Purpose: The LIMOS is a validated observational tool designed to assess stroke rehabilitation within hospital settings. To enable its application in outpatient settings in Brazil and similar low- and middle-income countries, it is necessary to adapt LIMOS into a Patient-Reported Outcome Measure (PROM). Accordingly, this study aimed to translate, cross-culturally adapt, and standardise LIMOS for the Brazilian context (LIMOS-Br) and transform it into a PROM.
Material and methods: The adaptation process included translation, synthesis, expert evaluation, back-translation, target population evaluation and re-evaluation by experts. The study involved 100 adult stroke survivors. We assessed content validity, reliability, internal consistency, Criterion-related validity with the Functional Independence Measure (FIM), item and participant calibration, and accuracy.
Results: The LIMOS-Br demonstrated good internal consistency (Cronbach's alpha = 0.8), and excellent intra- and inter-rater reliability (ICC2.1=0.97; 95%CI = 0.94-0.98 and ICC2.1=0.85; 95%CI = 0.74-0.91, respectively). Criterion-related validity with FIM was high (rho = 0.85; p < 0.01). Rasch analyses indicated high reliability indices (item: 0.96, people: 0.94), good item and person variance (separation indices: items 5.18, people 4.06), and adequate performance deviations. Accuracy for functional independence was optimal with a cut-off score of 180 points (sensitivity 83.3% and specificity 88.9%).
Conclusions: The LIMOS-Br maintained its clinimetric integrity, validating its use as a PROM.
Keywords: Neurorehabilitation; functioning assessment; psychometrics; stroke.
LIMOS-Br adopts a multidisciplinary approach grounded in the International Classification of Functioning, Disability, and Health (ICF), promoting standardised communication among healthcare professionals, patients, and family members.LIMOS-Br focuses on the ICF component of activity, guiding professionals in assessing specific tasks to tailor patient-centered therapeutic planning.Its adaptation as a Patient-Reported Outcome Measure (PROM) ensures standardised evaluations that incorporate the patient’s perspective across various environments and contexts.LIMOS-Br is valid and reliable for assessing the functioning of stroke patients in outpatient settings, enhancing data collection.