Mapping the Stroke Impact Scale (SIS-16) to the International Classification of Functioning, Disability and Health

Development of a Conversion Table Linking Functional Independence Measure Scores to International Classification of Functioning, Disability, and Health Qualifiers: Insights from a Survey of Healthcare Professionals

In clinical practice, patient assessments rely on established scales. Integrating data from these scales into the International Classification of Functioning, Disability, and Health (ICF) framework has been suggested; however, a standardized approach is lacking. Herein, we tested a new approach to develop a conversion table translating clinical scale scores into ICF qualifiers based on a clinician survey. The survey queried rehabilitation professionals about which functional independence measure (FIM) item scores (1-7) corresponded to the ICF qualifiers (0-4). A total of 458 rehabilitation professionals participated. The survey findings indicated a general consensus on the equivalence of FIM scores with ICF qualifiers. The median value for each item remained consistent across all item groups. Specifically, FIM 1 had a median value of 4; FIM 2 and 3 both had median values of 3; FIM 4 and 5 both had median values of 2; FIM 6 had a median value of 1; and FIM 7 had a median value of 0. Despite limitations due to the irreconcilable differences between the frameworks of existing scales and the ICF, these results underline the ICF's potential to serve as a central hub for integrating clinical data from various scales.

Components of a Behavior Change Model Drive Quality of Life in Community-Dwelling Older Persons

This study aimed to inform a measurement approach for older persons who wish to engage in active living such as participating in a walking program. The Patient Generated Index, an individualized measurement approach, and directed and summative content analyses were carried out. A sample size of 204 participants (mean age 75 years; 62% women) was recruited; it generated 934 text threads mapped to 460 unique categories within 45 domains with similarities and differences for women and men. The Capability, Opportunity, Motivation, and Behaviors Model best linked the domains. The results suggest that older persons identify the need to overcome impaired capacity, low motivation, and barriers to engagement to live actively. These are all areas that active living programs could address. How to measure the outcomes of these programs remains elusive.

The Stroke Stigma Scale: a reliable and valid stigma measure in patients with stroke

OBJECTIVE

The objective of the study is to analyse the psychometric properties of the Stroke Stigma Scale, a novel scale to assess perceived stigma of patients with stroke.

DESIGN

This is a psychometric study.

SETTING

Neurology or rehabilitation units in three hospitals in China.

SUBJECTS

A total of 288 patients with stroke.

INTERVENTIONS

None.

MEASURES

The content validity of the Stroke Stigma Scale was assessed through expert consultation. Criterion validity was evaluated based on the scale's relationships with the Stigma Scale for Chronic Illness and the Self-rating Depression Scale. Construct validity was assessed using exploratory factor analysis, and internal consistency was tested with Cronbach's α.

RESULTS

The final version Stroke Stigma Scale consists of 16 items. It showed strong positive correlations with both the Stigma Scale for Chronic Illness (ρ = 0.89, P < 0.001) and the Self-rating Depression Scale (ρ = 0.82, P < 0.001). The exploratory factor analysis revealed four components of the Stroke Stigma Scale: internalized stigma, physical impairment, discrimination experience, and social isolation, which were strongly associated with our perceived stroke stigma model. Cronbach's α for the total scale was 0.92, and that of each subscale was 0.77-0.86. The test-retest reliability with intra-class correlation coefficients of the total scale was 0.92 (P < 0.001), and intra-class correlation coefficients of each subscale were 0.74-0.89 (P < 0.001).

CONCLUSIONS

The Stroke Stigma Scale is a reliable and valid measure of perceived stigma in patients with stroke, which may be useful in stigma prevention and stroke rehabilitation.

Mapping a measure of physical ability for persons with long-term musculoskeletal pain to the ICF and ICF Core Sets

BACKGROUND

Test Instrument for Profile of Physical Ability (TIPPA) is used in the Swedish sickness certification process for patients with long-term musculoskeletal pain. The aim was to explore the content of TIPPA in the context of work-ability assessments.

