The Construct Validation of the Maleka Stroke Community Reintegration Measure (M-SCRIM)

Author(s): D. Maleka ⁽¹⁾, A. Stewart ⁽¹⁾, L. Hale ⁽²⁾, P. Becker ⁽³⁾

⁽¹⁾The University of the Witwatersrand, Johannesburg, South Africa; ⁽²⁾ the University of Otago, Dunedin, New Zealand ⁽³⁾ Biostatistics department, The South African Medical Research Council, Pretoria

Contact person: ⁽¹⁾morake.maleka@wits.ac.za; 2711717 3702 (w); 2711717 3719 (fax), P O Box 930, Noordwyk, Midrand, Johannesburg, South Africa, 1687.

Fit with Congress programme tracks and topic areas: Professional practice, Stroke and Stroke Rehabilitation

Abstract

Purpose: The Maleka Stroke Community Reintegration Measure (MSCRIM) is a new measure to assess community reintegration for black patients with stroke, who are living in low socioeconomic areas of South Africa. The MSCRIM has two versions, namely, rural and urban. The objective of this study was to establish the construct validity of the MSCRIM, by comparing it with an existing tool of community reintegration, the Subjective Index of Physical and Social Outcome (SIPSO).

Relevance: The use of outcome measures in health care is to enable clinical quality management, which forms part of the quality assurance process in patient management.

Design: A quantitative, cross sectional study design was used.

Ethical considerations

Ethical clearance was sought and obtained from the University of the Witwatersrand (M070816) prior to commencement of the study as well as from the respective health authorities and facilities in the two provinces. Consent was sought and obtained from all participants.

Setting and participants: The study took place in both a rural (Limpopo province, South Africa) (n=40) and urban (Gauteng province, South Africa) (n=40) setting. The sample comprised 80 participants who had sustained a stroke, were aged 18 years and above and were members of the community in which they lived pre-stroke, and had been back living in their community for six to twelve months since their stroke.

Method: Participants were recruited from the stroke register by the on-site physiotherapists. Participants’ demographic data were captured using a standardised form. Participants were given the option to be interviewed with the translated (South Sotho, Xitsonga, TshiVhenda, Zulu or English version) of the M-SCRIM and the SIPSO. Although the SIPSO is usually self-administered, in this study it was interview-administered. In each setting, one trained rater administered each questionnaire to all participants.

Analysis

The Pearson product moment correlation coefficient (r) was used to assess correlation between the total scores of the M-SCRIM and the SIPSO. R-values of 0 -0.4 were considered to be a poor correlation, 0.4 -0.6 moderate and 0.6 -1 a good-excellent correlation. The STATA (version 10) package was used to analyse data.

Results: The Pearson product moment correlation coefficient (r) between the total scores of the MSCRIM and the SIPSO was r = 0.95; p= 0.001 (rural version) and r = 0.88; p= 0.0001 (urban version).

Conclusion: The very high, positive correlation indicates that the two outcome measures were measuring a similar construct. However, MSCRIM (both versions) contains items that are contextually specific to black patients with a stroke living in low socioeconomic areas in South Africa.

Implications:

The M-SCRIM has sound construct validity, should therefore be the outcome measure of choice for stroke survivors living in low socioeconomic areas, such as those found in South Africa. The choice is due the fact that the M-SCRIM contains context specific items that are applicable to a rural and urban black South African setting.

Keywords: Stroke, construct validity, community reintegration, MSCRIM, SIPSO

Funding Source and Acknowledgement: Funding for this research was provided by the University of the Witwatersrand and the South African Society of Physiotherapy (SASP). The authors would like to acknowledge the following people for their various contributions to this study: The research assistants in Limpopo and Gauteng provinces. The hospital, clinic managers and heads of physiotherapy departments in Gauteng and Limpopo provinces for permission to do the study in their clinics. The participants with stroke and their caregivers in both Limpopo and Gauteng provinces, SA.

Brief biography:

Current position and research interest areas

Douglas is a senior lecturer in the physiotherapy department at the University of the Witwatersrand in Johannesburg. His areas of lecturing and special interest are public health and community physiotherapy for physiotherapy students. Research interest areas include disability issues, use and development of outcome measures especially at PHC level and management of rehabilitation programmes at primary health care clinics.

Professional qualifications

Douglas obtained his basic degree, BSc Physiotherapy at MEDUNSA in 1995 and a Master in Public Health (Community Rehabilitation) in 2005 and PhD in 2011 at the University of the Witwatersrand.

Presentation:

2011: The South African Neurological Rehabilitation Association Conference: Poster presentation: The development of an outcome measure to assess community reintegration following stroke.

Publication:

2011: The South African Cardiology and Stroke Journal: Published as a poster: The development of an outcome measure to assess community reintegration following stroke.