Classification of Limb and Mobility Impairments in Persons With Stroke Using the STREAM

Abstract

Background and Purpose: Classification of functional impairment in persons with stroke can influence treatment planning but this information is missing in the Stroke Rehabilitation Assessment of Movement (STREAM) Scale. This study aimed to establish the classification of limb mobility impairments and item difficulty of the STREAM. Methods: Rasch analysis was conducted on the STREAM scores to examine the person and item reliability, the item difficulty, and level of impairments. A total of 240 participants were evaluated using the STREAM, the Fugl-Meyer Stroke Assessment (FM), and the Functional Ambulation Categories (FAC). The concurrent validity of the STREAM extremity (STREAM-E) category with the FM-motor category and the STREAM mobility (STREAM-M) category with the FAC category was analyzed using the Spearman rank-order correlation. Results: Person reliabilities of the STREAM-E and STREAM-M were 0.92 and 0.80, respectively. High-item reliability was observed in both STREAM-E (0.97) and STREAM-M (0.99). The STREAM items "flexes hip and knee in supine"and "rolls onto side"were the easiest items, whereas the "dorsiflexes affected ankle with knee extended"item was the most difficult item. The STREAM-E category demonstrated excellent concurrent validity with the FM-motor category (ρ = 0.83) in classifying individuals with stroke into 5 groups: mild, moderate, moderately severe, severe, and very severe limb impairment. The STREAM-M category showed a moderate correlation with the FAC category (ρ = 0.71) in categorizing persons with stroke into 3 groups: mild, moderate, and severe mobility impairment. Discussion and Conclusions: Findings can be used in the assessment and treatment planning of persons with stroke. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A373).