METHODS

The full protocol of TIPPA was linked to the in relation to the International Classification of Functioning, Disability and Health (ICF) and evaluated in relation to the ICF Core Sets for Chronic Widespread Pain (CWP).

RESULTS

Twenty-two unique meaningful concepts were identified in TIPPA. Eighteen of those could be linked to ICF, yielding 27 third-level ICF-categories. Ten of these categories fitted the domains of 'body function', 16 were 'activity and participation', while one was related to 'environmental factors'. Perspective and aim varied between the parts of the test. When assessed against Brief ICF Core Set for CWP, TIPPA covered three of nine 'body function' categories and 2 out of 10 'activity and participation' categories. The coverage of the subgroup 'activity' was two out of five. TIPPA did not cover three categories, i.e. 'd175 solving problems', 'd230 carrying out daily routine' and 'd240 handling stress and other psychological demands', in the subgroup of 'activity'.

CONCLUSIONS

TIPPA could be a useful measure for the assessment of physical ability. However, additional condition-specific items/measures are required to obtain full coverage of core aspects of functioning and disability in a comprehensive work-ability assessment for patients with long-term musculoskeletal pain.

Individuals' perception about upper limb influence on participation after stroke: an observational study

Background Stroke can compromise upper limb performance and influence the individual's participation in real life situations. Objective To investigate how components of body function and activity affect the individuals' self-perception of their participation after stroke. Methods In this observational study, the International Classification of Functioning, Disability and Health was used as model. Body function was assessed by palmar grip and pinch strength; Ashworth modified scale; Fugl-Meyer scale; and Motor-Free Visual Perception Test. The Purdue Pegboard Test and the aiming movement performance measured the activity. Upper limb participation was analyzed by the Hand Function domain of the Stroke Impact Scale (SIS). Thirty-four individuals after chronic stroke were divided into two groups, according to their Hand function SIS scores (severe and non-severe). Differences between groups were analyzed. Relationships between individual variables and the SIS score were verified. A regression model was proposed. Results Strength and the Fugl-Meyer scale score were greater for the non-severe group. Muscle tone was greater for the severe group only in the wrist flexors. None of the activity variables differed between groups. The upper limb Fugl-Meyer score was able to predict 79% of the individuals in SIS Hand Function groups. Conclusion Sensory-motor impairment, as measured by the upper limb Fugl-Meyer scale, can explain the influence of the upper limbs on participation in the individuals' perception.

Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice

Background

There is uncertainty regarding the clinical utility of the data obtained from patient‐reported outcome measures (PROMs) for patient care. We evaluated the incremental information obtained by PROMs compared to the clinician‐reported modified Rankin Scale (mRS).

Methods and Results

This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROMs: Stroke Impact Scale‐16 (SIS‐16), EQ‐5D, Patient Health Questionnaire‐9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROMs explained by mRS was determined using r² after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c‐statistic was evaluated for mRS versus SIS‐16. Correlation between PROMs and mRS was highest for SIS‐16 (r=−0.64, P<0.01). The r² ranged from 0.11 (PROMIS fatigue) to 0.56 (SIS‐16). Change in scores occurred in 51% with mRS and 35% with SIS‐16. There was lower agreement and less ability to discriminate change in mRS than in SIS‐16 with change in the other measures.

Conclusions

PROMs provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS‐16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROMs may be a useful addition to mRS in the assessment of health status in clinical practice.

Effects of virtual reality-based rehabilitation on distal upper extremity function and health-related quality of life: a single-blinded, randomized controlled trial

BACKGROUND

Virtual reality (VR)-based rehabilitation has been reported to have beneficial effects on upper extremity function in stroke survivors; however, there is limited information about its effects on distal upper extremity function and health-related quality of life (HRQoL). The purpose of the present study was to examine the effects of VR-based rehabilitation combined with standard occupational therapy on distal upper extremity function and HRQoL, and compare the findings to those of amount-matched conventional rehabilitation in stroke survivors.

