CHAPTER 40: ORPINGTON PROGNOSTIC SCALE (OPS)

Description

The Orpington Prognostic Scale (OPS) is an impairment-based scale developed by Kalra and Crome (1993) to be a quick screen to estimate early survival, basic activities of daily living (ADLs), level of dependence, and the need for long-term care of stroke survivors (Studenski, Wallace, Duncan, Rymer, & Lai, 2001). The OPS is considered a consolidation of the Edinburgh Prognostic Score and the Hodkinson’s Mental Test and assesses motor deficit, proprioception, balance, and cognition (Rieck & Moreland, 2005). During administration the subject is graded on his or her ability to flex the shoulders to 90° with resistance while lying supine, locate his or her affected thumb with the opposite hand while the eyes are closed, sit, stand, and walk, as well as answer several cognitive recall questions. The OPS can be completed in less than 5 minutes and its scores range from 1.6 (lowest level of disability) to 6.8 (highest level of disability) (Rieck & Moreland, 2005) with higher scores suggesting more impairment.

Psychometrics

A study by 2 physical therapists of 94 subjects post-stroke found that inter-rater reliability as measured by intraclass correlation coefficients was high at r = 0.99 (Rieck & Moreland, 2005). Test-retest reliability was high as well (r= 0.95), whereas the accuracy for predicting discharge to home was 65% (Rieck & Moreland, 2005). A study by Celik, Aksel, and Karaoglan (2006) of 25 subjects 7 days post-cerebrovascular accident (CVA) found that the OPS significantly correlated with the National Institute of Health Stroke Scale (NIHSS) at 0.76. A longitudinal study by Shoemaker, Mullins-MacRitchie, Bennet, Vryhof, and Boettcher (2006) of 22 subjects with acute stroke found a significant negative correlation with the Functional Independence Measure (FIM) motor subscale at admission and discharge at r = –0.74 and r = –0.81,respectively. Lai, Duncan, and Keighley (1998) showed that the OPS balance subscale was able to explain 51% of the variance in ADL outcomes and when compared to the NIHSS it was able to explain more variance in individuals with a higher level of physical function than the NIHSS. Another study explored the predictive value of the OPS given at 48 hours post-CVA (OPS-1) and given at 2 weeks (OPS-2) where results showed that the sensitivity, specificity, and positive predictive values (PPV) of those with a good OPS (score < 3.2) at 6 months were 85%, 92%, and 85% for OPS-1 vs 63%, 87%, and 92% for OPS-2 (Pittock, Meldrum, Ni Dhuill, Hardiman, & Moroney, 2003). The sensitivity, specificity, and PPV of poor subjects (i.e., those with scores >5.2) were 100%, 93%, 100% for OPS -1 vs 48%, 35%, 97% for OPS-2 suggesting that the OPS, when given at 48 hours, is a good predictor of outcome after ischemic stroke and allows for early identification of patients most likely to benefit from intensive rehabilitation (Pittock et al., 2003).

Advantages

The OPS is easy to administer and can be completed in less than 5 minutes. No special training or certifications are needed and there is a good amount of research in support of its use in clinical practice. It is also located in the public domain and thus free to use in practice, research, or publication. The OPS has also shown to correlate well with other outcome measures such as the FIM scale, Barthel Index and the NIHSS.

Disadvantages

There is some evidence to suggest that its use may be limited to those with mild and moderate CVA.

Administration

During testing the clinician rates client performance as the client engages in basic physical and cognitive activities outlined on the assessment. Each of the 4 domains has unique scoring criteria and a total score of < 3.2 is suggestive of minor impairment, whereas a score between > 3.2 and ≤ 5.2 would be considered moderate, and scores > 5.2 would be considered major impairment.

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