This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lai, S.-M. Articles by Duncan, P. W. Search for Related Content PubMed PubMed Citation Articles by Lai, S.-M. Articles by Duncan, P. W. Related Collections Health policy and outcome research Embolic stroke Rehabilitation, Stroke

(Stroke. 1999;30:1840-1843.)
© 1999 American Heart Association, Inc.

Original Contributions

Evaluation of the American Heart Association Stroke Outcome Classification

Sue-Min Lai, PhD, MS, MBA Pamela W. Duncan, PhD, PT

From the Department of Preventive Medicine (S-M.L.), Center on Aging (S-M.L., P.D.W.), and Department of Health Policy and Management (P.W.D), University of Kansas Medical Center, Kansas City, Kan, and Department of Veteran Affairs Medical Center, Kansas City, Mo (P.W.D.).

Correspondence to Sue-Min Lai, PhD, MS, MBA, Department of Preventive Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160-7313. E-mail smlai{at}kumc.edu

Background and Purpose—The purpose of this study was to evaluate the concurrent validity of the American Heart Association Stroke Outcome Classification (AHA.SOC) and compare performance of its function classification with that of the Modified Rankin Scale.

Methods—The individuals in this study included the last 105 consecutive subjects who were part of a cohort of 459 stroke patients in the Kansas City Stroke Study. The patients were evaluated with a variety of standardized assessments at enrollment (within 14 days of stroke onset) and followed at 1, 3, and 6 months after stroke. Specifically, we examined validity of AHA.SOC by comparing its 3 domains (ie, Domain, Severe, and Function) with stroke severity. We correlated AHA.SOC-Function with scores of the Barthel Index, Lawton Instrumental Activities of Daily Living (IADL) Scale, and Medical Outcome Study 36-Item Short-Form Health Survey (SF-36) measures of physical function and mental health. Finally, we compared the discriminant ability of AHA.SOC-Function and the Modified Rankin Scale in assessing disability and handicap. These data were analyzed with the use of Spearman rank correlations and Kruskal-Wallis tests.

Results—All 3 domains of the AHA.SOC were significantly associated with stroke severity and scores of Barthel Index, Lawton IADL, and SF-36 physical function (all P<0.001). Both AHA.SOC-Function and the Modified Rankin Scale discriminated well the disabilities and handicap measured by Barthel Index, Lawton IADL, and SF-36 physical function (all P<0.001).

Conclusions—The AHA.SOC was able to capture impairments, disabilities, and handicap after stroke. The AHA.SOC-Function performed equally as well as the Modified Rankin Scale in assessing disabilities related to basic activities of daily living but differentiated slightly better than the Modified Rankin Scale in assessing disabilities/handicap related to instrumental activities of daily living. Neither the AHA.SOC-Function nor the Modified Rankin Scale captured differences in mental health after stroke.

Key Words: activities of daily living • disability evaluation • outcome assessment • stroke

This article has been cited by other articles:

				J. L. Banks and C. A. Marotta Outcomes Validity and Reliability of the Modified Rankin Scale: Implications for Stroke Clinical Trials: A Literature Review and Synthesis Stroke, March 1, 2007; 38(3): 1091 - 1096. [Abstract] [Full Text] [PDF]

				P. W. Schaefer, T. A. G. M. Huisman, A. G. Sorensen, R. G. Gonzalez, and L. H. Schwamm Diffusion-weighted MR Imaging in Closed Head Injury: High Correlation with Initial Glasgow Coma Scale Score and Score on Modified Rankin Scale at Discharge Radiology, October 1, 2004; 233(1): 58 - 66. [Abstract] [Full Text] [PDF]

				S. Kwon, A. G. Hartzema, P. W. Duncan, and S. Min-Lai Disability Measures in Stroke: Relationship Among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale Stroke, April 1, 2004; 35(4): 918 - 923. [Abstract] [Full Text] [PDF]

				T. A.G.M. Huisman, L. H. Schwamm, P. W. Schaefer, W. J. Koroshetz, N. Shetty-Alva, Y. Ozsunar, O. Wu, and A. G. Sorensen Diffusion Tensor Imaging as Potential Biomarker of White Matter Injury in Diffuse Axonal Injury AJNR Am. J. Neuroradiol., March 1, 2004; 25(3): 370 - 376. [Abstract] [Full Text] [PDF]

				P. W. Duncan, H. S. Jorgensen, and D. T. Wade Outcome Measures in Acute Stroke Trials : A Systematic Review and Some Recommendations to Improve Practice Stroke, June 1, 2000; 31(6): 1429 - 1438. [Abstract] [Full Text] [PDF]