http://informahealthcare.

com/dre
ISSN 0963-8288 print/ISSN 1464-5165 online

Disabil Rehabil, Early Online: 1–6

! 2015 Informa UK Ltd. DOI: 10.3109/09638288.2015.1031288

RESEARCH PAPER

Psychometric properties of the Five-Digit Test in patients with stroke

Gong-Hong Lin1, Yi Lu1, Chien-Te Wu1, En-Chi Chiu1, Sheau-Ling Huang1,2, I-Ping Hsueh1,2, and Ching-Lin Hsieh1,2
1
School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC and 2Department of Physical Medicine and
Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan, ROC
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15

Abstract Keywords
Purpose: To examine the ecological validity, predictive validity, and responsiveness of the Attention, responsiveness, validity
Five Digit Test (FDT) in patients with stroke. Methods: We included inpatients with stroke
(n ¼ 144, 114 and 105 in the ecological validity, predictive validity, and responsiveness analysis, History
respectively) in the study. At admission, the FDT and Barthel Index (BI) were assessed; at
discharge, the FDT, BI, Postural Assessment Scale for Stroke Patients (PASS), and Mobility Received 10 August 2014
Subscale of the Stroke Rehabilitation Assessment of Movement (MO-STREAM) were assessed. Revised 5 March 2015
Results: In the ecological validity analysis, the scores of the selective and alternating attention Accepted 16 March 2015
indices of the FDT were moderately correlated with those of the BI at admission and discharge Published online 7 April 2015
(Spearman  ¼ –0.38 to –0.45). In the predictive validity analysis, the scores of the two attention
indices of the FDT at admission were moderately correlated with the scores of the BI, PASS, and
MO-STREAM at discharge ( ¼ –0.33 to –0.45). In the responsiveness analysis, the two attention
For personal use only.

indices of the FDT between admission and discharge had large differences (success rate
difference ¼ 0.56–0.67, Wilcoxon Z ¼ –5.90 to –6.60). Conclusion: Our results indicate that the
selective and alternating attention indices of the FDT have acceptable ecological validity,
predictive validity, and good responsiveness in patients with stroke.

ä Implications for Rehabilitation

 The Five Digit Test (FDT), an efficient and culture-free assessment tool, has been used to
assess selective attention and alternating attention
 The selective index and alternating attention index of the FDT showed acceptable ecological
validity, predictive validity, and good responsiveness in patients with stroke.

Introduction The FDT is composed of four parts: a reading speed task, a

Selective attention and alternating attention are two crucial types
of attention for patients with stroke, up to 50% of whom have
impairment of either type [1,2]. Selective attention enables
humans to selectively focus on a goal-directed behaviour while
ignoring goal-irrelevant distractors [3]. A deficit in selective
attention can impede functional recovery of balance, motor status,
and activities of daily living (ADL) in patients with stroke [1].
Alternating attention enables a person to switch attention among
multiple tasks with different cognitive requirements [3]. Patients
with deficits in alternating attention after stroke tend to suffer
from poor motor status and limited social participation [2].
The Five Digit Test (FDT) was developed to assess selective
attention and alternating attention in patients with brain injury.
Address for correspondence: I-Ping Hsueh, School of Occupational
Therapy, College of Medicine, National Taiwan University, 4F, No 17,
Xuzhou Rd, Taipei 100, Taiwan. Tel: +886-2-33668174. Fax: +886-2-
23511331. E-mail: iping@ntu.edu.tw
counting speed task, a selective attention task, and an alternating
attention task [4]. These four parts require test-takers to read
Arabic numerals (1–5) or count stars. This easy-to-read design,
which presents no language barrier and low literacy requirements,
enhance the feasibility of the test for application to clinical
patients, regardless of language and education level. Therefore,
the FDT could be a useful assessment tool for evaluating attention
in patients with stroke in both research and busy clinical settings.
Three basic psychometric properties of assessment tools are
reliability, validity, and responsiveness [5]. The selective attention
and alternating attention indices of the FDT have sufficient test–
retest reliability (Spearman’s  ¼ 0.89–0.92) and concurrent
validity ( ¼ 0.50–0.71, correlated with the Stroop Colour Word
Test) in patients with stroke [4]. However, the ecological validity,
predictive validity, and responsiveness of the FDT have not been
examined in such patients, leading to uncertainty about whether
the attention indices of the FDT can reflect patients’ daily
functions, validly represent patients’ selective attention and
alternating attention, and sensitively detect patients’ changes. To
promote the practical applications of the test results of the FDT, it
is essential to provide clinicians and researchers with empirical
 2 G.-H. Lin et al. Disabil Rehabil, Early Online: 1–6

