Lawton IADL Research Articles

Functional measures, inflammatory markers and endothelin-1 as predictors of 360-day survival in centenarians.

Centenarians represent a rapidly growing population. To better characterize this specific age group, we have performed a cross-sectional study to observe associations between functional measures and a range of biochemical markers, including inflammatory markers and their significance as predictors of 360-day survival. Medical history and physical and functional assessment (Mini-Mental State Examination (MMSE), Katz Index (activities of daily living, ADL) and Barthel Index (Barthel Index) of Activities of Daily Living, and Lawton Instrumental Activities of Daily Living Scale (Lawton IADL)) were conducted on 86 101.9 ± 1.2-year-old (mean ± SD) subjects (70 women, 16 men). Blood tests were performed on 84 subjects of whom 43 also had extended biomarker assessment. As a reference group 30 51.8 ± 5.0-year old healthy subjects (20 women, 10 men) were recruited. The centenarians received follow-up phone calls. Fifty-two centenarians (60 %) survived ≥360 days. Longer survival was associated with higher MMSE (hazard ratio, HR = 0.934, 95 % confidence interval (CI) 0.896–0.975, P = .002), ADL (HR = 0.840, 95 % CI 0.716–0.985, P = .032), Barthel Index (HR = 0.988, 95 % CI 0.977–0.999, P = .026), and albumin level (HR .926, 95 % CI 0.870–0.986, P .016) and with lower white blood cell (WBC) (HR = 1.161, 95 % CI 1.059–1.273, P = .001), C-reactive protein (CRP) (HR = 1.032, 95 % CI 1.014–1.050, P < .001), IL-6 (HR = 1.182, 95 % CI 1.047–1.335, P = .007), and endothelin-1 (ET-1) level (HR = 3.711, 95 % CI 1.233–11.169, P = .020). Centenarians had higher 360-day survival probability with MMSE ≥13 (P < .001), ADL ≥1 (P < .001), Barthel Index ≥15 (P < .001), Lawton IADL ≥10 points (P = .009), WBC <8.3 G/L (P = .039), CRP <10 mg/L (P < .001), IL-6 <6 pg/mL (P .002), and ET-1 <1.1 pg/mL (P .007). Our results indicate that functional measures, inflammatory markers, and endothelin-1 are predictors of 360-day survival in centenarians.

Abstract T P413: Early Executive Dysfunction Predicts Poor Stroke Outcomes One Year Following Mild Ischemic Stroke

Background: Cognitive dysfunction has been considered a primary deficit to be addressed after mild stroke. Higher order cognitive deficits immediately after mild stroke may lead to poor longitudinal outcomes. However, existing stroke outcome studies tend to focus on physical capacity and mood rather than cognitive function. Aim: To examine contribution of acute impairment of executive function(EF) and verbal memory (VM) after mild stroke to one year outcomes on Stroke Impact Scale (SIS, health-related quality of life), Activity Card Sort (ACS, activity participation), and Reintegration to Normal Living (RNL, life satisfaction), independent of demographics, ADL and depression. Methods: Patients with ischemic stroke and initial NIHSS ≤ 5 enrolled in PROTECT-DC trial were included. Multiple linear regression analyses identified baseline variables significantly associated with each outcome of interest for all patients completing both baseline and one-year assessments. For each outcome, Model 1 included covariates: age, sex, race, education, lesion side, NIHSS, Barthel Index, Lawton IADL, and depression. In Model 2, all Model 1 variables and dichotomized cognitive variables (impaired versus not impaired) were entered into the equation. Examination of R2 change between Models 1 &amp; 2 identified unique contributions of impaired EF or VM to each one-year outcome beyond Model 1 variables. Results: A total of 86 participants completed baseline assessment and one-year SIS were included for analyses. Our results show that EF was significantly and independently associated with the SIS total score beyond other baseline variables. Participants with acute EF deficits at baseline had poorer SIS outcome at one year: mean 7.47 lower SIS score compared to patients without EF deficits (p = .021). Similar results were found for ACS and RNL. Conclusion: Analyses suggest impact of EF deficits on activity participation, health-related quality of life, and life satisfaction one year after mild stroke. The findings highlight importance of assessment of EF deficits after mild stroke. We suggest that rehabilitation interventions aimed at improving long-term outcomes require careful consideration of assessing and treating EF deficits during the acute phase of mild stroke.

Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study.

BackgroundA restriction in functional capacity occurs in all hip fractures and a variety of factors have been shown to influence patient functional outcome. This study sought to provide new and comprehensive insights into the role of factors influencing functional recovery six months after an accidental hip fracture.MethodsA prospective cohort study was conducted of patients aged 65 years or more who attended the Emergency Room (ER) for a hip fracture due to a fall. The following were studied as independent factors: socio-demographic data (age, sex, instruction level, living condition, received help), comorbidities, characteristics of the fracture, treatment performed, destination at discharge, health-related quality of life (12-Item Short Form Health Survey) and hip function (Short Western Ontario and McMaster Universities Osteoarthritis Index). As main outcome functional status was measured (Barthel Index and Lawton Instrumental Activities of Daily Living Scale). Data were collected during the first week after fracture occurrence and after 6 months of follow-up. Patients were considered to have deteriorated if there was worsening in their functional status as measured by Barthel Index and Lawton IADL scores. Factors associated with the outcome were studied via logistic regression analysis.ResultsSix months after the fall, deterioration in function was notable, with mean reductions of 23.7 (25.2) and 1.6 (2.2) in the Barthel Index and Lawton IADL Scale scores respectively. Patients whose status deteriorated were older, had a higher degree of comorbidity and were less educated than those who remained stable or improved. The multivariate model assessing the simultaneous impact of various factors on the functional prognosis showed that older patients, living with a relative or receiving some kind of social support and those with limited hip function before the fall had the highest odds of having losses in function.ConclusionIn our setting, the functional prognosis of patients is determined by clinical and social factors, already present before the occurrence of the fracture. This could make it necessary to perform comprehensive assessments for patients with hip fractures in order to identify those with a poor functional prognosis to tackle their specific needs and improve their recovery.

Validity and reliability of the Katz-15 scale to measure unfavorable health outcomes in community-dwelling older people.

To predict the risk of future unfavourable health outcomes in older people it is common to assess the level of both basic and instrumental activities of daily living. To accomplish this, the commonly used Katz-6 and the Lawton IADL questionnaires can be combined to form the 'Modified Katz ADL' scale, also known as the Katz-15 scale. So far, the validity and reliability of the Katz-15 scale is unknown. The objective of the current study is to investigate how well the Katz-15 is able to predict future unfavorable health outcomes and how this is related to the existing Katz-6 scale. We performed a follow-up study using data from a group of 60 year and older participants from a large Dutch clinical trial. We included 2321 participants in the analysis. The average age of the study population was 74 years and 44% was male. We studied the relation between the Katz-15 scale and a number of unfavourable health outcomes, such as hospitalization, admission to a nursing home, admission to a home for the aged and death within one year of follow-up. We found the Katz-15 to be both internally consistent and strongly associated with quality of life measures. We observed moderate to strong associations between the Katz-15 and the unfavourable health outcomes All associations studied were stronger for the Katz-15 scale as compared to the Katz-6 scale. The results of our study indicate that the Katz-15 scale is able to reliably and validly predict future unfavorable health outcomes. This makes the scale a valuable measure in determining both basic and instrumental activities of daily living.

Self-report prospective memory problems in people with stroke

Background and purpose: Prospective memory (PM) is a common problem which can limit performance of basic and instrumental activities of daily living in patients with stroke. This study compared self-report PM failures between older and younger people with stroke, examined differences in perceptions of PM failures between people with stroke and relatives, relationships between these PM failures and functional performance.Methods: A total of 105 patients with stroke, 65 relatives and 112 healthy controls were recruited. Both the patients with stroke and controls were further divided into an older (age > 55 years) and a younger (age ≤ 55 years) group. Data for patients with stroke and relatives were obtained via the Brief Assessment of Prospective Memory (BAPM), Basic Activity of Daily Living (BADL) related Modified Barthel Index (MBI) and Lawton Instrumental Activities of Daily Living (Lawton IADL) Scale. Healthy controls’ data were also collected.Results: The older stroke group had significantly higher BAPM total scores and BADL and IADL sub-scale scores than the younger group. Difference in perceptions of the patients’ self-report of PM failures and their relatives’ report was significant for the IADL sub-scale. Self-report of PM failure was significantly related to functional BADL and IADL measures.Conclusions: Results highlight the impact of PM failures in patients with stroke and their assessment, management and rehabilitation of these patients.

