Redefining a minimal assessment protocol for stroke rehabilitation: the new "Protocollo di Minima per l'ICtus" (PMIC2020)

Abstract

The use of standardized assessment protocols is strongly recommended to identify patient's needs, outcomes, and predictors of response to specific interventions in Stroke rehabilitation. In 2008, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the minimal protocol for the person with stroke ("Protocollo di Minima per l'ICtus" [PMIC]), in reference to the International classification of Functioning, Disability and Health. In 2019, the SIMFER appointed a working group to provide a revised, updated version in line with the most recent literature and suitable for all rehabilitation settings: the PMIC2020. Descriptive study based on the consensus of a panel of experts. The study setting includes all the rehabilitation settings. The population included is represented by stroke survivors with disability. The coordinator of the SIMFER National Stroke Section appointed the working group, including the 8 Stroke Section board members, and 4 more experts (3 physiatrists; 1 neurologist). An extensive revision of the international literature on stroke assessment recommendations was performed; each proposed change from PMIC was written and motivated, discussed and voted. The PMIC2020 is a single form, to be administered at any time of the rehabilitation pathway, including a minimum set of variables, consisting of a demographic/anamnestic section, and a clinical/functional assessment section. Newly introduced tools included measures of malnutrition (BMI<18.5); pain in verbal and non-verbal patients (Numeric Rating Scale-pain, Pain Assessment in Advanced Dementia Scale); neurological impairment (National Institute of Health-Stroke Scale); activity (Modified Barthel Index, Short Physical Performance Battery); and participation (Frenchay Activity Index). The PMIC2020 provides an updated tool for the multidimensional rehabilitation assessment of the stroke patient, at any stage of the rehabilitation pathway, aiming at a shared minimum set of variables defining patient's needs and at defined outcomes across different rehabilitation facilities and settings. The PMIC2020 identifies patient's needs, outcomes, and predictors of response to specific interventions in Stroke rehabilitation and provide ground for a highly needed Stroke Registry.