Measuring functional status of stroke patients with the Sickness Impact Profile

The case for using the repeatability coefficient when calculating test-retest reliability

The use of standardised tools is an essential component of evidence-based practice. Reliance on standardised tools places demands on clinicians to understand their properties, strengths, and weaknesses, in order to interpret results and make clinical decisions. This paper makes a case for clinicians to consider measurement error (ME) indices Coefficient of Repeatability (CR) or the Smallest Real Difference (SRD) over relative reliability coefficients like the Pearson’s (r) and the Intraclass Correlation Coefficient (ICC), while selecting tools to measure change and inferring change as true. The authors present statistical methods that are part of the current approach to evaluate test–retest reliability of assessment tools and outcome measurements. Selected examples from a previous test–retest study are used to elucidate the added advantages of knowledge of the ME of an assessment tool in clinical decision making. The CR is computed in the same units as the assessment tool and sets the boundary of the minimal detectable true change that can be measured by the tool.

Monitoring the functional health status of stroke patients: the value of the Stroke-Adapted Sickness Impact Profile-30

PURPOSE

To further validate the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and to determine its responsiveness in a stroke rehabilitation population.

METHOD

Data of 122 communicative stroke patients (mean age 57 years), selected for an inpatient rehabilitation programme, were available. All had suffered different types of stroke. Six months and one year post-stroke, the patients completed the SIP68 plus nine stroke-specific questions from the SIP136, enabling us to derive the SA-SIP30 from the questionnaire. We determined internal consistency, construct and clinical validity and responsiveness of the SA-SIP30. Total, physical and psychosocial dimension scores were calculated.

RESULTS

Internal consistency was moderate to good (alpha>0.68) and correlation between the SIP68 and the SA-SIP30 was high (r>0.85), indicating good construct validity for total score and both dimension scores. Clinical validity assessment showed that total and psychosocial dimensions scores were significantly higher for patients with a cortical infarction compared to respectively subarachnoid haemorrhage and subcortical infarction (p<0.05). Effect sizes for the SA-SIP30 were moderate (between 0.56 and 0.65).

CONCLUSIONS

The SA-SIP30 proved valid and responsive in our stroke rehabilitation population. The major advantages of the SA-SIP30 are the lesser number of items and, therefore, the shorter completion time and the fact that it is a stroke-specific scale to determine health-related functional status.

Determinants of change in quality of life from 1 to 6 months following acute stroke

BACKGROUND AND PURPOSE

Little information is available about change in health-related quality of life (HRQoL) during the first few months following acute stroke, and whether baseline variables can predict who will have the largest improvement in HRQoL. This study assessed the change in HRQoL from 1 to 6 months following acute stroke and the determinants of these changes.

METHODS

Patients >60 years of age, who had experienced an acute stroke and were admitted to hospital within 24 h of onset, were followed longitudinally. HRQoL was assessed with the Short Form 36 (SF-36) health status questionnaire.

RESULTS

Of 550 eligible stroke patients, 315 fulfilled the inclusion criteria and were alive after 30 days. At 1 month, 179 patients responded to the questionnaire, of whom also 140 responded at 6 months following acute stroke. From 1 to 6 months following stroke, all dimensions of the SF-36 improved. The magnitude of change was largest on the role-physical and role-emotional scales and lowest on the bodily pain and mental health scales. Higher physical component summary (PCS) score at 1 month was associated with lower odds of being above the 75th percentile of change in PCS score between the assessments, and higher baseline mental component summary (MCS) score was associated with lower odds of being above the 75th percentile of change in MCS. Treatment in a stroke unit was associated with an increase in the MCS score and higher neurological score with an increase in PCS score of the SF-36.

CONCLUSION

This prospective study showed a considerable improvement in HRQoL from 1 to 6 months after stroke; however, no baseline variables except baseline scores were associated with changes in HRQoL during the 5-month period.

Physical, psychological and social recovery patterns after coronary artery bypass graft surgery: A prospective repeated measures questionnaire survey

AIM

This study examined the physical, psychological and social recovery patterns of Hong Kong Chinese patients who have undergone CABG surgery over a period of six months.

