From the Departments of Rehabilitation Medicine (G.G., E.A., Y.D.) and
Handicap Research (E.A.), Göteborg University, Göteborg, Sweden, and
the Department of Education, University of Chicago, Chicago, Ill (B.W.).
Correspondence to Professor Gunnar Grimby, Department of Rehabilitation Medicine, Sahlgrenska University Hospital, S-41345 Göteborg, Sweden. E-mail Gunnar.Grimby{at}rehab.gu.se
Background and Purpose—There is
a need for better understanding of the structure of instruments for
functional outcome assessment after discharge from rehabilitation. One
purpose of the study was to contribute to the analysis of
instrumental dimensionality. Another purpose was to compare disability
in stroke patients within the younger age range 2 years after onset of
stroke with that at discharge with respect to both dependence and
patients' perceived difficulty and to extend the assessments with
instrumental activities.
Methods—We studied 68 stroke survivors aged 18 to 71 years at
onset (59% aged <55 years) by means of interviews in their home,
using activities from the Functional Independence Measure (FIM) and
Instrumental Activity Measure (IAM) for ratings of dependence and
perceived difficulty. Rasch analysis was used to construct
calibrated linear measures and to evaluate the level of fit.
Results—Acceptable models for comparison of dependence between
discharge and follow-up were found for the physical and the
social-cognitive items in FIM. However, personal care and
social-cognitive items showed an increased level of dependence at
follow-up compared with at discharge. A combination of physical
activities from FIM and IAM also gave acceptable models for both
dependence and perceived difficulty, and the hierarchical orders of
activities are presented. In general, there was agreement
between the ratings of dependence and perceived difficulty, but with
some discrepancies. Men found it harder to be independent in such
instrumental activities as cooking and cleaning than women; the
opposite was true for small-scale shopping and locomotion outdoors.
Subjects aged
Conclusions—Changes in the hierarchical order of activities
should be taken into account in follow-up studies. Differences in the
environment between hospital and home, as well as differences in
support and motivation, might explain the relatively larger degree of
dependence at follow-up compared with at discharge and indicate the
need for further rehabilitation efforts. Instrumental activities could
be combined with FIM activities in a model. For individual items,
ratings of both dependence and perceived difficulty may provide further
insight into the disablement process.
© 1998 American Heart Association, Inc.
Original Contributions
Dependence and Perceived Difficulty in Daily Activities in Community-Living Stroke Survivors 2 Years After Stroke
A Study of Instrumental Structures
55 years had slightly higher level of dependence
and perceived difficulty in IAM activities than those below that
age.
Key Words: activities of daily living • disability evaluation • rehabilitation • stroke outcome
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