Subjective Index Of Physical And Social Outcome Research Articles

Turkish Adaptation, Validity and Reliability of the Subjective Index of Physical and Social Outcome (SIPSO)

Turkish Adaptation, Validity and Reliability of the Subjective Index of Physical and Social Outcome (SIPSO)

Protocol for the development of the international population registry for aphasia after stroke (I-PRAISE)

ABSTRACT Background We require high-quality information on the current burden, the types of therapy and resources available, methods of delivery, care pathways and long-term outcomes for people with aphasia. Aim To document and inform international delivery of post-stroke aphasia treatment, to optimise recovery and reintegration of people with aphasia. Methods & Procedures Multi-centre, prospective, non-randomised, open study, employing blinded outcome assessment, where appropriate, including people with post-stroke aphasia, able to attend for 30 minutes during the initial language assessment, at first contact with a speech and language therapist for assessment of aphasia at participating sites. There is no study-mandated intervention. Assessments will occur at baseline (first contact with a speech and language therapist for aphasia assessment), discharge from Speech and Language Therapy (SLT), 6 and 12-months post-stroke. Our primary outcome is changed from baseline in the Amsterdam Nijmegen Everyday Language Test (ANELT/Scenario Test for participants with severe verbal impairments) at 12-months post-stroke. Secondary outcomes at 6 and 12 months include the Therapy Outcome Measure (TOMS), Subjective Index of Physical and Social Outcome (SIPSO), Aphasia Severity Rating Scale (ASRS), Western Aphasia Battery Aphasia Quotient (WAB-AQ), stroke and aphasia quality of life scale (SAQoL-39), European Quality of Life Scale (EQ-5D), lesion description, General Health Questionnaire (GHQ-12), resource use, and satisfaction with therapy provision and success. We will collect demography, clinical data, and therapy content. Routine neuroimaging and medication administration records will be accessed where possible; imaging will be pseudonymised and transferred to a central reading centre. Data will be collected in a central registry. We will describe demography, stroke and aphasia profiles and therapies available. International individual participant data (IPD) meta-analyses will examine treatment responder rates based on minimal detectable change & clinically important changes from baseline for primary and secondary outcomes at 6 and 12 months. Multivariable meta-analyses will examine associations between demography, therapy, medication use and outcomes, considering service characteristics. Where feasible, costs associated with treatment will be reported. Where available, we will detail brain lesion size and site, and examine correlations with SLT and language outcome at 12 months. Conclusion International differences in care, resource utilisation and outcomes will highlight avenues for further aphasia research, promote knowledge sharing and optimise aphasia rehabilitation delivery. IPD meta-analyses will enhance and expand understanding, identifying cost-effective and promising approaches to optimise rehabilitation to benefit people with aphasia.

Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

ObjectiveTo investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months. DesignLongitudinal study. SettingUniversity laboratory. ParticipantsAdults (N=75) recruited within 1 month of discharge home from inpatient stroke rehabilitation. InterventionsNot applicable. Main Outcome Measures36-Item Short Form Health Survey (SF-36) for HRQoL and Subjective Index of Physical and Social Outcome (SIPSO) for community reintegration. Physical performance measures were the 6-minute walk test, timed Up and Go (TUG) test, Berg Balance Scale, Community Balance and Mobility Scale, and isokinetic torque and power of hip, knee, and ankle on the paretic and nonparetic sides. Other prognostic variables included age, sex, stroke type and location, comorbidities, and motor FIM score. ResultsSeparate stepwise linear regressions were performed using the SF-36 and SIPSO as dependent variables. The total paretic lower limb torque and 6-minute walk test predicted the SF-36 Physical Component Summary (adjusted R2=.30). The total paretic lower limb torque and TUG test predicted the SIPSO physical component (adjusted R2=.47). The total paretic lower limb torque significantly predicted the SF-36 Mental Component Summary, but the adjusted R2 was low (.06). Similarly, the TUG test significantly predicted the SIPSO social component, but again the adjusted R2 was low (.09). ConclusionsMeasures of physical performance including muscle strength and mobility at discharge can partially predict HRQoL and community reintegration 6 months later. Further research is necessary for more accurate predictions.

