Frenchay Activities Index Research Articles

Poster 69: Outcomes of Patients Transitioning From Unilateral Transtibial Amputation to Bilateral Transtibial Amputations and Their Long-Term Outcomes

Objective: To compare the rehabilitation outcomes of people with bilateral transtibial amputation (BTTA) in relation to their outcomes after unilateral transtibial amputation rehabilitation (UTTA) and their long-term outcomes, using valid and reliable measures. Design: All consecutively admitted patients with BTTA due to diabetic or peripheral vascular disease between the years 1998 to 2003 were sampled. Data from database analysis, retrospective chart review, and a telephone interview were collected. Data were analyzed using SPSS. Setting: Regional amputee rehabilitation hospital, outpatient clinics, and telephone interviews (home setting). Participants: All consecutively admitted patients with BTTA due to diabetic or peripheral vascular disease between the years 1998 and 2003 were sampled (N=82). Interventions: Data from database analysis, retrospective chart review, and a telephone interview were collected. Main Outcome Measures: The main outcome measures used compared discharge scores after patients' first and second transtibial amputation rehabilitation stays for the Houghton (prosthetic wear), two-minute walk test (2MWT), 12-Item Short-Form Health Survey (SF-12), and prosthetic candidacy. Long-term outcomes collected included mortality, modified Houghton score, SF-12, Frenchay Activity Index. Results: The average age at the time of second amputation was 65.5 years and the average time between amputations was 2.96 years. The majority (73.2%) of patients were men. There was no significant difference between patients' matched outcomes (after unilateral vs bilateral amputation rehabilitation) for length of stay, Houghton, 2MWT, or prosthetic candidacy despite having more comorbidities (P<.01). However, BTTA patients required a more supportive gait aid than they did as a unilateral amputee (P<.01) and required more assistance to ambulate on discharge from rehabilitation (P=.02). Of 82 patients admitted for BTTA rehabilitation, 35 patients were interviewed an average of 3.31 years postamputation. Another 32 patients had died an average of 4.2 years postrehabilitation discharge (Kaplan-Meier survival analysis). The mean modified Houghton score at telephone follow-up was 6.3 (maximum score, 9) with a significant improvement from rehabilitation discharge to follow-up (P=.001). 86% were still wearing prostheses regularly and 83% were walking. Most remained independent in activities of daily living (ADLs). Conclusions: Patients undergoing BTTA who are referred to rehabilitation had prosthetic outcomes similar to what these patients had after rehabilitation for UTTA, despite having more advanced age and illness. They also tend to do very well at long-term follow-up and continue to make gains even after being discharged from rehabilitation. At long-term follow-up, the majority were independent in ADLs and 85% were wearing prostheses and ambulating independently indoors. The average life span after discharge was 4.2 years, which is a longer lifespan than that reported in the literature for patients with UTTA. These patients may represent a subset of patients who live longer after amputation. Therefore, strong consideration should be given for prosthetic rehabilitation of patients with BTTA.

Lack of Effectiveness of a Multidisciplinary Fall‐Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial

To assess whether a pragmatic multidisciplinary fall-prevention program was more effective than usual care in preventing new falls and functional decline in elderly people. A two-group, randomized, controlled trial with 12 months of follow-up. University hospital and home-based intervention, the Netherlands. Three hundred thirty-three community-dwelling Dutch people aged 65 and over who were seen in an emergency department after a fall. Participants in the intervention group underwent a detailed medical and occupational-therapy assessment to evaluate and address risk factors for recurrent falls, followed by recommendations and referral if indicated. People in the control group received usual care. Number of people sustaining a fall (fall calendar) and daily functioning (Frenchay Activity Index). Results showed no statistically significantly favorable effects on falls (odds ratio=0.86, 95% confidence interval (CI)=0.50-1.49) or daily functioning (regression coefficient=0.37, CI=-0.90 to 1.63) after 12 months of follow-up. The multidisciplinary fall-prevention program was not effective in preventing falls and functional decline in this Dutch healthcare setting. Implementing the program in its present form in the Netherlands is not recommended. This trial shows that there can be considerable discrepancy between the "ideal" (experimental) version of a program and the implemented version of the same program. The importance of implementation research in assessing feasibility and effectiveness of such a program in a specific healthcare setting is therefore stressed.

