Measuring continuity and discontinuity following stroke.

Abstract

To design and test a valid, reliable, and parsimonious instrument to measure continuity and discontinuity of self following stroke. A 45-item scale with a 3-point response set was developed. The conceptual basis, "continuity and discontinuity in the experience of self," was derived from an existential-phenomenological study of stroke survivors. Study instruments included the Barthel Index (measure of functional abilities) and the pre- and poststroke QoL Cantril Ladder. The instruments were administered one time, in random order, to 55 stroke survivors in the United States in rehabilitation hospitals and in the community. Data were analyzed using a principal components factor analysis. A 2-factor solution with 10 items per factor was derived. Cronbach's alpha for Factor 1 (discontinuity of self) was .874 and for Factor 2 (continuity of self) was .869. Continuity and discontinuity were inversely related; continuity was related to functional abilities, but discontinuity was not. Use of this instrument validated findings from a qualitative study, which showed that life following stroke was a paradoxical sense of both continuity and discontinuity in the experience of self. This instrument can be used to measure the effectiveness of nursing interventions aimed at increasing stroke survivors' sense of continuity.