L06 Specialised Multidisciplinary Day Care For Patients With Huntington's Disease, Living At Home

<h3>Background</h3> Independent living of patients with a chronic disease is preferred by most citizens A chronic progressive disease, such as Huntington’s disease (HD) may threaten this independent living. <h3>Aim</h3> To assess whether a specialised, multidisciplinary day care program for patients with HD, is effective in preserving or improving self-efficacy and self-management skills, in order to maintain independent living and postpone admission. Baseline data are presented in this paper. <h3>Methods</h3> In a cohort study, patients with HD and their informal caregiver were interviewed. The primary outcome was self-management (SMAS-30). Secondary outcomes included self-efficacy (SES-NL), care needs (CANE), quality of life (EQ-5D), functioning (KATZ and Lawton iADL, TUG, PPT), satisfactory specialised care program (VAS), caregiver burden (SRB scale). <h3>Results</h3> A total of 26 patients with HD (mean age: 51.7 years, range: 29–72), and 22 informal caregivers were interviewed. Patients tend to classify themselves as self-manageable (SMAS-30: mean 71.1, SD = 12.6), self-efficable (SES-NL: mean 31.5, SD = 5.4), and pertain a high level of functioning (KATZ: mean 6.7, SD = 1.2), whereas informal caregivers observe several existing care needs (CANE: mean 9.0, SD = 2.4) and experience themselves a moderate to severe care burden (SRB: 76% between score 50–80). In general, both patients and informal caregivers appreciate the specialised care provided. <h3>Conclusion</h3> Patients, as well as informal caregivers, appreciate the specialised care program. Future research will determine if this program is effective in preserving self-management abilities to maintain independent living and to postpone admission.

Efficacy and safety of haloperidol prophylaxis for delirium prevention in older medical and surgical at-risk patients acutely admitted to hospital through the emergency department: study protocol of a multicenter, randomised, double-blind, placebo-controlled clinical trial.

BackgroundDelirium is associated with substantial morbidity and mortality rates in elderly hospitalised patients, and a growing problem due to increase in life expectancy. Implementation of standardised non-pharmacological delirium prevention strategies is challenging and adherence remains low. Pharmacological delirium prevention with haloperidol, currently the drug of choice for delirium, seems promising. However, the generalisability of randomised controlled trial results is questionable since studies have only been performed in selected postoperative hip-surgery and intensive care unit patient populations. We therefore present the design of the multicenter, randomised, double-blind, placebo-controlled clinical trial on early pharmacological intervention to prevent delirium: haloperidol prophylaxis in older emergency department patients (The HARPOON study).Methods/DesignIn six Dutch hospitals, at-risk patients aged 70 years or older acutely admitted through the emergency department for general medicine and surgical specialties are randomised (n = 390) for treatment with prophylactic haloperidol 1 mg or placebo twice daily for a maximum of seven consecutive days. Primary outcome measure is the incidence of in-hospital delirium within seven days of start of the study intervention, diagnosed with the Confusion Assessment Method, and the Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria for delirium. Secondary outcome measures include delirium severity and duration assessed with the Delirium Rating Scale Revised 98; number of delirium-free days; adverse events; hospital length-of-stay; all-cause mortality; new institutionalisation; (Instrumental) Activities of Daily Living assessed with the Katz Index of ADL, and Lawton IADL scale; cognitive function assessed with the Six-item Cognitive Impairment Test, and the Dutch short form Informant Questionnaire on Cognitive Decline in the Elderly. Patients will be contacted by telephone three and six months post-discharge to collect data on cognitive- and physical function, home residency, all-cause hospital admissions, and all-cause mortality.DiscussionThe HARPOON study will provide relevant information on the efficacy and safety of prophylactic haloperidol treatment for in-hospital delirium and its effects on relevant clinical outcomes in elderly at-risk medical and surgical patients.Trial registrationEudraCT Number: 201100476215; ClinicalTrials.gov Identifier: NCT01530308; Dutch Clinical Trial Registry: NTR3207

