Postural Assessment Scale for Stroke Patients (PASS)

Postural Assessment Scale for Stroke Patients (PASS) Evaluation Summary

  What does the tool measure? Balance
  What types of clients can the tool be used for? Patients following stroke, regardless of balance performance
  Is this a screening or assessment tool? Assessment
Time to administer 10 minutes
  Versions wePASS (Swedish version)
SFPASS (5-item, 3-scale short form)
PASS-3P (12-item, 3-scale form)
Other Languages French, Swedish
Measurement Properties
  Reliability

Internal consistency:
– Three studies have reported excellent internal consistency of the PASS.
– One study reported excellent internal consistency of PASS trunk control items (PASS-TC).
– One study reported adequate to excellent internal consistency of the SFPASS.

Test-retest:
Three studies reported adequate to excellent intra-rater reliability of individual PASS items and excellent test-retest reliability of PASS total scores. Further, 1 study reported small limits of agreement using Bland-Altman plots, indicating high stability with low natural variation.
One study reported excellent test-retest reliability of individual items and total score of the SFPASS.

Intra-rater:
– One study reported adequate to excellent same-day intra-rater reliability of the SwePASS in patients with acute stroke.

Inter-rater:
– Two studies reported adequate to excellent inter-rater reliability of individual PASS items and excellent inter-rater reliability of the PASS total score.
– One study reported excellent inter-rater reliability of the PASS-TC.
– One study reported excellent inter-rater reliability of the SwePASS.

  Validity

Content:
No studies have reported on the content validity of the PASS.

Criterion:
Concurrent:
Four studies examined the concurrent validity of the PASS and reported excellent concurrent validity with the Berg Balance Scale, FMA modified balance scale (FMA-B), Trunk Impairment Scale (TIS), SFPASS and PASS-3P.

Predictive:
Six studies reported that the PASS shows adequate to excellent predictive validity for function at 90 days post-stroke or on discharge from rehabilitation, but poor predictive validity of function after 1 year. 2 studies reported excellent predictive validity of mobility at 180 days post-stroke or on discharge from rehabilitation.
One study reported that the PASS-TC shows excellent predictive validity of ADL function at 6 months post-stroke and is a stronger predictor of function than the BI or Fugl-Meyer Assessment (FMA) motor test.
Two studies reported that the SFPASS shows adequate to excellent predictive validity for function on discharge from rehabilitation or at 90 days post-stroke.

Construct:
Convergent/Discriminant:
Four studies examined the convergent validity of the PASS and reported excellent correlations with the BI; FIM total score, transfer tasks and locomotor tasks; and motricity scores of the upper and lower limb. Adequate negative correlations were found with the star cancellation test of spatial inattention; pressure sensitivity of the upper and lower limb; and measurement of postural stabilization and postural orientation with respect to gravity. The PASS demonstrated no significant correlation with the Ashworth Scale.
One study reported that the PASS-TC demonstrates excellent convergent validity with the BI and FMA-B.
Two studies have examined the convergent validity of the SFPASS or PASS-3P and reported that both measures show excellent correlations with the BI and FIM.

Known Groups:
No studies have reported on the known-groups validity of the PASS.

  Floor/Ceiling Effects Three studies have reported no floor or ceiling effect of the PASS from acute to chronic stages of stroke recovery. However, one study reported a poor floor effect at 90 days post-stroke.
  Does the tool detect change in patients?

– Six studies have examined responsiveness and found that the PASS is able to detect change in stroke. The PASS demonstrates good responsiveness before 90 days post-stroke but low responsiveness at later stages of recovery. Further, the PASS is more responsive to detecting change in moderate to severe stroke than mild stroke.
– Three studies have examined responsiveness in the PASS-3P or SFPASS and reported that both measures are able to detect change in acute and subacute stroke.

Sensitivity & specificity:
– No studies have reported on the sensitivity or the specificity of the PASS.

  Acceptability The PASS was designed for patients with stroke, regardless of balance function.
Feasibility The PASS is quick and simple test to administer, and requires minimal equipment and no specialized training.
How to obtain the tool?  The tool is available on line: http://www.brightonrehab.com/wp-content/uploads/2012/02/Postural-Assessment-Scale-for-Stroke-Patients-PASS.pdf