evidence of its ecological validity, predictive validity, and
responsiveness.
The purpose of this study was to examine the ecological
validity, predictive validity, and responsiveness of the two
attention indices (including the selective attention index and the
alternating attention index) of the FDT in patients with stroke. We
hypothesized that the ecological validity, predictive validity, and
responsiveness of the two attention indices of the FDT would be
acceptable.
Methods
Subjects
The sample of the prospective cohort study was patients with
stroke from a medical center in Taiwan. The patients received
regular rehabilitation programmes (e.g. rehabilitation of ADL,
motor, balance, mobility, or cognition) during the study period.
Patients were included in the project if they met the following
criteria: (1) stroke onset within 10 d before hospital admission;
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15
4. Subjects are required to complete the four parts of the FDT.
The total duration (in seconds) to complete a part is recorded as
the score of each part. In addition, the accuracy of each part is
recorded as the number of errors. The score of part 1 is a reading
speed index. The score of part 2 is a counting speed index. The
score of part 3 is a selective attention index [6]. The score of part
4 is an alternating attention index [6]. A shorter time to test
completion indicates better attention. Parts 1 and 2 of the FDT
were used to confirm that subjects had the fundamental abilities to
perform the selective attention and alternating attention parts of
the FDT. However, because parts 1 and 2 of the FDT do not assess
the attention of subjects, we did not analyse the psychometric
properties of these two parts. A previous study reported that parts
1 and 2 of the FDT had sufficient test–retest reliability and
acceptable convergent validity in patients with stroke [4].
Barthel index
The BI was used to assess the patients’ level of independence in

daily life [7]. It contains 10 basic ADL tasks: feeding, transfers,

(2) diagnosis (International Classification of Diseases, Ninth
grooming, toileting, bathing, ambulation, stair climbing, dressing,
Revision, Clinical Modification [ICD-9-CM] codes) of cerebral
bowel control and bladder control. The activities are rated using a
hemorrhage (430 and 431), cerebral infarction (434), or others
two-point (0, 5), three-point (0, 5, 10), or four-point (0, 5, 10, 15)
(432, 433, 436, and 437); and (3) ability to follow commands and
ordinal scale. The total score range of the BI is from 0 to 100. A
complete parts 1 and 2 of the FDT. The exclusion criteria for the
score of 0–50 indicates severe disability, 51–75 indicates
project were (1) unwillingness to participant; (2) another stroke or
moderate disability, and 76–100 indicates mild to no disability
other major disease during hospitalization; (3) dysfunction of
[8]. The reliability, validity, and responsiveness of the BI in
vision, hearing, or communication; and (4) a stay in the
patients with stroke have been well supported [9,10].
rehabilitation ward of less than 7 d. The study was approved by
the Institutional Review Board. All participants provided signed
Postural assessment scale for stroke patients
consent forms before participating in the current study.
For personal use only.

The PASS was developed to assess balance function in patients

Procedure with stroke [11]. The PASS contains 12 four-point (0, 1, 2, or 3)
items that assess a patient’s balance performance in situations of
The period for recruitment was from January 2009 to December
varying difficulty (i.e. maintaining or changing a posture,
2013. During the study, each participant was assessed twice. The
including lying, sitting, and standing). The total score range
first assessment was conducted within the first 3 d after the
patient was admitted to the Rehabilitation Ward, and the second,
within the 3 d before the patient was discharged from the
Rehabilitation Ward. In the first assessment, patients were
administered the FDT and Barthel Index (BI); in the second
assessment, patients were administered the FDT, BI, Postural
Assessment Scale for Stroke Patients (PASS), and Mobility
subscale of the Stroke Rehabilitation Assessment of Movement
(MO-STREAM). The BI was administered by the patients’
physicians. The other measures were administered by two
occupational therapists (A and B), who were familiar with the
assessments. The FDT was administered by occupational therapist
A. The PASS and MO-STREAM were administered by occupa-
tional therapist B. The demographic characteristics of the patients
were collected from their medical charts.