Functional Disability in Alzheimer Disease

This study aimed to determine the reliability and validity of the Turkish version of Disability Assessment for Dementia (DAD) scale in the Turkish elderly population with Alzheimer disease (AD). The DAD scale was administered to the primary caregivers of 157 patients (age 77.7 ± 6.8 years) with AD. The Turkish version of the DAD scale showed high internal consistency (Cronbach α = .942), excellent test-retest, and interrater reliability (intraclass correlation coefficient [ICC] = 0.996 and ICC = 0.994, respectively). The DAD scale was significantly correlated with activities of daily living (ADL; Modified Older Americans Research Survey ADL) and instrumental activities of daily living (IADL; Lawton and Brody IADL) scales (r = .89, P < .001 and r = .90, P < .001). Disability Assessment for Dementia had a high negative correlation with the Global Deterioration Scale (GDS; r = -.880, P < .001). Post hoc comparisons with Tukey test showed significant differences in the mean DAD scores in different GDS stages. Construct validity was estimated using total score correlation analyses between the standardized Mini-Mental State Examination (MMSE) and the DAD scale. Results revealed high and significant correlation between MMSE score and DAD scale (r = .812, P < .001). The results of multivariate analysis showed that DAD score was not correlated with gender, education, and age. The DAD total score was affected mostly by GDS, MMSE, and duration of the disease. Turkish version of the DAD scale was found to be a reliable and valid instrument to assess functional disability in Turkish elderly patients with AD. This scale assists caregivers and physicians to decide for proper interventions.

A pilot study of the SARC-F scale on screening sarcopenia and physical disability in the Chinese older people.

The SARC-F scale is a newly developed tool to diagnose sarcopenia and obviate the need for measurement of muscle mass. SARC-F ≥ 4 is defined as sarcopenia. The questions of SARC-F cover physical functions targeting sarcopenia or initial presentation for sarcopenia. The aim of the study is to explore the application of SARC-F in the Chinese people. Two hundred thirty Chinese people over 65 years old were assessed by the SARC-F scale, PSMS, Lawton IADL and the shortened version of the falls efficacy scale-international(the short FES-I). Hospitalization was investigated. Physical performance and strength were measured. The association of SARC-F with other scales or tests was analyzed. Poor physical performance and grip strength were associated with SARC-F ≥ 4 independently (P<0.005). The κ value for agreement of SARC-F ≥ 4 and cutoff points of tests were 0.391 to 0.635. The short FES-I were correlated to SARC-F scores (Spearman's coefficient 0.692). Poor PSMS and Lawton IADL scores were associated with SARC-F ≥ 4(P=0.000) and SARC-F ≥ 4 was associated with hospitalization in the past 2 years (P=0.000). The SARC-F scale can identify old Chinese people with impaired physical function who may suffered from sarcopenia. SARC-F judgment reflects fear of falling, indicates the hospitalization events and is associated with ability of daily life. Thus, SARC-F may be a simple and useful tool for screening individuals with impaired physical function. Further studies on SARC-F in Chinese people would be worthy.

Development and Initial Testing of Functional Task Exercise on Older Adults with Cognitive Impairment at Risk of Alzheimer's Disease – FcTSim Programme – A Feasibility Study

The purpose of this study was to illustrate the development of a new functional task-based exercise programme and initially test its feasibility as well as effectiveness for older adults with mild cognitive impairment (MCI). This study used a single-group repeated-measures design. A total of 11 patients (mean age 71.8 years) were recruited to participate in a structured functional task exercise programme for 10 weeks. All outcome measures were undertaken at baseline, post-intervention and post-3-month follow-up using the Neurobehavioral Cognitive Status Examination (NCSE), Verbal Fluency Test (VFT), Chinese Version Verbal Learning Test (CVVLT), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL) and Problems in Everyday Living test (PEDL). Data were analysed using a repeated-measures analysis of variance. Cohen's d effect size was used to assess the practical significant effects. The participants showed significant improvement in NCSE composite score, VFT, CVVLT total free recall, CVVLT 10-minute delayed free recall, Lawton IADL and PEDL. Results of this study demonstrate that the newly designed functional task exercise programme, which uses simulated tasks, is feasible and beneficial to cognitive functions and functional status of older persons with MCI. The findings of the current study further reinforce occupational therapy practitioners' understanding that "occupation" is a "means" and an "end". Further study with a larger population is needed to draw more definitive conclusions.

