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Rehab Measures: Orpington Prognostic Scale

Link to instrument

Can be found on the Stroke Center Website (external link) 

Title of Assessment

Orpington Prognostic Scale 

Acronym

OPS

Instrument Reviewer(s)

Summary Date

 

Purpose

Assessment of stroke severity (e.g., motor deficits, proprioception, balance and cognition)

Description

The OPS assessment includes measures of motor deficit (arm), proprioception, balance and cognition.

The OPS is based on an earlier prognostic tool, the Edinburgh Prognostic Score (Prescott et al, 1982) but adds an assessment of cognitive dysfunction (Kalra & Crome, 1993).

OPS scores range from 1.6 to 6.8 such that higher scores indicate greater deficit (Kalra & Crome, 1993; Kalra et al, 1994; Lai et al, 1998).

Deficits can be categorized as (Kalra and Crome, 1993; Lai et al, 1998):

Mild to moderate: 
(scores <3.2)
Moderate to moderately severe:
(scores 3.2 – 5.2)
Severe or major: 
(scores >5.2)

Area of Assessment

Activities of Daily Living 

Body Part

Not Applicable 

ICF Domain

Body Function 

Domain

Motor 

Assessment Type

Observer 

Length of Test

05 Minutes or Less 

Time to Administer

5 minutes

Number of Items

Not applicable 

Equipment Required

None Necessary

Training Required

None Necessary

Type of training required

No Training 

Cost

Free 

Actual Cost

Free

Age Range

Adult: 18-64 years 

Administration Mode

Paper/Pencil 

Diagnosis

Stroke 

Populations Tested

Stroke

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Acute Stoke: (Kalra & Crome, 1993; n = 96; assessed 1, 2, and 4 and 16 weeks post stroke; Kalra & Eade, 1995; n = 71)
  • Scores < 3.2 indicate a high likelihood of returning home.
  • Scores that fall between 3.2 and 5.2 generally respond better to rehabilitation.
  • Patients with scores > 5.2 are typically dependent with an increased risk of institutionalization.

Normative Data

Chronic & Acute Stroke: (Rieck & Moreland, 2005; n = 65; mean age = 77 (9.0) years; 41% had a previous stroke)
 

OPS total scores by discharge location*

Day 7 OPS total

Day 14 OPS total

Home:
3.2 (1.6 – 6.4)
n = 45
3.2 (1.6 – 5.2)
n = 34
Family’s Home:
3.6 (2.4 – 4.4)
n = 4
.6 (2.4 – 4.0)
n = 3
Retirement Home:
3.0 (2.0 – 4.4
n = 8
2.8 (2.0 – 5.2)
n = 6
Nursing Home:
4.8 (3.2 – 6.4)
n = 14
5.0 (2.8 – 6.8)
n = 16
Expired:
6.0 (4.8 – 6.4)
n = 5
6.4 (6.0 – 6.8)
n = 3
Transferred out of hospital to other rehabilitation unit:

4.0 (2.8 – 6.8)

n = 5

4.4 (3.2 – 6.4)

n = 6

*median (minimum–maximum)

 
Comparison of findings at day 14:
Rieck (2005)
Kalra (1993)
Discharge home
< 4.8
1.6 – 5.2
Discharge to Long Term Care
5.4 – 6.8
2.8 – 6.8

Test-retest Reliability

Chronic & Acute Stroke: (Rieck & Moreland, 2005; n = 27; mean age 76 (12.2) years; sample included patients with prior stroke)
  • Excellent test-retested reliability (ICC = 0.95)

Interrater/Intrarater Reliability

Chronic & Acute Stroke: (Rieck & Moreland, 2005; n = 65; mean age 77 (9) years; assessed 7 and 14 days post stroke by two physiotherapists; sample included patients with prior stroke)
  • Excellent inter-rater reliability (ICC = 0.99)
  • Excellent inter-rater reliability (weighted kappa = 0.84 - balance)
Acute Stroke: (Weir et al, 2003; prospectively n = 2 clinicians and 92 patients / retrospectively n = 2 auditors & 200 patients)
  • Adequate inter-rater reliability  (weighted kappa = 0.53-proprioception; 0.64-cognition; 0.72 motor deficit

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)

Acute Stroke: (Brott et al, 1989; Wright, Swinton & Green, 2004; Celik, Aksel & Karaoglan, 2006)
  • Excellent concurrent validity with NIHSS (see below for specific values by study):

Study 1: NIHSS (rho = 0.83)
Study 2: NIHSS (rho = 0.60)
Study 3: NIHSS (rho = 0.76)
 

Acute Stroke: (Kalra & Crome, 1993; Studenski et al, 2001; n = 413; 3 to 14 days post stroke)
  • Excellent predictive validity:

Predicts Barthel Index ADL scores at discharge.

