Using Machine Learning to Develop a Short-Form Measure Assessing 5 Functions in Patients With Stroke.

OBJECTIVE: This study aimed to develop and validate a machine learning-based short measure to assess 5 functions (the ML-5F) (activities of daily living [ADL], balance, upper extremity [UE] and lower extremity [LE] motor function, and mobility) in patients with stroke. DESIGN: Secondary data from a previous study. A follow-up study assessed patients with stroke using the Barthel Index (BI), Postural Assessment Scale for Stroke (PASS), and Stroke Rehabilitation Assessment of Movement (STREAM) at hospital admission and discharge. SETTING: A rehabilitation unit in a medical center. PARTICIPANTS: Patients (N=307) with stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The BI, PASS, and STREAM. RESULTS: A machine learning algorithm, Extreme Gradient Boosting, was used to select 15 items from the BI, PASS, and STREAM, and transformed the raw scores of the selected items into the scores of the ML-5F. The ML-5F demonstrated good concurrent validity (Pearson's r, 0.88-0.98) and responsiveness (standardized response mean, 0.28-1.01). CONCLUSIONS: The ML-5F comprises only 15 items but demonstrates sufficient concurrent validity and responsiveness to assess ADL, balance, UE and LE functions, and mobility in patients with stroke. The ML-5F shows great potential as an efficient outcome measure in clinical settings.

A functional generalized F-test for signal detection with applications to event-related potentials significance analysis.

Motivated by the analysis of complex dependent functional data such as event-related brain potentials (ERP), this paper considers a time-varying coefficient multivariate regression model with fixed-time covariates for testing global hypotheses about population mean curves. Based on a reduced-rank modeling of the time correlation of the stochastic process of pointwise test statistics, a functional generalized F-test is proposed and its asymptotic null distribution is derived. Our analytical results show that the proposed test is more powerful than functional analysis of variance testing methods and competing signal detection procedures for dependent data. Simulation studies confirm such power gain for data with patterns of dependence similar to those observed in ERPs. The new testing procedure is illustrated with an analysis of the ERP data from a study of neural correlates of impulse control.

Feeding Patterns and Parental Perceptions of Feeding Issues of Preterm Infants in the First 2 Years of Life.

We explored parental feeding practices, feeding issues during the first 2 yr of life, and the relationship between feeding issues and levels of maternal distress in preterm infants. Four hundred twenty mothers (239 with preterm infants, 181 with full-term infants) participated in the study. The Behavior-Based Feeding Questionnaire for Infants With Premature History and the Parenting Stress Index-Chinese Version were used as the two outcome measures. The results indicated that preterm infants had different feeding experiences compared with their full-term counterparts. They tended to start solid food later in life and had limited experiences in food variation. Parenting stress was prevalent in parents with preterm infants and was associated with the frequency of feeding issues, especially at later ages when supplementary foods were being introduced.

Latino-American Mothers' Perspectives on Feeding Their Young Children: A Qualitative Study.

OBJECTIVE: We explored the cultural beliefs that influence Latino-American mothers' feeding practices with their young children and the sources they referenced in making food choices for their children. METHOD: We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development. RESULTS: We identified four themes summarizing the mothers' feeding practices: (1) "Grandma knows best," (2) "I want my child(ren) to be healthy," (3) "always soup and always rice," and (4) "mealtime is family time." CONCLUSION: Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers' needs.

Practice effects and test-re-test reliability of the Five Digit Test in patients with stroke over four serial assessments.

OBJECTIVES: To investigate practice effect and test-re-test reliability of the Five Digit Test (FDT) over four serial assessments in patients with stroke. DESIGN: Single-group repeated measures design. METHODS: Twenty-five patients with stroke were administered the FDT in four consecutive assessments every 2 weeks. The FDT contains four parts with five indices: 'basic measures of attention and processing speed', 'selective attention', 'alternating attention', 'ability of inhibition' and 'ability of switching'. RESULTS: The five indices of the FDT showed trivial-to-small practice effects (Cohen's d = 0.03-0.47) and moderate-to-excellent test-re-test reliability (intra-class correlation coefficient = 0.59-0.97). Practice effects of the five indices all appeared cumulative, but one index, 'basic measures of attention and processing speed', reached a plateau after the second assessment. The minimum and maximum values of the 90% confidence interval (CI) of reliable change index modified for practice (RCIp) for this index were [-17.6, 11.2]. CONCLUSIONS: One of five indices of the FDT reached a plateau, whose minimum and maximum values of the 90% CI RCIp are useful to determine whether the change in an individual's score is real. However, clinicians and researchers should be cautious when interpreting the test results of these four indices over repeated assessments.

Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model.

OBJECTIVE: The reliability and validity of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) has not been examined while taking into account the correlation between subscales. The reliability of the EORTC QLQ-C30 subscales is modest, thus limiting their utility in both clinical and research settings. The purpose of this study was to validate the factor structure of multiple-item subscales of the EORTC QLQ-C30 and to improve their reliability by means of an item response analysis by using the multidimensional partial credit model. METHODS: A total of 2295 patients with complete data were used for the analysis. One- and nine-dimensional partial credit models were used to fit the data to validate the construct validity of the multiple-item subscales of the QLQ-C30. RESULTS: The model comparison showed that the nine-dimensional factor structure of multiple-item subscales was satisfactory. The multidimensional partial credit model fit data of the multiple-item subscales of the QLQ-C30 reasonably well. The estimated test reliabilities of each domain obtained from the multidimensional approach were higher than those obtained from the unidimensional approach. CONCLUSIONS: The constructs represented by the multiple-item subscales of the QLQ-C30 were validated. The improved reliability of the multiple-item subscales of the QLQ-C30 under the multidimensional approach can facilitate their applications in clinical and research settings.

Integrating health-related quality of life with sickness leave days for return-to-work assessment in traumatic limb injuries.

PURPOSE: A novel indicator called health-adjusted leave days (HALDs) is proposed. It integrates the opposite level of health-related quality of life (HRQoL) with the sick leave days (LDs) before return-to-work (RTW) to better measure the impact of injuries on occupational health. METHODS: A total of 1,167 limb injuries were consecutively recruited in a teaching hospital from January to December 2009. The number of LDs was calculated between the date of injury and the first episode of RTW. Each subject was repeatedly assessed with EuroQol instrument (EQ-5D) before RTW. The HRQoL index is defined as 1 minus the EQ-5D utility and re-scaled to 0-1 range to reflect the impact of injuries. The expected HALD of each group is calculated by integrating the product of the proportion of non-RTW function and the mean HRQoL index function over the days followed up to 2 years for the group. We compared the expected HALDs between subgroups according to various demographic characteristics and consequences of injury. RESULTS: Older and female workers tended to have longer LDs than men and younger workers, with an increase in percentage change of 16.0 or 139.5 %, respectively. After adjusting for HRQoL index, the percentages for HALDs were changed to 28.7 or 186.6 %, respectively. The percentages for the less-educated workers and blue collar workers were 185.7 and 155.8 %. The expected HALDs showed statistical significant differences in all subgroup analyses. CONCLUSION: We believed that the proposed HALD could better measure the impact of injuries and is potentially useful for the clinical decision and industrial policy-making with respect to the assessment of the importance of limb injury due to a worker's sick leaves.

Return to work and quality of life in workers with traumatic limb injuries: a 2-year repeated-measurements study.

OBJECTIVES: To assess the impact of return-to-work (RTW) status on health-related quality of life (HRQOL) over a 2-year period in workers with traumatic limb injuries and to elucidate factors that may contribute to the association of RTW with HRQOL. DESIGN: A 2-year repeated-measurements follow-up study using the generalized estimating equations approach for model fitting to account for within-subject correlations of HRQOL. SETTING: One teaching hospital. PARTICIPANTS: Injured patients (N=966, 61% men) with a mean age of 44.7 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The RTW status, HRQOL (assessed by the EuroQol five-dimensional questionnaire), and activity/participation were repeatedly surveyed at 2 weeks and 1, 3, 6, 12, 18, and 24 months after injury. A series of regression models was used to examine the associations between HRQOL and RTW, with sequential adjustment for explanatory variables such as personal and environmental factors, body structure and function, activity/participation, and postinjury period. RESULTS: Over a 2-year study period, 81.2% of the study participants had 1 or more RTW episodes; 38.2% of them successfully maintained their RTW status until the end. A significant positive association was found between RTW status and HRQOL. The association could largely be explained by the domains of activity/participation. A higher HRQOL was associated with a shorter length of hospital stay, better coping ability, frequent participation in activities of daily living, and a longer postinjury period. A reduced HRQOL, however, was observed for participants with more depressive symptoms. CONCLUSIONS: RTW showed a positive and independent influence on HRQOL in workers with limb injury. In addition, the activity/participation domains and the elapsed time since injury largely explained the association between RTW and HRQOL.