METHODS

The present study was a single-blinded, randomized controlled trial. The study included 46 stroke survivors who were randomized to a Smart Glove (SG) group or a conventional intervention (CON) group. In both groups, the interventions were targeted to the distal upper extremity and standard occupational therapy was administered. The primary outcome was the change in the Fugl-Meyer assessment (FM) scores, and the secondary outcomes were the changes in the Jebsen-Taylor hand function test (JTT), Purdue pegboard test, and Stroke Impact Scale (SIS) version 3.0 scores. The outcomes were assessed before the intervention, in the middle of the intervention, immediately after the intervention, and 1 month after the intervention.

RESULTS

The improvements in the FM (FM-total, FM-prox, and FM-dist), JTT (JTT-total and JTT-gross), and SIS (composite and overall SIS, SIS-social participation, and SIS-mobility) scores were significantly greater in the SG group than in the CON group.

CONCLUSIONS

VR-based rehabilitation combined with standard occupational therapy might be more effective than amount-matched conventional rehabilitation for improving distal upper extremity function and HRQoL.

TRIAL REGISTRATION

This study is registered under the title "Effects of Novel Game Rehabilitation System on Upper Extremity Function of Patients With Stroke" and can be located in https://clinicaltrials.gov with the study identifier NCT02029651 .

Mapping two measures to the International Classification Of Functioning, Disability and Health and the brief ICF core set for spinal cord injury in the post-acute context

OBJECTIVE

To evaluate the extent to which the rehabilitation outcome levels (ROL) and the spinal cord independence measure (SCIM) III could be mapped to the International Classification of Functioning, Disability and Health (ICF) and the brief core set for spinal cord injury (SCI) in the post-acute context.

METHODS

Two professionals used the published protocol to map the concepts derived from both measures to the ICF categories. Further, the endorsed categories at the second level of the ICF were used to determine the coverage of the Brief ICF Core Set for SCI.

RESULTS

Three items of the ROL could not be conceptualised within the ICF, while the rest were mapped to 42 second-level categories, mainly to the activity and participation domain. All the items of the SCIM III were mapped, yielding 52 ICF categories, mostly at the third level (32). For the mapping to the Core Set for SCI, the ROL covered five and the SCIM III all nine categories of 'activities and participation' included as the candidate categories of the brief version.

CONCLUSION

In terms of content, the ROL appears to be a more global measure of functioning, compared with the SCIM III that covers specific 'activity' aspects as proposed in the Brief Core Set for SCI. It is thus recommended that standardised measures, such as the SCIM III, be used due to its conceptual underpinnings and coverage of important aspects. Implications for Rehabilitation Rehabilitation professionals should select appropriately validated outcome measures specific to the health condition in order to evaluate the effectiveness of rehabilitation. Rehabilitation professional working with outcome measures should be aware of the limitations of measures, in terms of content, and supplement the evaluation with appropriate standardised measures or the use of the Core Sets. To enhance evidence-based practise in routine clinical practise, standardised outcome measures should be used.

Conceptualizing disability in US national surveys: application of the World Health Organization's (WHO) International Classification of Functioning, Disability, and Health (ICF) framework

PURPOSE

Disability data inform resource allocation and utilization, characterize functioning and changes over time, and provide a mechanism to monitor progress toward promoting and protecting the rights of individuals with disability. Data collection efforts, however, define and measure disability in varied ways. Our objective was to see how the content of disability measures differed in five US national surveys and over time.

METHODS

Using the WHO ICF as a conceptual framework for measuring disability, we assessed the National Health Interview Survey (NHIS), Current Population Survey (CPS), Survey of Income and Program Participation (SIPP), National Survey of SSI Children and Families (NSCF), and American Community Survey (ACS) for their content coverage of disability relative to each of the four ICF components (i.e., body functions, body structures, activities and participation, and environment). We used second-level ICF three-digit codes to classify question content into categories within each ICF component and computed the proportion of categories within each ICF component that was represented in the questions selected from these five surveys.

RESULTS

The disability measures varied across surveys and years. The NHIS captured a greater proportion of the ICF body functions and body structures components than did other surveys. The SIPP captured the most content of the ICF activities and participation component, and the NSCF contained the most content of the ICF environmental factors component.

