- The STREAM was designed for use by physical therapists to provide a quantitative evaluation of motor functioning for stroke patients. The STREAM was specifically designed to be easy to administer in a clinical setting.
- Upper-limb movements (scored on a 3-point ordinal scale
- Lower-limb movements (scored on a 3-point ordinal scale)
- Basic mobility items (scored on a 4-point ordinal scale)
- Total of 20 points for each of the limb sub-scales (40 points total)
- Total of 30 points for the mobility subscale
- Scores can be transformed, allowing for items that can't be scored
- Subscales are converted to a percentage, even though the scores are not interval based. This is done to allow for occasional items that cannot be scored. Total scores are calculated using the average of the 3 subscale scores
- Instructions for score transformation can be found in the instruments manual
- Stroke
- Standard Error of Measurement (SEM) = 1.5 points
- Smallest Real Difference (SRD) = 4.2 points
Acute Stroke: (Hsueh et al, 2008; n = 50 mean age = 61.9 (11.7) years; onset to admission 18.6 (11.7) days; stay in rehab = 22.3 (5.7) days)
- STREAM Smallest Real Difference:MeasureICC95% CISRD (SRD%)STREAMUE-STREAM.970.96-0.982.8 (14.0)LE-STREAM.980.96-0.992.5 (12.6)Motor-STREAM.980.97-0.993.9 (9.9)S-STREAMUE-S-STREAM.950.92-0.9711.6 (11.6)LE-S-STREAM.970.95-0.989.1 (9.1)
Motor-S-STREAM .97
0.95-0.98
17.4 (8.7)
FM UE-FM .98
0.96-0.99
7.2 (10.9)
LE-FM .95
0.91-0.97
3.8 (11.3)
Motor-FM .98
0.97-0.99
8.4 (8.4)
S-FM UE-S-FM .93
0.89-0.96
12.2 (12.2)
LE-S-FM .96
0.93-0.97
8.6 (8.6)
Motor-S-FM .96
0.94-0.98
16.0 (8.0)
STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement
S-STREAM = Simplified Motor Scale of STREAM
SRD = smallest real difference
FM = Fugl-Meyer Motor Scale
S-FM = Simplified Fugl-Meyer Motor Scale
UE = Upper Extremity
LE = Lower Extremity
- MCID for upper-extremity subscale (n = 42) = 2.2
- MCID for lower-extremity subscale (n = 38) = 1.9
- MCID for mobility subscale (n = 43) = 4.8
STREAM Norms Over Time with Comparisons: | |||||||
Instrument | Intial | 5 week | 3 months | ||||
Name | Domain | Mean (SD) | Median | Mean (SD) | Median | Mean (SD) | Median |
STREAM | Total Score | 75 (26.7) | 86 | 86 (19.1) | 94 | 89 (18.0) | 97 |
| UE subscale | 73 (33.3) | 90 | 85 (26.2) | 100 | 88 (24.0) | 100 |
LE subscale | 75 (28.9) | 85 | 86 (22.3) | 95 | 90 (19.0) | 100 | |
Mobility subscale | 74 (25.9) | 83 | 88 (16.4) | 97 | 91 (15.0) | 97 | |
Barthel Index | Total | 72 (27.9) | 85 | 86 (20.4) | 100 | 92 (14.0) | 100 |
Gait speed (m/s) | Total | 0.55 (0.38) | 0.58 | 0.82 (0.43) | 0.90 | 0.85 (0.36) | 0.93 |
STREAM = Stroke Rehabilitation Assessment of Movement UE = Upper Extremity LE = Lower Extremity |
Test re-test data for the Mobility subscale of the STREAM | |
First Session Mean (SD) | 17.9 (7.2) |
Second Session Mean (SD) | 17.8 (7.6) |
Mean d (SD) | 0.1 (2.1) |
ICC (95% CI) | 0.96 (0.93 to 0.98)* |
SEM | 1.5 |
SRD | 4.2 |
*Excellent | |
d = difference of score between the 2 test sessions ICC = intraclass correlation coefficient CI = confidence interval SEM = standard error of measurement SRD = smallest real difference |
Interrater and Intrarater Reliability: | ||
Sub scale | Direct Observation (Interrater Agreement) | Videotaped Assessments (Intrarater Agreement) |
Upper-extremity subscale | .994 | .963 |
Lower-extremity subscale | .993 | .999 |
Basic mobility subscale | .982 | .999 |
Total scores on STREAM | .995 | .999 |
GCC = generalizability correlation coefficient Reliability coefficients of .95 or better are recommended |
- Internal Consistency (Cronbach's alpha):
- Excellent: Mobility subscale = .965
- Excellent: Limb subscales = .979
- Excellent: overall STREAM scores = .984
STREAM Predictive and Concurrent Validity Correlations: | |||||||
Stream | Time | Box and Block (Affected UE) | Box and Block (Unaffected UE) | Barthel | Balance | TUG | Gait |
Total | Initial | .73 | .36 | .78 | .75 | .80 | .74 |
5 weeks | .77 | .37 | .71 | .68 | .64 | .62 | |
3 months | .78 | .44 | .75 | .65 | .57 | .73 | |
UE | Initial | .78 | .31 | .67 | .57 | .69 | .56 |
5 weeks | .79 | .36 | .66 | .61 | .49 | .53 | |
3 months | .76 | .31 | .67 | .53 | .60 | .64 | |
LE | Initial | .53 | .40 | .71 | .73 | .75 | .74 |