A structural equation model of the relationship between muscle strength, balance performance, walking endurance and community integration in stroke survivors.

PurposeTo use structural equation modelling (SEM) to determine (1) the direct and indirect associations of strength of paretic lower limb muscles with the level of community integration, and (2) the direct association of walking endurance and balance performance with the level of community integration in community-dwelling stroke survivors.Materials and methodsIn this cross-sectional study of 105 stroke survivors, the Subjective Index of Physical and Social Outcome (SIPSO) was used to measure the level of community integration. Lower-limb strength measures included isometric paretic ankle strength and isokinetic paretic knee peak torque. The Berg Balance Scale (BBS) and the 6-minute walk test (6MWT) were used to evaluate balance performance and walking endurance, respectively.ResultsSEM revealed that the distance walked on the 6MWT had the strongest direct association with the SIPSO score (β = 0.41, p <0.001). An increase of one standard deviation in the 6MWT distance resulted in an increase of 0.41 standard deviations in the SIPSO score. Moreover, dorsiflexion strength (β = 0.18, p = 0.044) and the BBS score (β = 0.21, p = 0.021) had direct associations with the SIPSO score.ConclusionsThe results of the proposed model suggest that rehabilitation training of community-dwelling stroke survivors could focus on walking endurance, balance performance and dorsiflexor muscle strengthening if the aim is to augment the level of community integration.

An investigation of the psychometric properties of the Chinese (Cantonese) version of Subjective Index of Physical and Social Outcome (SIPSO)

Objective: The objectives of this study were 1) to translate and make cultural adaptations to the English version of the SIPSO questionnaire to create a Chinese (Cantonese) version, 2) evaluate the internal consistency, test-retest reliability the C-SIPSO questionnaire, and 3) compare the SIPSO-C scores of stroke survivors with different demographic characteristics to establish the discriminant validity of the questionnaire Design: Translation of questionnaire, cross sectional study. Setting: University-based clinical research laboratory. Subjects Community-dwelling chronic stroke survivors. Interventions: Not applicable. Main measures: Subjective Index of Physical and Social Outcome, Geriatric Depression Scale, 10-metre Walk test. Results: Two bilingual professional translators translated the SIPSO questionnaire independently. An expert panel comprising five registered physiotherapists verified the content validity of the final version (C-SIPSO). C-SIPSO demonstrated good internal consistency (Cronbach’s α = 0.83) and excellent test-retest reliability (ICC3,1 = 0.866) in ninety-two community dwelling chronic stroke survivors. Stroke survivors scored higher than 10 in the Geriatric Depression Scale (U = 555.0, P < 0.001) and with the comfortable walking speed lower than 0.8ms–1 (U = 726.5; P = 0.012) scored significantly lower on SIPSO-C. Conclusion: SIPSO-C is a reliable instrument that can be used to measure the level of community integration in community-dwelling stroke survivors in Hong Kong and southern China. Stroke survivors who were at high risk of minor depression and with limited community ambulation ability demonstrated a lower level of community integration as measured with SIPSO-C

Scaling Properties of the Subjective Index of Physical and Social Outcome After Stroke in a Study Population Unselected by Age

ObjectiveTo investigate the scaling properties of the Subjective Index of Physical and Social Outcome (SIPSO) after stroke in survivors to hospital discharge, unselected by age. DesignFactor, Mokken, and Rasch analyses of the SIPSO using data from a prospective observational cohort study. SettingThree acute care hospitals. ParticipantsConsecutive admissions (N=312) with acute stroke, unselected by age. InterventionsNot applicable. Main Outcome MeasuresPatient- or proxy-reported SIPSO, collected by postal survey 6 months after stroke. ResultsComplete SIPSO questionnaires were returned by 166 of 268 survivors (median age, 72y; interquartile range, 66-81y). Factor and Mokken analyses supported both 1- and 2-factor solutions. Fit to the Rasch model for the 10-item scale was poor (χ2 test for item-trait interaction, χ2=69.6; P<.001). Differential item functioning by sex and age was demonstrated for the physical subscore and was dealt with through the creation of 2 super items, resulting in a good fit to the Rasch model (χ2=2.35; P=.67), ordered thresholds, good targeting to the latent trait, and reasonable separation reliability (Person-Separation Index, 0.8). For the social subscore, no differential item functioning was demonstrated by age or sex. Local dependence was dealt with through the creation of 2 super items. Thereafter, fit to the Rasch model (χ2=5.21; P=.27) and targeting to the latent trait were good, and thresholds ordered. Separation reliability was poor (Person-Separation Index, .67). ConclusionsThe 10-item SIPSO is a valid ordinal scale in a population including older stroke survivors. A physical and social subscale structure is also supported. Subscales can be manipulated to fit the Rasch model, and a conversion table for conversion to an interval scale is provided. The social subscore has poor separation reliability, limiting its use in older stroke survivors.

