intervention framework 
components (TST, CSE, cognitive strategy training) have been specified previously.12,17,19,20 
The theoretical justification for combining motor and cognitive domains in a single approach 
has been outlined;12,21,22 and includes a substantial collection of neuroimaging data indicating 
that brain regions traditionally considered to be cognitive, such as the dorsolateral prefrontal 
area, are active during complex motor skill acquisition and when implementing motor tasks 
in presence of neuropathology.22 Thus, we begin with model development using the 
following steps: literature review, preliminary CAMP model development by investigators, 
and refinement of the CAMP model for pilot testing. 
Stroke rehabilitation literature was reviewed with an emphasis on meta-analyses and 
evidence-based practice guidelines. Clinical research coordinator KD and principal 
investigator SM use extracted information to develop a preliminary model for CAMP 
(described in the section below). The CAMP preliminary model will be reviewed by the 
studies co-investigators who have expertise in TST (JC), CSE (AT) , balance and mobility (EI), 
cognitive strategy training (EL) and the stroke health system (EL,JS).  The final CAMP model 
will be decided by group consensus.  
3.1.1 Preliminary CAMP Model Overview 
CAMP will combine education, one-on-one cognitive strategy training, and a cardiovascular 
and strength-training program conducted within a group setting. It will be run as a group of 
up to 6 participants, facilitated by a physiotherapist (PT) and a physiotherapy assistant (PTA) 
or kinesiologist (KIN). It consists of 2 phases with a total of 19 sessions: Intervention 

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Preparation (3 sessions), Active Intervention (16 sessions), and Follow-Up (1 session). 
 
3.1.1.1 Phase 1, Intervention Preparation: There will be two education sessions that 
will occur with the whole group. The first education session will introduce the rationale for 
CAMP, explaining the benefits of cognitive strategy training, task-specific training, and 
cardiorespiratory and strength training, and will be one hour long. The second education 
session will teach the global cognitive strategy that is used for self-directed problem solving, 
and will also be one hour long.  In between the two education sessions there will be a one-
on-one session with each participant and the PT to set individual functional mobility goals for 
the intervention that will also be one hour long. To minimize participant travel, some goal 
setting sessions will occur immediately after Education Session #1, and some will occur 
immediately before Education Session #2.  
 
3.1.1.2 Phase 2, Active Intervention: The intervention sessions will consist of a 60-
minute individualized exercise program (ExP), conducted within a group, twice per week for 8 
weeks (16 sessions total), developed by a physiotherapist and overseen by a PTA or KIN; and 
a 30-minute goal practice (GP) session that will occur one-on-one with a licensed 
physiotherapist, once per week (8 sessions total).  The one-on-one GP sessions will be 
adjacent to the ExP group sessions, so participants will only attend the CAMP program twice 
per week total, once for 90 minutes (30 minutes one-on-one and 60 minutes group) and once 
for 60 minutes (group only). Up to 6 participants will go through the CAMP program at a 
time.  
 
During the one-on-one GP session the PT will implement the use of global cognitive 
strategies to teach the participants to consciously apply problem-solving skills to attain the 
goals they have set.  The PT will use guided discovery to assist the participants to discover 
strategies to achieve their individual mobility goals.  
 
Group ExP sessions will include a warm-up and cool-down, approximately 20 minutes 
of aerobic exercise individually prescribed (e.g. stationary bike, treadmill, or overground 
walking), and approximately 30 minutes of resistance and task-oriented training (e.g. heel 
raises, toe raises, squats, lunges, sit-to-stand, walk and carry tasks, reaching tasks, modified 
push ups, sit-ups/curls, bridging, etc). A physiotherapist will develop an ExP individualized for 

