Redefining a minimal assessment protocol for stroke rehabilitation: the new "Protocollo di Minima per l'ICtus" - PMIC2020.

BACKGROUND The use of standardized assessment protocols is strongly recommended to identify patient's needs, outcomes, and predictors of response to specific interventions in Stroke rehabilitation. In 2008, the Italian Society of Physical and Rehabilitation Medicine (SIMFER) published the minimal protocol for the person with stroke (PMIC), in reference to the International classification of Functioning, Disability and Health. AIM In 2019, the SIMFER appointed a working group (WG) to provide a revised, updated version in line with the most recent literature and suitable for all rehabilitation settings: the PMIC2020. DESIGN descriptive study based on the consensus of a panel of experts. SETTING all the rehabilitation settings. POPULATION stroke survivor people with disability. METHODS the coordinator of the SIMFER national Stroke Section appointed the WG, including the 8 Stroke Section board members, and 4 more experts (3 physiatrists; 1 neurologist). An extensive revision of the international literature on stroke assessment recommendations was performed; each proposed change from PMIC was written and motivated, discussed and voted. RESULTS The PMIC2020 is a single form, to be administered at any time of the rehabilitation pathway, including a minimum set of variables, consisting of a demographic/anamnestic section, and a clinical/functional assessment section. Newly introduced tools included measures of malnutrition (BMI<18,5); pain in verbal and non-verbal patients (Numeric Rating Scale-pain, Pain Assessment in Advanced Dementia Scale); neurological impairment (National Institute of Health-stroke scale); activity (Modified Barthel Index, Short Physical Performance Battery); and participation (Frenchay Activity Index). CONCLUSIONS The PMIC2020 provides an updated tool for the multidimensional rehabilitation assessment of the stroke patient, at any stage of the rehabilitation pathway; it aims to provide a shared minimum set of variables defining patient's needs and outcomes across different rehabilitation facilities and settings. CLINICAL REHABILITATION IMPACT The PMIC2020 identifies patient's needs, outcomes, and predictors of response to specific interventions in Stroke rehabilitation and provide ground for a highly needed Stroke Registry.