Stroke Rehabilitation Assessment Tools Survey Final · PDF fileStroke Rehabilitation Assessment Tools Survey ... Scale and Numeric Rating Scale for pain, ... Toronto Beside Swallowing

Stroke Rehabilitation Assessment Tools Survey

Final Report

October 2011

2

Stroke Rehabilitation Assessment Tools Survey

Northeastern and Northwestern Ontario Stroke Networks

Final Report – October 2011

Table of Contents

Topic Page

Executive Summary 3

Background 4

Purpose 4

Methods 5

Table 1: Assessment Tools Surveyed 6

Findings 7

Table 2: Respondents 7

Table 3: Use of Selected Stroke Rehabilitation Assessment Tools in NEO & NWO 8

Figures 1-6: Top Tools Reported by Clinician Group 9

Figures 7-8: Electronic Resources - Awareness and Usage 14

Next Steps 16

Appendix 1: Survey Template 18

Appendix 2: Physiotherapy Demographics and Discipline Specific Information 20

Appendix 3: Occupational Therapy Demographics and Discipline Specific Information 23

Appendix 4: Speech Language Pathology Demographics and Discipline Specific Information 26

Appendix 5: Social Work Demographics and Discipline Specific Information 29

Appendix 6: Recreation Demographics and Discipline Specific Information 32

Appendix 7: Psychology Demographics and Discipline Specific Information 35

Commonly Used Abbreviations

Full Name Abbreviation Full Name Abbreviation

Berg Balance Scale BBS Northwestern Ontario NWO

Boston Diagnostic Aphasia Examination

BDAE Occupational Therapist OT

Canadian Best Practice Recommendations for Stroke Care

CPBRSC Physiotherapy PT

Chedoke McMaster Stroke Assessment

CMSA Psychologist or Psychological Associate

Psych

Montreal Cognitive Assessment MOCA Social Worker SW

Northeast(ern) NE Speech Language Pathologist

SLP

Northwest(ern) NW Therapeutic Recreationist or Recreation Therapist

Rec

Northeastern Ontario NEO

Stroke Rehabilitation Assessment Tools Survey Final Report – October 2011 3

Executive Summary

In May/June 2011 a survey was developed and distributed to determine to what extent rehabilitation

clinicians in northeastern (NE) and northwestern (NW) Ontario use standardized, valid assessment tools to

evaluate patient’s stroke-related impairments and functional status. Assessment tools that were included

were drawn from Canadian Best Practice recommendations and only included those that are currently

available to clinicians. Additionally, the survey results were used to determine the extent to which the “core

set” of assessment tools *Berg Balance Scale, Montreal Cognitive Assessment, Chedoke-McMaster Stroke

Assessment, Boston Diagnostic Aphasia Examination, AlphaFIM®/FIM® Instruments (not specifically surveyed

as regional use already determined)] as recommended by the Provincial Outcome Measures Working Group

(Jan 2010) were being utilized. Clinicians were also surveyed regarding their familiarity with electronic

resources for assessment tools. The information gathered from the survey and the work of other regional

stroke networks is currently being used to identify educational opportunities, barriers and facilitators

towards the use of assessment tools and to help facilitate improved communication and information transfer

between rehabilitation providers across the care continuum.

The survey was sent to a total of 493 (253 NE, 240 NW) clinicians (OT, PT, Psych, Rec, SLP, SW). Overall

response rate was 36%. There was strong use reported for the core set of assessment tools: Berg Balance

Scale (98% PT, 28% OT), Montreal Cognitive Assessment (89% OT), Chedoke-McMaster Stroke Assessment

(66% PT, 21% OT) and Boston Diagnostic Aphasia Examination (74% SLP). In reviewing the data from an

urban/rural perspective, there was no apparent difference in the overall use of the core set of assessment

tools between clinicians practicing in these environments. In the NE AlphaFIM® and FIM® are being utilized

by 5 hospitals, all 5 hospitals have designated rehabilitation beds and 4 of the hospitals are either a district or

the regional stroke centre. In the NW AlphaFIM® is being utilized by 4 hospitals, including the regional stroke

centre, the FIM® is being utilized by the 1 NW hospital with designated rehab beds. Additional commonly

used assessment tools reported included: OSOT Perceptual Evaluation, Mini Mental State Examination, 9

Hole Peg Test, Box and Block Test, Motor-Free Visual Perception Test, Line Bisection Test, Visual Analogue

Scale and Numeric Rating Scale for pain, Timed Up and Go Test, 6 Minute Walk Test, Western Aphasia

Battery, Geriatric Depression Scale and the Beck Depression Inventory. Many tools not included in the

Canadian Best Practice Recommendations for Stroke Care were also being utilized. The majority of

respondents, both urban and rural, were familiar with electronic resources for assessment tools. However

some respondents were unaware that the following websites existed: StrokEngine Assess (45% unaware),

Evidence-Based Review of Stroke Rehabilitation (41% unaware) and Canadian Best Practice

Recommendations for Stroke Care (20% unaware). Action plans to address identified regional priorities

around the use of assessment tools are in development.


Background

The Northeastern (NE) and Northwestern (NW) Ontario Stroke Networks support the uptake and

dissemination of information regarding best practices in stroke care.

Published in 2010, the Canadian Best Practice Recommendations for Stroke Care (CBPRSC) state that:

“Clinicians should use standardized, valid assessment tools to evaluate the patient’s stroke-related

impairments and functional status” (5.1.iv.).

Other stroke networks in Ontario have also completed various activities (forums, workshops, educational

events, surveys, etc…) to collect and disseminate information on use of stroke rehabilitation assessment tools

across the continuum of care in their regions. As such, a need to define the current state regarding use of

assessment tools in NE and NW Ontario was identified.

Purpose

An electronic survey was used to determine to what extent Canadian Best Practice Recommendation 5.1.iv

(2010) is being implemented throughout NE and NW Ontario.

Additionally, the survey results will be used to help determine the extent to which the “core set” of

assessment tools [Berg Balance Scale, AlphaFIM®/FIM®, Montreal Cognitive Assessment, Chedoke-McMaster

Stroke Assessment, Boston Diagnostic Aphasia Examination] as recommended by the Provincial Outcome

Measures Working Group (Jan 2010) are being utilized.

The survey results will also assist in the:

identification of educational opportunities with respect to assessment tools

identification of barriers towards the use of assessment tools in order to develop strategies to support

uptake where feasible

facilitation of improved communication and information transfer between rehabilitation providers across

the care continuum

The survey results from the NE and NW Ontario Stroke Networks will add to provincial body of knowledge

regarding the use of assessment tools within the Ontario Stroke System.


Methods

Data Collection:

An electronic survey was distributed using Survey MonkeyTM. Assessment tools that were included were

drawn from the 2008 and 2010 CBPRSC reports and only included those that are currently available (see

Table 1). The AlphaFIM®/FIM® Instruments were not included as the extent of regional usage has been

determined. Three pain rating scales were included as the domain of “pain” was reported by clinicians in

other provincial stroke assessment tool forums as being a domain that required consideration. In order to

encourage participation, clinicians were offered the opportunity to submit their email address to be entered

into a prize draw. Two $25.00 Gift Cards were randomly awarded after the survey deadline. The information

provided in the survey was not linked to the email address provided.

Participants Surveyed: Physiotherapists (PT), Psychologists or Psychological Associates (Psych), Occupational

Therapists (OT), Speech Language Pathologists (SLP), Social Workers (SW), Therapeutic

Recreationists/Recreation Therapists (Rec) who treat adults with stroke in publically funded hospital-based

programs (acute care, in-patient/ out-patient rehabilitation or CCC, day programs), home/community settings

and urban/rural environments were targeted for the survey. Therapists working in the long term care,

paediatric and private sectors were not specifically surveyed.

E-Mail Distribution Strategy: The link to the survey was e-mailed to:

Clinicians (PT, Psych, OT, SLP, SW, Rec)

Managers of hospital rehabilitation programs for distribution

Managers of CCAC rehab contract providers for distribution

Professional practice leaders of OT, PT, Rec, SLP and SW for distribution

Timeframe: The data for the survey was collected between May 15, 2011 and June 8, 2011.