Variations in functioning and disability in multiple sclerosis

The aim of the present study was to explore variations in functioning and disability--with regard to cognition, manual dexterity, walking, energy, mood, activities of daily living and social/ lifestyle activities--every six months during a 2-year period, in 200 people with MS (PwMS) at an outpatient MS specialist clinic. Symbol Digit Modalities Test, Nine Hole Peg Test, Timed 25 Foot Walk, Fatigue Severity Scale, Beck Depression Inventory, Katz ADL Index Extended and Frenchay Activities Index were used to collect data. For analyses of statistically significant changes in scores during the study period, repeated measures ANOVA was used for ratio data and Friedman ANOVA for ordinal data. In addition, effect size as well as the mean/median change in score during the study period were determined for each functioning. Nearly all functioning studied varied significantly but there was no general deterioration in the sample. Small effect sizes were mainly found for the Frenchay Activities Index and a plausible practice effect was detected for the Symbol Digit Modalities Test. As many as 63% with regard to walking and 46% with regard to manual dexterity demonstrated >20% mean change in scores which has proved to be a reliable and clinically meaningful change. This study illustrates the importance of systematic and regular multidimensional assessment of functioning and disability in PwMS aiming to identify disabilities that could be minimized through timely and appropriate evidence-based interventions. The fluctuation in functioning and the conceivable learning effect inherent in instruments used should be taken into consideration when designing studies and interpreting the results.

Rationale and design of the PRSM study: Pulmonary rehabilitation or self management for chronic obstructive pulmonary disease (COPD), what is the best approach?

Background:Pulmonary rehabilitation is only accessible by a small proportion of individuals with COPD. For the vast majority who are not able to access these programs, self management approaches may be an alternative to improve health care outcomes. Methods:The PRSM study is a three group randomised controlled trial with individual randomisation, blinded outcome assessment, 3 monthly follow-up assessments across a 12-month period and concurrent economic evaluation. The inclusion criteria are adults with COPD. The primary outcome measure is the St George Respiratory Disease Questionnaire. Secondary outcome measures include a series of questionnaires (Frenchay Activities Index, International Physical Activity Questionnaire, the Hospital Anxiety and Depression Scale and the COPD self-efficacy scale) and two physiological measures (Forced Vital Capacity in 1-second and an incremental shuttle walk). Economic outcome measures include assessment of direct and indirect costs. The sample size of 318 patients (106 per group) is required to detect 4 point difference in the SGRQ, power 90% employing a 2 tailed alpha=0.05. Results:Enrollment to start April 2008 and complete December 2010. Intention to treat analyses will be used to compare group effect. Conclusion:The results will provide an evidence base regarding the community management of individuals with COPD.

Long‐term follow‐up of thalamic stimulation versus thalamotomy for tremor suppression

Thalamic stimulation and thalamotomy for treatment of tremor due to Parkinson's disease, essential tremor, and multiple sclerosis were compared in a randomized trial. The symptomatic and functional outcome was studied after 5 years of follow-up. Sixty-eight patients were treated (45 Parkinson's disease, 13 essential tremor, 10 multiple sclerosis) by thalamotomy (n = 34) or thalamic stimulation (n = 34). After 5 years, 48 patients were available for follow-up. The primary outcome measure was change in functional status measured by the Frenchay Activities Index (FAI), scores ranging from 0 to 60. Secondary outcome measures were tremor severity, frequency of complications, and patients' assessment of the outcome. The mean difference in FAI scores between thalamic stimulation and thalamotomy was 4.4 (95% CI: 1.1-7.7) after 6 months, 3.3 (95% CI: -0.03-6.6) after 2 years and 4.0 (95% CI: 0.3-7.7) after 5 years in favor of stimulation. Tremor suppression was equally effective after both procedures, and stable in Parkinson patients. In ET and multiple sclerosis, a diminished effect of stimulation was observed in half of the patients. There were six stimulation equipment-related complications, but neurological side effects of surgery were higher after thalamotomy. Subjective outcome-assessment by the patients was more favorable in the stimulation group.