BACKGROUND

Recovery from coronary artery bypass graft (CABG) surgery is a dynamic process and the associated physical, psychological and social effects could lead to failure to recuperate leading to hospital re-admission and morbidity.

DESIGN

A prospective repeated measures design was used for this research. Patients were interviewed in person 5 days before surgery and at 1 week after discharge, and by telephone at 3 and 6 months after discharge. Physical recovery dimension was assessed by three categories of the Sickness Impact Profile (ambulation, sleep-rest, body movement and care). Social recovery dimension was assessed by three categories of the Sickness Impact Profile (SIP) (home management, social interaction, and recreation and pastimes). Psychological recovery was assessed using the Centre for Epidemiologic Studies-Depression (CES-D).

RESULTS

Sixty-eight patients participated in this research. The mean physical SIP-dimension score and depression level at discharge was the highest then gradually decreased at 6 months after CABG. The SIP-physical and SIP-social and depression level differed significantly across the four-assessment time within-group. There were no gender differences in physical and social recovery and depression levels. Patients who had poorer physical and social recovery had more depression at one week and three months after CABG surgery.

CONCLUSION

Patients should be prepared for discharge after CABG surgery. Cultural factors may have influenced the similar recovery patterns between genders. These factors contributing to early recovery must be further examined.

RELEVANCE TO CLINICAL PRACTICE

Because of the large number of patients who undergo CABG worldwide, and because of healthcare cost related to this intervention, it is important for both patients and healthcare providers to have realistic expectations about the recovery process and to recognise deviations from the norm. The results provided some insights into the Hong Kong Chinese patients' recovery from CABG surgery that would guide the development of culturally appropriate pre-operative and discharge teaching for this group of patients.

The SIP68: an abbreviated sickness impact profile for disability outcomes research

The Sickness Impact Profile (SIP) is one of the most widely recognized generic health status instruments, but its length has often left it out of consideration for outcomes research. We assess a short alternative, the Sickness Impact Profile 68 (SIP68), for retest and proxy reliability, validity, and scaling properties, in a population of adults with disability (PWD). For convergent validity, the SIP68 was compared to the instrumental activities of daily living (IADLs), activities of daily living (ADLs) and the short-form 36 (SF-36). We completed 398 interviews with PWD, 131 index-proxy sets, and 40 retests. Retest intraclass correlations were above 0.75 for all scales and dimensions except the physical dimension (0.61). Proxy reliability ranged from 0.26 (psychological autonomy and communication) to 0.85 (somatic autonomy). Correlation between the SIP68 and SIP was 0.94 overall; between the SIP68 and similar scales of the SF-36 correlations was moderate, and highest for physical health scales. We repeated the SIP68 development factor analysis and reproduced a structure of the full SIP that included 65 of SIP68 items. However, 36 additional items were retained that are not part of the SIP68. Overall, the SIP68 shows promise for use as a disability outcomes tool.

Socioeconomic variations in the course of stroke: unequal health outcomes, equal care?

STUDY OBJECTIVE

The aim of this paper is to quantify the socioeconomic gap in long term health outcomes after stroke and related health care utilisation, in order to evaluate whether those in need of care do actually receive appropriate levels of care.

DESIGN

Stroke patients from the lower socioeconomic group were compared with stroke patients from the higher socioeconomic group with respect to sociodemographic and clinical characteristics, health outcomes, and related health care utilisation.

SETTING

Patients were recruited from admissions to 23 randomly selected hospitals in the Netherlands.

PATIENTS

465 patients were included who had had a stroke six months earlier and were followed up three years and five years after stroke.

MAIN RESULTS

The observed odds ratios suggest that patients from the lower socioeconomic group experienced more disabilities up to three years after stroke and more handicaps up to five years after stroke. After adjusting for health care needs there were no significant associations between socioeconomic status and health care utilisation. The observed figures, however, suggest that a lower socioeconomic status tended to increase admission to nursing homes and to decrease receiving care in non-institutional settings.

CONCLUSIONS

Overall, inequalities in long term health outcomes were observed but solid indications for large inequalities in health care utilisation were not found. More investments in coordinated stroke services are needed to alleviate the unfavourable health situation of disadvantaged groups and to ensure that health care services respond appropriately to the health care needs of different socioeconomic groups.