Aggressive and prosocial behavior: community violence, cognitive, and behavioral predictors among urban African American youth.

We use longitudinal multilevel modeling to test how exposure to community violence and cognitive and behavioral factors contribute to the development of aggressive and prosocial behaviors. Specifically, we examine predictors of self-, peer-, and teacher-reported aggressive and prosocial behavior among 266 urban, African American early adolescents. We examine lagged, within-person, between-person, and protective effects across 2 years. In general, results suggest that higher levels of violence exposure and aggressive beliefs are associated with more aggressive and less prosocial peer-reported behavior, whereas greater self-efficacy to resolve conflict peacefully is associated with less aggression across reporters and more teacher-reported prosocial behavior. Greater knowledge and violence prevention skills are associated with fewer aggressive and more prosocial teacher-reported behaviors. Results also suggest that greater self-efficacy and lower impulsivity have protective effects for youth reporting higher levels of exposure to community violence, in terms of teacher-reported aggressive behavior and peer-reported prosocial behavior. Differences among reporters and models are discussed, as well as implications for intervention.

Development of a computerized adaptive testing system of the Fugl-Meyer motor scale in stroke patients.

OBJECTIVE: To develop a computerized adaptive testing system of the Fugl-Meyer motor scale (CAT-FM) to efficiently and reliably assess motor function in patients with stroke. DESIGN: First, a simulation study was used to develop and examine the psychometric properties of the CAT-FM. Second, a field study was employed to determine the administration efficiency of the CAT-FM. SETTING: One medical center and 1 teaching hospital. PARTICIPANTS: Patients' responses (n=301) were used for the simulation study; 49 patients participated in the field study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 2 CAT-FM item banks (upper extremity and lower extremity) include 37 items from the original Fugl-Meyer scale. The reliability, validity, and responsiveness of the CAT-FM were determined by the simulation study. RESULTS: Two stopping rules (reliability ≥0.9 or an increase of reliability <.01 after testing an item) were used. The simulation study showed that the CAT-FM had high reliability (≥.93 for upper-extremity and lower-extremity subscales) and concurrent validity (Pearson r≥.91 for the upper-extremity and lower-extremity subscales and motor scale). The responsiveness was moderate (standardized response mean for the upper extremity=.67, lower extremity=.79, and motor=.77) for the 226 patients who completed both assessments at 14 and 90 days after stroke. The field study found that, on average, the time needed to administer the CAT-FM was 242 seconds with 4.7 items. CONCLUSIONS: The CAT-FM is an efficient, reliable, valid, and responsive clinical tool for assessing motor function in patients with stroke.

A factor-adjusted multiple testing procedure for ERP data analysis.

Event-related potentials (ERPs) are now widely collected in psychological research to determine the time courses of mental events. When event-related potentials from treatment conditions are compared, often there is no a priori information on when or how long the differences should occur. Testing simultaneously for differences over the entire set of time points creates a serious multiple comparison problem in which the probability of false positive errors must be controlled, while maintaining reasonable power for correct detection. In this work, we extend the factor-adjusted multiple testing procedure developed by Friguet, Kloareg, and Causeur (Journal of the American Statistical Association, 104, 1406-1415, 2009) to manage the multiplicity problem in ERP data analysis and compare its performance with that of the Benjamini and Hochberg (Journal of the Royal Statistical Society B, 57, 289-300, 1995) false discovery rate procedure, using simulations. The proposed procedure outperformed the latter in detecting more truly significant time points, in addition to reducing the variability of the false discovery rate, suggesting that corrections for mass multiple testings of ERPs can be much improved by modeling the strong local temporal dependencies.

