Modifying the Mobility Scale for Acute Stroke (MSAS) for All Stroke Phases (MSAllS): Measurement Properties and Clinical Application

Shamala Thilarajah; Ai Ying Low; Amanda Lee; Sherie Ng; Hui Chueng Seow; Silvana Choo; Chek Wai Bok; Deidre De Silva; Eleanor Shuxian Chew; Tse Lert Chua; Li Khim Kwah; Yong Hao Pua

doi:10.1016/j.apmr.2024.02.722

Modifying the Mobility Scale for Acute Stroke (MSAS) for All Stroke Phases (MSA^llS): Measurement Properties and Clinical Application

Arch Phys Med Rehabil. 2024 Feb 29:S0003-9993(24)00832-3. doi: 10.1016/j.apmr.2024.02.722. Online ahead of print.

Authors

Affiliations

¹ Department of Physiotherapy, Singapore General Hospital, Singapore; Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore. Electronic address: shamala.thilarajah@sgh.com.sg.
² Department of Physiotherapy, Singapore General Hospital, Singapore.
³ Department of Occupational Therapy, Singapore General Hospital, Singapore.
⁴ Department of Rehabilitation Medicine, Singapore General Hospital, Singapore.
⁵ Department of Neurology, Singapore General Hospital, Singapore; National Neuroscience Institute, Singapore; DukeNUS Medical School, Singapore.
⁶ Applied Analytics, Singapore General Hospital, Singapore.
⁷ Health and Social Sciences Cluster, Singapore Institute of Technology, Singapore.

PMID: 38430995
DOI: 10.1016/j.apmr.2024.02.722

Abstract

Objective: To develop and examine the measurement properties and interpretability of the Mobility Scale for "All" Stroke Phases (MSA^llS) as a potential single outcome measure to capture improvements in physical function throughout the stroke continuum.

Design: Retrospective cross-sectional study.

Setting: Inpatient rehabilitation unit.

Participants: People after stroke at discharge from rehabilitation (N=309).

Intervention: Not applicable.

Main outcome measure(s): We developed MSA^llS by extending the highest MSAS level (walk 10 m independently) with 4 gait speed levels. To establish a clinical anchor, we extracted a 4-level discharge outcome. To assess the distributional properties and internal consistency of MSA^llS, we evaluated its ceiling effects and calculated the Cronbach alpha, respectively. To assess structural validity, we performed a confirmatory factor analysis. To assess (i) its convergent validity with the FIM and (ii) its predictive validity with the clinical anchor, we used Spearman's rank correlations. To evaluate the clinical interpretability of MSA^llS, we used an item-response theory-based method to estimate MSA^llS thresholds associated with the clinical anchor.

Results: The MSA^llS had lower ceiling effects compared with MSAS (0% vs 25%). Internal consistency of MSA^llS was excellent (α=0.94). Structural validity of MSA^llS demonstrated a good fit (Comparative Fit Index=0.95; Tucker-Lewis Index=0.92; Root Means Square Error of Approximation=0.17). MSA^llS demonstrated a moderate correlation (rho=0.66) with FIM score and with the clinical anchor (rho=0.75). MSA^llS thresholds for increasing levels of the clinical anchor were 22 (20.8 to 23.6) - at least moderate assistance with walking/transfers, 28 (27.5 to 29.4) - at most supervision with walking, and 33 (32.5 to 33.4) - able to walk unassisted.

Conclusion: The MSA^llS showed adequate measurement properties and clinical interpretability. MSA^llS has the potential to be a single universal measure to evaluate physical function after stroke but further evaluation of clinical interpretability is required.

Keywords: Outcome measure; Physical function; Rehabilitation; Stroke.