A better predictor of Barthel Index scores (R-sqr = 0.89) when compared to Edinburgh Prognostic Score (R-sqr = 0.57)

Predicts Barthel Index ADL and Sf-36 Physical Function scores at 1, 3, and 6 months post-stroke

  • Adequate predictive validity with:

Functional Recovery Rate  (OPS cut-offs <2.4 and >4.4 at 3 months)  

Construct Validity (Convergent/Discriminant)

Convergent validity:
 
Acute Stroke: (Meldrum et al, 2004; OPS performed within 48 hours of admission; Pittock et al. 2003; n = 117; assessed 48 hours post stroke and again 6 and 24 months later)
  • OPS administered 2 days post-stroke demonstrated adequate predictive validity of upper limb function at 6 and 24 months post stroke
  • OPS administered within 2 days of stroke predicted Rivermead Motor Assessment, Oxford Handicap Scale, Barthel Index and length of stay at 6 and 24 months.  Results suggest significant convergence in predicted motor performance, disability level, ADL and length of stay (particularly at month 6).

Content Validity

Not Established

Face Validity

Not Established

Floor/Ceiling Effects

Not Established

Responsiveness

Comparison of Results across studies(Rieck & Moreland, 2005)

Predictive statistics comparing results:
Kalra (1994)
Rieck (2005)
Sensitivity
96%
82% (0.68 – 0.93)
Specificity
36%
42% (0.25 – 0.61)
Accuracy
75%
65% (0.52 – 0.76)
Positive Predictive Value (going home) OPS < 3.0
100%

81% (0.58 – 0.95)

Professional Association Recommendations

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (VEDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

 

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

 

Abbreviations:

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended

 

Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post)

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

StrokEDGE

HR

HR**

NR

 

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

StrokEDGE

HR

HR**

NR

NR

NR

 

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

StrokEDGE

Yes

Yes

Yes

Not reported

Considerations

  • Should not be used for acute prognosis (Kalra et al, 1994).
  • Scale should only be used when the patient's neurological condition has stabilized
  • Optimal predictive power was observed when administered 2 weeks post stroke (Kalra et al, 1994)
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Bibliography

Brott, T., Adams, H. P., Jr., et al. (1989). "Measurements of acute cerebral infarction: a clinical examination scale." Stroke 20(7): 864-870. Find it on PubMed

Celik, C., Aksel, J., et al. (2006). "Comparison of the Orpington Prognostic Scale (OPS) and the National Institutes of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke." Disabil Rehabil 28: 609-612. Find it on PubMed

Kalra, L. and Crome, P. (1993). "The role of prognostic scores in targeting stroke rehabilitation in elderly patients." J Am Geriatr Soc 41(4): 396-400. Find it on PubMed

Kalra, L., Dale, P., et al. (1994). "Evaluation of a clinical score for prognostic stratification of elderly stroke patients." Age Ageing 23: 492-498. Find it on PubMed

Lai, S. M., Duncan, P. W., et al. (1998). "Prediction of functional outcome after stroke: comparison of the Orpington Prognostic Scale and the NIH Stroke Scale." Stroke 29: 1838-1842. Find it on PubMed

Mahoney, F. (1965). "The Barthel Index." Maryland State Med J 14: 61-65.

Meldrum, D., Pittock, S. J., et al. (2004). "Recovery of the upper limb post ischaemic stroke and the predictive value of the Orpington Prognostic Score." Clin Rehabil 18: 694-702. Find it on PubMed

Prescott, R. J., Garraway, W. M., et al. (1982). "Predicting functional outcome following acute stroke using a standard clinical examination." Stroke 13: 641-647. Find it on PubMed

Rieck, M. and Moreland, J. (2005). "The Orpington Prognostic Scale for patients with stroke: reliability and pilot predictive data for discharge destination and therapeutic services." Disabil Rehabil 27: 1425-1433. Find it on PubMed

Studenski, S. A., Wallace, D., et al. (2001). "Predicting stroke recovery: three- and six-month rates of patient-centered functional outcomes based on the orpington prognostic scale." J Am Geriatr Soc 49(3): 308-312. Find it on PubMed

Weir, N. U., Counsell, C. E., et al. (2003). "Reliability of the variables in a new set of models that predict outcome after stroke." J Neurol Neurosurg Psychiatry 74: 447-451. Find it on PubMed

Wright, C. J., Swinton, L. C., et al. (2004). "Predicting final disposition after stroke using the Orpington Prognostic Score." Can J Neurol Sci 31(4): 494-498. Find it on PubMed

Year published

1993 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 10/30/2010 11:36 AM  by Dawood Ali 
Last modified at 8/29/2014 11:19 AM  by Jason Raad