Long-Term Outcomes and Survival of Patients with Bilateral Transtibial Amputations After Rehabilitation

To examine long-term outcomes and survival of patients after bilateral transtibial amputation (BTTA). A retrospective chart review and a cross-sectional interview was conducted at Amputee Rehabilitation Service, West Park Healthcare Centre, Toronto, Canada, with consecutive diabetic or vascular BTTA patients (n = 82) admitted for rehabilitation from 1998 to 2003. Main outcome measures included the Houghton scale of prosthetic use, SF-12, Frenchay Activities Index, and qualitative measurement of activities of daily living (ADL). Of 82 patients admitted for BTTA rehabilitation, 34 patients were interviewed an average of 3.7 yrs after amputation. Another 32 patients had died. Life expectancy was 4.2 yrs beyond rehabilitation discharge (Kaplan-Meier survival analysis). The mean modified Houghton score at telephone follow-up was 6.3 (maximum score of 9), with a significant improvement from rehabilitation discharge to follow-up (P = 0.001). Eighty-five percent were still wearing prostheses regularly and were walking. Most remained independent in ADLs. Patients undergoing rehabilitation for BTTA continue to do well at long-term follow-up and to survive, on average, for more than 4 yrs after discharge. Therefore, they should be given strong consideration for prosthetic fitting.

Health-related quality of life of stroke survivors attending the volunteer stroke scheme

The Volunteer Stroke Scheme (VSS) provides patients with the opportunity to participate in community-based therapeutic activities and physiotherapy sessions. To provide the first profile of VSS attendees in terms of their functioning across the range of recommended WHO International Classification of Functioning, Disability and Health (ICF) outcomes. A convenience sample of 41 VSS patients completed standardised measures of cognitive functioning (MMSE), activity levels [Frenchay Activity Index (FAI), and Barthel Index (BI)], depression [Hospital Anxiety and Depression Scale (HADS)] and Quality of Life (SF-36). A total of 37% met the criteria for mild cognitive impairment and 44% met the criteria for clinical depression. Scores on the BI (M = 79.5) and FAI (M = 18.4) incidated limitations in activity levels. Quality of life levels was low. High levels of psychological morbidity, severe disability across a range of domains and poor quality of life were reported.

A pilot randomized controlled trial to evaluate the benefit of the cardiac rehabilitation paradigm for the non-acute ischaemic stroke population

Objective: To evaluate risk factor reduction and health-related quality of life following a 10-week cardiac rehabilitation programme in non-acute ischaemic stroke subjects. Design: Single-blinded randomized control trial. Setting: Outpatient rehabilitation. Subjects: Forty-eight community-dwelling ischaemic stroke patients (38 independently mobile, 9 requiring assistance, 1 non-ambulatory) were randomly assigned to intervention or control groups by concealed allocation. Intervention: The trial consisted of a 10-week schedule with measures taken at weeks 1 and 10. Both groups continued usual care (excluding aerobic exercise); intervention subjects attended 16 cycle ergometry sessions of aerobic-training intensity and two stress-management classes. Main outcome measures: Cardiac risk score (CRS); VO2 (mL O2/kg per minute) and Borg Rate of Perceived Exertion (RPE) assessed during a standardized ergometry test; Hospital Anxiety and Depression Scale (HADS); Frenchay Activity Index; Fasting Lipid Profiles and Resting Blood Pressure. Results: Group comparison with independent t-tests showed significantly greater improvement at follow-up by intervention subjects than controls in VO2 (intervention 10.6 ±1.6 to 12.0 ± 2.2, control 11.1 ±1.8 to 11.1 ±1.9 t=4.734, P<0.001) and CRS (intervention 13.4 ±10.1 to 12.4 ±10.5, control 9.4 ±6.7 to 15.0 ±6.1 t=-2.537, P<0.05). RPE rating decreased in intervention subjects (13.4 ±12.2 to 12.4 ±2.0) and increased in controls (13.8 ±1.8 to 14.4 ±1.6); Mann—Whitney U (U = 173.5, P<0.05). Within-group comparison showed significant decrease in the HADS depression subscale in the intervention group alone (5.1 ±3.4 to 3.0 ±2.8) (Wilcoxon signed ranks test Z=-3.278, P<0.001). Conclusion: Preliminary findings suggest non-acute ischaemic stroke patients can improve their cardiovascular fitness and reduce their CRS with a cardiac rehabilitation programme. The intervention was associated with improvement in self-reported depression.

