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Author List:
Kwon S (Rehabilitation Outcomes Research Center)
Duncan PW (Rehabilitation Outcomes Research Center)
Studenski S (GRECC and HSR&D, Pittsburgh Veterans Affair Health Care System)
Lai SM (University of Kansas Medical Center)
Perera S (University of Pittsburgh)
Reker DM (Rehabilitation Outcomes Research Center)
Objectives:
The purpose of this study was to examine the concurrent and discriminant validity of the Stroke Impact Scale (SIS) in a veteran stroke population using a telephone mode of administration.
Methods:
Stroke patients were identified using national VA administrative data and ICD-9 codes in 13 participating VA hospitals. Stroke was confirmed by reviewing electronic medical records. Patients were administered SIS by telephone at 12-weeks post-stroke, and administered the Functional Independence Measure (FIM) and SF-36V at 16 weeks post-stroke. Concurrent and discriminant validity was examined using Pearson’s correlations and Kruskal-Wallis one way ANOVA tests.
Results:
All the relevant relationships presented high correlation coefficients with statistical significance: 0.86 for FIM-motor vs. SIS-ADL, and 0.77 for PF in SF-36V vs. SIS-PHYSICAL. The SIS presented better score discrimination and distribution for different severity of stroke than FIM and SF-36V without severe ceiling and floor effects that make instrument insensitive to patient’s changes in health states. Kruskal-Wallis tests showed the Physical Component Score in SF-36V did not discriminate any disability levels. Physical Functioning (PF) in SF-36V, FIM-motor, SIS-PHYSICAL, SIS-16, and SIS-ADL showed statistically significant difference across Rankin levels. in Kruskal-Wallis tests. The post-hoc pairwise comparisons showed that SIS-PHYSICAL, SIS-16, and SIS-ADL discriminated more Rankin levels than FIM-motor and PF in SF-36V.
Implications:
SIS telephone survey had concurrent and discriminant validity compared to FIM and SF-36V with no evidence of ceiling and floor effects. Telephone administration of SIS would be a useful and cost-effective method to follow-up with community dwelling veterans with stroke.
Impacts:
The new Veterans Health Administration Stroke Guideline states that patients who received rehabilitation services require follow-up in 3 to 6 months after discharge. Even though guidelines require follow-ups, it is not always feasible for practitioners to comply with recommendations because of limited resources. Using the SIS telephone mode of administration, seamless evaluation on patient health state could be facilitated with significantly reduced resource use compared to the traditional in-person interview.
