Adapting the stroke therapy outcome measure for use by multidisciplinary teams: considering reliability

Purpose: The Therapy Outcome Measure (TOM) comprises many profession and client group-specific adapted scales based on the International Classification of Functioning Model, used by different Health Care Professionals (HCPs). A new Multidisciplinary stroke TOM scale (MDT Stroke TOMs) was developed by amalgamating the relevant scales. This study aimed to develop a scale to describe patients’ abilities and improve communication and collaboration within the stroke Multidisciplinary Team (MDT). The present study investigated the inter-rater and intra-rater reliability of this adaptation.

Materials and Methods: The MDT Stroke TOM Scale was developed by combining and rewording four profession-specific adapted TOM scales following iterative trials and discussions leading to an agreed version. 150 stroke Allied Health Professional (AHPs) and nurses were trained virtually in TOM and the MDT Stroke TOM Scale. Ten AHP and nursing raters from five professions evaluated ten composite stroke case studies for inter-rater reliability. Six participated in the intra-rater reliability review of the same three case studies at different time points. Reliability was quantified using intraclass correlation coefficients and measurement error using the smallest detectable change.

Results: There was good to excellent concordance between the raters in terms of scoring. Raters’ scores were also consistent. The MDT Stroke TOMs is being used consistently across the South West London Stroke Network.

Conclusion: The Stroke MDT TOMs is psychometrically robust and should assist with improving team work in the rehabilitation of stroke patients and their carers. Future research may use MDT Stroke TOM to promote interprofessional team working and facilitate communication in Stroke Rehabilitation.