ISS Commentary
The Indian Stroke Scale: Commentary by Prof Emerita. Susan R Harris
The recently developed Indian Stroke Scale(ISS) is a promising new clinical and research tool that fulfills a number of components that are critical to a well-designed test in today’s world of stroke rehabilitation. By focusing on patient participation (involvement in real life situations), the ISS is congruent with the International Classification of Functioning, Disability and Health (ICF), published by the World Health Organization in 2001 [1]. For most individuals living with stroke, opportunities to enhance activity and participation within their daily lives are critical goals for them as well as for their caregivers and family members.
Another important asset of the ISS is that it is patient-centered. In patient-centered care, “an individual’s specific health needs and desired health outcomes are the driving force behind all health care decisions and quality measurements. Patients are partners with their health care providers, and providers treat patients not only from a clinical perspective, but also from an emotional, mental, spiritual, social, and financial perspective.” [2]
Not only has the ISS been shown to be reliable, valid and methodologically rigorous [3], it was appropriately developed as an evaluative outcome measure, i.e., able to detect change over time as a result of an intervention, such as physical therapy or other rehabilitation treatments [4]. Thus the ISS will be valuable for use by clinicians as well as by clinical researchers.
And finally, the ISS fills an important niche not covered by other available stroke scales because it measures participation in daily activities within the Indian sociocultural context [3]. The author and developer of the ISS, Dr. V Prakash, must be heartily congratulated for making this seminal contribution to stroke rehabilitation in his native India!
References
[1] International Classification of Functioning, Disability, and Health: ICF. Geneva: World Health Organization, 2001.
[2] NEJM Catalyst. What is patient-centered care? 2017. Accessed on January 8, 2020. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0559
[3] Prakash V, Ganesan M. The Indian Stroke Scale: Development and validation of a scale to measure participation in daily activities among patients with stroke in India. Int J Stroke. 2020 Dec 20:1747493020979361. doi: 10.1177/1747493020979361. Epub ahead of print.
[4] Kirshner B, Guyatt G. A methodological framework for assessing health indices. J Chronic Dis. 1985;38:27-36. doi: 10.1016/0021-9681(85)90005-0.
