A Systematic Review of the Responsiveness of Lower Limb Physical Performance Measures in Inpatient Care After Stroke

Background: Responsiveness refers to a measurement tool's ability to detect change in performance over time. The aim of the review was to summarise studies of responsiveness of lower limb physical performance measures during inpatient care after stroke.

Methods: A systematic literature review was conducted. Prospective studies that included participants with a diagnosis of stroke, were commenced in the acute or subacute phase of inpatient care and included a measure of a lower limb physical performance were included in this review.

Results: Twenty-one studies met these inclusion criteria. A variety of measures were investigated including the Berg Balance Scale, various timed walking tests and the Rivermead Mobility Index. Ten of the included studies had small sample sizes (50 participants or less), 2 studies used a convenience sample rather than consecutive recruitment and 5 studies excluded potential participants with poor physical abilities at baseline. Responsiveness varied between and within studies but was generally large, Effect Size (ES) or Standardised Response Mean (SRM) > 0.8. Measures displaying large responsiveness included the twelve-minute walk test (SRM 1.90) and the Modified Rivermead Mobility Index (SRM 1.31) when re-measured at four weeks after stroke, and the Berg Balance Scale (ES 1.11) and Postural Assessment Scale for Stroke Patients (ES 1.12) when re-measured at approximately six months after stroke.

Conclusion: Studies conducted to date have generally found physical performance measures after stroke to have large responsiveness i.e., to be able to detect changes. Further investigation of the responsiveness of measurement tools after stroke in larger prospective cohort studies is required.