Predicting Patient-Reported Stroke Outcomes: A Validation of the Six Simple Variable Prognostic Model

Background: Case-mix represents the range of disease severity and baseline characteristics that may be the cause of variation in outcomes between individuals and populations. Adjustment for case-mix is therefore important to allow meaningful comparison of healthcare outcomes. The best available case-mix adjustment model for stroke (the Six Simple Variable [SSV] model) was developed to adjust the hard endpoints of independent survival, survival and alive and living at home. There is increasing interest in the measurement of patient-reported outcomes through self-completed questionnaires, though there are currently no robust adjustment models for any such outcome. We aimed to determine whether the SSV prognostic model derived to predict 6-month post-stroke independent survival has wider utility in case-mix adjustment of a patient-reported functional outcome measure, the Subjective Index of Physical and Social Outcome (SIPSO), collected by post 6 months after stroke onset. Methods: We examined data from 176 patients admitted following an acute stroke and recruited into a prospective cohort study in three participating acute hospitals in Yorkshire, UK. Patients in receipt of palliative care or with transient ischaemic attack were excluded. Using the beta coefficients from the published SSV model to predict independent survival, individual probabilities of ‘good' outcome as measured with the dichotomised SIPSO collected by post 6 months after stroke onset were calculated. The ability of the SSV case-mix adjustment model to discriminate patients with ‘good' over ‘poor' outcome was assessed through calculation of C statistics. Correct predictions were visualised with calibration plots. Results: The C statistics for the SSV model to predict the physical and social subscales of the SIPSO outcome measure were 0.73 (95% CI 0.65-0.79) and 0.66 (0.58-0.82), respectively. Inclusion of patients who died prior to follow-up and ascribing them a score of 0 improved the discrimination (0.76 [0.70-0.82] and 0.70 [0.64-0.76], respectively). Calibration plots demonstrated a tendency to over-optimistic predictions, although confidence limits were wide. Conclusions: The SSV model predicts adequately the physical component of the SIPSO patient-reported outcome measure and may be useful to adjust this outcome for case-mix following stroke in survivors to follow-up. This could be of benefit in observational studies, stratified randomisation for trials, and in comparison of between-institution clinical trials. Further exploration of the generalizability of the model to adjust other patient-reported stroke outcomes may be warranted.

Action for Rehabilitation from Neurological Injury (ARNI): A pragmatic study of functional training for stroke survivors

This study evaluated the effectiveness of a twelve-week community-based functional training on measures of impairment, activity and participation in a group of stroke survivors. Isometric strength of the knee musculature, Centre-OfPressure (COP) based measures of balance, Berg Balance Scale (BBS), 10 m walk test, and the Subjective Index of Physical and Social Out come (SIPSO), were recorded at baseline, postintervention, and after twelve weeks (follow-up). Exercise instructors delivered training once a week in a group format at a community centre. Significant improvement was noted in the BBS (p < 0.002), and 10 m walk speed (p = 0.03) post intervention which remained unchanged at follow-up. Total SIPSO score improved significantly post-intervention (p = 0.044). No other significant differences and no adverse effects were observed. It is possible that functional training provided more opportunity for the improvement of dynamic aspects of balance control that could be captured by the BBS but not with the traditional measures of balance using COP data. Results also suggest positive effects on the level of participation, and lack of association between measures of impairment and activity. Community based functional training could be effective and used to extend access to rehabilitation services beyond the acute and sub-acute stages after stroke.