Construct validity of the stroke-specific quality of life questionnaire in ischemic stroke patients.

OBJECTIVES: To investigate the construct validity of the commonly used 8- and 12-domain versions of the Stroke-Specific Quality of Life (SS-QOL) with a first-order factor model. The better-fitted version was further evaluated by a second-order factor structure model in order to determine whether a summary score is justified. DESIGN: Cohort study. SETTING: Outpatient stroke clinic. PARTICIPANTS: Patients (N=388) with ischemic stroke. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: The SS-QOL. We first conducted confirmatory factor analysis (CFA) to evaluate the construct validity of the first-order 8- or 12-domain versions of the SS-QOL. The better-fitted version was then validated by investigating the second-order health-related quality of life (HRQOL) factor. RESULTS: The 12-domain version, but not the 8-domain version, had sufficient goodness of fit (χ(2)=2041.7, df=1061, χ(2)/df=1.9, comparative fit index [CFI]=0.98, Tucker-Lewis index [TLI]=0.98, and root mean square error of approximation=0.05). All items of the 12-domain version showed acceptable factor loadings (>0.40) and were retained. Furthermore, the second-order CFA fit indices of the 12 domains were acceptable (χ(2)=2630.3, df=1115, χ(2)/df=2.4, CFI=0.97, TLI=0.97, root mean square error of approximation=0.06), indicating that a summary score was justified for representing the overall status of HRQOL. CONCLUSIONS: Our results show that the construct validity of the 12-domain SS-QOL is well supported for measuring HRQOL in ischemic stroke patients. Thus, we recommend the 12-domain version of the SS-QOL for use in capturing the multiple impacts of stroke as well as overall HRQOL status on the basis of patients' perspectives.

Comparison of virtual reality versus physical reality on movement characteristics of persons with Parkinson's disease: effects of moving targets.

OBJECTIVE: To compare the performance of reaching for stationary and moving targets in virtual reality (VR) and physical reality in persons with Parkinson's disease (PD). DESIGN: A repeated-measures design in which all participants reached in physical reality and VR under 5 conditions: 1 stationary ball condition and 4 conditions with the ball moving at different speeds. SETTING: University research laboratory. PARTICIPANTS: Persons with idiopathic PD (n=29) and age-matched controls (n=25). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Success rates and kinematics of arm movement (movement time, amplitude of peak velocity, and percentage of movement time for acceleration phase). RESULTS: In both VR and physical reality, the PD group had longer movement time (P<.001) and lower peak velocity (P<.001) than the controls when reaching for stationary balls. When moving targets were provided, the PD group improved more than the controls did in movement time (P<.001) and peak velocity (P<.001), and reached a performance level similar to that of the controls. Except for the fastest moving ball condition (0.5-s target viewing time), which elicited worse performance in VR than in physical reality, most cueing conditions in VR elicited performance generally similar to those in physical reality. CONCLUSIONS: Although slower than the controls when reaching for stationary balls, persons with PD increased movement speed in response to fast moving balls in both VR and physical reality. This suggests that with an appropriate choice of cueing speed, VR is a promising tool for providing visual motion stimuli to improve movement speed in persons with PD. More research on the long-term effect of this type of VR training program is needed.

Effects of luminance contrast and character size on reading speed.

Both luminance contrast and character size are critical factors affecting reading performance. Previous studies reported on the effect of luminance contrast on the reading-speed function, that is, the relationship between reading speed and character size. In particular, when contrast was reduced, the critical print size (CPS) was found to shift to a larger character size even though the maximum reading speed and function shape did not change [Japanese Journal of Ophthalmology 52(1) (2008) 44-47]. In the present study, the effect of luminance contrast on the reading function was quantitatively examined. Japanese phrases with a luminance contrast of 0.03-0.99 were prepared as stimuli. Observers with normal vision were asked to read aloud phrases with several character sizes. Then, the reading functions were obtained for each luminance contrast. CPS was found to increase as the luminance contrast decreased. The relationship between contrast and CPS was linear in log-log coordinates, that is, log-CPS increased as the log-contrast of the characters decreased. It was found that the contrast of the stimulus systematically affects the location of the reading function.

