The Minimal assessment Protocol for Cerebral Stroke 2020 (PMIC2020): a multicenter feasibility study in post-stroke inpatient rehabilitation

Abstract

Background: In 2008, a Working Group of the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the first minimum protocol for assessing stroke patients (PMIC) to define functional needs and outcomes. The recent PMIC revision (PMIC2020) introduces a document for all rehabilitation settings, incorporating updated measurement tools.

Aim: The aim of this study was to investigate the PMIC2020 feasibility and administration time (AT) in post-stroke inpatients and to examine the influence of demographic and clinical variables on AT.

Design: Multicenter prospective observational study.

Setting: Eight Italian rehabilitation centers for post-acute inpatients.

Population: Adult patients consecutively admitted to rehabilitation after ischemic/hemorrhagic stroke, reporting the first event or recurrence, with a modified Barthel Index (mBI)<75 points, without cognitive impairment and clinical instability.

Methods: PMIC2020 was administered at admission (T0) and discharge (T1), recording AT of each section/ tool. A feasibility questionnaire was administered to assessors. Univariate and multivariate analyses were conducted to investigate the effect of demographics and clinical variables on AT.

Results: One hundred fifty-one subjects were enrolled at T0 and 139 at T1; the mean±SD AT (seconds) was 1634±401 at T0 and 1087±360 at T1 (P<0.001). National Institute of Health-Stroke Scale and Mini-Mental State Examination required the highest AT. All but two scales had significantly lower AT at T1 (P<0.05). Severe disability (as measured by mBI) was associated with higher AT than either complete or minimal/absent disability. The feasibility questionnaire showed good PMIC2020 appraisal by assessors without relevant critical issues.

Conclusions: PMIC2020 was feasible in post-acute inpatient rehabilitation settings. No relevant critical issue was raised by users. Even though more comprehensive than PMIC, PMIC2020 required only slightly more AT (27 minutes at T0 and 18 minutes at T1, on average); more AT was needed to assess patients with severe disability.

Clinical rehabilitation impact: The study has immediate transferability for the National Health Service, as PMIC2020 can be routinely implemented in clinical practice and research to assess stroke patients' needs and outcomes. The updated measures allow more immediate comparisons with international data on stroke rehabilitation. Future research should investigate the PMIC2020 feasibility in other rehabilitation settings and its relevance in predicting stroke rehabilitation needs and outcomes.

Figure 1

—Mean and standard deviation of the time required for administration of clinical tests/scales at admission (T0) and discharge (T1) (Data from 139 participants who were assessed on both occasions). Clin Exam: clinical examination; NIHSS: National Institute of Health Stroke Scale; MAS: Modified Ashworth Scale; TCT: Trunk Control Test; MI: Motricity Index; FAC: Functional Ambulation Category; MMSE: Mini Mental State Examination; SPPB: Summary Performance Physical Battery; mBI: modified Barthel Index; NRS_pain: Numerical Rating Scale 0-10 for pain; Mood: mood examination.

Figure 2

—Mean and standard error of the total time required for administration of PMIC2020 at discharge (total AT at T1) in subgroups of participants with different levels of disability according to modified Barthel Index (mBI) Score. 1: complete disability; 2: severe disability; 3: moderate disability; 4: mild disability; 5: minimal or no disability.