Relationship between usual physical, cognitive and social activities and functional recovery at hospital discharge after acute stroke

To assess the relationship between lifestyle prior to the event and functional recovery at hospital discharge after acute stroke. Cohort study. A sample of 191 patients with first stroke episode (87.4% ischaemic). Severity of the event at admission was measured by the Modified National Institutes of Health Stroke Scale. The Frenchay Activity Index was used to evaluate the patients' previous lifestyles. Functional recovery was assessed using the Modified Rankin scale on discharge from hospital. A Rankin score < or = 2 was the main outcome. At discharge, 37.2% of the patients were functionally independent. A receiver operating characteristic curve analysis established a value of > or = 18 on the Frenchay Activity Index scale as the best cut-off point to predict favourable outcome (specificity 62%; 95% confidence interval (CI) 54-69% and a sensibility of 60%; 95% CI 49-69%) with an area under the curve of 0.65 (95% CI 0.57-0.71). There was a positive association between Frenchay Activity Index > or = 18 and a Rankin score < or = 2, after controlling for potential confounders (odds ratio 2.62; 95% CI 1.21-5.66; p = 0.001). This result emphasizes the protective effect of mental, physical and social activity for the prevention of functional damage after an acute cerebrovascular event.

Disability and Lifestyle of Subacute Myelo-Optico-Neuropathy and Stroke Patients and Elderly Persons Living at Home : A Comparison of the Barthel Index Score and the Frenchay Activities Index Score

To evaluate subacute myelo-optico-neuropathy (SMON) and stroke patients and elderly persons by using the Barthel Index (BI) and Frenchay Activities Index (FAI) and to reveal the disability and lifestyle of SMON patients, cross sectional comparison study was performed. Forty SMON patients, 92 age-matched stroke patients with the same level of BI score and 92 age-matched elderly persons living at home were subjected in this study. The SMON patients responded to a self-administered BI and FAI at their yearly health counseling, and the score of the BI and FAI of stroke outpatients and elderly persons were sampled from the databases. The differences in age distribution and sex ratio between the three groups were analyzed by the chi2 test and one-way analysis of variance, respectively, and the differences in BI and FAI between the three groups were analyzed by the Kruskal-Wallis test, followed by the Mann-Whitney test. The BI total score of the SMON patients was the same as that of the stroke patients and lower than that of the elderly persons. The 4 items of self-care index and 2 items of mobility index in the SMON patients were rated significantly higher and lower than the stroke patients respectively, and all items except eating and toileting in the SMON patients were rated lower than elderly persons (Mann-Whitney test, P < 0.05). The FAI scores in the SMON patients were lower than the elderly persons and higher than the stroke patients. These results suggest that the scores of the BI and FAI differentiated the features of disability and lifestyle of the SMON patients from those of stroke patients and elderly persons.

Activities of daily living among St Petersburg women after mild stroke

The aim of the present study was to determine how women living in St Petersburg, Russia, who have had a mild stroke, describe their performance in activities of daily living (ADL) and to elicit possible causes of their occupational dysfunction. Thirty-six women who had experienced a mild stroke and been referred to a rehabilitation centre participated in the study. Data collection was conducted through interviews, including the 'ADL Staircase' and a modified 'Frenchay Activities Index for Stroke Patients'. Additional data were collected through field notes and information from team members and relatives. The results showed that women who have had a mild stroke and ADL limitations experience occupational dysfunction in ADL that is most often caused by a combination of overprotection from relatives, the women's own feelings of anxiety and insecurity, and an overemphasizing of their disability. The results are limited, based on the small sample and restricted geographic area. There is a need to further investigate how individuals who have had a mild stroke can be physically and socially rehabilitated and reintegrated into the community in countries with developing economies such as Russia.

