Comprehensive assessment of activities of daily living in stroke. The Copenhagen stroke study

Abstract

Objective: To assess activities of daily living (ADL) in stroke in a comprehensive way. The Barthel Index (BI) is widely used in stroke research, but is limited because it measures basic ADL functions only. This study sought to determine whether the Frenchay Activities Index (FAI) is a good choice for supplementary assessment of higher order ADL functions. Design: Prospective and consecutive. Setting: Follow-up investigation 6 months after stroke of patients who were admitted to, and completed rehabilitation at, a stroke unit. Patients: 437 patients with strokes. Main Outcome Measures: Factor analysis of the BI, FAI, and the Scandinavian Neurological Stroke Scale (SSS); distribution characteristics of a comprehensive, combined ADL scale. Results: Five factors were found. One factor comprised all items from the BI and all the motor items from the SSS, but no items from the FAI. The FAI loaded on three other factors. Finally, orientation and speech from the SSS loaded on a separate factor. A combined score consisting of the BI total score and a simple transformation of the FAI total score had a much improved distribution without strong ceiling or floor effects. Conclusions: The FAI supplements the BI with minimal overlap in content. A combined total score has a distribution that makes it very usable for research in stroke outcome and stroke rehabilitation effect.