Agreement in activities of daily living performance after stroke in a postal questionnaire and interview of community-living persons.

OBJECTIVE: To compare assessments of activities of daily living (ADL) made in a postal questionnaire and an interview. DESIGN: Comparative study of a convenience sample. SUBJECTS: Results in 36 persons with stroke >10 years previously. METHODS: Data on ADL were gathered in a self-administered postal questionnaire followed by a semi-structured interview (within 1-2 weeks) using items in the Functional Independence Measure, combined with instrumental items, Instrumental Activity Measure or the ADL taxonomy (personal and instrumental items). RESULTS: There was generally moderate to good agreement between the postal questionnaire and the interview. Other dependence identified was reported during the interviews. Although the operational descriptions of the items varied between the ADL indices, they primarily identified ADL independence in the same persons. CONCLUSION: The use of a self administrated postal ADL questionnaire was feasible for studying ADL performance. However, in some persons, interviews may be needed to complement the results.

Reliability of an interview approach to the Functional Independence Measure.

OBJECTIVE: To establish the reliability of an interview approach to the Functional Independence Measure (FIM). DESIGN: Two raters were present at the same time during the interviews in the home and did independent ratings of the 18 FIM items. The interview procedure was repeated within a week by another two raters in the clinic. SUBJECTS: Sixty-three stroke survivors (median age 63 years, range 18-71 years) were studied approximately two years after onset. RATERS: Three occupational therapists and one nurse. METHODS: Reliability was calculated as unweighted kappa statistics, percentage agreement (PA), and intraclass correlation coefficient (ICC). RESULTS: Best agreement was found in the motor items of FIM. The kappa statistics showed good to excellent inter-rater values during the same interview except for the Social interaction item. The ICCs based on sum-score for motor (0.92) and social-cognitive items (0.75) respectively, were similar to those reported in the literature. The repeated interview by different raters showed less stable agreement according to kappa values for the items dealing with transfers, locomotion and social-cognition. CONCLUSIONS: FIM assessments showed high inter-rater agreement for the same interview setting (home as well as clinic), but the stability of the measure over time with a repeated interview by different raters was somewhat less satisfactory.

Dependence and perceived difficulty in daily activities in community-living stroke survivors 2 years after stroke: a study of instrumental structures.

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 > or =55 years had slightly higher level of dependence and perceived difficulty in IAM activities than those below that age. 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.