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each participant following their goal-setting session and before Session #1. The ExP will be 
modified on an ongoing basis based on heart rate and input from the participant regarding 
his or her perception about the utility of the ExP towards goal achievement. 
3.2 Feasibility/Pilot Testing 
A single group pre-post design and 1-month follow-up with 12 participants will be 
employed for feasibility and pilot testing. Inclusion criteria are patients aged 18 years of age 
who are post stroke (ICD-10 codes 160-164), have completed outpatient therapy and who can 
walk a minimum of 3 metres with or without an aid. Those without mobility goals, with 
neurological diagnoses other than stroke, major psychiatric illness, and significant dementia 
(MoCA scores <21)23 will be excluded. A research assistant not involved with delivering the 
intervention will conduct assessments, and will occur pre and post intervention and at a 1-
month follow up. Feasibility will be determined by evaluating practicality (recruitment and 
withdrawal rates, adverse events, attendance), which will be evaluated by logs kept 
throughout the recruitment and intervention process , and acceptability (participant 
satisfaction and intent to continue use), which will be determined using a short Likert-type 
survey administered immediately post-intervention (Appendix A). Additionally, participant 
experiences with the CAMP program will be explored using a semi-structured interview that 
will be conducted at the 1-month follow-up assessment (See Appendix B for Interview Guide). 
The interviews will be audio recorded and transcribed verbatim and subsequently analyzed 
using directed content analysis (Hsieh & Shannon, 2005). Outcomes for pilot testing will 
include gait speed, endurance, balance, activity and mobility self-efficacy, goal performance 
and attainment, functional independence, participation and HRQoL. All outcome measures are 
described in detail in Appendix C. To estimate cost the number of visits, time spent with health 
professionals, hourly cost of health professionals, and equipment required will be considered. 
To estimate cost-effectiveness quality-adjusted life-year (QALY) gained will be estimated using 
SF-12 data collected (derived from the SF-36). Sf-12 data will be converted to a utility score 
using a validated algorithm. Data analysis for quantitative outcomes will be exploratory and 
descriptive; changes scores, confidence intervals and effect size estimates will be calculated 
for all outcomes, to plan for a future RCT. 

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3.3 Timeline 
In the first 6 months (July 2016-December 2016), REB approval will be obtained, and 
the literature review, model development, and model refinement will be completed. 
Recruitment will begin in January 2017. Past experience suggests a recruitment rate of 
approximately 2 participants per month; up to 6 participants will be recruited from January 
2017-March 2017 and will go through CAMP together in April and May 2017, with 2-month 
follow-up in July 2017. A second group of up to 6 participants will be recruited from April 
2017- August 2017 and will go through CAMP in September and October 2017 , with 2-
month follow-up occurring in December 2017. Analysis and manuscript preparation will 
occur in January and February 2018. 
4.0 EXPECTED PROJECT OUTCOMES 
The immediate outcome of this development work will be a fully defined novel gait 
and mobility intervention and effect size and cost estimates to design an appropriately 
powered RCT. Long-term outcomes may include improved functional mobility, community 
participation, and productivity for those living with the effects of stroke, decreased health 
system costs, and improved understanding of motor-cognition interactions. From a systems 
level the development of rehabilitation research capacity by engaging and educating 
therapists and scientists will build evidence for a more integrative approach to stroke 
rehabilitation and contribute to an overall shift in practice. 
 
 