Post-stroke quality of life and depression

BACKGROUND

Studies on the determinants of the quality of life (QOL) after stroke bring differing results depending on the applied concept of QOL. This may lead to confusion about the contribution of various factors to the post-stroke QOL.

OBJECTIVE

The aim of the study was: (i) to investigate functional and psychological QOL in the individuals after the first ischemic stroke; (ii) to identify the most important correlates of QOL; and (iii) to examine the significance of depression among the other possible predictors of QOL.

METHODS

A hospital-based sample of 72 stroke patients was followed up to 6 months after stroke onset. QOL was assessed using the Polish version of the Quality of Life Index and the Sickness Impact Profile. A multiple regression procedure was performed to examine relationships between QOL and the study variables.

RESULTS

In spite of good recovery, the psychological and functional QOL of the examined patients was impaired, although the negative impact of stroke was greater on the objective QOL than on the subjective QOL. Stroke-related impairment, depression, functional disability and marital status predicted 80% of the variance in the functional QOL. Emotional support, depression and functional disability explained 38% of the variance in psychological well-being.

CONCLUSIONS

Depression and physical disability were the most important predictors of QOL after stroke since their impact on QOL was more robust in comparison to the remaining variables. For improving QOL, a comprehensive care for patients aimed at reducing physical dependence and ameliorating depressive symptoms could be recommended.

Attentional dynamics in postural control during perturbations in young and older adults

Temporal dynamics of attention during postural perturbations in young and older adults were investigated. Nineteen young and older subjects performed simple reaction time tasks during translational platform perturbations. Auditory or visual stimuli were presented randomly at delays from the onset of the platform perturbation. Reaction time was slowed before and during the platform movement, particularly in older subjects. Reaction times to stimuli presented at a 250-millisecond delay or later were not influenced by perturbation. The reaction times to the auditory stimuli were influenced more by perturbation than were those to visual targets. The postural response was unaltered by the presence of the reaction time task, but it differed between groups. Attention is engaged in response to a perturbation during the preperturbation time and during the initiation of the postural response in young and older adults. Sensory selection occurs in young and older adults, but to a greater degree in older subjects.

Smallest real difference, a link between reproducibility and responsiveness

The aim of this study is to show the relationship between test-retest reproducibility and responsiveness and to introduce the smallest real difference (SRD) approach, using the sickness impact profile (SIP) in chronic stroke patients as an example. Forty chronic stroke patients were interviewed twice by the same examiner, with a 1-week interval. All patients were interviewed during the qualification period preceding a randomized clinical trial. Test-retest reproducibility has been quantified by the intraclass correlation coefficient (ICC). the standard error of measurement (SEM) and the related smallest real difference (SRD). Responsiveness was defined as the ratio of the clinically relevant change to the SD of the within-stable-subject test-retest differences. The ICC for the total SIP was 0.92, whereas the ICCs for the specified SIP categories varied from 0.63 for the category 'recreation and pastime' to 0.88 for the category 'work'. However, both the SEM and the SRD far more capture the essence of the reproducibility of a measurement instrument. For instance, a total SIP score of an individual patient of 28.3% (which is taken as an example, being the mean score in the study population) should decrease by at least 9.26% or approximately 13 items, before any improvement beyond reproducibility noise can be detected. The responsiveness to change of a health status measurement instrument is closely related to its test-retest reproducibility. This relationship becomes more evident when the SEM and the SRD are used to quantify reproducibility, than when ICC or other correlation coefficients are used.

Is there a relation between neuropsychologic variables and quality of life after stroke?

OBJECTIVES

To describe the quality of life (QOL) of stroke patients and to distill neuropsychologic predictors for poor QOL.

DESIGN

A cohort study in which patients were neuropsychologically assessed at a mean of 72.2 days after stroke, with follow-up at a mean of 9.8 months after stroke.

SETTING

Research department of a rehabilitation center.