(Instrumental) activities of daily living in older adults with intellectual disabilities

Daily living skills are important to ageing adults with intellectual disabilities (ID). The purpose of this study was to investigate the level of these skills in older adults with ID and to investigate the influence of gender, age, level of ID and mobility on these skills. Daily living skills were measured with the Barthel Index (for Activities of Daily Living, ADL) and the Lawton IADL scale (for Instrumental Activities of Daily Living, IADL) in 989 adults with ID aged 50 years and over living in community-based and institutional settings. Descriptives were presented by categories of gender, age, level of ID and mobility. Regression analysis was used to investigate the influence of these variables on total and item scores of ADL and IADL questionnaires. ADL and IADL scores in older adults with ID are comparable to those of vulnerable patient groups. Total ADL score was mainly determined by mobility, while total IADL score was mainly determined by level of ID. Of all 18 separate items of these questionnaires, 11 were determined more by mobility than level of ID. The Barthel Index and Lawton IADL scale are recommended for future use in research and clinical practice in this group. This study stresses the need to support mobility older adults with ID as much as possible, in order to optimalize independency in this group.

Prism intervention helped sustainability of effects and ADL performances in chronic hemispatial neglect: A follow-up study

To investigate the sustainability of effect and the changes in basic and instrumental activities of daily living (ADL and IADL) after long-term prism intervention, we carried out a follow-up assessment on five subjects with hemispatial neglect in the chronic stage. At 2-3.5 years after the end of prism intervention, we measured six parameters: 1) eye movement of the neglect side when watching three different video clips, 2) center of gravity as an index of subjective internal midline bias, 3) star and letter cancellation tests, 4) the line bisection test, and ADL scales: 5) Barthel Index and 6) Lawton's IADL scale. In addition, we interviewed and observed the subjects' present ADL performance at home. The eye movement on the neglect side significantly increased compared with that before intervention. The center of gravity was shifted significantly to the left side and forward. The improvement in cancellation and line bisection tests was also observed. All subjects showed improvement in ADL performance. Two of the subjects could return to work after intervention. The results suggested that long-term prism intervention might effectively exert long-lasting effects and bring benefits to ADL performance for subjects with hemispatial neglect.

Functional correlates of lower cognitive test scores in essential tremor

Although motor features have been the defining element of essential tremor (ET), lower neurocognitive test scores are increasingly being recognized. However, the clinical correlates, if any, of these lower test scores remain largely unexplored. The aim of this study was to determine whether cognitive test scores in ET have any functional correlates. The Modified Mini Mental Status Examination (MMSE), Katz Activities of Daily Living (ADL) scale and Lawton Instrumental (I) ADL scale were administered to 95 cases. The Katz ADL score (rho = 0.26, P = 0.01) and Lawton IADL score (rho = 0.32, P = 0.001) were correlated with MMSE scores, such that poorer cognitive performance indicated greater dysfunction. Furthermore, cognitive test scores were a better predictor of functional disability than was tremor severity. Poorer cognitive performance in ET was associated with greater functional deficit. Cognition should enter the clinical dialog with ET patients as an issue of clinical significance.

Psychometric Investigation of the Modified Scales of Independent Behavior-Revised in an Elderly Sample

Psychometric analysis of a modified version of the Scales of Independent Behavior-Revised (mSIB-R) was done by obtaining self- and informant- (e.g., spouse) reports of participants' functioning. Both reports showed excellent reliability, but with lower scores on the informant-reports than on the self-reports. Factor analysis of the mSIB-R resulted in three factors: basic living skills, social/cognitive engagement, and physical/environmental engagement. However, the composition of the factors varied somewhat by report (self or informant). The basic living skills factor on both reports correlated with Lawton and Brody's IADL measure. Investigating the mSIB-R's utility in differentiating among five groups with mild cognitive impairment suggested that informants rated individuals with deficits in multiple cognitive domains (including memory) the lowest across all factors. Self-reports were dependent on the factor in question. These results support the usefulness of the mSIB-R with non-demented elderly adults.