CONCLUSIONS

This research successfully illustrated demonstrated the utility of the ICF in examining the content of disability measures in five national surveys and over time.

Content verification of the EORTC QLQ-C30/EORTC QLQ-BR23 with the International Classification of Functioning, Disability and Health

PURPOSE

The aims of this study were to estimate the extent to which the content of the EORTC QLQ-C30 and EORTC QLQ-BR23 goes beyond functioning and include global feeling of well-being.

METHODS

Respectively, 21 and 13 healthcare professionals agreed to link the EORTC QLQ-C30 and EORTC QLQ-BR23 to the ICF. Mappers were asked to independently identify appropriate codes for the corresponding items of the EORTC QLQ-C30 and EORTC QLQ-BR23 following standardized linking rules and methodology. A Delphi technique was used in order to reach consensus. The threshold of agreement was 70 %. Rounds were stopped when the threshold was obtained or when it was clear that no consensus would be reached.

RESULTS

A total of 25 items out of 30 were endorsed for the EORTC QLQ-C30: 8 items were endorsed at the 4-digit level, 15 items at the 3-digit level, and 2 items reach the consensus that the items were not cover within the ICF. Only 2 items out of 23 did not reach consensus in the EORTC QLQ-BR23. Of the 21 items endorsed, 3 items were endorsed at the 5-digit level, 10 items at the 4-digit level, and 8 at the 3-digit level.

CONCLUSION

This study demonstrates that the content of the EORTC QLQ-C30 goes beyond functioning and includes global feeling of well-being and that the content of the EORTC QLQ-BR23 is related to functioning. Furthermore, linking items to the ICF framework could be an additional method to validate the content of health-related questionnaires.

The Effects of Peroneal Nerve Functional Electrical Stimulation Versus Ankle-Foot Orthosis in Patients With Chronic Stroke

Background. Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle-foot orthoses (AFO) for treatment of foot drop poststroke, but few randomized controlled comparisons exist. Objective. To compare changes in gait and quality of life (QoL) between FES and an AFO in individuals with foot drop poststroke. Methods. In a multicenter randomized controlled trial (ClinicalTrials.gov #NCT01087957) with unblinded outcome assessments, 495 Medicare-eligible individuals at least 6 months poststroke wore FES or an AFO for 6 months. Primary endpoints: 10-Meter Walk Test (10MWT), a composite of the Mobility, Activities of Daily Living/Instrumental Activities of Daily Living, and Social Participation subscores on the Stroke Impact Scale (SIS), and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test, GaitRite Functional Ambulation Profile (FAP), Modified Emory Functional Ambulation Profile (mEFAP), Berg Balance Scale (BBS), Timed Up and Go, individual SIS domains, and Stroke-Specific Quality of Life measures. Multiply imputed intention-to-treat analyses were used with primary endpoints tested for noninferiority and secondary endpoints tested for superiority. Results. A total of 399 subjects completed the study. FES proved noninferior to the AFO for all primary endpoints. Both the FES and AFO groups improved significantly on the 10MWT. Within the FES group, significant improvements were found for SIS composite score, total mFEAP score, individual Floor and Obstacle course time scores of the mEFAP, FAP, and BBS, but again, no between-group differences were found. Conclusions. Use of FES is equivalent to the AFO. Further studies should examine whether FES enables better performance in tasks involving functional mobility, activities of daily living, and balance.

Content identification of the IWQOL-Lite with the International Classification of Functioning, Disability and Health

INTRODUCTION

The identification of the content of a measure could ensure that the most appropriate measure is chosen to meet a particular objective. Mapping the Impact of Weight on Quality Of Life (IWQOL-Lite) to the International Classification of Functioning, Disability and Health (ICF) will improve the understanding of its structure and aid in the interpretation of the results.

METHODS

A mapping exercise was performed by 21 raters using the Delphi technique to identify the ICF codes that best describe the content of the items of the IWQOL-Lite. Both French and English versions were linked to validate the French translation. The results were validated on a sample of 122 participants and were also compared to the mapping performed by another group.

