Background and purpose Improving mobility of individuals in their home and environment has been the important goal in rehabilitation of patients with stroke. Impairments in mobility, restricts the ability of individuals to move about in their natural environment, a condition referred as mobility disability. Review of literature suggests that there is no scale to measure mobility disability comprehensively in home and environment of community dwelling individuals. Mobility disability scale (MDS) is a newly developed scale to assess the level of mobility disability in community dwelling individuals under the proposed domains of mobility. This scale consists of 50 items, grouped under 10 domains, with the total score ranging from 0 to 200, where 0 is no disability and 200, complete mobility disability. MDS being a new scale, need to be rigorously assessed for its psychometric properties for its effective use in the community. Earlier studies conducted, suggests that MDS has adequate content validity and good reliability. However, responsiveness, one of the important psychometric property required for the use of this scale to test the effect of interventions was not determined. Objective of the study The objective of the study was to determine the responsiveness of a newly developed mobility disability scale in community dwelling stroke patients. Subjects: Stroke patients living in community after discharge from the hospital Materials/Methods The study protocol was screened by institutional research and ethical committee following which, the approval to conduct the study was obtained. Fifty-eight community dwelling stroke patients were screened and selected based on the inclusion and exclusion criteria. Patients with first stroke, onset duration more than one month and who were able to understand and communicate were included. Patients with any coexisting illnesses who required immediate management were excluded. The selected patients were explained about the study and informed consent to participate in the study was obtained. These patients were assessed using mobility disability scale for all the items under ten domains. The items scores were added to calculate the individual domain scores and the total scores of MDS. After the initial assessment, all the patients were given standard physiotherapy treatment. Exercises were given one hour per session, five sessions per week for eight weeks. All the exercise sessions were supervised by the physiotherapists. After eight weeks of therapy, post treatment assessment was done using Mobility Disability Scale. The patients were also asked to rate their self-perceived recovery using Global Rating of Change Scale (GRCS) by comparing their mobility status before and after the treatment sessions. The GRCS scores were correlated with the change scores of MDS to determine the responsiveness of the new scale using Spearman’s rank correlation coefficient. Wilcoxon Signed Rank test was used to analyze the pre and post treatment change in domain and total scores of MDS. The quantity of change in MDS along with the GRCS scores measured by the patient perception was used to calculate the minimally clinical important difference (MCID) for the MDS. Results Moderate positive correlation (r= 0.655) was found between the change scores of MDS and the GRCS scores (p<0.001).The pre and post treatment scores of MDS in stroke patients was found to be statistically significant with a median (IQR) change of 46 points [pre-treatment: 124 (86.8, 137.5) and post treatment 78 (58.7, 99)]. MCID of the scale was found to be 32/200 points in total score, while the individual domains MCID ranged from 2 to 7 points. Conclusion The newly developed mobility disability scale had shown good responsiveness in community dwelling stroke patients. Clinical relevance The responsiveness of the scale indicates that MDS could be used to test the effect of intervention in patients with stroke. The MCID values could help in determining the effect of outcome across individual domains of the new scale in stroke patients.
|Publication status||Published - 07-2016|