Table 1: Assessment Tools Surveyed

Name of Measure (Abbreviation)

American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA-FACS)

Assessment of Life Habits – Leisure Subscale (LIFE-H)

Beck Depression Inventory (BDI)

Behavioural Inattention Test (BIT)

Berg Balance Scale (BBS)

Boston Diagnostic Aphasia Examination (BDAE)

Box and Block Test (BBT)

Chedoke Arm and Hand Activity Inventory (CAHAI)

Chedoke-McMaster Stroke Assessment - Impairment Inventory (CMSA)

Chedoke-McMaster Stroke Assessment - Impairment Inventory Shoulder Pain (CMSA-SP)

Comb and Razor Test (CRT)

Frenchay Aphasia Screening Test (FAST)

Geriatric Depression Scale (GDS)

Hospital Anxiety and Depression Scale (HADS)

Line Bisection Test (LBT)

Mini Mental State Examination (MMSE)

Modified Ashworth Scale (MAshS)

Montreal Cognitive Assessment (MOCA)

Motor-free Visual Perception Test (MVPT)

Nine Hole Peg Test (NHPT)

Numeric Pain Rating Scale (NPRS)

OSOT Perceptual Evaluation (OSOT)

Reintegration to Normal Living Index (RNLI)

Six Minute Walk Test (6MWT)

Stroke Impact Scale (SIS)

Timed Up and Go Test (TUG)

Toronto Beside Swallowing Screening Test (TOR-BSST)

Visual Analogue Pain Scale (VAS)

Western Aphasia Battery (WAB)

Wong-Baker FACES Pain Rating Scale (WBFPRS)


Findings

Respondents

The survey was sent to a total of 493 clinicians (253 NE, 240 NW). Eighteen clinicians indicated that they did

not treat people with stroke and therefore were not eligible to participate in the survey. Overall response

rate was 36%, representing clinicians from a variety of disciplines, practice locations and settings (e.g.

urban/rural, rehab/acute care/community). See Table 2 below and Appendices 2-7 for more detailed

information on respondent demographics.

Table 2: Respondents

PT OT SLP SW Rec Psych TOTAL

NE SENT 95 73 26 45 12 2 253

NE RESPONSES 30 26 13 16 8 1 94

% RESPONSE RATE 32% 36% 50% 36% 67% 50% 37%

NW SENT 57 69 24 48 38 4 240

NW RESPONSES 26 15 7 4 8 3 63

% RESPONSE RATE 46% 22% 29% 8% 21% 75% 26%

Use of Recommended Stroke Rehabilitation Assessment Tools in NE and NW Ontario

The use of selected stroke rehabilitation assessment tools by clinicians in NE and NW Ontario is illustrated in

Table 3.

There was strong use reported for the core set of assessment tools: Berg Balance Scale (98% PT, 28% OT),

Montreal Cognitive Assessment (89% OT), Chedoke-McMaster Stroke Assessment (66% PT, 21% OT) and

Boston Diagnostic Aphasia Examination (74% SLP). Please refer to Table 3, core set is highlighted.

Although not included in the survey, as regional use has been determined, there is significant regional uptake

with respect to the use of the AlphaFIM® and FIM® Instruments. In the NE, AlphaFIM® and FIM® are being

utilized by 5 hospitals, all 5 hospitals have designated rehabilitation beds and 4 of the hospitals are either a

district or the regional stroke centre. In the NW AlphaFIM® is being utilized by 4 hospitals, including the

regional stroke centre, the FIM® is being utilized by the 1 NW hospital with designated rehab beds.

Additional commonly used assessment tools reported included the OSOT Perceptual Evaluation, Mini Mental

State Examination, 9 Hole Peg Test, Box and Block Test, Motor-Free Visual Perception Test, Line Bisection

Test, Visual Analogue Scale and Numeric Rating Scale for pain, Timed Up and Go Test, 6 Minute Walk Test,

Western Aphasia Battery, Geriatric Depression Scale and the Beck Depression Inventory. Figures 2-7 display

the top tools reported on the survey by each professional discipline. Note that for OT, PT, SLP and Psych the

top tools are identified as those having 50% use in at least one region. In SW and Rec, no one tool was

identified as being used by 50% of respondents and as such, 20% was used to identify the top tools

reported.


Table 3: Use of Selected Stroke Rehabilitation Assessment tools in NEO & NWO

NW NE NW NE NW NE NW NE NW NE NW NE

N=15 N=26 N=26 N=30 N=7 N=13 N=4 N=16 N=8 N=8 N=3 N=1

Name of Tool

American Speech-Language-Hearing

Association Functional Assessment of

Communication Skills (ASHA-FACS) n/a n/a n/a n/a 29% 15% n/a n/a n/a n/a n/a n/a

Assessment of Life Habits (LIFE-H) Leisure

Subscale 0% 0% 0% 0% n/a n/a 0% 6% 13% 0% 0% 0%

Beck Depression Inventory (BDI) 27% 8% 8% 0% 0% 0% 0% 24% 0% 0% 67% 100%

Behavioural Inattention Test (BIT) 7% 23% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Berg Balance Scale (BBS) 33% 23% 96% 100% n/a n/a n/a n/a n/a n/a n/a n/a

Boston Diagnostic Aphasia Examination

(BDAE) n/a n/a n/a n/a 71% 77% n/a n/a n/a n/a n/a n/a

Box and Block Test (BBT) 47% 35% 4% 0% n/a n/a n/a n/a n/a n/a n/a n/a

Chedoke Arm and Hand Activity Inventory

(CAHAI) 27% 54% 12% 47% n/a n/a n/a n/a n/a n/a n/a n/a

Chedoke McMaster Stroke Assessment

(CMSA) - Impairment Inventory 7% 35% 54% 77% n/a n/a n/a n/a n/a n/a n/a n/a

Chedoke McMaster Stroke Assessment -

Impairment Inventory Shoulder Pain

(CMSA-SP) 7% 15% 46% 53% n/a n/a n/a n/a n/a n/a n/a n/a

Comb and Razor Test (CRT) 7% 31% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Frenchay Aphasia Screening Test (FAST) n/a n/a n/a n/a 0% 8% n/a n/a n/a n/a n/a n/a

Geriatric Depression Scale (GDS) 27% 35% 15% 3% 0% 0% 25% 44% 13% 0% 100% 0%

Hospital Anxiety and Depression Scale

(HADS) 7% 0% 8% 7% 0% 0% 25% 19% 13% 0% 33% 0%

Line Bisection Test (LBT) 40% 85% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Mini Mental State Examination (MMSE) 73% 69% 23% 23% 0% 0% 0% 13% n/a n/a 0% 0%

Modified Ashworth Scale (MAshS) 0% 0% 15% 27% n/a n/a n/a n/a n/a n/a n/a n/a

Montreal Cognitive Assessment (MOCA) 93% 85% 8% 13% 14% 23% 0% 13% n/a n/a 67% 0%

Motor-free Visual Perception Test (MVPT) 40% 77% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Nine Hole Peg Test (NHPT) 53% 39% 4% 0% n/a n/a n/a n/a n/a n/a n/a n/a

Numeric Pain Rating Scale (NPRS) 40% 54% 58% 73% n/a n/a 0% 19% 13% 25% n/a n/a

OSOT Perceptual Evaluation (OSOT) 73% 73% n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Reintegration to Normal Living Index