Psychometric comparisons of 2 versions of the Fugl-Meyer Motor Scale and 2 versions of the Stroke Rehabilitation Assessment of Movement.

OBJECTIVE: To provide empirical justification for selecting motor scales for stroke patients, the authors compared the psychometric properties (validity, responsiveness, test-retest reliability, and smallest real difference [SRD]) of the Fugl-Meyer Motor Scale (FM), the simplified FM (S-FM), the Stroke Rehabilitation Assessment of Movement instrument (STREAM), and the simplified STREAM (S-STREAM). METHODS: For the validity and responsiveness study, 50 inpatients were assessed with the FM and the STREAM at admission and discharge to a rehabilitation department. The scores of the S-FM and the S-STREAM were retrieved from their corresponding scales. For the test-retest reliability study, a therapist administered both scales on a different sample of 60 chronic patients on 2 occasions. RESULTS: Only the S-STREAM had no notable floor or ceiling effects at admission and discharge. The 4 motor scales had good concurrent validity (rho >or= .91) and satisfactory predictive validity (rho = .72-.77). The scales showed responsiveness (effect size d >or= 0.34; standardized response mean >or= 0.95; P < .0001), with the S-STREAM most responsive. The test-retest agreements of the scales were excellent (intraclass correlation coefficients >or= .96). The SRD of the 4 scales was 10% of their corresponding highest score, indicating acceptable level of measurement error. The upper extremity and the lower extremity subscales of the 4 showed similar results. CONCLUSIONS: The 4 motor scales showed acceptable levels of reliability, validity, and responsiveness in stroke patients. The S-STREAM is recommended because it is short, responsive to change, and able to discriminate patients with severe or mild stroke.

Estimating the minimal clinically important difference of the Stroke Rehabilitation Assessment of Movement measure.

BACKGROUND: The minimal clinically important difference (MCID) of the Stroke Rehabilitation Assessment of Movement (STREAM) measure is unknown, which limits the application and interpretation of change scores. OBJECTIVE: To estimate the MCID of the 3 subscales (ie, lower extremity, upper extremity, and mobility subscales) of the STREAM using the method of patients' global ratings of change. METHODS: Eighty-one stroke patients participated in this study. The patients' global ratings of change were used to rate their changes of limb movements and basic mobility skills on the 15-point Likert scale. The mean change scores on the 3 subscales of STREAM of the MCID group (ie, scored on +2 to +3 or -2 to -3) served as the estimates of the MCID. RESULTS: There were 42, 38, and 43 patients in the MCID group, and the estimates of the MCID were 2.2, 1.9, and 4.8 points for the upper-extremity subscale, lower-extremity subscale, and mobility subscale, respectively. CONCLUSIONS: These findings suggest that if the mean change scores on the 3 subscales of the STREAM within a stroke group have reached 2.2, 1.9, and 4.8 points, the change scores on the 3 subscales of the STREAM can be perceived by patients as clinically important.

Teaching Theory in Occupational Therapy Using a Cooperative Learning: A Mixed-Methods Study.

Cooperative learning provides an important vehicle for active learning, as knowledge is socially constructed through interaction with others. This study investigated the effect of cooperative learning on occupational therapy (OT) theory knowledge attainment in professional-level OT students in a classroom environment. Using a pre- and post-test group design, 24 first-year, entry-level OT students participated while taking a theory course in their second semester of the program. Cooperative learning methods were implemented via in-class group assignments. The students were asked to complete two questionnaires regarding their attitudes toward group environments and their perception toward group learning before and after the semester. MANCOVA was used to examine changes in attitudes and perceived learning among groups. Students' summary sheets for each in-class assignment and course evaluations were collected for content analysis. Results indicated significant changes in students' attitude toward working in small groups regardless of their prior group experience.

Development and validation of a short form of the Fugl-Meyer motor scale in patients with stroke.

