Validations of the Computerized Adaptive Testing System of the Functional Assessment of Stroke
Condition: Stroke
MeSH terms: Stroke
Study type: Observational [Patient Registry]

Summary: 
      Purposes: The aim of this study is to preliminarily validate the test-retest reliability,
      random measurement error, practice effect, and responsiveness of the the Computerized
      Adaptive Testing System of the Functional Assessment of Stroke (CAT-FAS) in real clinical
      settings.

      Methods: Patients in both chronic (get stroke over 6 months) and sub-acute (get stroke less
      than 6 months) stages will be recruited. These patients will be classified into "test-retest
      reliability group" and "responsiveness group" to examine the test-retest reliability and
      responsiveness of the CAT-FAS, respectively. All participants will receive the
      administrations of CAT-FAS twice. For those in the test-retest reliability group, the
      administrations will be performed with a 4-week interval. For those in the responsiveness
      group, the administrations will be performed at admitting to the rehabilitation unit and
      before they are discharged.
    

Detailed description: 
      Participants Persons with stroke were recruited from the Department of Physical Medicine and
      Rehabilitation at a medical center in Taiwan using consecutive sampling. The study was
      approved by the local institutional review board, and all of the participants provided
      informed consent. Because the targeted populations for examining the test-retest reliability
      and responsiveness were different, the inclusion and exclusion criteria are listed separately
      below.

      Test-retest reliability Outpatients with chronic stroke were recruited to examine the
      test-retest reliability. The participants met the following criteria: (1) diagnosis of
      cerebral hemorrhage or cerebral infarction, (2) age ≥ 20 years, (3) stroke onset ≥ 6 months
      (first and recurrent stroke included), and (4) ability to follow 3-step verbal instructions.

      Responsiveness Inpatients undergoing rehabilitation with subacute stroke were recruited to
      examine the responsiveness. The participants met the following criteria: (1) diagnosis of
      cerebral hemorrhage or cerebral infarction, (2) age ≥ 20 years, (3) stroke onset < 3 months
      (first and recurrent stroke included), and (4) ability to follow 3-step verbal instructions.

      Procedures Test-retest design was adopted. The data were collected by an experienced and
      well-trained occupational therapist, and included demographic characteristics, the National
      Institutes of Health Stroke Scale (NIHSS), and the the Computerized Adaptive Testing System
      of the Functional Assessment of Stroke (CAT-FAS). The demographic and clinical
      characteristics were gathered from medical records. The NIHSS and the CAT-FAS were
      administered by the therapist twice, at different intervals depending on the groups. For the
      participants in the test-retest reliability group, the two assessments were performed at an
      one-month interval. For participants in the responsiveness group, the two assessments were
      administered at study commencement and hospital discharge.
    

Intervention name(s): the Computerized Adaptive Testing System of the Functional Assessment of Stroke (CAT-FAS)
Intervention type(s): Diagnostic Test
Intervention description(s): The CAT-FAS comprises 58 items. The items were selected from four well-known physical function measures for patients with stroke: 26 items from the Fugl-Meyer Assessment-Upper Limb, 11 items from the Fugl-Meyer Assessment-Lower Limb, 12 items from the Postural Assessment Scale for Stroke Patients, and 9 items from the Barthel Index. These items evaluate motor control, postural control, and activity of daily living functions in patients with stroke. The CAT-FAS assesses all these functions simultaneously. Results are automatically reported as Rasch scores. A higher score indicates greater physical functions. In the previous study, results indicated that the CAT-FAS had sufficient efficiency (< 10 items on average), reliability (Rasch reliability ≥ 0.88), concurrent validity (Pearson r ≥ 0.91), and responsiveness (SRM ≥ 0.65) in persons with stroke.
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Persons with stroke were recruited from the Department of Physical Medicine and
        Rehabilitation at a medical center in Taiwan using consecutive sampling.