(RNLI) 0% 0% 4% 0% n/a n/a 0% 0% 13% 13% 0% 0%

Six Minute Walk Test (6MWT) 0% 4% 54% 53% n/a n/a n/a n/a n/a n/a 0% 0%

Stroke Impact Scale (SIS) 0% 4% 4% 10% 0% 8% 0% 6% 0% 0% n/a n/a

Timed Up and Go Test (TUG) 13% 8% 65% 73% n/a n/a n/a n/a n/a n/a n/a n/a

Toronto Beside Swallowing Screening Test

(TOR-BSST) n/a n/a n/a n/a 0% 8% n/a n/a n/a n/a n/a n/a

Visual Analogue Pain Scale (VAS) 13% 39% 73% 73% n/a n/a 0% 19% 13% 0% n/a n/a

Western Aphasia Battery (WAB) n/a n/a n/a n/a 100% 69% n/a n/a n/a n/a n/a n/a

Wong-Baker FACES Pain Rating Scale

(WBFPRS) 0% 0% 0% 10% n/a n/a n/a n/a n/a n/a n/a n/a

Recommended for inclusion in 'Core Set' of Outcome Measures

PSYCH

% Using

OT PT SLP SW TR

Highlighted = Recommended for inclusion in “core set” of assessment tools

n/a = discipline was not asked about this tool in the survey as it would generally not be applicable or commonly used by the specific discipline


TOP TOOLS REPORTED (>50% USE IN AT LEAST ONE REGION)

Figure 1: Occupational Therapy Top Tools

Figure 2: Physiotherapy Top Tools

Name of Measure (Abbreviation): Berg Balance Scale (BBS); Chedoke Arm and Hand Activity Inventory (CAHAI); Chedoke-McMaster Stroke Assessment - Impairment Inventory (CMSA); Chedoke-McMaster Stroke Assessment – Shoulder Pain (CMSA-SP); Line Bisection Test (LBT); Mini Mental State Examination (MMSE); Montreal Cognitive Assessment (MOCA); Motor-free Visual Perception Test (MVPT); Nine Hole Peg Test (NHPT); Numeric Pain Rating Scale (NPRS); OSOT Perceptual Evaluation (OSOT); Six Minute Walk Test (6MWT); Timed Up and Go Test (TUG); Visual Analogue Pain Scale (VAS)


TOP TOOLS REPORTED (>50% USE IN AT LEAST ONE REGION)

Figure 3: Speech Language Pathology Top Tools

Figure 4: Psychology Top Tools

Name of Measure (Abbreviation): Beck Depression Inventory (BDI); Boston Diagnostic Aphasia Examination (BDAE); Geriatric Depression Scale (GDS); Montreal Cognitive Assessment (MOCA); Western Aphasia Battery (WAB)


TOP TOOLS REPORTED (>20% USE IN AT LEAST ONE REGION)*

*No one tool was identified as being used by > 50% of respondents from Recreation or Social Work

Figure 5: Recreation Top Tools

Figure 6: Social Work Top Tools

Name of Measure (Abbreviation): Beck Depression Inventory (BDI); Geriatric Depression Scale (GDS); Hospital Anxiety and Depression Scale (HADS); Numeric Pain Rating Scale (NPRS)


Overview of Common Themes in “Core” Assessment Tools

When reviewing the data collected from the four core assessment tools captured in the survey, there was

nearly complete consensus from those who frequently (>50% of the time) administered the core set that

each tool took a reasonable length of time to complete.

Respondents who frequently administered the tools were asked to rate the ‘usefulness of the tool’ on a five

point scale across four categories. The categories were: Establishing a baseline measure; measuring progress

or change; communicating the patient’s status; and assisting with identification of goals (see Appendix 1,

question 1.c). The majority of the respondents rated all of the four tools as either extremely or very useful for

establishing a baseline measure. The same findings occurred for measuring progress or change and

communicating the patient’s status with the exception of the BDAE which was rated as either very useful or

useful. Reponses for rating the ‘usefulness’ of assisting with the identification of goals were more

widespread for three of the tools with the exception of the BDAE which was rated as very useful or useful

again. When reviewing the responses for the ‘usefulness’ of all the tools, only one individual gave a rating of

not useful and that was by an OT with reference to the MOCA's assistance with identification of goals.

In reviewing the data from an urban/rural perspective, there was no apparent difference in the overall use of

the core set of assessment tools between clinicians practicing in these environments. However, it was

observed that in some of the rural communities, there was increased use of tools by clinicians who may not

traditionally administer that assessment. For example, urban PT’s generally did not administer the MOCA

citing that the OT’s usually assessed cognition. However some rural PT’s did use the MOCA as they may not

have had access to OT’s as part of their interdisciplinary team.

The survey explored some common reasons as to why a tool may be used infrequently or not at all, which are

summarized under the subheadings below. However, two of the choices (the cost of the tools and licensing

requirements) appeared to be non-issues as they were mentioned only once for one specific tool, the CMSA.

Montreal Cognitive Assessment (MOCA)

The survey results for both the NE and NW showed that the MOCA was primarily administered by the OTs.

Physiotherapy, psychology and social work occasionally or rarely administered it. The primary reason for the

other professions not using it was they felt it was not applicable to their profession/area of practice or that

the OTs at their site administered it. Furthermore, approximately one third of the PTs were unaware this tool

existed and a small percentage (10% - 20%) of the SWs and PTs cited lack of training as the reason why they

were not using it. Within the comments on the measure, one OT who used it less frequently stated that

he/she was “…awaiting further study re use of the MOCA with stroke patients”.

Chedoke-McMaster Stroke Assessment - Impairment Inventory (CMSA)

In the NE, approximately three quarters of the PTs administered the CMSA and of those, half of them did so

frequently (>50% of the time). In comparison, in the NW approximately half of the PTs administered the tool

and of those, one third did so frequently.

In the NE, slightly more than one third of the OTs administered the CMSA and similar to the PTs half of them

did so frequently. A very small percentage (< 10%) of the NW OTs reported administering it and only did so

rarely due to lack of training and time.


For both disciplines in both regions, lack of time to administer or not finding the tool to be clinically useful

were common themes for infrequently (≤ 50% of the time) or not using the tool at all. Therapists in acute

care most often commented on time constraints, however it was a consistent theme across the continuum

from acute to community care.

A small percentage of the NE PTs and OTs cited lack of training/expertise as reasons why they were

administering it infrequently or not at all, whereas, in the NW a quarter of the therapists reported that as the

reason. For both regions, a small percentage the OT group also indicated that they didn’t use the CMSA as it

was not applicable for their area of practice, that PTs administered it, and a very small percentage were

unaware that this tool existed.

Boston Diagnostic Aphasia Examination (BDAE)

In both regions approximately three quarters of the SLPs use the BDAE, and of those, a quarter used it

frequently.

Lack of time to administer, across the continuum from acute to community care was the most common

reason for either infrequently or not using the tool. Lack of training was only reported on one occasion.

Further comments noted that other tools are more useful in the community setting given the client

demographics. One SLP commented more severe stroke patients are better suited to assessment using the

Western Aphasia Battery, a tool which was reported to be commonly used by both NE and NW SLP’s.

Berg Balance Scale (BBS)

In both regions all PTs use the BBS with the exception of one individual who reported not using it because it

was not applicable to their area of practice as their clients were very low functioning. In the NE eighty

percent of the PTs use the BBS frequently versus eighty-eight percent in the NW.

For OTs and PTs in both regions the issue of time constraints was raised by those who did not administer the

tool as frequently. The OTs who did not administer the BBS primarily cited that the PTs administered it or

that it was not applicable for their area of practice. Lack of training/expertise was also indicated in the NW

by a small percentage of OT respondents.

Other Commonly Used Tools

Many tools not included in the Canadian Best Practice Recommendations for Stroke Care were also being

utilized by clinicians. Examples of additional tools being utilized in stroke rehabilitation in NE and NW Ontario

include the Community Balance and Mobility Scale, Trail Making A and B Tests, Boston Naming Test,

Cognitive Assessment Scale for the Elderly, Leisure Motivational Scale and Wisconsin Card Sorting Test.

Appendices 2-7 outline for each discipline the variety of other tools reported to be used in stroke

rehabilitation.

Use of Electronic Resources

As illustrated in Figures 7 and 8, the majority of respondents were familiar with electronic resources for

assessment tools. However some respondents were unaware that the following websites existed:

StrokEngine Assess (45% unaware), Evidence-Based Review of Stroke Rehabilitation (41% unaware) and

Canadian Best Practice Recommendations for Stroke Care (20% unaware).


