Stroke, Vol 25, 2391-2397, Copyright © 1994 by American Heart Association
ME Segal and RR Schall
BACKGROUND AND PURPOSE: Determining the functional/health status of stroke
survivors poses special difficulties because of cognitive impairments that
frequently result from stroke. A possible means of assessing the status of
stroke survivors who are cognitively impaired is getting proxy responses
from a family member or other caregiver. Proxy agreement was evaluated for
two measures of functional/health status, the Frenchay Activities Index
(FAI) and the Health Status Questionnaire (HSQ), and a measure of
disability, the Functional Independence Measure (FIM). METHODS:
Thirty-eight stroke survivors were administered the measures at follow-up
(median time since the stroke, 6 months). Caregivers were instructed to
answer as proxies for the stroke survivors in their care. Demographics on
age, sex, race, marital status, educational level, side of lesion, and
relation of stroke survivor to caregiver were collected. RESULTS: Proxy
agreement was excellent for the FAI (intraclass correlation, .85) and the
FIM (.87), but poor for the HSQ scales (average proxy agreement, .32).
Patients' scores were low and positively skewed for the FAI but high and
negatively skewed for the FIM. Although Spearman rho coefficients between
the measures were fairly high for both stroke survivors and proxy
respondents, the correlation of scores was substantially weaker when the
group of less severely impaired survivors (as established by FIM ratings)
was considered separately. CONCLUSIONS: The FAI and the FIM are useful for
assessing the functional/health status of stroke survivors because answers
can be obtained by proxy. Future studies should examine the relations
between disability and functional/health status, with explicit attention
paid to variations in the level of disability in the stroke survivors.
ARTICLES
Determining functional/health status and its relation to disability in stroke survivors
Moss Rehabilitation Research Institute, Philadelphia, PA 19141.
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