Development and evaluation of a pictorial-based analogical problem-solving programme for people with traumatic brain injury

Background: People with traumatic brain injury (TBI) must often deal with cognitive problems, including social problem-solving. The study reported herein evaluated the effectiveness of a newly developed pictorial-based analogical problem-solving skills training programme. It is hypothesized that the programme can help people with TBI to learn better problem-solving skills through systematic, theoretically driven learning strategies.Method: Based on the instrumental enrichment model and the hierarchy of daily problem-solving as suggested by Holloran and Bressler, analogical problem-solving training software was developed. Thirty subjects with TBI then attended a 20-session interactive analogical problem-solving skills training programme. Another 20 subjects with TBI and of similar demographics formed the control group. The outcome measures included session-based quizzes on analogical problem-solving, the Category Test of the Halstead Reitan Test Battery (HRTB) and the Lawton IADL Scale.Findings: The analogical problem-solving training strategies were found to be effective in improving problem-solving skills. The subjects generally demonstrated a selective improvement in their functional and overall problem-solving skills, but not in their basic problem-solving skills. The subjects in the control group showed stable problem-solving skills over a 4-week interval (no statistically significant changes). The findings indicated the therapeutic significance of the training programme.Conclusions: The results of the study suggested that innovative cognitive rehabilitation programmes can be customized to match the needs of clients with TBI. The applicability and implications of the interactive pictorial-based analogical problem-solving skill-training programme that was used in the study and possibilities for future study in this research area are also discussed.

Management of impaired self-awareness in persons with traumatic brain injury

Aim: To develop and evaluate a systematic intervention programme for the management of impaired self-awareness (ISD) in people with traumatic brain injury.Methods: This study adopted a pre-test–post-test control group design. Twenty-one patients with traumatic brain injury were randomly assigned to an experimental group and a control group according to their admission sequence. The groups joined a newly developed Awareness Intervention Programme (AIP) and a conventional rehabilitation programme respectively for 4 weeks. Pre- and post-intervention outcome measures taken from the two groups were compared. Wilcoxon Signed-Ranks Tests were conducted to compare the within-group changes of the outcome measures of the Self-Awareness of Deficits Interview (SADI), the Functional Independence Measure (FIM) and the Lawton Instrumental Activities of Daily Living Score (Lawton IADL) in the control and experimental groups. Mann Whitney U-tests were conducted to compare the across-group differences of improvements of outcome measures between the participants in the two groups.Results: After AIP training, the participants in the experimental group demonstrated significant improvement in their level of awareness as compared to the control group. However, the functional outcomes of the participants in experimental group did not show significant differences.Conclusion: The AIP can promote improvement in the level of self-awareness of people with traumatic brain injury. This new programme can be further developed to extend a better carryover treatment effect to functional improvement in daily activities.

Emergency department admissions, older people, functional decline, and length of stay in hospital

Objective: Early identification of patients at risk of a prolonged admission to the hospital may allow targeted management decisions and discharge planning to begin in the emergency department. The aim of this study was to evaluate the effect of recent decline in function, measured in the emergency department, on length of stay (LOS) in the hospital. Methods: A total of 469 patients with a mean age of 79.4 years presenting to the emergency department of a tertiary hospital were comprehensively assessed by a nurse practitioner. The Modified Barthel Index (MBI) was used to measure recent decline in function (MBI‐change, the decline in MBI in the month before the emergency visit). Other measures included recent decline in instrumental activities of daily living (IADL‐change, using the Lawton IADL Scale), Folstein Mini Mental State Examination, Geriatric Depression Scale (GDS), Waterlow Scale, Social Support Instrument (SSI), principal medical diagnosis, living arrangement, care needs, and self‐rated health. Using multivariate survival analysis, the influence of MBI‐change on LOS was modelled in 249 randomly selected patients, and validated in the remaining 220. Results: In total, 327 patients (69.7%) were admitted to the hospital, for a median LOS of 10 days. In the modelling sample, variables significantly associated with LOS included MBI‐change (hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.85–0.98), IADL‐change (HR 1.14, 95% CI 1.02–1.28), whether known to the Aged Care Assessment Team (ACAT) (HR 1.65, 95% CI 1.04–2.59) and Waterlow score (HR 0.95, 95% CI 0.90–0.99). MBI‐change (HR 0.94, 95% CI 0.88–0.99) and Waterlow score (HR 0.95, 95% CI 0.91–0.99) were also significant predictors of LOS in the validation sample. Conclusions: Recent decline in function predicts LOS in the hospital, is easy to measure in the emergency department, and may prove useful across the full spectrum of disease. It should be considered when formulating diagnostic and management plans, and when developing funding models.

