Development and evaluation of the Sheffield Motor Assessment Chart.

This research was undertaken in order to develop and evaluate a physiotherapeutic assessment of hemiplegic patients to be called the "Sheffield Motor Assessment Chart". Specifications for its performance and appearance are described on the basis of an extensive review of the literature. Discussion covers aspects of clinical acceptability concerning stroke and hemiplegia, and physiotherapy and rehabilitation; criteria of scientific acceptability; and the presentation and communication of information. Original observations are recorded which were made during development and evaluation of both the protocol of items of assessment and the graphic display of findings of assessments. A sequence of recovery of control of movement and balance was identified using data collected from sixty-three patients, and it was confirmed against data from one hundred and thirty-one patients. Items of assessment based on this sequence are described in two homogeneous scales (r[s]= 0.79; p< 0.01) according to the World Health Organisation's definitions of impairment and disability. The Guttman scalogram technique shows the items to be a valid representation of recovery from hemiplegia (CR = 0.92; CS = 0.75). Tests of inter-observer reliability show each item to be reproducible (p<0.05). From physiotherapists' responses to questionnaires, it is estimated that 0.79 +/-0.21 of the whole population of physiotherapists will find the assessment acceptable. Its potential contribution to multidisciplinary rehabilitation of stroke patients was also investigated during interviews with practitioners and patients. It is concluded that the specifications have been fulfilled so that a valid and reliable physiotherapeutic assessment is available which: (A) is suitable for routine clinical use; (B) offers an aid to communication between physiotherapists and other practitioners; (C) is suitable for gathering data for research; (D) provides a model for other assessments so that multidisciplinary "patient profiles" could be developed for the use of teams of practitioners involved in rehabilitation of stroke patients.