Introduction
A stroke is a clinical syndrome characterised by rapidly developing clinical symptoms and / or signs of focal, and at times global, loss of cerebral function, with symptoms lasting more than 24 hours or leading to death, with no apparent cause other than that of vascular origin.
There are different ways of evaluating clinical conditions and interventions. Interviews and clinical observations are two important methods.1 Testing / measuring function is another method. Ideally, the assessment process involves all three; an interview, where the patient's perceptions of the main problems are at focus, observations of performance, and tests of performance followed by a process of interpreting the information into goals, a treatment plan and continuously evaluate outcome throughout the intervention process.2
In physiotherapy for evaluating the stroke subjects voluntary movement of the limbs and basic mobility there are many assessment tools are available for assessing Balance, Functional activity, mobility and gait through Berg Balance Scale, Functional Independence Measure, Barthal Index and observational Gait Analysis.3,4 Other than these scales, Stroke Rehabilitation Assessment of Movement Scale (STREAM) is one of the good reliable and valuable scale for the assessing of voluntary movement of the limbs and basic mobility in stroke patients.5,6,7
Objectives of the study
To evaluate the Intra rater reliability of S-STREAM scale on Voluntary movement of the Limbs and basic mobility in patients with stroke.
To evaluate the validity of S-STREAM scale’s Voluntary movement of the Limbs compared with Fugl-meyer motor assessment scale and the basic mobility of S -STREAM scale compared with Rivermead mobility index in patients with stroke.
Materials and Methods
Study setting
This study was carried out in the Department of Physiotherapy and Neurology ward, Sri Ramakrishna Hospital Coimbatore-44.
Exclusion criteria
History of previous stroke; uncontrolled hypertension, dementia, other significant movement disorders
Development of hemodynamic instability following the stroke
Abnormal clinical laboratory values on routine clinical laboratory testing
History of drug or alcohol abuse
Not understanding the commands
Procedure
100 patients were selected based upon the inclusion criteria. For intra rater Reliability testing test re-test procedure was carried out. In which 3 session for proceeding weeks were taken.8,9,10 The Therapist made a initial assessment on the first day the procedure. The same were carried out on the second day. This was proceeded for 2 more sessions for next two weeks by the same therapist.
The validity of S-STREAM was determined by comparing the S -STREAM scales upper and lower extremity voluntary movement with Fugl meyer motor assessment scales upper and lower extremity voluntary movement and the mobility component of S-STREAM scale was compared with Rivermead mobility index scale. The validity and reliability study assessed at the same day and on the same environment by the same physiotherapist.
Ethical consideration
The study was conducted after approval from the concerned institution. Assurance was given to the participants regarding the confidentiality.
Data analysis for reliability and validity
The reliability and validity of S-STREAM SCALE for 100 Stroke patients were measured using Pearsons correlation coefficient
Pearsons correlation coefficient test:
Table 1
Correlations for S-STREAM 1st week assessment descriptive Statistics
From the above table the comparison of test (1st ) and re-test (2nd ) day S-STREAM scale assessment in the 1st week in stroke patients shows similar mean value.
Table 2
Correlations for S-STREAM 2nd week assessment: Descriptive Statistics
From the above table the comparison of test (1st) and re- test (2nd) day S-STREAM scale assessment in the 2nd week in stroke patients shows similar mean value.
Table 3
Correlations of S-stream 3rd week in stroke patients Descriptive Statistics
**. Correlation is significant at the 0.01 level (2-tailed).
From the above table the comparison of test (1st) and re-test (2nd) day S-STREAM scale assessment in the 3rd week in stroke patients shows similar mean value.
Table 4
‘t’ -Test Value for comparing 1ST, 2ND, 3rd week S- Stream scale assessment to find the reliability Paired Samples Test
Table 5
| Paired Sampzes Correlations | N | Correlation | Sig. | |
| Pair 1 | W1Test & W1Retest | 100 | .971 | .000 |
| Pair 2 | W2Test & W2Retest | 100 | .978 | .000 |
| Pair 3 | W3Test & W3Retest | 100 | .953 | .000 |
Table 6
From the data analysis using Pearson correlation coefficient test, the reliability of S-STREAM scale was evaluated in 100 stroke patients at 1st, 2nd and 3rd week obtained a significant value of 0.9847, 0.98, and 0.97 respectively. Therefore, S-STREAM scale was more reliable to assess stroke patients voluntary movement of the limbs and basic mobility.
Data analysis for S-S tream scale in 100 stroke patients to find the validity
Table 7
| Mean | Std. Deviation | N | |
| S-Stream | 3.0000 | 1.53083 | 100 |
| Fugl-Meyer | 12.0200 | 3.19400 | 100 |
Correlations for S- Stream and Fugl-Meyer1 st week assessment: Descriptive Statistics
Table 8
| S-Stream | Fugl-Meyer | ||
| S-Stream | Pearson Correlation | 1 | .942** |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
| Fugl-Meyer | Pearson Correlation | .942** | 1 |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
Correlations
Table 9
| Mean | Std. Deviation | N | |
| S-STREAM | 3.0000 | 1.53083 | 100 |
| Rivermead Mobility index | 1.5000 | 1.08711 | 100 |
Correlations for S-Stream and RMI 1ST week assessment descriptive statistics
Table 10
| S-STREAM | RMI | ||
| S-STREAM | Pearson correlation | 1 | .534** |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
| RMI | Pearson Correlation | .534** | 1 |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
Correlations
**. Correlation is significant at the 0.01 level (2-tailed).
From the above table the comparison of S-STREAM and RMI scale was assessed in the 1st day of 1st week in stroke patients.
Table 11
| Mean | Std. Deviation | N | |
| RMI | 1.5000 | 1.08711 | 100 |
| FM | 12.0200 | 3.19400 | 100 |
Correlation for RMI and FM for 1 st week assessment Descriptive statistics
Table 12
| RMI | FM | ||
| RMI | Pearson Correlation | 1 | .538** |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
| FM | Pearson Correlation | .538** | 1 |
| Sig. (2-tailed) | .000 | ||
| N | 100 | 100 | |
Correlations
**. Correlation is significant at the 0.01 level (2-tailed).
From the above table the comparison of FM and RMI scale was assessed in the 1st day of 1st week in stroke patients.
Validity assessed for 100 stroke patients using S-STREAM scale, Fugl-meyer motor assessment scale, Rivermaed mobility index on 1st week. From pearson correlation coefficient the standard deviation for s-stream, fugl-meyer motor assessment scale, rivermead mobility index was 1.5308, 3.1940, 1.087.
Conclusion
Many assessment tools available for evaluating voluntary movement of the limbs and basic mobility in patients with stroke, among that one of the gold standard scale is Stroke Rehabilitation Assessment of movement (STREAM).11
The results of this study shows that the S-STREAM has high Intra rater reliability and validity when compare with the Fugl-meyer and Rivermead mobility index on voluntary movement of the limbs and basic mobility in patients with stroke.
Further the S-STREAM scale has efficient to administer, as it consists of only half the number of items in the original STREAM.
Therefore this study recommends that S-STREAM is a highly reliable and valid tool for measuring voluntary movement of the limbs and basic mobility in patients with stroke.
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