Performance of a mail-administered version of a stroke-speci” c outcome measure, the Stroke Impact Scale

To evaluate the feasibility and concurrent validity of a new, mail-administered, stroke-specific outcome measure, the Stroke Impact Scale (SIS). Observational cohort study. Stroke patients who had lived independently in the community prior to their stroke and who were candidates for post-stroke rehabilitation were recruited from nine, high-volume, Department of Veteran Affairs Medical Centers. Two hundred and six patients were mailed the SIS after a six-month post-stroke telephone interview. Telephone assessments included the Functional Independence Measure, the Lawton IADL and the SF-36. The response rate for the mailed SIS was 63%, with 45% of the responses from proxies. The average rate of missing item level scores per patient was 1.3 (range 0-20) resulting in an average rate of 0.13 missing domain scores per patient (range 0-3). Nonresponders to the mailed SIS had more severe strokes with lower functional status at the time of the survey than responders. Proxies were more likely to complete the survey if the subjects were older, married, cognitively impaired and more functionally limited. The SIS did not exhibit a high rate of floor and ceiling effects, particularly in physical function domains, as did the FIM and the SF-36. The mailed SIS is a feasible means of assessing post-stroke function. Missing items and missing domain scores were extremely low, however, there is a trade-off between the low-cost mail SIS survey on the one hand and the resulting nonresponse bias on the other.

Reliability of Self-Reported Pre-Stroke Function

P135 Purpose: The purpose of this study was to examine the reliability of self-reported pre-stroke function when reported within 28 days post-stroke and again at 90 days post-stroke. Methods: Sixty consecutive patients who participated in the Kansas City Stroke Registry were included in this analysis. Pre-stroke function was self-reported by participants using the Lawton IADL and SF-36 Physical Function Index at baseline (within 28 days of stroke onset) and again at 90 days post-stroke. The Intra-class Correlation Coefficient (ICC) was used to examine the reliability of self-reported pre-stroke physical function. The Orpington Prognostic Scale was used to characterize stroke severity. Results: Sixty subjects (24 males and 36 females) with an average age of 75±8.2 years were included in this study. Stroke severity at baseline was mild in 19, moderate in 37, and severe in 4. When compared to pre-stroke function reported at baseline using the Lawton IADL, prior function reported at 90 days was lower in 17 subjects, no change in 21 subjects, and higher in 22. Similarly, when compared to pre-stroke physical function reported at baseline using the SF-36 PFI, prior function reported at 90 days was lower in 18 subjects, no change in 11 subjects, and higher in 30. The calculated ICCs were .53 for both measures. Conclusions: Recall of pre-stroke function is not consistent across time.

Reliability of Self-Reported Pre-Stroke Function

P135 Purpose: The purpose of this study was to examine the reliability of self-reported pre-stroke function when reported within 28 days post-stroke and again at 90 days post-stroke. Methods: Sixty consecutive patients who participated in the Kansas City Stroke Registry were included in this analysis. Pre-stroke function was self-reported by participants using the Lawton IADL and SF-36 Physical Function Index at baseline (within 28 days of stroke onset) and again at 90 days post-stroke. The Intra-class Correlation Coefficient (ICC) was used to examine the reliability of self-reported pre-stroke physical function. The Orpington Prognostic Scale was used to characterize stroke severity. Results: Sixty subjects (24 males and 36 females) with an average age of 75±8.2 years were included in this study. Stroke severity at baseline was mild in 19, moderate in 37, and severe in 4. When compared to pre-stroke function reported at baseline using the Lawton IADL, prior function reported at 90 days was lower in 17 subjects, no change in 21 subjects, and higher in 22. Similarly, when compared to pre-stroke physical function reported at baseline using the SF-36 PFI, prior function reported at 90 days was lower in 18 subjects, no change in 11 subjects, and higher in 30. The calculated ICCs were .53 for both measures. Conclusions: Recall of pre-stroke function is not consistent across time.