RESULTS

Most of the content of the IWQOL-Lite was identified. All five components of the ICF were represented in the IWQOL-Lite. The mapping differed across languages. The results of the mapping were similar to those obtained by another group.

CONCLUSIONS

The content of the IWQOL-Lite is compatible with the ICF. The measure has good content validity. The content could be improved by the addition and the specification of some terms. The French translation of some items should be revised.

The extent to which common health-related quality of life indices capture constructs beyond symptoms and function

PURPOSE

This study proposes to identify for 5 widely used generic HRQL and QOL measures the extent to which function and global feelings of well-being are represented in their content.

METHODS

The 5 indices were the EQ-5D, the HUI, the SF-36, SF-12, and the WHOQOL-Bref. A total of 15 raters with a variety of health and research backgrounds mapped the items. Raters independently identified all codes that could possibly map to the item and indicated the code that best reflected the underlying intent of the item, using the standardized mapping rules and methodology. A Delphi process aided consensus for each of the items. The consensus rounds involved reconsideration of item codes for which 70% of raters did not agree on the "best" code. These consensus rounds were terminated when item codes reached the threshold of 70% agreement or when it became evident from that consensus would not be reached.

RESULTS

Function was a predominant construct for the 5 indices, with the proportion of items capturing function ranging from a low of 27% for the WHOQOL-Bref to a high of 92% for the SF-12. Less than 50% of items within the indices mapped to the granularity of function as described by the ICF.

CONCLUSIONS

This paper demonstrates an additional method to validate the content of health-related indices to supplement the qualitative methods of consulting with experts and patients.

Systematic literature review on ICF from 2001 to 2009: its use, implementation and operationalisation

PURPOSE

To present a systematic literature review on the state of the art of the utilisation of the International Classification of Functioning, Disability and Health (ICF) since its release in 2001.

METHOD

The search was conducted through EMBASE, MEDLINE and PsychInfo covering the period between 2001 and December 2009. Papers were included if ICF was mentioned in title or abstract. Papers focussing on the ICF-CY and clinical research on children and youth only were excluded. Papers were assigned to six different groups covering the wide scenario of ICF application.

RESULTS

A total of 672 papers, coming from 34 countries and 211 different journals, were included in the analysis. The majority of publications (30.8%) were conceptual papers or papers reporting clinical and rehabilitation studies (25.9%). One-third of the papers were published in 2008 and 2009.

CONCLUSIONS

The ICF contributed to the development of research on functioning and on disability in clinical, rehabilitation as well as in several other contexts, such as disability eligibility and employment. Diffusion of ICF research and use in a great variety of fields and scientific journals is a proof that a cultural change and a new conceptualisation of functioning and disability is happening.

Predictors of change in quality of life after distributed constraint-induced therapy in patients with chronic stroke

BACKGROUND

There are no reports of predictive models or predictors for quality of life (QoL) after constraint-induced therapy (CIT).

OBJECTIVE

This investigation identified predictors of change in stroke-related QoL after distributed CIT using the Chi-squared Automatic Interaction Detector (CHAID) method.

METHODS

A total of 58 patients with chronic stroke were treated with CIT for 2 hours daily for 3 weeks. The 7 potential predictors were age, gender, side of lesion, time since stroke, cognitive status, motor impairment of upper extremity, and activities of daily living (ADL). QoL was measured by the Stroke Impact Scale (SIS). CHAID analysis was used to examine for associations between the 7 predictors and each SIS domain. The validity of each model generated by the analysis was evaluated.

RESULTS

Daily functional performance as measured by the Functional Independence Measure (FIM) was found to determine SIS outcomes, including overall score (P = .006) and the ADL/instrumental ADL (IADL) domain (P = .004). None of the potential predictors emerged as significant predictors of the strength, memory, emotion, communication, mobility, hand function, and participation domains of SIS. The misclassification risk estimates were small, indicating good validity for the CHAID models.

CONCLUSIONS

The functional independence score of the FIM can predict the overall SIS score as well as the ADL/IADL domain of the SIS in chronic stroke patients who receive CIT, but larger databases are needed to confirm this. CHAID analysis was a useful approach for an exploratory study.