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REFERENCES 
1. Mayo NE, Wood-Dauphinee S, Cote R, Durcan L, Carlton J. Activity, participation, and 
quality of life 6 months poststroke. Arch Phys Med Rehabil. 2002;83(8):1035-1042. 
2. Appelros P, Samuelsson M, Karlsson-Tivenius S, Lokander M, Terent A. A national stroke 
quality register: 12 years experience from a participating hospital. Eur J Neurol. 
2007;14(8):890-894. 
3. van der Zee CH, Visser-Meily JM, Lindeman E, Jaap Kappelle L, Post MW. Participation in the 
chronic phase of stroke. Top Stroke Rehabil. 2013;20(1):52-61. 
4. Alzahrani MA, Ada L, Dean CM. Duration of physical activity is normal but frequency is 
reduced after stroke: An observational study. J Physiother. 2011;57(1):47-51. 
5. Andrenelli E, Ippoliti E, Coccia M, et al. Features and predictors of activity limitations 
and participation restriction 2 years after intensive rehabilitation following first-ever 
stroke. Eur J Phys Rehabil Med. 2015. 
6. Pollock A, Baer G, Campbell P, et al. Physical rehabilitation approaches for the 
recovery of function and mobility following stroke. Cochrane Database Syst Rev. 
2014;4:CD001920. 
7. Veerbeek JM, van Wegen E, van Peppen R, et al. What is the evidence for physical 
therapy poststroke? A systematic review and meta-analysis. PLoS ONE. 
2014;9(2):e87987. 
8. McEwen SE, Polatajko H, Baum C, et al. Combined cognitive-strategy and task-specific 
training improves transfer to untrained activities in subacute stroke: An exploratory RCT. 
Neurorehabil Neural Repair. 2015;29(6):526-536. 
9. Skidmore ER, Dawson DR, Butters MA, et al. Strategy training shows promise for 
addressing disability in the first 6 months after stroke. Neurorehabil Neural Repair. 
2015;29(7):668-676. 
10. Teasell RW, Foley NC, Salter KL, Jutai JW. A blueprint for transforming stroke rehabilitation 
care in Canada: The case for change. Arch Phys Med Rehabil. 2008;89(3):575-578. 
11. Pang MY, Charlesworth SA, et al. Using aerobic exercise to improve health outcomes and 
quality of life in stroke... Cerebrovasc Dis. 2013;35(1):7-22. 
12. Polatajko H, Mandich A. Enabling occupation in children: The cognitive orientation 
to daily occupational performance (CO-OP) approach. Ottawa, ON: CAOT Publications 
ACE; 2004. 
13. Mayer RE. Should there be a three-strikes rule against pure discovery learning? The 
case for guided methods of instruction. Am Psychol. 2004;59(1):14-19. 
14. Skidmore ER, Dawson DR, Whyte EM, et al. Developing complex interventions: Lessons 
learned from a pilot study examining strategy training in acute stroke rehabilitation. Clin 
Rehabil. 2014;28(4):378-387. 
15. Wolf TJ, Polatajko HJ, Baum C, et al. Combined cognitive-strategy and task-specific 
training affects cognition and upper-extremity function in subacute stroke: An 
exploratory RCT. AJOT 2016;70(2):1-10. 
16. Skidmore ER, Whyte EM, Butters MA, Terhorst L, Reynolds CF,3rd. Strategy training 
during inpatient rehab may prevent apathy symptoms after acute stroke. PM R. 
2015;7(6):562-570. 
17. 
French B, Leathley M, Sutton C, et al. A systematic review of repetitive functional task 

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practice resource use, costs and effectiveness. Health Technol Assess. 2008;12(30):iii, ix-x, 1-
117. 
18. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and 
evaluating complex interventions: The new MRC guidance. BMJ : British Medical Journal. 
2008;337:a1655. 
19. Wevers L, van de Port I, Vermue M, Mead G, Kwakkel G. Effects of task-oriented circuit class 
training on walking competency after stroke: A systematic review. Stroke. 2009;40(7):2450-
2459. 
20. Brogardh C, Lexell J. Effects of cardiorespiratory fitness and muscle-resistance training 
after stroke. PM R. 2012;4(11):901-907. 
21. Fuster JM. The cognit: A network model of cortical representation. 
IntJPsychophysiol. 2006;60,125-132. 
22. Serrien DJ, Ivry RB, Swinnen SP. The missing link between action and cognition. Prog 
Neurobiol. 2007;82(2):95-107. 
23. Aggarwal A, Kean E. Comparison of the Folstein MMSE to the MoCA as a cognitive 
screening tool in an inpatient rehabilitation setting. 2010;1:39-42. 
24. 
Mayo NE, Korner-Bitensky NA, Becker R. Recovery time of independent function post-
stroke. Am J Phys Med Rehabil. 1991;70(1):5-12. 
 
