Chedoke-McMaster Stroke Assessment Measure

Acute Stroke: (Gowland et al 1993; n = 32; mean age = 64; mean time since stroke onset = 9 months)

• MCID = 8 points (total CMSA via stroke patients) and 7 points (total CMSA via caregivers of stroke patients).

> 9 on the leg and postural control scores indicates that the individual is able to ambulate independently. (Stevenson, 1999)

Acute Stroke: (Gowland et al, 1993)

• Excellent test-retest reliability, Disability Inventory (ICC = 0.98)

Acute Stroke: (Gowland et al, 1993)

• Excellent inter-rater reliability, Impairment inventory ICC = 0.97
• Excellent inter-rater reliability, Disability inventory ICC = 0.99
• Excellent intra-rater reliability, Impairment inventory ICC = 0.98

Acute Stroke: (Gowland et al, 1993)

• Excellent internal consistency, Total scale ICC = 0.98

Acute Stroke: (Gowland et al, 1993)

• Excellent concurrent validity: Fugl-Meyer (r = 0.95)
• Excellent concurrent validity: FIM (r = 0.79)
• Excellent concurrent validity: Barthel Index of ADLs (r = 0.75 -0.87 *Disability Index)
• Poor concurrent validity with, Barthel Index: areas of shoulder pain & eating and bowel incontinence (r <0.30)
• Excellent predictive validity, Physical Impairment Scale Leg postural control scores of >9 showed 100% sensitivity and 80% specificity in prediction of independent ambulation.
• Excellent predictive validity, Total outcome of CMSA stroke assessment could be predicted by 7 items on the Barthel Index (R-2 = 0.75)

Predictive Equations:

Predicting Clinical Outcomes following Stroke Rehabilitation (Gowland et al, 1995):

Outcome Variables 

 R squared

 Equation

 CI

Discharge Destination

0.38

5.97 – (0.06 x Gross Motor Function) – (0.21 x Bladder) 

±3.5

Length of Stay

0.38

22.03–(1.18 x Leg)–(0.05 x Adult FIMSM)–(0.06 xAge)

±6.9

Adult FIMSM

0.65

39.23+(0.73 x Adult FIMSM)

±29.6

Activity Inventory

0.73

17.45+(0.88 x Gross Motor Function) + (4.30 x Leg) 

±23.3

Gross Motor Function

0.7

24.94+(0.76 x Gross Motor Function)–(0.30 x Weeks) 

±16.1

Walking

0.71

(Gross Motor Function x 0.28)+(Postural Control+Leg x 1.23)–4.55

±9.2

Shoulder Pain

0.55

2.33+(0.44xShoulder Pain) + (0.28 x Arm)

±1.6

Postural Control

0.60

2.23 + (0.35 x Postural Control) + (0.3 x Leg) 

±1.3

Arm

0.80

0.82+(1.03 x Arm)-(0.03 x Weeks) 

±1.5

Hand

0.78

0.53+(0.98 x Hand) 

±1.5

Leg

0.69

1.83+(0.77 x Leg)-(0.02 x Weeks) 

±1.5

Foot

0.73

1.11+(0.90 x Foot)-(0.03 x Weeks) 

±1.3

Predictive Equations for Stroke Acute Care can be found http://www.chedokeassessment.ca/Default.aspx?tabid=531

Acute Stroke: (Gowland et al, 1993)

• Excellent convergent validity with subscales of the Fugl-Meyer Assessment (FMA)
• Excellent convergent validity with the CMSA Arm and hand Impairment Inventory and FMA shoulder, elbow, forearm, wrist and hand scale (r = 0.95)
• Excellent convergent validity with the CMSA Leg and foot Impairment Inventory and FMA hip, knee, foot and ankle scale (r = 0.93)
• Excellent convergent validity with the CMSA Postural control and FMA balance scale (r = 0.84)
• Excellent convergent validity with the CMSA Shoulder pain Impairment Inventory and FMA upper limb joint pain scale (r = 0.76)

CMSA Activity Inventory and the Functional Independence Measure (FIM) convergent validity evidence:

• Excellent convergent validity with the CMSA gross motor function index and the FIM Mobility subscale (r = 0.90)
• Excellent convergent validity with the CMSA walking index and the FIM Locomotion subscale (r = 0.85)

Moreland, Gowland, Van Hullenar, and Huijbregts (1993) performed a literature review to gather evidence for a theoretical basis of the Chedoke-McMaster Stroke Assessment. All items from both inventories had enough scientific evidence supporting its assumptions. Thus, the authors were able to establish a theoretical basis underlying the content of the Chedoke-McMaster Stroke Assessment.

The CMSA Disability Inventory is more sensitive to the FIM at detecting clinically important change. (Gowland et al, 1993)