The Responsiveness of the Lucerne ICF-Based Multidisciplinary Observation Scale: A Comparison with the Functional Independence Measure and the Barthel Index.

Tim Vanbellingen,Jan Mehrholz,Beatrice Ottiger,Tobias Nef,Tobias Pflugshaupt,Stephan Bohlhalter,Thomas Nyffeler

doi:10.3389/fneur.2016.00152

Tim Vanbellingen, Jan Mehrholz + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2016.00152

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Abstract

Good responsive functional outcome measures are important to measure change in stroke patients. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients. One hundred eighteen stroke patients participated in this study. Admission and discharge score distributions of the LIMOS motor, LIMOS cognition and communication, FIM motor and FIM cognition, and BI were analyzed based on skewness and kurtosis. Floor and ceiling effects of the scales were determined. Internal responsiveness was assessed with t-tests, effect sizes (ESs), and standardized response means (SRMs). External responsiveness was investigated with linear regression analyses. The LIMOS motor and LIMOS cognition and communication subscales were more responsive, expressed by higher ESs (ES = 0.65, SRM = 1.17 and ES = 0.52, SRM = 1.17, respectively) as compared with FIM motor (ES = 0.54, SRM = 0.96) and FIM cognition (ES = 0.41, SRM = 0.88) and the BI (ES = 0.41, SRM = 0.65). The LIMOS subscales showed neither floor nor ceiling effects at admission and discharge (all <15%). In contrast, ceiling effects were found for the FIM motor (16%), FIM cognition (15%) at discharge and the BI at admission (22%) and discharge (43%). LIMOS motor and LIMOS cognition and communication subscales significantly correlated (p < 0.0001) with a change in the FIM motor and FIM cognition subscales, suggesting good external responsiveness. We found that the LIMOS motor and LIMOS cognition and communication, which are ICF-based multidisciplinary standardized observation scales, might have the potential to better detect changes in functional outcome of stroke patients, compared with the FIM motor and FIM cognition and the BI.

Highlights

Several measures for activities of daily living (ADL) have been published for patients with stroke
The main finding of the present study is that the motor, cognition and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) – which is an ICFbased, comprehensive, reliable and valid assessment measuring functional outcome in stroke patients [14] – are more responsive than the motor and cognition subscales of the functional independence measure (FIM), and the Barthel index (BI)
Our data further demonstrate that the LIMOS subscales are less prone to ceiling effects than the FIM and the BI

Summary

Introduction

Several measures for activities of daily living (ADL) have been published for patients with stroke. The FIM covers two main aspects of functional outcome, by including a motor and cognitive subscale, while the BI includes motor items only. Previous studies have explored floor and ceiling effects, and responsiveness of both FIM subscales, often comparing the FIM motor subscale with the BI. Floor and ceiling effects have been suggested for both FIM motor subscale [7,8,9] and BI [10, 11]. The aim of study was to compare the internal and external responsiveness, floor and ceiling effects of the motor, cognition, and communication subscales of the Lucerne ICF-based Multidisciplinary Observation Scale (LIMOS) with the motor and cognition subscales of the Functional Independence Measure (FIM), and the Barthel Index (BI), in a large cohort of stroke patients

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