Surface Electrical Stimulation for the Affected Shoulder After Stroke: Reconsidering the Findings of Church and Colleagues

To the Editor: We would like to raise serious methodological concerns with Church et al’s recent article, “Randomized Controlled Trial to Evaluate the Effect of Surface Neuromuscular Electrical Stimulation to the Shoulder After Acute Stroke.”1 First, we are perplexed by the authors’ choice for a primary outcome measure, the Action Research Arm Test (ARAT), and their use of the Frenchay Activities Index (FAI) as an outcome measure. Sixteen of the 19 ARAT items assess affected hand and finger movement. The FAI asks patients to rate how often they have undertaken valued activities (eg, preparing meals). Most items comprising these measures evaluate active movement in the distal regions of the affected arm. However, …

Life after survival: long-term daily life functioning and quality of life of patients with hypoxic brain injury as a result of a cardiac arrest

Objectives : To determine the level of daily functioning and quality of life of patients with hypoxic brain injury after a cardiac arrest and to investigate the predictive value of the duration of coma and post-traumatic amnesia in long-term functioning. Design : A retrospective cohort study. Setting : A Dutch rehabilitation centre. Subjects : Thirty-two patients with hypoxic brain injury caused by a cardiac arrest 2—7 years ago, who were admitted to a brain injury rehabilitation programme. Main outcome measures : Cognitive Failures Questionnaire (CFQ), Frenchay Activities Index (FAI), Impact on Participation and Autonomy Questionnaire (IPAQ) and Quality of Life after Brain Injury questionnaire (QOLIBRI). Data on duration of coma and post-traumatic amnesia were retrieved from medical files. Results : A significant association was found between duration of coma, complaints of cognitive functioning (r = 0.57, P < 0.05) and quality of life after brain injury (r = —0.70, P < 0.01). Duration of post-traumatic amnesia was associated with both daily functioning (r = —0.70, P < 0.01) and quality of life (r = —0.70, P < 0.01). Furthermore complaints of cognitive functioning were associated with both the level of participation in society (r = 0.76, P < 0.01) and quality of life (r = 0.77, P < 0.01). Conclusions : Long-term outcome of patients with hypoxic brain injury after a cardiac arrest shows that this group is limited in cognitive and daily functioning, participation and quality of life. Based on the duration of coma and post-traumatic amnesia, an estimation of daily life functioning and quality of life 2—7 years after a cardiac arrest can be made.

Differences between patient and proxy reports in the assessment of disability after stroke

Objective : To determine whether the assessment of disability level including basic activities of daily living (ADL) and instrumental ADL varies between patients' and proxy respondents' reports, and to explore the factors influencing proxy agreement. Design : Patient—proxy agreement study. Setting : Hospital settings. Subjects : Fifty-two stroke patients with mild or without cognitive impairments and their primary caregivers voluntarily participated in this study. Main measures : The self-administered versions of the Barthel Index and Frenchay Activities Index were completed by the patients and their proxy respondents concurrently, yet separately, to assess the level of disability. Results : The proxy agreement on total scores of the self-administered Barthel Index and self-administered Frenchay Activities Index demonstrated moderate to good agreement (self-administered Barthel Index: intraclass correlation coefficient (ICC) = 0.71; self-administered Frenchay Activities Index: ICC = 0.6). There were no significant differences between patient and proxy reports on self-administered Barthel Index and self-administered Frenchay Activities Index scores (paired t = —0.22, P = 0.83; paired t = 0.88, P = 0.39, respectively). However, limits of agreement of patient and proxy reports on the self-administered Barthel Index and self-administered Frenchay Activities Index were notable. Stepwise regression analysis found no significant variables associated with proxy agreement. Conclusions : These results indicate that it is appropriate for research purposes, but not appropriate for clinical usage, to use proxy reports to measure disability levels in patients with stroke. Furthermore, the two methods should not be used interchangeably to monitor patients because of the wide limits of agreement between patient and proxy reports on the self-administered Barthel Index and self-administered Frenchay Activities Index.

