ISS Commentary
The Indian Stroke Scale: Commentary by Distinguished Professor Robert Palisano
Active engagement of patients in setting goals, planning rehabilitation interventions, and evaluating outcomes are hallmarks of patient centered care. Goals that are meaningful to patients and interventions that are feasible and acceptable to patients increase the likelihood that outcomes will be achieved and have a positive impact on daily life. Patient-reported measures are central to patient centered care.
The Indian Stroke Scale developed and validated by Prakash and Ganesan is a culturally sensitive patient report measure. The construct of the Indian Stroke Scale is participation in daily activities by individuals with stroke living in an Indian sociocultural context. Item (activity) selection was informed by the perspectives of individuals living in India who had a stroke. Items are clearly worded for the general population. In the first section of 15 items, patients report the extent they are limited in performance of mobility and self-care activities that are essential for independent living. The results have direct implications for goal setting and intervention planning. In the second section of 14 items, patients report the extent they are limited in performance only if the activity is important to them. Items in section two include clean your house, wash clothes by hand, travel on a public transport vehicle, and attend social ceremonies, illustrating activities that might not be important (or applicable) to all individuals with stroke. Patient report of importance is a unique feature of the Indian Stroke Scale and has direct implications for patient motivation and engagement in the rehabilitation process. The total score for the Indian Stroke Scale is calculated only for items (activities) that the patient perceives as important. This is advantageous in measuring change as it provides a better indicator of a patient’s response to rehabilitation interventions.
I highly recommend use of the Indian Stroke Scale by all practitioners providing rehabilitation services to patients with stroke in India to inform goal setting, intervention planning, and objectively document rehabilitation outcomes. Scores are an indicator of a patient’s ability to participate in daily activities, the ultimate outcome of rehabilitation services. The Indian Stroke Scale is feasible to use in clinical practice and complements tests and measures administered by practitioners. Based on psychometric properties and clinical feasibility, the Indian Stroke Scale is a promising benchmark to evaluate rehabilitation outcomes within a healthcare organization and comparison of outcomes regionally and nationally. This would enable systematic evaluation of variances in intensity and focus of rehabilitation services to identify best practices and clinical practice guidelines. The Indian Stroke Scale is recommended as an outcome measure for clinical trials in India to determine the effects of rehabilitation interventions.