Measures
Five Digit Test
The FDT has four parts, each of which contains 50 items [4]. The
testing items are groups of digits or stars arranged in frames like
those seen on playing cards (Figure 1). In part 1, subjects have to
read digits; in part 2, subjects have to count the number of stars; in
part 3, subjects are required to count the number of digits (if five
2s are in an item, the correct response is five); and in part 4,
subjects are required to switch their task-relevant attention
between counting the number of digits and reading digits.
When the digits are presented in a bold frame, the subjects have
to count the number of digits. When the digits are presented in a
slim frame, the subjects have to read the digits. The digits in bold
frames and those in slim frames are alternatingly presented in part Figure 1. Examples of the four parts of the FDT.
 DOI: 10.3109/09638288.2015.1031288
from 0 to 36. A score of 36 indicates good balance function, and a
score of 0 indicates a severe balance deficit. The PASS has good
reliability and predictive validity in patients with stroke [11–13].
Mobility subscale of the stroke rehabilitation assessment
of movement
The MO-STREAM was used to assess mobility function in
patients with stroke [14]. The MO-STREAM contains 10 four-
point (0, 1, 2, or 3) items: rolling, bridging, moving from supine
to sitting, moving from sitting to standing, standing for a count to
20, placing the affected foot on to the first step, taking three steps
backward, taking three steps to the affected side, walking 10 m,
and walking down three steps. The total score for the MO-
STREAM ranges from 0 to 30. A score of 30 indicates good
mobility function, and a score of 0 indicates severe mobility
deficit. The MO-STREAM has sufficient reliability, validity, and
responsiveness in patients with stroke [15–17].
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15
Albert’s cancellation test
The Albert’s Cancellation Test was used to assess visual neglect
in patients with cerebral lesions [18]. The test sheet contains
40 lines (2.5 cm in length) pseudo-randomly scattered. To perform
Albert’s Cancellation Test, patients are requested to cancel each
of the lines with a pen. The score of the test is the number of
omissions, and the score range is from 0 to 40. A higher score
represents more severe visual neglect.
Mini-mental state examination
For personal use only.
The mini-mental state examination (MMSE) was used to assess
cognitive status in patients with brain injury [19]. The MMSE
comprises five cognitive domains: orientation, registration,
attention and calculation, recall, and language. The score range
is from 0 to 30, and a higher score represents better cognitive
status. The MMSE has acceptable reliability and validity [20].
Data analysis
Descriptive statistics (people counting, central tendency indices,
dispersion indices, and data distribution) were used for analysis of
the participants’ demographic characteristics. Non-parametric
analysis was adopted for further psychometric analyses in this
study because previous studies found that the scores (total
duration in seconds) of the two attention indices were non-
normally distributed [21,22]. To confirm the non-normality, the
skewness was examined for score distributions at both time points
(i.e. admission and discharge). When skewness is beyond the
range of –1 to 1, the distribution of the scores can be considered
as non-normal [23]. All statistical analyses were conducted by
SPSS 15.0 software (SPSS Inc., Chicago, IL). All statistical
analyses were two-tailed tests. Alpha was set at 0.05.
Ecological validity refers to the extent of agreement between
performance on a measure and performance in the real world [24].
Previous studies indicate that patients’ selective and alternating
attention are moderately correlated with patients’ functional
independence [1,2]. Therefore, the ecological validity was
investigated by examining the correlations between the scores
of the two attention indices of the FDT and the total scores of the
BI at both time points (i.e. admission and discharge). The
Spearman correlation coefficient () was adopted to calculate
the extent of the correlations. A  greater than 0.6 indicates high
ecological validity, 0.3–0.6 acceptable, and less than 0.3 poor
[25]. We hypothesized that the two attention indices of the FDT
would have at least acceptable ecological validity.
Predictive validity indicates the ability of a measure to predict
functions at a specific time point [26]. Previous studies have
Psychometric properties of the FDT 3
indicated that patients’ selective and alternating attention are both
moderately correlated with patients’ functional recovery of
balance, motor status, and ADL [1,2]. Hence, the predictive
validity of the two attention indices of the FDT was investigated
by examining the associations between each of the attention
indices at admission and the PASS, the MO-STREAM, and the BI
scores at discharge using the Spearman correlation coefficient ().
A  greater than 0.6 indicates high predictive validity, 0.3–0.6
acceptable, and less than 0.3 poor [25]. We hypothesized that the
two attention indices of the FDT would have at least acceptable
predictive validity.
Responsiveness is defined as the ability of a measure to detect
changes that take place over a specific time period [27]. In the
study, the participants’ selective attention and alternating attention
would improve during the hospital stay because of natural
recovery and/or cognitive rehabilitation [28,29]. Thus, we
examined the responsiveness of the two attention indices with
two approaches. First, Wilcoxon signed-rank test was performed
to determine the statistical significance of the change scores.
Second, the success rate difference (SRD) [30], one type of effect
size for non-parametric statistics, was calculated using the
following formula:
SRD ¼ ½#ðx1 > x2 Þ  #ðx1 5 x2 Þ=n
where # indicates the number of patients, x1 is the score of the test
at admission, x2 is the score of the test at discharge, and n is the
sample size. An SRD greater than 0.43 is large, 0.28–0.43
moderate, and 0.11–0.27 small [31].
Results
Descriptive analysis
In total, 144, 136, 114, and 105 patients with stroke participated
in the ecological validity study at admission, ecological validity
study at discharge, predictive validity study, and responsiveness
study, respectively. The patients in the four psychometric property
studies were extracted from the same group of patients. The
numbers of patients in the analyses were slightly different because
some patients were lost to follow-up (e.g. discharged or
transferred to another ward) or did not complete all measurements
in the study (i.e. three patients were unwilling to complete the
assessments of the MO-STREAM and PASS because of discom-
fort or fear of falling). The characteristics (i.e. age, days of
rehabilitation ward stay, Albert’s Cancellation Test, and MMSE)
of the participants without completing two assessments had no
statistically significant differences from those of the participants
with two assessments (p ¼ 0.19–0.55).
Most of the patients were severely disabled at admission
(median BI ¼ 45), but mildly disabled at discharge (median
BI ¼ 80–85). The results showed that most of the participants had
no hemineglect (median of Albert’s Cancellation Test ¼ 0) and
high cognitive status (median of the MMSE ¼ 25–26). The
distributions of the selective and alternating attention indices at
both time points (i.e. admission and discharge) were non-normal
(skewness ¼ 1.4–4.4). Further characteristics of these patients are
shown in Table 1.
Table 2 shows patient performance (i.e. completion time and
accuracy) in the selective and alternating attention indices of
the FDT. The median completion times for the selective attention
index at admission and discharge were 59–60 and 49–54
s, respectively. The median completion times for the
alternating attention index at admission and discharge were 92–
94 and 74–83 s, respectively. Further information about the
patient performances on both attention indices of the FDT are
shown in Table 2.
 4 G.-H. Lin et al. Disabil Rehabil, Early Online: 1–6