Figure 7: NW Electronic Resources: Awareness and Usage

Stroke Assessment Tools Survey - All Clinicians - NW

2010 Canadian Best Practice Recommendations for Stroke Care (www.strokebestpractices.ca)

Answer Options Response

Count Response Percent

Unaware this website existed 9 14%

Aware of website however have not looked at it 18 29%

Visited the website once 16 25%

Visited it 2-5 times 13 21%

Visited it greater than 5 times 7 11%

Total 63 100%

EBRSR: Evidence-Based Review of Stroke Rehabilitation (www.ebrsr.com)








Total 63 100%

StrokEngine Assess (www.medicine.mcgill.ca/strokengine-assess)








Total 63 100%


Figure 8: NE Electronic Resources: Awareness and Usage

Stroke Assessment Tools Survey - All Clinicians NE

2010 Canadian Best Practice Recommendations for Stroke Care (www.strokebestpractices.ca)








TOTAL 94 100%

EBRSR: Evidence-Based Review of Stroke Rehabilitation (www.ebrsr.com)








TOTAL 94 100%

StrokEngine Assess (www.medicine.mcgill.ca/strokengine-assess)








TOTAL 94 100%


Next Steps

Discuss survey findings with each stroke network’s steering committees, advisory and professional

practice groups.

Develop educational strategies to enhance uptake and awareness of the core set of assessment tools

and of the resources available to support clinicians. During this process, take into account and build

on previous strategies developed by provincial counterparts such as the regional rehabilitator

coordinators and the Ontario Regional Educators Group (OREG).

Consider the target audience in developing strategies. Although there may be excellent uptake of the

tool such as the BBS by PTs who regularly administer the tool we need to also consider the other

team members who do not administer the tool. In order to have a common/shared language they

need to have a basic understanding of what the reported scores mean. Consider use of

communiqués or the possibility of having Lunch and Learn sessions via videoconference providing an

overview of the core tools.

Look further into the demographics of the respondents (profession, district, area(s) of practice) who

expressed interest in learning more about a specific recommended tool. For example, one SLP

commented ‘Would be very interested in training related to the TOR-BSST’. For comments such as

this, we might consider a communiqué to the appropriate professions that at minimum would

provide information on how to access education on the tool.

Survey and Final Report prepared by:

Jenn Fearn

Regional Rehabilitation Coordinator

NEO Stroke Network

Hôpital régional de Sudbury Regional Hospital

41 Ramsey Lake Road, Sudbury, ON P3E 5J1

Ph. 705.523.7100 ext. 1718

Fax. 705.523.7170

Email: [email protected]

Web: www.neostrokenetwork.com

Esmé French

Regional Stroke Rehabilitation Specialist

NWO Regional Stroke Network

201-984 Oliver Road

Thunder Bay, ON P7B 7C7

Ph. 807.684.6498

Fax. 807. 684.5883

Email: [email protected]

Web: www.nwostroke.ca

mailto:[email protected]

http://www.neostrokenetwork.com/

mailto:[email protected]

http://www.nwostroke.ca/

17

Appendices

Appendix 1: Survey Template

Appendix 2: Physiotherapy Demographics and Discipline Specific Information

Appendix 3: Occupational Therapy Demographics and Discipline Specific Information

Appendix 4: Speech Language Pathology Demographics and Discipline Specific Information

Appendix 5: Social Work Demographics and Discipline Specific Information

Appendix 6: Recreation Demographics and Discipline Specific Information

Appendix 7: Psychology Demographics and Discipline Specific Information

18

Appendix 1: Survey Template

Demographic information collected:

Profession

Location of practice [region, district, urban/rural (size of community) and setting (rehab, acute

care etc.)]

Years of clinical experience (general and stroke specific)

Average percentage of caseload that patients with stroke represent

Outcome Measure Specific Questions:

For each outcome measure, the following questions were asked:

1. Do you use this tool? Yes No

A response of Yes led to the following questions:

a. In what percentage of cases do you use this tool with your patients with stroke?

If the clinician responded occasionally or rarely ( 50 %) they were asked the following:

i. Could you please elaborate why you only occasionally or rarely use this tool? If more than one reason, select all that apply.

o Lack of time to administer o Lack of training/expertise o Not clinically useful (information does not inform my practice) o Not clinically appropriate (another measure is more appropriate) o Cost of the tool o Other, please specify:

b. Is the length of time to administer the tool reasonable?

c. In the following questions, please rate the usefulness of the tool by selecting the number that

best reflects the tool in each circumstance (1=not useful 5=extremely useful, n/a)

i. Establishing a baseline measure ii. Measuring progress or change

iii. Communicating the patient’s status iv. Assisting with identification of goals

A response of No led to the following question:

a. Could you please elaborate why you do not use this tool? If more than one, select all that apply.

o Lack of time to administer o Lack of training/expertise o Not clinically useful (information does not inform my practice) o Not clinically appropriate (another measure is more appropriate) o Not applicable for my profession/area of practice o Cost of the tool o Licensing requirements o Unaware this tool existed o Other, please specify

19

2. Please list any other tools you commonly use with your patients with stroke. If they were developed

by your facility please provide a brief description of their purpose i.e. Smith test (Swallowing Screen)

3. If you have any further comments you wish to provide, feel free to provide them here.

A general question was asked to determine the participant’s familiarity with electronic resources that contain information regarding assessment tools in stroke rehabilitation.

4. Please indicate your familiarity/usage of the following 3 websites?

(unaware this website existed visited it greater than 5 times)

1. StrokEngine Assess (www.medicine.mcgill.ca/strokengine-assess)

2. Evidence-Based Review of Stroke Rehabilitation (www.ebrsr.com)

3. Canadian Best Practice Recommendations for Stroke Care (www.strokebestpractices.ca)

20

Appendix 2: Physiotherapy Demographics and Discipline Specific Information

Answer

OptionsThunder Bay 69.2% 18

West of Thunder Bay 23.1% 6

East of Thunder Bay 7.7% 2

Thunder BayWest of Thunder

Bay

East of

Thunder Bay

Response

Percent

Response

Count

17 0 0 65.4% 17

1 5 0 23.1% 6

0 1 2 11.5% 3

26

0

Thunder Bay West of Thunder East of Response Response 2 4 2 30.8% 8

8 2 2 46.2% 12

1 2 2 19.2% 5

4 3 2 34.6% 9

2 0 0 7.7% 2

5 1 0 23.1% 6

1 1 0 7.7% 2

260

Community, LTC


Bay

East of

Thunder Bay

Response

Percent

Response

Count

2 0 1 11.5% 3

6 0 0 23.1% 6

3 1 0 15.4% 4

5 4 1 38.5% 10

2 1 0 11.5% 3

26

0


Bay

East of

Thunder Bay

Response

Percent

Response

Count

3 0 1 15.4% 4

7 1 0 30.8% 8

3 3 0 23.1% 6

4 1 1 23.1% 6

1 1 0 7.7% 2

26

0


Bay

East of

Thunder Bay

Response

Percent

Response

Count

7 5 1 50.0% 13

6 0 0 23.1% 6

1 1 0 7.7% 2

1 0 1 7.7% 2

3 0 0 11.5% 3

26

0

Stroke Assessment Tools Survey - Demographics NW Physio

Please select the geographical district(s) you practice in:

Response Percent & Count

answered question 26

skipped question 0

answered questionskipped question

What size of setting(s) do you practice in? Please check all that apply.

Please select the geographical district(s) you

Answer Options

Population ≥ 40 000

Population 5000 - 39 999

Population < 5000

answered question

skipped question

Please indicate the setting(s) that you work in. If more than one, select all that apply.