 
 

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APPENDICES 
 Appendix A: CAMP Satisfaction and Intent to Use Questionnaire 
 
 
Strongly 
disagree 
Somewhat 
disagree 
Neither 
agree or 
disagree 
Somewhat 
agree 
Strongly 
agree 
1. I am satisfied with the 
CAMP program 
1 
2 
3 
4 
5 
2. I will continue to use the 
skills I learned during the 
CAMP program 
1 
2 
3 
4 
5 
 
 

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Appendix B: Pilot Testing Interview Guide 
 
Opening Statement: Thanks once again for your participation in this study to develop a new 
program to help people who have had a stroke to relearn mobility skills and improve their 
fitness, called the Cognitive-Augmented Mobility Program (CAMP). This interview will help us 
to better understand your experiences with CAMP. In particular, we are interested in your 
experiences with making Goals and Plans and executing those Plans, your experiences with the 
program as a whole, whether or not you found it helpful to be involved with the development of 
your own Plan, whether or not you continued with an exercise program after CAMP ended, and 
if not, what were the reasons you did not.  Findings from these interviews will be used to 
generate a better understanding of the perspective on this new program from those who are 
actually using it, and will help us to make the program better for other people in the future. 
Please feel free to be completely open. When we report on this interview, your name will not be 
used. Your name will not appear in any reports related to this project. You should feel free to 
speak your mind. 
 
Do you have any questions before we begin? 
 
If it's O.K. with you, I may take a few notes throughout the interview. 
 
1. Why did you want to participate in the CAMP research project?  
 
2. Please describe your overall experience with the CAMP program.   
Probes: Was there anything you particularly liked or disliked? Was it similar to other 
rehabilitation experiences you had? Why or why not? 
 
3. Can you tell me about setting mobility and fitness goals at the beginning of CAMP? 
Probes: Can you tell me more about the goal-setting process? What goals did you set? Did 
you find it helpful to set goals? Were you able to implement your plan?  Please elaborate.  
 
4. Can you tell me about the process of developing a plan to meet your goals? 
Probes: How easy or difficult was it for you to develop plans? What sorts of things did you 
try? Which plans worked? Which plans didn’t work?   
 
5. Were you able to implement your plans outside of CAMP, that is to say at home or in 
your community?  
Probes: Can you tell me more about that? What worked or didn’t work?  
 
6. CAMP began with an education component.  Was the information you received 
helpful? 
Probes: Was the information new to you? Did the information help with your goal setting? 
What would have been more helpful? Was the information presented in a helpful way? How 

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would you have preferred to receive the information? 
 
7. As part of the CAMP program, there was a time slot each week devoted to working on 
your personal mobility and fitness goals. Can you tell me about that?  
Probes: Did you achieve your goals? Were the one-on-one goal-focused sessions helpful in 
achieving your goals? What could have been done differently? 
 
8. Another part of the CAMP program was working on exercises that were specific to you 
and your goals.  Can you tell me about the exercise part of CAMP?  
Probes: Did the exercises help you to achieve your goals? Were the exercises the right 
difficulty level? Could they have been easier or harder? Did you have input into changing the 
exercises when it was necessary to do so?  
 
9. After CAMP was over, were you able to continue with an exercise program or continue 
improving your walking and other mobility?  
Probes:  Why or why not? What helped you to continue making gains after the CAMP 
program? What were the barriers to making gains after the program ended? Have you sought 
other rehabilitation services since? 
 
10. Is the approach used in this program new to you?  Have you used it before in a 
different setting?  Probes: Have you been involved in goal setting and planning your 
program before CAMP? Have you had to problem solve to improve your ability to complete 
a task before?  
 
11. Are you currently facing any challenges with day-to-day activities?  
Probes: How are you managing these challenges? Did the CAMP program have any role in 
helping you to manage these challenges or other challenges?   
 
12. Is there anything else you would like to tell me about the CAMP program, either 
positive or negative? 
 
General Probes: Can you elaborate on that idea? Would you explain that further? I’m not sure I 
understand what you are saying. Is there anything else? Would you give me an example? Can 
you give me a specific example? Do you personally feel that way? Is that something you have 
experienced? Can you tell me more? Can you expand on your answer? 
 
Closing Statement: Thank you for participating in this interview today. Your responses will help 
us to make CAMP better for others in the future.  

