Date Presented 4/18/2015
The Stroke Upper Limb Capacity Scale (SULCS) is a newer assessment that needs to be further understood and related to other measures commonly used in rehabilitation settings. This research suggests that the SULCS may be preferred over other traditional assessments as a brief measure of upper-extremity capacity.
SIGNIFICANCE: Functional limitations of the upper extremity (UE) are common after a stroke. An UE measure that is quick, that is objective, and that has good psychometric properties is important for clinical and research use. In this project, we examine the concurrent validity of the Stroke Upper Limb Capacity Scale (SULCS), a new measure of upper limb capacity, and describe its relationship with other measures.
INNOVATION: Time constraints and test length present obstacles to use of conventional standardized arm assessments by occupational therapists within inpatient settings. Most assessments focus on impairments rather than functional capacity. The SULCS is an evidenced-based arm assessment that is quick, is relevant, and relates to arm functional capacity (Houwink, Roorda, Smits, Molenaar, & Geurts, 2011).
APPROACH: In this study, we attempted to answer the following research questions: How does the SULCS compare with other well-established measures of impairment and activity on an inpatient rehabilitation unit (IRU; i.e., concurrent validity)? How does the SULCS score relate to actual arm performance abilities during functional tasks?
Inpatient units need brief, comprehensive, and evidence-based UE assessments. The SULCS is a new assessment that requires further study as to its relationship with other measures commonly used in a rehabilitation setting.
METHOD: We used a descriptive, correlational design, and the setting was an IRU. Participants included patients admitted to an IRU with a new diagnosis of stroke (N = 95). The participants had a mean age = 70 (±14) yr, a National Institutes of Health Stroke Scale score = 9 (±7), and a median days poststroke = 7; in addition, 37% of the participants had a left brain lesion.
The following measures were taken at admission: (1) SULCS—measure of UE functional capacity; (2) Upper-Extremity Functional Classification (UEfc)—therapist’s rating of functional use; (3) Upper Extremity Motricity Index (UE-MI)—impairment-based measure of UE; and (4) Functional Independence Measure Self-Care (FIMsc)—rating of assistance in self-care. Frequency distributions were analyzed. The relationships between all measures with the SULCS were analyzed with Spearman rank correlation coefficients.
RESULTS: Results show that 8% and 17% of SULCS scores were at the highest and lowest values, respectively, whereas 24% and 25% of the UE-MI scores were at the highest and lowest values, respectively. The SULCS held strong relationships with the UE-MI (ρ = .88, p = .000), FIMsc (ρ = .76, p = .000), and UEfc (ρ = .88, p = .000).
CONCLUSION: The SULCS is strongly related to measures of impairment and activity limitations supporting its concurrent validity. Compared with a conventional impairment measure, it has less of a floor and ceiling effect. The SULCS’s strong relationship with the FIMsc and UEfc suggests that it may be preferred as a brief, objective measure of UE capacity for inpatient settings.
References
Houwink, A., Roorda, L. D., Smits, W., Molenaar, I. W., & Geurts, A. C. (2011). Measuring upper limb capacity in patients after stroke: Reliability and validity of the Stroke Upper Limb Capacity Scale. Archives of Physical Medicine and Rehabilitation, 92, 1418–1422. http://dx.doi.org/10.1016/j.apmr.2011.03.028