5 weeks | .64 | .29 | .59 | .55 | .59 | .55 | |
3 months | .70 | .30 | .63 | .55 | .51 | .65 | |
Mobility | Initial | .66 | .55 | .84 | .88 | .85 | .83 |
5 weeks | .69 | .40 | .75 | .71 | .57 | .65 | |
3 months | .66 | .40 | .82 | .78 | .62 | .76 |
Convergent Validity and Predictive Validity of the STREAM at 4 Time Points | |||
Days | n | Convergent Validity* (p) | Predictive Validity† (p) |
14 | 57 | 0.80 | 0.54 |
30 | 54 | 0.87 | 0.67 |
90 | 44 | 0.82 | 0.81 |
180 | 43 | 0.76 | -- |
*Relationships between the STREAM and the BI at 4 time points. †Relationships between the STREAM and the BI at 3 time points (14, 30, and 90 days) after stroke. |
STREAM Floor and Ceiling Effects at Admission and Discharge | ||||
At Admission, n (%) | t Discharge, n (%) | |||
Floor | Ceiling | Floor | Ceiling | |
UE-STREAM | 13 (26.0) | 10 (20.0) | 4 (8.0) | 20 (40.0) |
LE-STREAM | 10 (20.0) | 2 (4.0) | 1 (2.0) | 12 (24.0) |
Motor-STREAM | 9 (18.0) | 1 (2.0) | 1 (2.0) | 10 (20.0) |
S-STREAM | 2 (4.0) | 0 (0.0) | 0 (0.0) | 6 (12.0) |
UE = Upper Extremity LE = Lower Extremity STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement S-STREAM = Simplified Motor Scale of STREAM |
STREAM Floor and Ceiling Effects at 4 Time Points | ||
Days after Stroke | Floor n (%) | Ceiling n (%) |
14 (n = 57) | 0 (0) | 0 (0) |
30 (n = 54) | 0 (0) | 2 (3.7) |
90 (n = 44) | 0 (0) | 6 (13.6) |
180 (n = 43 | 0 (0) | 7 (16.3) |
Standard Response Means (SRM) for STREAM: | ||
Sub-scale | SRM | 95% Confidence Interval |
STREAM Total | 0.98 | 0.74 − 1.17 |
STREAM (upper limb) | 0.75 | 0.56 − 0.93 |
STREAM (lower limb) | 0.63 | 0.36 − 0.86 |
STREAM Responsiveness: | ||||
Scale | Change score (SD) | Strength | Effect Size d | SRM |
STREAM | ||||
UE-STREAM | 3.3 (4.2) | small | 0.38 | 0.78 |
LE-STREAM | 3.3 (3.9) | small | 0.44 | 0.84 |
Motor-STREAM | 6.5 (6.9) | small | 0.45 | 0.95 |
S-STREAM | ||||
UE-S-STREAM | 14.5 (12.2) | small | 0.49 | 1.19 |
LE-S-STREAM | 14.7 (12.9) | medium | 0.54 | 1.14 |
Motor-S-STREAM | 29.1 (23.2) | medium | 0.53 | 1.26 |
FM | ||||
UE-FM | 8.4 (8.5) | small | 0.34 | 1.00 |
LE-FM | 4.3 (5.2) | small | 0.41 | 0.83 |
Motor-FM | 12.7 (11.0) | small | 0.38 | 1.16 |
S-FM | ||||
UE-S-FM | 14.6 (14.4) | small | 0.47 | 1.00 |
LE-S-FM | 14.9 (17.9) | medium | 0.51 | 0.83 |
Motor-S-FM | 29.4 (29.7) | medium | 0.51 | 0.99 |
STREAM = Motor Scale of Stroke Rehabilitation Assessment of Movement S-STREAM = Simplified Motor Scale of STREAM FM = Fugl-Meyer Motor Scale UE = Upper Extremity LE = Lower Extremity S-FM = Simplified Fugl-Meyer Motor Scale SRM = Standardized Response Mean |
Responsiveness of the STREAM at Different Stages of Recovery | |||
Days | n | SRM | Wilcoxon z |
14–30 | 51 | 1.17 | 6.02* |
30–90 | 43 | 0.95 | 4.95* |
90–180 | 43 | 0.40 | 2.23† |
14–90 | 43 | 1.61 | 5.72* |
14–180 | 43 | 1.65 | 5.57* |
*P < 0.001; †P < 0.05 |
Ahmed, S., Mayo, N. E., et al. (2003). "The Stroke Rehabilitation Assessment of Movement (STREAM): a comparison with other measures used to evaluate effects of stroke and rehabilitation." Phys Ther 83(7): 617-630. Find it on PubMed
Chen, H. M., Hsieh, C. L., et al. (2007). "The test-retest reliability of 2 mobility performance tests in patients with chronic stroke." Neurorehabil Neural Repair 21(4): 347-352. Find it on PubMed
Daley, K., Mayo, N., et al. (1999). "Reliability of scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure." Phys Ther 79(1): 8-19; quiz 20-13. Find it on PubMed
Higgins, J., Mayo, N. E., et al. (2005). "Upper-limb function and recovery in the acute phase poststroke." J Rehabil Res Dev 42(1): 65-76. Find it on PubMed
Hsieh, Y. W., Wang, C. H., et al. (2008). "Estimating the minimal clinically important difference of the Stroke Rehabilitation Assessment of Movement measure." Neurorehabil Neural Repair 22(6): 723-727. Find it on PubMed
Hsueh, I. P., Hsu, M. J., et al. (2008). "Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement." Neurorehabil Neural Repair 22(6): 737-744. Find it on PubMed
Hsueh, I. P., Wang, C. H., et al. (2003). "Comparison of psychometric properties of three mobility measures for patients with stroke." Stroke 34(7): 1741-1745. Find it on PubMed
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