Answer OptionsAcute Care

In-patient Rehabilitation

Complex Continuing Care

Out-patient Rehabilitation

Hospital-based Day Program

Home Care/CCAC

Other (please specify)

0-1

2-5

6-10

11-19

20+

Please indicate your total number of years of clinical experience (not stroke specific): Please select the geographical district(s) you

Answer Options

Answer Options

0-1

2-5

6-10

11-19

answered question

skipped question

Please indicate your total number of years of clinical experience working with people who have had a stroke: Please select the geographical district(s) you

76-100

answered question

skipped question

Answer Options

0-10

11-25

26-50

51-75

20+

answered question

skipped question

Please estimate the average percentage of your caseload that patients with stroke represent:


21

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

20.0% 6

20.0% 6

20.0% 6

40.0% 12

30

0

Alg o ma T imminsNip iss ing -

T e miska mingSud b ury

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

5 4 1 6 53.3% 16

1 2 4 4 36.7% 11

0 0 1 2 10.0% 3

30

0



Re sp o nse

Pe rce nt

Re sp o nse

Co unt

6 5 3 6 66.7% 20

4 4 1 8 56.7% 17

5 4 2 2 43.3% 13

5 3 3 3 46.7% 14

0 0 0 2 6.7% 2

0 2 4 1 23.3% 7

1 1 0 1 10.0% 3

30

0

LTC and elCAP beds in LTC facility, LTC, private practice, retirement homes



Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 0 0.0% 0

0 3 1 1 16.7% 5

1 0 0 1 6.7% 2

4 2 1 4 36.7% 11

1 1 4 6 40.0% 12

30

0



Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 1 0 1 6.7% 2

0 2 1 1 13.3% 4

2 0 1 1 13.3% 4

3 3 0 5 36.7% 11

1 0 4 4 30.0% 9

30

0



Re sp o nse

Pe rce nt

Re sp o nse

Co unt

3 3 6 5 56.7% 17

3 3 0 3 30.0% 9

0 0 0 1 3.3% 1

0 0 0 2 6.7% 2

0 0 0 1 3.3% 1

30

0

Stroke Assessment Tools Survey - Demographics NE Physio

Answe r Op tio ns

Timmins

Sudbury-Manitoulin

Ple a se se le c t the g e o g ra p hica l d is tric t(s ) yo u p ra ctice in:

Home Care/CCAC

a nswe re d q ue stio n

sk ip p e d q ue stio n




Wha t s ize o f se tting d o yo u p ra ctice in?

Algoma

Answe r Op tio ns




Ple a se ind ica te yo ur to ta l numb e r o f ye a rs o f c linica l e xp e rie nce (no t s tro ke sp e c ific ):


Answe r Op tio ns

0-1

2-5

6-10



Acute Care

11-19

Answe r Op tio ns

2-5

20+


Ple a se e stima te the a ve ra g e p e rce nta g e o f yo ur ca se lo a d tha t p a tie nts with s tro ke re p re se nt:

6-10

11-19

0-1

Ple a se ind ica te yo ur to ta l numb e r o f ye a rs o f c linica l e xp e rie nce wo rk ing with p e o p le who ha ve ha d a s tro ke :


20+


76-100



Answe r Op tio ns

0-10

11-25

26-50

51-75

Nipissing-Temiskaming

Urban (population ≥ 40 000)

Rural (population < 40 000)

Answe r Op tio ns

Both Urban and Rural


Ple a se ind ica te the se tting (s) tha t yo u wo rk in. If mo re tha n o ne , se le c t a ll tha t a p p ly .

22

PHYSIOTHERAPY – REPORTED USE OF OTHER TOOLS

REPORTED BY BOTH NE & NW

Community Balance and Mobility Scale (CBMS)

Functional Independence Measure (FIM) ®

Alpha FIM®

Tinetti Balance Test

2 minute walk test REPORTED BY NE ONLY

Elderly Mobility Scale REPORTED BY NW ONLY

Clinical Outcome Variables Scale

Gait speed

10 m walk test

Activities-specific Balance Confidence Scale (ABC Scale)

Action Plans for goal setting

Manual muscle testing - Oxford scale

Modified sphygmomanometer or myometer for assessing muscle strength

Range of motion - goniometer

Functional reach test

Morse fall risk assessment

National Institutes of Health Stroke Scale (NIHSS)

Gait assessment

PT OTHER COMMENTS NW

I strictly take outpatient neuro clients so the CMSA scale is much too long to be useful for both client and clinician. I have access to the electronic medical record and see the scores that the inpatient physiotherapist has assessed, but I do not redo this score.

For a lot of the self-report measures, it is difficult in clinical practice to complete them due to time restrictions. Also, there is often cognitive difficulties and/or communication issues that makes their administration difficult. It would be good to have them completed as they do have an impact on our therapy. Perhaps not directly but definitely indirectly.

Working within in a team and having other team members (ie. Psych or Social work) administer these outcome measures would be helpful.

I do not actively treat many post-stroke clients in my current position (less than 2 a year)

Due to low number of stroke patients per year, there is not a large focus/amount of time spent on learning or attempting to implement a lot of the aforementioned assessment and outcome tools. Perhaps a seminar introducing the previously mentioned tools would be of benefit for those therapists in the area that treat stroke patients so that an informed decision could be made on an individual basis about which tools would be the most appropriate one(s) to use in each particular setting.

NE

Due to caseload demands, standardized tools are not commonly used. Functional assessments are used to determine course of treatment and measure progress.

I realize, even prior to this survey that I need to be using more outcome measures. However, as I've mentioned, stroke patients make up such a small percentage of my clientele, it is hard to feel confident in using them. Also, time is definitely an issue with many of these, as I am a sole-charge physiotherapist covering many different areas.

Do not use all the outcome measurements on every client, more appropriate with some than others. Am limited in the time it takes to do the assessment (and therefore thoroughness) as our agency feels that 1 1/2 hours for an assessment, including travel time & paper work is sufficient.

23

Appendix 3: Occupational Therapy Demographics and Discipline Specific Information

Response

PercentResponse Count

73.3% 11

20.0% 3

13.3% 2

15


Bay

East of Thunder

Bay

Response

Percent

Response

Count

8 0 1 53.3% 8

2 3 1 33.3% 5

3 0 2 26.7% 4

15

0


Bay

East of Thunder

Bay

Response

Percent

Response

Count

4 1 1 40.0% 6

3 1 0 26.7% 4

1 0 0 6.7% 1

2 1 0 20.0% 3

0 0 0 0.0% 0

2 1 2 26.7% 4

2 1 0 20.0% 3

15

0

contract work for veteran's affairs

community geriatric psychiatry

Mental Health Case management in the community


Bay

East of Thunder

Bay

Response

Percent

Response

Count

1 0 0 6.7% 1

1 2 0 20.0% 3

2 1 0 20.0% 3

3 0 0 20.0% 3

4 0 2 33.3% 5

15

0


Bay

East of Thunder

Bay

Response

Percent

Response

Count

1 0 0 6.7% 1

5 2 1 46.7% 7

2 1 0 20.0% 3

0 0 1 6.7% 1

3 0 0 20.0% 3

15

0


Bay

East of Thunder

Bay

Response

Percent

Response

Count

5 1 1 46.7% 7

2 2 1 26.7% 4

1 0 0 6.7% 1

0 0 0 0.0% 0

3 0 0 20.0% 3

15

0

76-100

answered question

skipped question

Answer Options

0-10

11-25

26-50

51-75

20+

answered question

skipped question


Please select the geographical district(s) you practice

Answer Options

0-1

2-5

6-10

11-19

skipped question

Please indicate your total number of years of clinical experience working with people who have had a stroke:


2-5

6-10

11-19

20+

answered question


Answer Options

0-1

Home Care/CCAC


answered question

skipped question

Please indicate your total number of years of clinical experience (not stroke specific):

Acute Care







in:

Answer Options



Population < 5000

answered question

skipped question

Answered Question

Stroke Assessment Tools Survey - Demongraphics NW OT

Thunder Bay


Answer Options



Answer Options

East of Thunder Bay

West of Thunder Bay

24

Response PercentResponse

Count

11.5% 3

26.9% 7

30.8% 8

38.5% 10

26

Algoma Timmins Nipissing-

Temiskaming

Sudbury-

Manitoulin

Response

Percent

Response

Count

2 4 5 8 65.4% 17

0 3 3 1 26.9% 7

1 0 0 1 7.7% 2

26

0


Temiskaming

Sudbury-

Manitoulin

Response

Percent

Response

Count

2 4 5 3 53.8% 14

2 4 4 5 57.7% 15

2 3 4 0 34.6% 9

1 5 4 4 46.2% 12

0 0 0 0 0.0% 0

1 2 1 1 19.2% 5

1 1 1 0 11.5% 3

26

0

Minor Procedures Clinic

LTC

Interim Long Term Care


Temiskaming

Sudbury-

Manitoulin

Response

Percent

Response

Count

0 0 3 3 23.1% 6

0 0 0 2 7.7% 2

0 2 0 0 7.7% 2

0 3 3 5 34.6% 9

3 2 2 0 26.9% 7

26

0


Temiskaming

Sudbury-

Manitoulin

Response

Percent

Response

Count

0 0 3 3 23.1% 6

0 1 0 3 15.4% 4

0 1 0 0 3.8% 1

1 5 3 4 42.3% 11

2 0 2 0 15.4% 4

26

0


Temiskaming

Sudbury-

Manitoulin

Response

Percent

Response

Count

2 3 3 3 34.6% 9

1 2 2 2 26.9% 7

0 2 2 3 26.9% 7

0 0 1 2 11.5% 3

0 0 0 0 0.0% 0

26

0

answered question

skipped question



answered question

skipped question

Answer Options

0-10

11-25

26-50

51-75

76-100

20+

answered question

skipped question

Please indicate your total number of years of clinical experience working with people who have had a stroke:


Answer Options

0-1

2-5

6-10

11-19

20+

answered question

skipped question



Answer Options

0-1

2-5

6-10

11-19


Answer Options

Acute Care



answered question



What size of setting do you practice in?




Home Care/CCAC

skipped question




Algoma

Sudbury-Manitoulin

answered question

Answer Options


Timmins

Answer Options

Stroke Assessment Tools Survey - Demongraphics NE OT


25

OCCUPATIONAL THERAPY – REPORTED USE OF OTHER TOOLS


Trail Making A and B

Clock Drawing Test

Alpha FIM®

Cognitive Assessment of Minnesota

JAMAR hand and pinch strength assessments.

Canadian Occupational Performance Measure (COPM)

Cognitive Competency Test

Functional Independence Measure (FIM)®

REPORTED BY NE ONLY

Independent Living Scales

Goal Attainment Scale

Test of Everyday Attention

Rivermead Behavioural Memory Test

Protocole d'Examen Cognitif de la Personne Agee (PECPA)

Cognitive Assessment Scale for the Elderly (CASE)

"perceptual screen" - includes letter cancellation, read & write sentence, draw front view of house, person

Brain Injury Visual Assessment Battery for Adults (BIVABA)

Sunnybrook Neglect Assessment Protocol (SNAP)

Manual Muscle Testing

Behavioural Assessment of the Dysexecutive Syndrome (BADS) REPORTED BY NW ONLY

National Institutes of Health Stroke Scale

Functional assessment: e.g. observe transfers from tub, chair, bed, toilet, focus on practical activities Home safety assessment: e.g. measure doorways, recommend ramps

Reviewing goals such as cooking, bathing, mobility

Gardner Test of Visual Perceptual Skills (non-motor)

OT OTHER COMMENTS NW

There are a few standardized assessment tools that are new to me and I do hope that there will be some training provided so all clinicians dealing with stroke clients will have more awareness of the tools that are out there.

Active rehabilitation is not taking place in the community specifically the client's home. Implementing standardized tools is simply not effective use of time when the client is discharged from home care after 2-4 visits.

Primary focus seems to been ensuring home safety and accessibility versus improving overall function. Clients who have participated in an in-pt rehab program often return as an out-pt which limits the role of active home care therapy. I do feel that a more significant role can be played by home care OT, Pt, etc.

Therapy in the client's residence can be very effective for some clients at assisting them in re-engaging in their routine activities.

NE

Some outcome measures, I feel are inappropriate to use, because you are penalized if you've had your stroke a while back whether it be 3, 6 12 months or more.

I feel these outcome are biased and these scores are looked at by other health care professionals and decisions are made based on these scores. Even though a client may have a low score, maybe they just need the right therapy to improve and often these scores mask their potential.

When working in augmentative communication, I'm not sure if I would be missing an assessment tool that I could be using. At this time, I don't use any.

26

Appendix 4: Speech Language Pathology Demographics and Discipline Specific Information

57.1% 4

28.6% 2

28.6% 2

7

T hund e r Ba yW e st o f T hund e r

Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

4 0 1 57.1% 4

1 2 1 42.9% 3

1 0 2 28.6% 2

7

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 1 1 42.9% 3

2 1 1 57.1% 4

0 0 0 0.0% 0

1 0 0 14.3% 1

0 0 0 0.0% 0

1 2 2 57.1% 4

1 0 1 14.3% 1

7

0

private practice


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 1 0 14.3% 1

2 0 1 28.6% 2

0 0 0 0.0% 0

2 0 1 42.9% 3

0 1 0 14.3% 1

7

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 1 0 14.3% 1

2 1 1 42.9% 3

0 0 0 0.0% 0

2 0 1 42.9% 3

0 0 0 0.0% 0

7

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 1 14.3% 1

0 1 0 14.3% 1

3 0 1 42.9% 3

1 1 0 28.6% 2

0 0 0 0.0% 0

7

0

East of Thunder Bay

West of Thunder Bay

Population < 5000

Thunder Bay

Stroke Assessment Tools Survey - Demographics NW Speech Language Pathology

W ha t s ize o f se tting (s) d o yo u p ra ctice in? Ple a se che ck a ll tha t a p p ly .

Answe r Op tio ns




Answe r Op tio ns Re sp o nse Pe rce nt & Co unt




0-1

Home Care/CCAC



Acute Care


6-10

20+

Answe r Op tio ns

0-1



Answe r Op tio ns

2-5


11-19

76-100



Answe r Op tio ns

0-10

11-25

26-50

51-75

Answe re d Que stio n



Ple a se ind ica te yo ur to ta l numb e r o f ye a rs o f c linica l e xp e rie nce wo rk ing with p e o p le who ha ve ha d a

s tro ke :

2-5

6-10

11-19

20+



Answe r Op tio ns




27

Re sp o nse

Pe rce nt

Re sp o nse Co unt

23.1% 3

0.0% 0

46.2% 6

30.8% 4

13


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

2 0 3 4 69.2% 9

0 0 2 0 15.4% 2

1 0 1 0 15.4% 2

13


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

2 0 4 1 53.8% 7

2 0 4 3 69.2% 9

2 0 4 0 46.2% 6

2 0 4 1 53.8% 7

0 0 0 0 0.0% 0

1 0 3 0 30.8% 4

1 0 0 0 7.7% 1

13

private practice


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 1 7.7% 1

1 0 3 1 38.5% 5

0 0 0 2 15.4% 2

2 0 2 0 30.8% 4

0 0 1 0 7.7% 1

13


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 1 7.7% 1

1 0 3 1 38.5% 5

1 0 0 2 23.1% 3

1 0 3 0 30.8% 4

0 0 0 0 0.0% 0

13


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 0 1 1 23.1% 3

0 0 2 0 15.4% 2

1 0 0 1 15.4% 2

1 0 2 0 23.1% 3

0 0 1 2 23.1% 3

13a nswe re d q ue stio n

0-10

11-25

26-50

51-75

6-10

20+




2-5

Answe r Op tio ns

0-1

Answe r Op tio ns

11-19

20+




76-100

0-1

2-5

6-10

11-19

Answe r Op tio ns





Home Care/CCAC


Answe r Op tio ns

Acute Care








Answe r Op tio ns


Timmins



Answe r Op tio ns

Algoma

Sudbury-Manitoulin




Stroke Assessment Tools Survey - Demographics NE Speech Language Pathology


28

SPEECH LANGUAGE PATHOLOGY – REPORTED USE OF OTHER TOOLS


Reading Comprehension Battery for Aphasia (RCBA) Boston Naming Test Frenchay Dysarthria Assessment Scales of Cognitive Ability for Traumatic Brain Injury (SCATBI) Assessment of Intelligiblity of Dysarthric Speech