A Comparison of Psychometric Properties of the Smart Balance Master System and the Postural Assessment Scale for Stroke in People Who Have Had Mild Stroke

Chien C-W, Hu M-H, Tang P-F, Sheu C-F, Hsieh C-L. A comparison of psychometric properties of the Smart Balance Master system and the Postural Assessment Scale for Stroke in people who have had mild stroke. Objective To compare the psychometric properties (including the test-retest reliability, responsiveness, and predictive validity) of the Smart Balance Master (SBM) system and the Postural Assessment Scale for Stroke patients (PASS) in patients with mild stroke. Design One repeated-measures design (at a 2-wk interval) was used to examine the test-retest reliability of the SBM and PASS, and another similar design was applied to investigate their responsiveness. Patients who participated in the responsiveness study were followed up approximately 1 year later, and the predictive validity of the SBM system and PASS were examined by assessing the patients’ comprehensive activities of daily living (ADL) function. Setting Three rehabilitation units in Taiwan. Participants Twenty patients with chronic stroke in the reliability study; 40 and 32 patients who had recently had a stroke in the responsiveness and predictive validity studies, respectively. Interventions Not applicable. Main Outcome Measures Three computerized tests of the SBM (the equilibrium score of the Sensory Organization Test, scores in rhythmic weight-shifting tests, and scores in the limits of stability test) and the PASS were used. The combination of the Barthel Index and Frenchay Activities Index was used to represent the comprehensive ADL function. Results For the SBM, all but the weight-shifting tests of the SBM had moderate to high reliability (intraclass correlation coefficient [ICC] range, .78−.91). The responsiveness of the equilibrium score and the limits of stability test were moderate (effect size [ d], .63) and small ( d range, .27−.33), respectively, whereas the responsiveness of the weight-shifting tests was limited ( d range, .04−.29). All but the weight-shifting tests of the SBM in the second evaluation had acceptable predictive validity for comprehensive ADL function ( r 2 range, .15−.17). The PASS showed high reliability (ICC=.84) and small responsiveness ( d=.41), and the PASS in the second evaluation had acceptable predictive validity ( r 2=.24). Conclusions The PASS and the equilibrium score and limits of stability scores of the SBM had acceptable test-retest reliability, responsiveness, and predictive validity in patients with mild stroke, but the psychometric properties of the weight-shifting tests of the SBM should be further examined before consideration of their usage in patients with stroke.

A Rasch Analysis of the Frenchay Activities Index in Patients With Spinal Cord Injury

A prospective interview study. To determine whether items of the Frenchay Activities Index (FAI) measure Instrumental Activities of Daily Living (IADL), as a unidimensional construct, in patients with spinal cord injury (SCI). To examine whether the response categories of the FAI are useful in discerning the various ability levels of IADL. No known IADL scale has been designed for SCI patients. The FAI, to our knowledge, has never been validated in patients with SCI. A total of 233 persons with SCI participated in this study. The FAI was administered to the patients by interview at locations convenient for the participants. A Rasch analysis was used to examine the unidimensionality and appropriateness of the response categories of the FAI. All but 2 items ("going outside" and "reading books") of the FAI fitted the model's expectations. The results of Rasch analysis indicated that the response categories for the remaining 13 items of the FAI should be collapsed to create more suitable response categories (4 items, into dichotomies, and the remaining 9 items, into trichotomies). Thus, a revised 13-item FAI was formed by deleting the 2 misfitting items and collapsing the response categories of the items. This study demonstrated that the revised 13-item FAI assesses a single, unidimensional IADL for SCI patients living in the community. The revised FAI shows potential for assessment of IADL in SCI patients.

Characteristics of the Frenchay Activities Index one year after a stroke: A population-based study

Purpose. To further describe the properties of Frenchay Activities Index (FAI) with special emphasis on relationships with stroke severity and cognition.Methods. Survivors from a population-based first-ever stroke cohort (n = 246) were assessed with FAI one year post-stroke. At the same time patients were asked about their status pre-stroke. Stroke severity was assessed at baseline with the NIH stroke scale (NIHSS). Cognition was assessed at one year with the Mini Mental State Examination (MMSE).Results. Pre-stroke and post-stroke FAI averaged at 40.1 and 32.4, respectively. There was a floor effect post-stroke, where 17% had the lowest possible score. The sum score was related to age, but not to gender. Individual items, however, were gender-related. NIHSS was clearly related to the difference FAI pre-stroke – post-stroke, but individual variations were large. Individual NIHSS items differed regarding their impact on post-stroke FAI. MMSE post-stroke also has a clear relationship with FAI, but there are large individual variations.Conclusions. This study establishes a population-based standard for FAI scores one year after a stroke. The effects of stroke severity and cognition have been demonstrated. FAI gives useful information that is not obtained from basic ADL scales, such as the Barthel Index.