Table 1. Demographic and clinical characteristics of the patients.

Ecological validity Predictive validity Responsiveness

Admission Discharge
(n ¼ 144) (n ¼ 136) (n ¼ 114) (n ¼ 105)
Age, years, mean (SD) 62.3 (12.8) 62.3 (12.9) 61.7 (12.5) 61.7 (12.8)
Sex, male/female, n 91/53a 96/40 76/38 70/35
Stroke type, n
Cerebral haemorrhage 47 55 38 43
Cerebral infarction 97 81 76 62
Side of hemiplegia, right/left/bilateral, n 69/64/11 63/72/1 50/56/8 46/56/3
Albert’s Cancellation Test, omissions, median (1st–3rd quartile) 0 (0–0) 0 (0–0) 0 (0–0) 0 (0–0)
MMSE, median 25 (22–28) 26 (23–29) 25 (21–28) 25 (21–28)
(1st–3rd quartile)
Period of onset to initial evaluation, days, median (1st–3rd quartile) 18 (12–24) – 18 (12–24) 18 (13–24)
Days of rehabilitation ward stay, days, median (1st–3rd quartile) 29 (19–40) 31 (22–44) 29 (20–38) 29 (21–42)
BI, median (1st–3rd quartile)
At admission 45 (30–55) – – –
At discharge – 80 (65–90) 85 (70–95) –
PASS at discharge, median (1st–3rd quartile) – – 32 (30–34) –
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15

Mo–STREAM at discharge, median (1st–3rd quartile) – – 27 (20–29) –

MMSE, mini-mental status examination; BI, Barthel Index; PASS, postural assessment scale for stroke patients; MO-STREAM, Mobility subscale of
the stroke rehabilitation assessment of movement.
a
The numbers of males and females in the ecological validity studies were different because 39 participants (21 male and 18 female) completed the
assessments at admission and 31 participants (26 male and 5 female) completed the assessments at discharge.

