The OPS is an assessment of stroke severity (e.g., motor deficits, proprioception, balance and cognition).
5 minutes
Adult
18 - 64
yearsUpdated by Carmen Capo-Lugo, PT, PhD and Dorian Rose PT, PhD and the StrokEdge task force in 2016.
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 (Vestibular EDGE) 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:
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Abbreviations: |
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HR |
Highly Recommend |
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R |
Recommend |
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LS / UR |
Reasonable to use, but limited study in target group / Unable to Recommend |
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NR |
Not Recommended |
Recommendations for use based on acuity level of the patient:
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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) |
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StrokEDGE |
HR |
HR** |
NR |
Recommendations based on level of care in which the assessment is taken:
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Acute Care |
Inpatient Rehabilitation |
Skilled Nursing Facility |
Outpatient Rehabilitation |
Home Health |
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StrokEDGE |
HR |
HR** |
NR |
NR |
NR |
Recommendations for entry-level physical therapy education and use in research:
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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) |
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StrokEDGE |
Yes |
Yes |
Yes |
Not reported |
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).
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.
Chronic & Acute Stroke: (Rieck & Moreland, 2005; n = 65; mean age = 77 (9.0) years; 41% had a previous stroke)
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OPS total scores by discharge location* |
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Day 7 OPS total |
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Day 14 OPS total |
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Home: |
3.2 (1.6 – 6.4) |
n = 45 |
3.2 (1.6 – 5.2) |
n = 34 |
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Family’s Home: |
3.6 (2.4 – 4.4) |
n = 4 |
.6 (2.4 – 4.0) |
n = 3 |
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Retirement Home: |
3.0 (2.0 – 4.4 |
n = 8 |
2.8 (2.0 – 5.2) |
n = 6 |
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Nursing Home: |
4.8 (3.2 – 6.4) |
n = 14 |
5.0 (2.8 – 6.8) |
n = 16 |
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Expired: |
6.0 (4.8 – 6.4) |
n = 5 |
6.4 (6.0 – 6.8) |
n = 3 |
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Transferred out of hospital to other rehabilitation unit: |
4.0 (2.8 – 6.8) |
n = 5 |
4.4 (3.2 – 6.4) |
n = 6 |
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*median (minimum–maximum) |
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Comparison of findings at day 14: |
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Rieck (2005) |
Kalra (1993) |
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Discharge home |
< 4.8 |
1.6 – 5.2 |
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Discharge to Long Term Care |
5.4 – 6.8 |
2.8 – 6.8 |
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)
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
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)
Chronic Stroke (Alghwiri, 2015; n = 61; mean = 3.3 months post-stroke; All assessments were conducted in Arabic)
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OPS Level |
BDI Score |
DGI Score |
SIS-16 Score |
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Mild |
22.7 |
35.2 |
35.6 |
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Moderate |
37.3 |
22.2 |
23.1 |
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Severe |
38.7 |
7.2 |
25.6 |
The non-parametric Kruskal-Wallis H test was used to assess any differences between participant's depression, balance, and self-reported physical performance measurements among OPS levels of stroke severity. Beck Depression Scores (BDI) revealed higher depressive symptoms with increasing severity of stroke as measured by the OPS. Similarly more severe stroke levels showed lower balance ability (DGI Score) and lower self-reported physical functioning (Stroke Impact Scale -16).
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).
Comparison of Results Across Studies: (Rieck & Moreland, 2005)
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Predictive statistics comparing results: |
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Kalra (1994) |
Rieck (2005) |
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Sensitivity |
96% |
82% (0.68 – 0.93) |
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Specificity |
36% |
42% (0.25 – 0.61) |
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Accuracy |
75% |
65% (0.52 – 0.76) |
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Positive Predictive Value (going home) OPS < 3.0 |
100% |
81% (0.58 – 0.95) |
Alghwiri A. A. (2015). "The correlation between depression, balance, and physical functioning post stroke." Journal of Stroke and Cerebrovascular Diseases.
Brott, T., Adams, H. P., Jr., et al. (1989). "Measurements of acute cerebral infarction: a clinical examination scale." Stroke 20(7): 864-870.
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.
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.
Kalra, L., Dale, P., et al. (1994). "Evaluation of a clinical score for prognostic stratification of elderly stroke patients." Age Ageing 23: 492-498.
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.
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.
Prescott, R. J., Garraway, W. M., et al. (1982). "Predicting functional outcome following acute stroke using a standard clinical examination." Stroke 13: 641-647.
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.
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.
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.
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.
We have reviewed more than 500 instruments for use with a number of diagnoses including stroke, spinal cord injury and traumatic brain injury among several others.