A review of stroke outcome measures valid and reliable for administration by postal survey

SummaryCollecting outcome measures by patient or proxy-completed postal survey in stroke research offers a pragmatic and cost-effective alternative to interview-based assessments. The psychometric properties of outcome measures cannot be assumed to be equivalent across methods of questionnaire administration. Many stroke outcome measures have variable or unproven psychometric properties when administered by post. The validity of stroke research that uses postal surveys may be improved through the adoption of questionnaires with acceptable postal psychometric properties. This review identifies 60 reports of quantitative stroke studies using one or more of 36 instruments to collect stroke outcome data by postal survey. Three of these instruments have acceptable psychometric properties for postal administration in stroke populations (the Frenchay Activities Index (FAI), Subjective Index of Physical and Social Outcome (SIPSO) and the EuroQoL (EQ5D)). Two further instruments lack evidence to support proxy reliability (Nottingham Extended Activities of Daily Living and London Handicap Score), but have otherwise acceptable properties.

A community-based exercise and education scheme for stroke survivors: a randomized controlled trial and economic evaluation

Objective: The evaluation of a community-based exercise and education scheme for stroke survivors. Design: A single blind parallel group randomized controlled trial. Setting: Leisure and community centres in the south-west of England. Subjects: Stroke survivors (median (IQR) time post stroke 10.3 (5.4—17.1) months). 243 participants were randomized to standard care (124) or the intervention (119). Intervention: Exercise and education schemes held twice weekly for eight weeks, facilitated by volunteers and qualified exercise instructors (supported by a physiotherapist), each with nine participants plus carers or family members. Method: Participants were assessed by a blinded independent assessor at two weeks before the start of the scheme, nine weeks and six months. One-year follow-up was by postal assessment. Main measures: Primary outcomes: Subjective Index of Physical and Social Outcome (SIPSO); Frenchay Activities Index; Rivermead Mobility Index. NHS, social care and personal costs. Secondary outcomes included WHOQoL-Bref. Analysis: Intention-to-treat basis, using non-parametric analysis to investigate change from baseline. Economic costs were compared in a cost-consequences analysis. Results: There were significant between-group changes in SIPSO physical at nine weeks (median (95% confidence interval (CI)), 1 (0, 2): P = 0.022) and at one year (0 (—1, 2): P = 0.024). (WHOQol-Bref psychological (6.2 (—0.1, 9.1): P = 0.011) at six months. Mean cost per patient was higher in the intervention group. The difference, excluding inpatient care, was £296 (95% CI: —£321 to £913). Conclusion: The community scheme for stroke survivors was a low-cost intervention successful in improving physical integration, maintained at one year, when compared with standard care.

The Subjective Index of Physical and Social Outcome: its usefulness in a younger stroke population.

Studies on stroke subjects that aim to improve their well-being or community support have not been shown to be effective when measures of disability and handicap have been employed. This paper illustrates the usefulness of the Subjective Index of Physical and Social Outcome (SIPSO) with young adults following a stroke. The study comprised a cross-sectional survey of people (57% male; 39% female; median age 55.7) with a stroke (1-10 years ago), aged 18-65, recruited via NHS stroke registers and young stroke groups (response rate 53%). The SIPSO was incorporated into a postal needs-assessment questionnaire. Median SIPSO score: 24.5 (IQR 17-32). The SIPSO internal reliability: ICC 0.91 (95% CI, 0.90-0.92), item to total SIPSO correlations ranged from 0.52-0.83. The SIPSO construct validity was good: those with poorer employment, mobility and sex-life outcomes had lower SIPSO scores than those with better outcomes; there was no association between age and SIPSO scores, SIPSO scores were not significantly different for men and women. Test-retest reliability was good. The SIPSO had excellent reliability and validity properties in his population. Further work on its responsiveness needs to be carried out. The measurement of personal experience of integration can be a vital basis for effective clinical care.

The validation of the Subjective Index of Physical and Social Outcome (SIPSO).