Table 2. Completion time and accuracy of the selective and alternating attention indices of the FDT.

Ecological validity Predictive validity Responsiveness

For personal use only.

Admission (n ¼ 144) Discharge (n ¼ 136) (n ¼ 114) (n ¼ 105)

Selective attention index of FDT
At admission
Seconds, median (IQR) 60 (48–79) – 59 (48–80) 59 (48–80)
Number of errors, median (IQR) 1 (0–2) – 1 (0–2) 1 (0–3)
At discharge
Seconds, median (IQR) – 54 (41–68) – 49 (39–64)
Number of errors, median (IQR) – 0 (0–2) – 0 (0–2)
Alternating attention index of FDT
At admission
Seconds, median (IQR) 93 (72–130) – 92 (72–134) 94 (72–132)
Number of errors, median (IQR) 4 (1–11) – 4 (1–11) 4 (1–11)
At discharge
Seconds, median (IQR) – 83 (60–107) – 74 (54–101)
Number of errors, median (IQR) – 4 (1–11) – 3 (1–10)

IQR, interquartile range.

Ecological validity
The ecological validities of the two attention indices of the FDT
are shown in Table 3. The correlations between each of the
indices and the BI at admission and discharge were moderate
( ¼ –0.38 to –0.45) and significant (p50.01).
Predictive validity
Table 3 shows that the scores of the two attention indices of the
FDT at admission were moderately correlated with those of the
BI, the PASS, and the MO-STREAM scores at discharge
( ¼ –0.33 to –0.45). All correlations in the predictive validity
study were significant (p50.01).
Responsiveness
The responsiveness of the two attention indices is presented in
Table 3. The changes in the two attention indices were all
significant (p50.01), and the SRDs of the two attention indices
were large (SRD ¼ 0.56–0.67). The Wilcoxon Z scores of the two
attention indices were negative because the improvements in
selective and alternating attention in the patients resulted in lower
scores on the two attention indices.
Discussion
To our knowledge, this study is the first to examine the predictive
validity, ecological validity, and responsiveness of the FDT in
patients with stroke. The results of the study indicate that the two
attention indices of the FDT have acceptable ecological validity,
acceptable predictive validity, and sufficient responsiveness. The
strength of the study was that the psychometric properties of the
FDT were validated with quite a large sample size (n4100),
which allows a more reliable generalization of our findings to
other patients who meet the inclusion criteria of this study. The
findings of this study are critical for clinicians and researchers to
interpret the two attention indices of the FDT in patients with
stroke.
 DOI: 10.3109/09638288.2015.1031288
Table 3. Ecological validity, predictive validity, and responsiveness of
the FDT.
Selective Alternating
attention attention
Psychometric property index index
Ecological validity ()
BI at admission (n ¼ 144) –0.38* –0.39*
BI at discharge (n ¼ 136) –0.43* –0.45*
Predictive validity () (n ¼ 114)
BI at discharge –0.44* –0.36*
PASS at discharge –0.42* –0.38*
MO-STREAM at discharge –0.42* –0.33*
Responsiveness (n ¼ 105) –5.90* –6.60*
Wilcoxon Z
SRD 0.56 0.67
*p  0.01.
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15
The results of ecological validity analysis showed that the
correlations between the scores of the two attention indices and
those of the BI were moderate at admission and discharge
( ¼ –0.38 to –0.45, p50.01). The findings indicate that the two
attention indices have acceptable ecological validity for ADL
function at both admission and discharge. These results suggest
that the performances on each of the two attention indices can
partially reveal the levels of living independence in patients with
stroke. To care for patients with worse scores in each of the two
attention indices, clinicians should note that the patients are very
For personal use only.
likely to have difficulties in basic ADL (e.g. eating, dressing,
toileting, and grooming).
Predictive validity analysis showed moderate correlations
between the two attention indices of the FDT at admission and
the scores of the BI, the PASS, and the MO-STREAM at
discharge ( ¼ –0.33 to –0.45, p50.01). The findings indicate
that the two attention indices of the FDT had acceptable
predictive validity in patients with stroke during hospitalization.
However, the study investigated only the predictive validity in
