The Stroke Impact Scale 3.0

Abstract

We sought to assess the psychometric attributes of the Brazilian version of the Stroke Impact Scale (SIS) 3.0 in stroke survivors. Patients were evaluated by the National Institutes of Health Stroke Scale, Mini-Mental State Examination, Barthel Index, Lawton Instrumental Activities of Daily Living Scale, modified Rankin Scale, Geriatric Depression Scale, and Hospital Anxiety and Depression Scale. Health-related quality of life was evaluated with the MOS-Short Form 36 and SIS 3.0. One hundred seventy-four stroke survivors were assessed (mean age, 56.9 years; 55.2% male). Hand function had a prominent floor effect (45.9%), whereas a ceiling effect was observed in the communication domain (17.3%). The internal consistency of SIS (Cronbach's alpha=0.94) and SIS domains (item-dimension correlation, 0.17 to 0.89) were satisfactory; only the emotion domain had poor internal consistency (Cronbach's alpha=0.49). Test-retest reliability was evaluated in 50 consecutive patients. Concerning the stability of the SIS, the weighted kappa values ranged from 0.33 (item 3a) to 0.94 (item 7e). Intraclass correlation coefficient values for the SIS domains ranged from 0.48 (emotion) to 0.94 (hand function). Standard error of measurement values for SIS domains ranged from 6.85 (mobility) to 9.63 (social participation). Regarding convergent validity, a significant correlation (Spearman's correlation coefficient, P<0.0001) was found between the SIS composite physical domain and the National Institutes of Health Stroke Scale (-0.69), modified Rankin Scale (-0.81), Barthel Index (0.87), Lawton Scale (0.76), and MOS-Short Form 36 physical component summary (0.61). SIS domain scores significantly decreased as modified Rankin Scale scores increased (discriminative validity; ANOVA, P<0.0001). The Brazilian version of SIS 3.0 has satisfactory psychometric properties and can be used in stroke survivors to assess health-related quality of life.