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Appendix C: Description of Outcome Measures 
Instrument(s) 
Description and Pyschometric Properties 
 
Gait speed 
5 metre walk test (5 
mWT)a 
The 5 mWT is a measure of gait speed where participants are asked to walk 
a distance of 5 m including an additional 2 m to accelerate and 2 m to 
decelerate. The 5 mWT has high reliability and responsiveness in stroke.a,b 
 
Endurance 
6-minute walk test 
(6MWT)c 
The 6MWT is a widely used measure of walking endurance after stroke and 
has shown excellent reliability in stroke populations.d-f 
 
Balance 
Berg Balance Scale 
(BBS)g 
The BBS is a 14-item assessment of static balance and fall risk. In stroke 
populations, the BBS has excellent test-retest and interrater reliability and a 
minimally detectable change of 4.7.h,i 
Mini BESTestj 
The Mini BESTest is a 14 item assessment that uses a 3-level ordinal scale to 
assess dynamic balance. The Mini BESTest has excellent reliability and a cut-
off score of 17.5 is used with people with chronic stroke.k 
 
Balance and mobility self-efficacy 
Activity-specific 
Balance Confidence 
Scale (ABC)l 
The ABC is a 16-item assessment that measures a participant’s confidence 
to perform daily activities without falling. The ABS has excellent internal 
consistencym and adequate to excellent test-retest reliability.n 
 
Individualized mobility goal attainment 
Canadian 
Occupational 
Performance Measure 
(COPM)o 
The COPM is a semi-structured interview that focuses on identifying 
activities within performance domains that are important to the client The 
client and therapist then create goals for therapeutic interventions. The 
COPM has been validated for use with stroke patients.p 
 
Mobility skill transfer 
Community Balance 
and Mobility Scaleq;  
The CB&M measures balance and mobility in participants and is less 
susceptible to ceiling effects than other commonly used balance scales. 
Item(s) will not be trained during CAMP and will be assessed as a universal 
transfer item. 
 
Functional independence 
Functional 
Independence 
Measure (FIM)r 
The FIM is a reliables 18-item measure that asks a rater to assess the 
amount of assistance a patient requires to complete ADL using a 7-level 
scale. The FIM has two subscales, motor and cognition. 
 
Health-related quality of life 
Stroke Impact Scale 
(SIS)t 
The SIS is a 59-item questionnaire about the perceived impact of stroke on 
function and everyday life. Each item is scored on a 5-point Likert scale 
related to the degree of difficulty the person with stroke is experiencing. 
psychometric properties of the instrument are well-defined.t-v 
SF-36w 
The RAND 36-Item Short Form Health Survey (SF-36) will be administered 
and SF-12 scores will be derived from SF-36 data. The SF-12 has been 
validated for use with participants with strokex and the summary scores are 
strongly correlated with SF-36 summary scores in stroke populations.y  
 
Participation 
SIS participation 
domain 
See SIS description above. 
Community 
Participation 
Indicators (CPI)z 
The CPI is a self-report measure of community participation. The two 
enfranchisement factors importance of participation and control over 
participation are rated on a 5-point scale and scored using a Rasch-based 
key form. There is good evidence of validity and reliability.z 
Note. References for table 1 are found in the Appendices

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Appendix D: References For Outcome Measures 
a. Collen FM, Wade DT, Bradshaw CM. Mobility after stroke: Reliability of measures of 
impairment and disability. Int Disabil Stud. 1990;12(1):6-9. 
b. Salbach NM, Mayo NE, Higgins J, Ahmed S, Finch LE, Richards CL. Responsiveness 
and predictability of gait speed… in acute stroke. Arch Phys Med Rehabil. 
2001;82(9):1204-1212. 
c. Butland R, Pang J, Gross E, Woodcock A, Geddes D. Two-, six-, and twelve-minute 
walking tests in respiratory diseases. BMJ. 1982;284:1607-1608. 
d. Wevers LE, Kwakkel G, van de Port IG. Is outdoor use of the 6MWT with a GPS in stroke 
patients' own neighbourhoods reproducible and valid? J Rehabil Med. 
2011;43(11):1027-1031. 
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