Community Skill Performance and Its Association with the Ability to Perform Everyday Tasks by Stroke Survivors One Year Following Rehabilitation Discharge

Background: Stroke survivors experience functional loss in basic activities of daily living (ADLs) and in everyday community activities or instrumental activities of daily living (IADLs). Historically there has been a greater focus by rehabilitation professionals on basic ADLs than on IADLs. Purpose: The purpose of this study was to describe the relationship between the ability to perform ADLs and community activities in a large group of stroke patients measured 1 year following rehabilitation discharge. Method: A structured survey was administered by telephone. Outcome measures were the Frenchay Activities Index (FAI), a measure of IADL, and the FIMTM, a measure of disability. Results: Visual inspection of the relationship between FAI scores and FIMTM scores revealed that the data largely followed a curvilinear pattern. Curve estimation regression models were used to determine the line of best fit. A cubic function was found to give a good fit with an R2 of 0.644. The three activities in which stroke patients most frequently engaged were social outings, walking outside for more than 15 minutes, and local shopping. The three activities in which stroke patients engaged the least were gainful work, gardening outside, and household/car maintenance. Conclusion: A score of approximately 80 or greater on the FIMTM was associated with a substantially increased level of participation in home and community activities.

Comparing contents of functional outcome measures in stroke rehabilitation using the International Classification of Functioning, Disability and Health

Purpose. To examine the content of outcome measures that are frequently used in stroke rehabilitation and focus on activities and participation, by linking them to the International Classification of Functioning, Disability and Health (ICF).Method. Constructs of the following instruments were linked to the ICF: Barthel Index, Berg Balance Scale, Chedoke McMaster Stroke Assessment Scale, Euroqol-5D, Functional Independence Measure, Frenchay Activities Index, Nottingham Health Profile, Rankin Scale, Rivermead Motor Assessment, Rivermead Mobility Index, Stroke Adapted Sickness Impact Profile 30, Medical Outcomes Study Short Form 36, Stroke Impact Scale, Stroke Specific Quality of Life Scale and Timed Up and Go test.Results. It proved possible to link most constructs to the ICF. Most constructs fitted into the activities and participation component, with mobility being the category most frequently covered in the instruments. Although instruments were selected on the basis of their focus on activities and participation, 27% of the constructs addressed categories of body functions. Approximately 10% of the constructs could not be linked.Conclusions. The ICF is a useful tool to examine and compare contents of instruments in stroke rehabilitation. This content comparison should enable clinicians and researchers to choose the measure that best matches the area of their interest.

Being restricted in participation after a traumatic brain injury is negatively associated by passive coping style of the caregiver

Purpose: To examine whether the caregivers’ coping style is associated with the functional outcome of the traumatic brain injury (TBI) patient 1 year post-injury.Method: A cross-sectional study among patients with a TBI, including their primary caregivers. The study included 51 patients aged 17–64 years with a moderate-to-severe TBI and 51 caregivers (23 parents and 28 partners) aged 23–67 years. The coping preferences of the caregivers were assessed at minimum 6 and maximum 12 months post-injury, by filling out the Utrecht Coping List (UCL) and were related to limitations in activity, as measured with the Frenchay Activities Index and with restrictions in participation as measured with the Sickness Impact Profile-68 of TBI patients 1 year post-injury. The patients were interviewed at their homes; the caregivers received and returned the UCL by mail.Results: The patients’ age and the caregivers’ coping style are independently associated with restrictions in participation 1 year post-injury.Conclusions: A passive coping style of the primary caregiver is negatively associated with the patient's functional outcome in terms of participation in society.