REPORTED BY NE ONLY Burns Left and Right Hemisphere Inventory Woodcock Johnson - passage comprehension subtest Discourse Comprehension Test Swallowing Screening for TIA/CVA - developed at facility Cognitive-Linguistic Quicktest Western Aphasia Battery – Revised (bedside) (WAB-R) Butt Non-Verbal Reasoning Test Test of Adolescent/Adult Word Finding Reading Comprehension Battery for Adults with Aphasia Apraxia Battery for Adults (ABA-2) Communication Activities of Daily Living (CADL-2) Examining for Aphasia - 4 (EFA-4) Test for Adolescent and Adult Word-Finding Cognitive-Linguistic Quick Test Ross Information Processing Assessment (RIPA) REPORTED BY NW ONLY Sentence/Discourse Comprehension Test Adapted version of the Morton Plant Mease Health Care Screening tool for Stroke-Dysphagia Screen

SLP OTHER COMMENTS NW It is so great that you are doing this survey! I am very interested in improving my knowledge and skills in this area! NE Would be very interested in training related to the TOR-BSST

29

Appendix 5: Social Work Demographics and Discipline Specific Information

75.0% 3

25.0% 1

0.0% 0

4


Ba y

Ea st o f

T hund e r

Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

2 0 0 50.0% 2

0 0 0 0.0% 0

1 1 0 50.0% 2

4

0


Ba y

Ea st o f

T hund e r

Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 1 0 25.0% 1

1 0 0 25.0% 1

1 0 0 25.0% 1

1 0 0 25.0% 1

0 0 0 0.0% 0

0 0 0 0.0% 0

1 0 0 25.0% 1

4

0

hospital palliative


Ba y

Ea st o f

T hund e r

Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 0.0% 0

0 0 0 0.0% 0

1 0 0 25.0% 1

1 1 0 50.0% 2

1 0 0 25.0% 1

4

0


Ba y

Ea st o f

T hund e r

Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 0.0% 0

1 1 0 50.0% 2

1 0 0 25.0% 1

1 0 0 25.0% 1

0 0 0 0.0% 0

4

0


Ba y

Ea st o f

T hund e r

Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

2 1 0 75.0% 3

0 0 0 0.0% 0

1 0 0 25.0% 1

0 0 0 0.0% 0

0 0 0 0.0% 0

4

0



Answe r Op tio ns



Population < 5000



Stroke Assessment Tools Survey - Demographics NW Social Work

Thunder Bay


Answe r Op tio ns

East of Thunder Bay

West of Thunder Bay

Re sp o nse Pe rce nt & Co unt


Answe r Op tio ns

Home Care/CCAC


Acute Care




Answe r Op tio ns

2-5




0-1

2-5

6-10

11-19

20+




11-19



Ple a se ind ica te yo ur to ta l numb e r o f ye a rs o f c linica l e xp e rie nce wo rk ing with p e o p le who ha ve

ha d a s tro ke :

20+


6-10

Answe r Op tio ns

0-1

76-100



Answe r Op tio ns

0-10

11-25

26-50

51-75

30

Alg o ma T immins N ip iss ing -

T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

5 0 0 0 31.3% 5

0 2 0 0 12.5% 2

0 0 5 0 31.3% 5

0 0 0 4 25.0% 4

16

0

2 1 2 3 50.0% 8

0 0 2 0 12.5% 2

3 1 1 1 37.5% 6

16

4 1 1 2 50.0% 8

1 1 1 1 25.0% 4

1 1 1 0 18.8% 3

0 0 0 0 0.0% 0

0 0 0 0 0.0% 0

1 1 1 0 18.8% 3

0 0 1 1 12.5% 2

16

Discharge planning, seniors mental health

0 0 1 0 6.3% 1

0 1 1 0 12.5% 2

2 0 0 0 12.5% 2

3 1 2 0 37.5% 6

0 0 1 4 31.3% 5

16

1 1 1 0 18.8% 3

1 0 3 1 31.3% 5

3 0 0 1 25.0% 4

0 1 0 2 18.8% 3

0 0 1 0 6.3% 1

16

0

1 1 2 2 37.5% 6

3 1 2 1 43.8% 7

1 0 1 1 18.8% 3

0 0 0 0 0.0% 0

0 0 0 0 0.0% 0

16

0

Stroke Assessment Tools Survey - Demographics NE Social Work

0-10



11-25

26-50

51-75

76-100




0-1


6-10

11-19

20+



s tro ke :

0-1

2-5

6-10

11-19

20+


2-5


Acute Care





Home Care/CCAC






W ha t s ize o f se tting d o yo u p ra ctice in?


Timmins



Sudbury-Manitoulin

Algoma


Answe r Op tio ns

31

SOCIAL WORK –REPORTED USE OF OTHER TOOLS REPORTED BY BOTH NE & NW

none REPORTED BY NE ONLY

Developing a self medication administration tool in relation to discharge planning for all patients in rehab including stroke

Cognitive Assessment Scale for the Elderly (CASE)

Psycho-social Assessments REPORTED BY NW ONLY

none

SW OTHER COMMENTS NW

My role is very much as a discharge planner and not assessment. NE

It would be highly beneficial to have training geared to this topic. Often I have questions from my clients and I am searching for their answers however it would great to have an overall training to discuss the various elements that clients and workers face when assisting these clients. In this training I would include (funding options, resources for client and worker in Northern Ontario, overall understanding of the impact it has on the client and recovery, various tools as indicated in this questionnaire, etc).

I spend more time doing discharge planning than providing the social/emotional support re: stroke although do provide some on individual basis though not via formal assessment tool. Also wonder about the aphasia depression tool and is there also a depression tool for stroke patients in particular.

On an acute care floor the primary role of SW is to provide education and support. Formal testing often occurs during the Rehabilitation phase of their treatment.

32

Appendix 6: Recreation Demographics and Discipline Specific Information

87.5% 7

0.0% 0

12.5% 1

8


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

4 0 1 62.5% 5

2 0 0 25.0% 2

1 0 0 12.5% 1

8

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 0 0.0% 0

1 0 0 12.5% 1

0 0 1 12.5% 1

2 0 0 25.0% 2

2 0 0 25.0% 2

0 0 0 0.0% 0

4 0 0 50.0% 4

8

0

OTHER: vascular dementia, LTC x3


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 0 0 12.5% 1

0 0 0 0.0% 0

1 0 0 12.5% 1

3 0 1 50.0% 4

2 0 0 25.0% 2

8

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 0 0 12.5% 1

1 0 0 12.5% 1

1 0 0 12.5% 1

2 0 1 37.5% 3

2 0 0 25.0% 2

8

0


Ba y

Ea st o f

T hund e r Ba y

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 0 0 12.5% 1

3 0 1 50.0% 4

1 0 0 12.5% 1

2 0 0 25.0% 2

0 0 0 0.0% 0

8

0



Thunder Bay


Answe r Op tio ns Re sp o nse Pe rce nt & Co unt

Stroke Assessment Tools Survey - Demographics NW Recreat ion

East of Thunder Bay

West of Thunder Bay

Population < 5000


Answe r Op tio ns




Home Care/CCAC




Answe r Op tio ns

Acute Care




Ple a se se le c t the g e o g ra p hica l d is tric t(s ) yo u

p ra ctice in:

11-19

20+

2-5

6-10

11-19

20+





p ra ctice in:Answe r Op tio ns

0-1


p ra ctice in:




s tro ke :

2-5

6-10

Answe r Op tio ns

0-1


Answe r Op tio ns

0-10

11-25

26-50

51-75

76-100



p ra ctice in:




33

Re sp o nse Pe rce nt Re sp o nse Co unt

25.0% 2

0.0% 0

50.0% 4

25.0% 2

8


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

1 0 4 2 87.5% 7

0 0 0 0 0.0% 0

1 0 0 0 12.5% 1

8

0


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

2 0 1 0 37.5% 3

0 0 2 1 37.5% 3

1 0 3 0 50.0% 4

0 0 0 1 12.5% 1

0 0 0 0 0.0% 0

0 0 0 0 0.0% 0

1 0 0 0 12.5% 1

8

0

Other: Assess and Restore unit


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 1 0 12.5% 1

1 0 1 0 25.0% 2

0 0 0 0 0.0% 0

0 0 2 2 50.0% 4

1 0 0 0 12.5% 1

8

0


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 2 0 25.0% 2

1 0 0 0 12.5% 1

0 0 1 0 12.5% 1

0 0 1 2 37.5% 3

1 0 0 0 12.5% 1

8

0


T e miska ming

Sud b ury-

Ma nito ulin

Re sp o nse

Pe rce nt

Re sp o nse

Co unt

0 0 1 0 12.5% 1

0 0 1 0 12.5% 1

2 0 2 2 75.0% 6

0 0 0 0 0.0% 0

0 0 0 0 0.0% 0

8

0

Stroke Assessment Tools Survey - Demographics NE Recreat ion

76-100


2-5

6-10


Answe r Op tio ns

0-10

11-25

26-50

51-75


11-19

20+






Answe r Op tio ns

0-1



Answe r Op tio ns

Acute Care




Answe r Op tio ns

0-1




Home Care/CCAC



Answe r Op tio ns







Algoma

Timmins




Answe r Op tio ns


Sudbury-Manitoulin


2-5


6-10

11-19

20+


34

RECREATION – REPORTED USE OF OTHER TOOLS REPORTED BY BOTH NE & NW

none REPORTED BY NE ONLY

Leisure Motivational Scale (LMS)

Leisure Competence Measure (LCM)

Leisure Satisfaction Scale (LSS)

State Technical Institute's Leisure Assessment Process (STILAP)

Ohio Functional Assessment Battery

Laurentian Outing Functional Assessment Measure (LOFAM)

Leisurescope

Tinkertoy

Leisure Interest Measure (LIM)

Free Time Boredom Measurement

Leisure Satisfaction Measure (LSM)

Leisure Attitude Measurement (LAM)

Social Empowerment and Trust REPORTED BY NW ONLY

Leisure Barriers Assessment

REC OTHER COMMENTS NW

Please help educate us on these tools you have listed in the survey. I would like to implement.

Would love more workshops and training. NE

The OT’S do more of these tests. Outcomes are then put on chart for the rest of the team to read.

Many of the scales you asked about would be used by our social worker (all the depression ones). The leisure ones are more for people living in the community which is not my area of practice.

Recreation therapists do not do any of these tools/assessments....we get feedback from the OT/PT.

35

Appendix 7: Psychology Demographics and Discipline Specific Information

100.0% 3

0.0% 0

0.0% 0

3


Bay

East of

Thunder

Bay

Response

Percent

Response

Count

3 0 0 100.0% 3

0 0 0 0.0% 0

0 0 0 0.0% 0

3

0


Bay

East of

Thunder

Bay

Response

Percent

Response

Count

0 0 0 0.0% 0

1 0 0 33.3% 1

0 0 0 0.0% 0

1 0 0 33.3% 1

0 0 0 0.0% 0

0 0 0 0.0% 0

1 0 0 33.3% 1

3

0

Other: out patient neurology


Bay

East of

Thunder

Bay

Response

Percent

Response

Count

0 0 0 0.0% 0

0 0 0 0.0% 0

0 0 0 0.0% 0

3 0 0 100.0% 3

0 0 0 0.0% 0

3

0


Bay

East of

Thunder

Bay

Response

Percent

Response

Count

0 0 0 0.0% 0

0 0 0 0.0% 0

0 0 0 0.0% 0

3 0 0 100.0% 3

0 0 0 0.0% 0

3

0


Bay

East of

Thunder

Bay

Response

Percent

Response

Count

0 0 0 0.0% 0

1 0 0 33.3% 1

1 0 0 33.3% 1

1 0 0 33.3% 1

0 0 0 0.0% 0

3

0

Answered question

76-100

answered question

answered question

Answer Options

0-1

2-5


11-19

skipped question

Please indicate your total number of years of clinical experience working with people who have had a

stroke:

6-10

20+

skipped question

Answer Options

0-10

11-25

26-50

51-75

answered question

skipped question



Answer Options

0-1

Home Care/CCAC


answered question

skipped question

2-5

6-10

11-19

20+






Population < 5000

answered question

skipped question

Acute Care


Answer Options

Stroke Assessment Tools Survey - Demographics NW Psychology

East of Thunder Bay

West of Thunder Bay

Thunder Bay


Answer Options


Answer Options Response Percent & Count

36

Response

Percent

Response

Count

0.0% 0

0.0% 0

0.0% 0

100.0% 1

1

0

Response

Percent

Response

Count

0.0% 0

0.0% 0

100.0% 1

1

0

Response

Percent

Response

Count

0.0% 0

0.0% 0

0.0% 0

100.0% 1

0.0% 0

0.0% 0

0.0% 0

1

0

Response

Percent

Response

Count

0.0% 0

0.0% 0

0.0% 0

100.0% 1

0.0% 0

1

0

Response

Percent

Response

Count

0.0% 0

100.0% 1

0.0% 0

0.0% 0

0.0% 0

1

0

Response

Percent

Response

Count

0.0% 0

100.0% 1

0.0% 0

0.0% 0

0.0% 0

1

0

Stroke Assessment Tools Survey - Demographics NE Psychology

20+

answered question

skipped question

Answer Options

0-1

2-5

6-10

skipped question

26-50

51-75

76-100

answered question

Please estimate the average percentage of your caseload

that patients with stroke represent:

Answer Options

0-10

11-25

20+

answered question

skipped question

Please indicate your total number of years of clinical

experience working with people who have had a stroke:

0-1

2-5

6-10

11-19

11-19

skipped question

Please indicate the setting(s) that you work in. If more than

one, select all that apply.

answered question

skipped question

Please indicate your total number of years of clinical

experience (not stroke specific):

Answer Options



Home Care/CCAC



Answer Options

Algoma

Timmins

What size of setting do you practice in?

Answer Options




Sudbury-Manitoulin

answered question

skipped question

Answer Options

Acute Care




answered question

37

PSYCHOLOGY – REPORTED USE OF OTHER TOOLS


Wisconsin Card Sorting Test (WCST)

Behavior Rating Inventory of Executive Functioning – Adult Version (BRIEF-A). REPORTED BY NE ONLY

Ruff Neurobehavioral Inventory

Hamilton Depression Scale

Coping Response Inventory

Personality Assessment Inventory (PAI)

Beck Anxiety Inventory (BAI)

C omprehensive Test of Nonverbal Intelligence (CTONI)

Paced Auditory Serial Addition Test (PASAT)

REPORTED BY NW ONLY

Wechsler Adult Intelligence Scale-IV (WAIS IV)

Test of Premorbid Functioning (TOPF)

Wechsler Memory Scale IV - (WMS-IV)

Delis-Kaplan Executive Function System (D-KFES, Word Fluency)

Trailmaking Test

Depression Anxiety Stress Scale (DASS)

Patient Competency Rating Scale

PSYCHOLOGY OTHER COMMENTS NW

I have looked at the Best Practice Recommendations for Stroke, 2010 and really, there is very little for the work that I do... most of the recommendations tend to refer to physical/cognitive well being... and even mention family members, but very little on the emotional recovery while in an outpatient rehab. setting. I am very aware that depression/anxiety are common with folks who have had strokes.. and we see them on a Follow-up basis even after they are discharged, so I am meeting with clients years following CVA, on an as needed basis. The Best Practices guidelines seem to be most intense/stringent immediately following a stroke (which makes sense), but once past a certain window (let's say 9-12 months and beyond), recommendations seem to fade to nothing... sadly, stroke effects are life long, and depression can hit and recur throughout their lifetime. Once there is one depression, there is a greater likelihood of another and another... I think it would be good if the Best Practices Guidelines could look beyond the first year or so, to think about a lifetime of living with a stroke.

How are you defining Outcomes? Outcome measurement implies pre and post treatment testing, and it seemed to me that you are actually asking about clinically useful measures. Measures used clinically are not necessarily useful for looking at "outcomes"", as I have defined it above.

NE

none

Documents

Stroke Rehabilitation Assessment Tools Survey Final · PDF fileStroke Rehabilitation Assessment Tools Survey ... Scale and Numeric Rating Scale for pain, ... Toronto Beside Swallowing