patients who stayed in hospital. To further explore examinations
of the predictive validity of the two attention indices, future
studies are needed to examine the predictive validity with a longer
predictive period (e.g. a period between discharge and 6 months
after discharge).
The results of responsiveness analysis showed that both
attention indices had large effect sizes to detect changes in
attention during the hospital stay (SRD ¼ 0.56–0.79). In addition,
the score changes of the two attention indices were statistically
significant (p50.01). These findings indicate that the two
attention indices of the FDT have sufficient responsiveness to
detect changes in selective and alternating attention in patients
with stroke. Changes in selective or alternating attention follow-
ing natural recovery or rehabilitation can be detected by the
selective or alternating attention index of the FDT. The two
attention indices of the FDT, given their sufficient responsiveness,
could be adopted as outcome measures for selective or alternating
attention treatments in patients with stroke.
A positive skew was found in the distributions of the scores
(total duration in seconds) of the two attention indices at
admission and at discharge. The main reason for the positive
skew may be that the FDT has no time limit for completion
[21,32]. For example, some patients spent more than 300s
completing each part of the FDT, which may have led to the
positive skew distributions of the two attention indices of the
FDT. To eliminate the positive skew distribution of the scores of
the two attention indices, we suggest setting time limits for the
Psychometric properties of the FDT 5
completion of each part of the FDT (e.g. the first part of the FDT
cannot take more than 100 s) [21]. Moreover, setting time limits
for completion of the FDT could reduce the time of administration
and promote testing efficiency for clinicians.
There are two limitations that should be considered for proper
interpretation of the findings of this study. The first limitation is
that our sampling included patients who had only one occurrence
of stroke and stayed in a rehabilitation ward for more than 7 d.
Therefore, the findings of this study might not be applicable to
patients with recurrent stroke or those with mild stroke who are
discharged from the hospital within 7 d. The second limitation is
that this study recruited only patients who were hospitalized. The
evidence for the ecological validity, predictive validity, and
responsiveness of the FDT in outpatients with stroke is still
limited. Future studies should examine the validity and respon-
siveness of the FDT in outpatients with stroke.
Conclusions
Our results provide evidence that the selective attention and
alternating attention indices of the FDT have acceptable eco-
logical validity, acceptable predictive validity, and sufficient
responsiveness in patients with stroke. These results indicate that
the two attention indices of the FDT are useful for assessing
selective and alternating attention in patients with stroke.
Acknowledgements
We would like to thank the participants and raters for their work
during data collection.
Declaration of interest
The authors report no conflicts of interest. This study was
supported by a research grant from the National Science Council
Taiwan. The grand numbers were NSC97-2314-B-002-010-MY3
and NSC102-2314-B-002-018-MY3.
References
1. Hyndman D, Ashburn A. People with stroke living in the
community: attention deficits, balance, ADL ability and falls.
Disabil Rehabil 2003;25:817–22.
2. McDowd JM, Filion DL, Pohl PS, et al. Attentional abilities and
functional outcomes following stroke. J Gerontol B Psychol Sci Soc
Sci 2003;58:45–53.
3. Sohlberg MM, Mateer CA. Effectiveness of an attention-training
program. J Clin Exp Neuropsychol 1987;9:117–30.
4. Sedo MA. Test de los cinco dı́gitos [Five digit test]. Madrid: TEA
Ediciones; 2005.
5. Sharrack B, Hughes RA, Soudain S, Dunn G. The psychometric
properties of clinical rating scales used in multiple sclerosis. Brain
1999;122:141–59.
6. Verdejo-Garcı́a A, Pérez-Expósito M, Schmidt-Rı́o-Valle J, et al.
Selective alterations within executive functions in adolescents with
excess weight. Obesity 2010;18:1572–8.
