Chedoke-McMaster stroke assessment and modified Barthel Index self-assessment in patients with vascular brain damage

With the conception of interdisciplinary and joint rehabilitation, and the adherence to impairment, activity and participation as rehabilitation goals, a comparison of assessment instruments that use different perspectives (professional, lay person, patient) and are employed by different professional groups addressing different issues such as in occupational therapy and in physical therapy, is required. The clinical admission-discharge assessment of the Chedoke-McMaster stroke assessment and the Barthel index data of 127 vascular brain-damaged patients, including patients with other neurological disorders, were compared. The German language version of these instruments proved highly reliable; the factorial structure indicated, with a few exceptions, the conceptualized dimensions and the Barthel index contributed to this structure with an additional dimension of drinking and eating as well as a continence factor. It takes eight items of the Barthel index to predict a substantial part of the total variance of the 15-item Chedoke-McMaster stroke assessment (r2=76), but only three Chedoke-McMaster items to predict the Barthel index total (r2=77). It is suggested that although further analyses of all instruments used in a rehabilitation centre are required, addressing their relationship to each other and their usefulness as admission-discharge measures, a rehabilitation conceptualization should proceed closely linked with the optimization of the assessment measures, thus providing a lean but comprehensive monitoring system.