BACKGROUND AND PURPOSE: The 50-item Fugl-Meyer motor scale (FM) is commonly used in outcome studies. However, the lengthy administration time of the FM keeps it from being widely accepted for routine clinical use. We aimed to develop a short form of the FM (the S-FM) with sound psychometric properties for stroke patients. METHODS: The FM was administered to 279 patients. It was then simplified based on expert opinions and the results of Rasch analysis. The psychometric properties (including Rasch reliability, concurrent validity, predictive validity, and responsiveness) of the S-FM were examined and were compared with those of the FM. The concurrent validity and responsiveness of the S-FM were further validated in a sample from the Netherlands. RESULTS: We selected 6 items for each subscale to construct a 12-item S-FM. The S-FM demonstrated high Rasch reliability, high concurrent validity with the original scale, moderate responsiveness, and moderate predictive validity with the comprehensive activities of daily living function. The S-FM also showed sufficient concurrent validity and responsiveness on the Dutch sample. CONCLUSIONS: Our results provide strong evidence that the psychometric properties of the S-FM are comparable with those of the FM. The S-FM contains only 12 items, making it a very efficient measure for assessing the motor function of stroke patients in both clinical and research settings.

Establishing the minimal clinically important difference of the Barthel Index in stroke patients.

BACKGROUND: The interpretation of the change scores of the Barthel Index (BI) in follow-up or outcome studies has been hampered by the fact that its minimal clinically important difference (MCID) has not been determined. OBJECTIVE: This article was written to establish the MCID of the BI in stroke patients. METHODS: Both anchor-based and distribution-based methods were used to establish the MCID. In the anchor-based method, 43 stroke inpatients participated in a follow-up study designed to determine the MCID of the BI using patients' global ratings of the activities of daily living function on a 15-point Likert-type scale. The mean change scores on the 20-point scale of the BI of the MCID group, based on the patients' ratings on the Likert-type scale, served as the first estimate of the MCID. In the distribution-based method, 56 chronic stroke patients participated in the test-retest reliability study to determine the MCID of the BI. One standard error of measurement (SEM) served as the second estimate for the MCID. The larger MCID value of the 2 estimates was chosen as the MCID of the BI. RESULTS: In the anchor-based study, there were 20 patients in the MCID group, with a mean change score of 1.85 points (ie, the first MCID estimate). In the distribution-based study, the SEM based on test-retest agreement was 1.45 points (ie, the second MCID estimate). The MCID of the BI in stroke patients was estimated to be 1.85 points. CONCLUSION: The authors' results, within the limitations of their design, suggest that if the mean BI change score within a stroke group has reached 1.85 points in a study, the change score on the BI can be perceived by patients as important and beyond measurement error (ie, such a change score is clinically important).

Developing a Short Form of the Postural Assessment Scale for people with Stroke.

OBJECTIVE: To develop a Short Form of Postural Assessment Scale for Stroke patients (SFPASS) with sound psychometric properties (including reliability, validity, and responsiveness). METHODS: This study consisted of 2 parts: developing the SFPASS and cross-validation. In the 1st part, 287 people with stroke were evaluated with the PASS at 14- and 30-day post-stroke intervals. The authors reduced the number of test items that constitute the PASS by more than half (i.e., making 5-, 6-, and 7-item sets) and simplified the scoring system (i.e., collapsing the 4-level scale in the original PASS into a 3-level scale [PASS-3L]), making both 4-L and 3-L versions available. Thus, a total of 6 SFPASSs were generated. In addition, 2 external criteria, the Barthel activities of daily living index and the Fugl-Meyer motor test, were used to examine the validity of the 6 SFPASSs. The psychometric properties of the new 6 SFPASSs were compared with each other as well as with those of the original PASS to determine which scale outperformed the others. In the 2nd part of the study, the authors cross-validated the best SFPASS using another independent sample of 179 people with stroke. RESULTS: All 6 SFPASSs demonstrated good reliability, validity, and responsiveness. However, the Bland-Altman plots showed that only the 5-item PASS-3L demonstrated no systematic trend between the difference and mean score of the 5-item PASS-3L and the original PASS. The 5-item PASS-3L also had psychometric properties similar to those of the original PASS, as demonstrated in a cross-validation sample. CONCLUSION: The authors' results provide strong evidence that the 5-item PASS-3L has sound psycho-metric properties in people with stroke. The 5-item PASS-3L is simple and fast to administer and is thus recommended.