7. Mahoney FI. Functional evaluation: the Barthel index. Md State
Med J 1965;14:61–5.
8. Supervı́a A, Aranda D, Márquez MA, et al. Predicting length of
hospitalisation of elderly patients, using the Barthel Index. Age
Ageing 2008;37:339–42.
9. Hsueh IP, Lin JH, Jeng JS, Hsieh CL. Comparison of the
psychometric characteristics of the functional independence meas-
ure, 5 item Barthel index, and 10 item Barthel index in patients with
stroke. J Neurol Neurosurg Psychiatr 2002;73:188–90.
10. Hsueh IP, Lee MM, Hsieh CL. Psychometric characteristics of the
Barthel activities of daily living index in stroke patients. J Formos
Med Assoc 2001;100:526–32.
11. Benaim C, Pérennou DA, Villy J, et al. Validation of a standardized
assessment of postural control in stroke patients the Postural
 6 G.-H. Lin et al.
Assessment Scale for Stroke Patients (PASS). Stroke 1999;30:
1862–8.
12. Mao HF, Hsueh IP, Tang PF, et al. Analysis and comparison of the
psychometric properties of three balance measures for stroke
patients. Stroke 2002;33:1022–7.
13. Berg K. Measuring balance in the elderly: preliminary development
of an instrument. Physiother Can 1989;41:304–11.
14. Daley K, Mayo N, Danys I, et al. The Stroke Rehabilitation
Assessment of Movement (STREAM): refining and validating the
content. Physiother Can 1997;49:269–78.
15. Ahmed S, Mayo NE, Higgins J, et al. The Stroke Rehabilitation
Assessment of Movement (STREAM): a comparison with other
measures used to evaluate effects of stroke and rehabilitation. Phys
Ther 2003;83:617–30.
16. Wang CH, Hsieh CL, Dai MH, et al. Inter-rater reliability and
validity of the Stroke Rehabilitation Assessment of Movement
(STREAM) instrument. J Rehabil Med 2002;34:20–4.
17. Hsueh IP, Hsu MJ, Sheu CF, et al. Psychometric comparisons of 2
versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke
Rehabilitation Assessment of Movement. Neurorehabil Neural
Repair 2008;22:737–44.
18. Albert ML. A simple test of visual neglect. Neurology 1973;23:
Disabil Rehabil Downloaded from informahealthcare.com by Nyu Medical Center on 04/13/15
658–64.
19. Folstein MF, Folstein SE, McHugh PR. ‘‘Mini-mental state’’: a
practical method for grading the cognitive state of patients for the
clinician. J Psychiatr Res 1975;12:189–98.
20. Grace J, Nadler JD, White DA, et al. Folstein vs modified Mini-
Mental State Examination in geriatric stroke: stability, validity, and
screening utility. Arch Neurol 1995;52:477–84.
21. Jensen AR. The importance of intraindividual variation in reaction
time. Pers Individ Dif 1992;13:869–81.
For personal use only.
Disabil Rehabil, Early Online: 1–6
22. Juhel J. Should we take the shape of reaction time distributions into
account when studying the relationship between RT and psycho-
metric intelligence? Pers Individ Dif 1993;15:357–60.
23. Chan Y. Biostatistics 101: data presentation. Singapore Med J 2003;
44:280–5.
24. Chaytor N, Schmitter-Edgecombe M. The ecological validity of
neuropsychological tests: a review of the literature on everyday
cognitive skills. Neuropsychol Rev 2003;13:181–97.
25. Salter K, Jutai J, Teasell R, et al. Issues for selection of outcome
measures in stroke rehabilitation: ICF activity. Disabil Rehabil 2005;
27:315–40.
26. Kline P. The new psychometrics: science, psychology and meas-
urement. Florence (KY): Routledge; 1998.
27. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for
assessing responsiveness: a critical review and recommendations.
J Clin Epidemiol 2000;53:459–68.
28. Barker-Collo S, Feigin V, Lawes C, et al. Natural history of attention
deficits and their influence on functional recovery from acute stages
to 6 months after stroke. Neuroepidemiology 2009;35:255–62.
29. Hyndman D, Pickering RM, Ashburn A. The influence of attention
deficits on functional recovery post stroke during the first 12 months
after discharge from hospital. J Neurol Neurosurg Psychiatr 2008;79:
656–63.
30. Cliff N. Dominance statistics: ordinal analyses to answer ordinal
questions. Psychol Bull 1993;114:494.
31. Kraemer HC, Kupfer DJ. Size of treatment effects and their
importance to clinical research and practice. Biol Psychiatr 2006;59:
990–6.
32. Van Zandt T. How to fit a response time distribution. Psychon Bull
Rev 2000;7:424–65.