Does the Global Rating Scale Correlate with Standard Clinical Outcomes in Chronic Individuals with Stroke?

Abstract

Several well-accepted stroke assessment scales have been developed for use in clinical settings such as Stroke
Impact Scale (SIS), Fugl-Meyer Assessment for the Upper Extremity and Lower Extremity (FMA-UE and FMA-LE),
Berg Balance Score (BBS), Modified Ranking Scale (MRS), and the global rating of change scale (GROC). However,
clinical outcomes were assessed by patient self-evaluation and physiotherapists, responsiveness and discrimination of
high and low disability in the context of functional recovery have not yet been confirmed. The purpose of this study was
to 1) compare the Stroke Impact Scale (SIS) and clinical outcomes between the baseline and after the 12-week physical
therapy treatment program and 2) to investigate the correlation between the global rating of change (GROC) with the SIS
and other clinical outcomes in individuals with chronic stroke. Participants underwent physical therapy at least twice a
week. The SIS and clinical outcome measures including Fugl-Meyer Assessment for the Upper Extremity and Lower
Extremity (FMA-UE and FMA-LE), Berg Balance Score (BBS), Modified Ranking Scale (MRS), gait speed, and the
GROC were measured at the baseline and after the 12-week physical therapy treatment. The data analysis examined the
differences between the SIS and all clinical outcomes and between the baseline and after the 12-week physical therapy
treatment. Then, the authors explored the correlation between the GROC and SIS in each domain. The authors also
explored the correlation between the GROC and changes in the other clinical outcomes after the 12-week physical therapy
treatment. The results showed that there was a significant difference in only the SIS score between the baseline and after
12-week of physical therapy treatment in the domains of strength, emotion, ADL, mobility, social participation, and
global recovery. Besides, the GROC score showed a median score of +3.25 (3, 4) after the 12-week of physical therapy
treatment. Finally, there was a fair correlation between the GROC and the SIS. Therefore, the differences between the
baseline and after the 12-week of physical therapy treatment were explored in the SIS, and the GROC scale could be
applied to suit the needs of physiotherapists or clinicians when time and difficulties in other methods of assessment exist.