To validate the Subjective Index of Physical and Social Outcome (SIPSO) in its final 10-item version as a measure of reintegration to pre-stroke lifestyle. Postal and interview administration of questionnaires. SIPSO, Functional Limitations Profile (FLP), Reintegration to Normal Living Index (RNLI). Community setting, Bath, UK. Two hundred and sixty-one survivors of stroke discharged from a district general hospital. Internal consistency (item-total correlations >0.6) and test-retest reliability (intraclass correlation coefficient (ICC) = 0.96) of the measure were confirmed. Construct validity was confirmed through significant correlations with the six subsections of the FLP and the RNLI. Confirmatory factor analysis of the measure found that the first five items form a robust subscale that clearly relates to physical function. The items within the second subscale (questions 6-10) measure several domains (social, leisure, self-image) and do not form a homogeneous group. The SIPSO was able to detect an improvement in integration within a sample of patients over a three-month period soon after discharge (effect size = 0.26). The hypothesis that the degree of improvement experienced by patients following discharge from hospital would be small, but should be detectable was confirmed. The agreement between proxy and patient on the SIPSO was acceptable for individual items (kappa value range = 3.1-5.8) and total score (ICC = 0.96). The SIPSO is a brief self-complete measure, with proven validity and reliability, which addresses both quantitative and qualitative aspects of activities and interaction. It provides a useful measure for evaluating rehabilitation programmes that aim to reintegrate patients to their pre-stroke lifestyle. The authors suggest that the SIPSO should be used as a 10-item measure.

The Subjective Index of Physical and Social Outcome (SIPSO): a new measure for use with stroke patients

To develop a measure of social integration following stroke. Question and response scale generation from qualitative interview-based work followed by item and factor analytic methods of test construction. Analysis of the psychometric properties of final index. Frenchay Activities Index, Nottingham Health Profile, Wakefield Depression Inventory, Barthel Index. Community setting, Bath, UK. Two hundred and sixty survivors of stroke, discharged at least six months previously from a general hospital. A 10-item Subjective Index of Physical and Social Outcome (SIPSO) was developed. Each question is scored on a scale of 0-4 with a low score indicating a poor level of integration. From the 157 completed questionnaires, total scores ranged from 0 to 40 with a median of 24 (interquartile range 15-32). Initial testing of the psychometric properties of the SIPSO suggest that it is able to provide assessment of two distinct areas of patient integration. From analysis of completed questionnaires it is suggested that questions 1-5 on the SIPSO measure a factor related to physical functioning/mobility whilst questions 6-10 measure a factor related to social/emotional functioning. Internal consistency, test-retest reliability and construct validity were established. The SIPSO provides a brief, valid and reliable assessment of an individual's ability to reintegrate to a 'normal' lifestyle. The SIPSO differs from other measures in that it provides assessment of both quantity and quality of activities and interaction, reflecting an individual's ability to reintegrate to his/her own satisfaction. As a 10-item self-report questionnaire the SIPSO can be administered quickly and cheaply to large numbers of patients.

Social reintegration after stroke: the first stages in the development of the Subjective Index of Physical and Social Outcome (SIPSO).

To ensure at outset the content validity of a measure (to be developed) of social integration following stroke. Qualitative study, using in-depth interviews with patients at least six months following stroke. Community setting, Bristol, UK. Thirty survivors of stroke, discharged at least six months previously from a neurological rehabilitation unit in a district general hospital. Patients reported a change, usually for the worse, in their levels of integration following stroke. More specifically they alluded to a decrease in both the quantity and quality of activities, especially with regard to leisure and those activities occurring outside the home. Social interaction was reduced in most patients, in terms of frequency and quality of contact. From the data, six dimensions of change in quality of interaction emerged. Finally, changes in patients' physical and financial environments were reported. Based on the findings, four diagrams were developed, providing a structure for questionnaire development. The results of this study confirm the findings of previously reported research. An individual's level of social integration can be affected by stroke in a wide variety of areas and along many different dimensions. Data from this study have highlighted the importance of the patient's subjective impression of the quality of both functional and social performance. This has provided the opportunity to develop a questionnaire based on the patient's perspective, rather than that of health professionals.