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Πέμπτη 25 Αυγούστου 2016

Stroke Rehabilitation Assessment of Movement Measure

Link to instrument: STREAM
Acronym:
STREAM
Purpose:
  • 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.
Description:
The STREAM is composed of 30 items distributed across 3 domains:
  • 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)
Scoring the STREAM:
  • 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
Area of Assessment: Coordination, Functional Mobility, Range of Motion
Body Part: Upper Extremity, Lower Extremity
ICF Domain: Body Function, Activity
Domain: Motor
Assessment Type: Performance Measure
Length of Test: 06 to 30 Minutes
Time to Administer:
15 minutes
Number of Items: 30
Equipment Required:
None
Training Required:
None
Type of training required: No Training
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Paper/Pencil
Diagnosis: Stroke
Populations Tested:
  • Stroke
Standard Error of Measurement (SEM):
Chronic Stroke: (Chen et al, 2007; n = 50; mean age = 60.9 (12.8) years; median time between stroke and assessment = 24 months, mean Barthel Index (BI) scores = 15.9 (5.3) points)
  • Standard Error of Measurement (SEM) = 1.5 points
Minimal Detectable Change (MDC):
Chronic Stroke: (Chen et al, 2007)
  • 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:
    Measure
    ICC
    95% CI
    SRD (SRD%)
    STREAM
    UE-STREAM
    .97
    0.96-0.98
    2.8 (14.0)
    LE-STREAM
    .98
    0.96-0.99
    2.5 (12.6)
    Motor-STREAM
    .98
    0.97-0.99
    3.9 (9.9)
    S-STREAM
    UE-S-STREAM
    .95
    0.92-0.97
    11.6 (11.6)
    LE-S-STREAM
    .97
    0.95-0.98
    9.1 (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
Minimally Clinically Important Difference (MCID):
Stroke: (Hsieh et al, 2008; n = 81 stroke patients who were recruited from Departments of Physical Medicine and Rehabilitation of three hospital in Taiwan; mean age = 55.9 (13.3) years; mean MMSE score = 25.8 (2.8) years; mean STREAM baseline score = 10.27 (7.6) for upper extremity, 9.6 (6.7) for lower extremity, and 16.1 (7.6) for mobility)
  • 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
Cut-Off Scores:
Not Established
Normative Data:
Acute Stroke: (Ahmed et al, 2003; n = 63; mean age = 67 (14) years; assessed within a week of stroke, then again at 4 weeks and 3 months)
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-retest Reliability:
Chronic Stroke: (Chen et al, 2007, n = 50, 7 days between assessments)
 
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/Intrarater Reliability:
Chronic Stroke: (Daley et al, 1999; n = 20; mean age = 66.7 (10.7) years; mean time between stroke onset and assessment = 104.5 (42.7) days)
 
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:
Chronic Stroke: (Daley et al, 1999)
  • Internal Consistency (Cronbach's alpha):
    • Excellent: Mobility subscale = .965
    • Excellent: Limb subscales = .979
    • Excellent: overall STREAM scores = .984
Criterion Validity (Predictive/Concurrent):
Acute Stroke: (Ahmed et al, 2003)
 
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
Construct Validity (Convergent/Discriminant):
Acute Stroke: (Hsueh et al, 2003, n = 59; mean age 64.2 (11.5) years; assessed within 14 days of stroke onset, Taiwanese sample)
 
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.
 
 
Content Validity:
Items from the initial STREAM were reviewed by two panels of experts made up to 20 physical therapists. Feedback from these experts were used to refine the measure.
Face Validity:
Not statistically assessed
Floor/Ceiling Effects:
Acute Stroke: (Hsueh et al, 2008)
 
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
 
Acute Stroke: (Hsueh et al, 2003)
 
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)
Responsiveness:
Acute Stroke: (Higgins et al, 2005; n = 55; mean age = 66 (15), assessed at 5 weeks after onset)
 
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
 
Acute Stroke: (Hsueh et al, 2008; assessed at admission and within 48 hours of discharge; mean time in rehabilitation = 22.3 (5.7) days)
 
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
 
Acute Stroke: (Hsueh et al, 2003)
 
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
Considerations:

 

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!
Bibliography:

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 

Year published: 1986
Instrument in PDF Format: Yes


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