PATIENTS

A consecutive sample of 164 stroke patients (mean age, 55.2yr) recruited from a university hospital, a regional hospital, and a rehabilitation center.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Orientation, memory, attention and concentration, visuospatial and visuoconstructive functions, language, and arithmetic skills were assessed with neuropsychologic tests. QOL was assessed with the Sickness Impact Profile (SIP).

RESULTS

An overall mean SIP score +/- standard deviation of 20 +/- 11 showed that stroke has a high impact on everyday functioning. Further analyses indicated that QOL is related in particular to tests measuring spatiotemporal and/or sequential aspects of behavior. Forward/backward stepwise regression analysis (n = 106) showed that poor QOL was more likely if patients had a poor result on the Trailmaking Test (TMT) B and/or were women.

CONCLUSION

The predictive value of the TMT is most effective and very useful because the TMT is a short and economical procedure. However, the gender-related aspects of recovery deserve more attention, as does the possible bias that can be caused by the composition of a measurement. Further research is needed to refine predictive models that are needed to facilitate the development of more adequate, individual rehabilitation programs.

Economic and health-related quality of life considerations of new therapies in Parkinson's disease

The progressive disability of Parkinson's disease results in substantial burdens for patients, their families and society in terms of increased health resource use, poorer quality of life, caregiver burden, disrupted family relationships, decreases in social and leisure activities, deteriorating emotional well-being, and direct and indirect costs of illness. Health-related quality of life (HR-QOL) measures have been used successfully in cross-sectional studies to identify and characterise these burdens; however, there is not yet substantial evidence that these instruments will be responsive to changes in patients over time and that the results will provide patients and health professionals with clinically meaningful information useful in making decisions about treatment strategies. The few studies documenting direct and indirect costs indicate increased use of ancillary health and community services, significant adaptations in home and transportation, increased use of mobility and self-care aids, and lack of access to appropriate healthcare providers. Patients with Parkinson's disease incur higher hospital expenses, have increased number of prescriptions, and experience earnings loss; the latter also applies to family caregivers. The choice, intensity and timing of therapy are determined by a variety of factors: presenting symptoms, age, employment status, comorbidity, cognitive impairment and level of functional impairment. Choices must be individually tailored to a patient's physical and personal needs. To be useful for patients with Parkinson's disease in clinical practice, clinicians should be able to use HR-QOL measures to identify appropriate medical interventions or socio-behavioural modifications to modify the HR-QOL deficits. However, while the interplay of interventions and clinical outcomes are often well understood, the effects of interventions on HR-QOL outcomes have not been studied extensively. Little research has been done that explicitly links the signs and symptoms of Parkinson's disease to the HR-QOL outcomes. The only Parkinson's disease cost-effectiveness study as yet performed indicated higher costs for patients receiving pramipexole than for those not taking the drug, but additional quality life-years were gained. Longer term effectiveness of many treatment strategies, and the usefulness of HR-QOL instruments to assess these treatments for individual patients over time, are critical areas for future research.

Health-related quality of life outcomes measures

OBJECTIVE

To review critically the features of measures of generic health-related quality of life (HRQOL) for disability outcomes research.

DATA SOURCES

A search of electronic databases, summary reviews, books, and government documents was performed. Comment and experiences from participants of a conference on outcomes research were also incorporated.

STUDY SELECTION

English language literature from scientists from a broad range of disciplines and research settings, including medicine, nursing, social science, and public health, and health services research and practice.

DATA EXTRACTION

A critical review of measures that have been or might be used to measure disability outcomes.

DATA SYNTHESIS

Commonly used generic measures of HRQOL can be applied to disability outcomes research with some caveats. Three common tools are the Medical Outcomes Study Short-Form Health Survey (SF-36), Sickness Impact Profile (SIP), and Quality of Well-Being (QWB) scale. The SF-36 and SIP have been used with some success in research with people with disability. The QWB scale has been used less frequently.

CONCLUSION

Most studies using generic HRQOL tools are of groups with specific impairments rather than heterogeneous groups of people with disability. None of the tools appears to measure HRQOL without some potential biases (eg, inappropriate wording) for people with disability, but more specific testing of these problems is needed. Also needed are studies to determine whether these tools can measure meaningful longitudinal changes.

Clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 and the Sickness Impact Profile-136

BACKGROUND AND PURPOSE

Handicap or health-related quality of life (HRQL) measures are seldom used in stroke trials, although the importance of these measures has been stressed frequently. We studied the clinical meaning of the Stroke-Adapted Sickness Impact Profile-30 (SA-SIP30) and the original SIP136 for use in stroke research.

METHODS

We included 418 patients who had had a stroke 6 months earlier. We studied the associations between the SA-SIP30 and SIP136 scores versus other frequently used outcome measures from the International Classification of Impairments, Disabilities, and Handicaps (ICIDH) (Barthel Index, Rankin Scale) and the HRQL model (health perception items, Euroqol). To interpret the continuous SA-SIP30 and SIP136 scores, we used receiver operating characteristic curve analysis with the aforementioned measures as external criteria.

RESULTS

The psychosocial dimension scores of both SIP versions remained largely unexplained. The physical dimension and total scores of both SIP versions were mainly associated with the disability measures derived from the ICIDH model, as well as with the physical HRQL domains. Most patients with an SA-SIP30 total score >33 or an SIP136 total score >22 had poor health profiles. There were no major differences between the SA-SIP30 and the SIP136, although the SA-SIP30 scores were less skewed toward the healthier outcomes than the SIP136.

CONCLUSIONS

Our study showed that (1) both SIP total scores primarily represent aspects of physical functioning and not HRQL; (2) both SIP versions provide more clinical information than the frequently used disability measures; and (3) the SA-SIP30 should be preferred over the SIP136.

Hepatitis C virus infection: quality of life and side effects of treatment

Studies of the subtle symptoms associated with chronic diseases and detected by quality of life questionnaires are still in their infancy. The techniques used to examine these impairments in well being are still being developed and their use is far from routine. There is a growing body of evidence to show that patients with chronic hepatitis C virus (HCV) without major disease related complications do perceive themselves to be unwell and do have significant changes in their physical and mental well being. These abnormalities cannot be attributed to the mode of acquisition of the infection or to the severity of liver damage. The mechanism of these changes is unknown but the symptoms do remit following successful therapy, indicating that the presence of the virus plays a role in their aetiology. These symptoms require careful evaluation and may be sufficiently severe to justify therapy in the absence of advancing liver damage. Treatment of chronic HCV significantly impairs a patient's quality of life. The decision as to whether an individual patient's symptoms are sufficient to justify therapy in the absence of progressive liver damage is one which must be based on an assessment of the individual's current and future status as well as the individual's ability to tolerate current therapy.

Selecting a generic measure of health-related quality of life for use among older adults. A comparison of candidate instruments

Selecting an outcomes assessment instrument requires knowledge of their relative merits, especially head-to-head comparisons. The authors compare health-related quality-of-life (HRQOL) instruments among older adults for their psychometric properties and subject burden, specifically the Sickness Impact Profile (SIP) and Medical Outcomes Study Short-Form 36 (SF-36). Subjects were 282 of 373 eligible older adults (75.6% response) ranging in age from 65 to 96. SIP scores demonstrated a strong skew toward low (good health) scores with a mean of 11.1% (+/- SD 11.5) on the Total SIP index score. Similar components of the SIP and SF-36 were moderately to strongly correlated. The SIP suffered from a ceiling (good health) scaling effect, and the SF-36 scales also demonstrated some scaling extremes. These results demonstrate the relative scaling limits, especially the ceiling effect, of the SIP compared to the SF-36, and in general, the SF-36 is preferred for use among community-living older adults.

A stroke-adapted 30-item version of the Sickness Impact Profile to assess quality of life (SA-SIP30)

BACKGROUND AND PURPOSE

In view of the growing therapeutic options in stroke, measurement of quality of life has become increasingly relevant as an outcome parameters. The Sickness Impact Profile (SIP) is one of the most widely used measures to assess quality of life. To overcome the major disadvantage of the SIP, its length, we constructed a short stroke adapted 30-item SIP version (SA-SIP30).

METHODS

Data on the original SIP version were collected for 319 communicative patients at 6 months after stroke. The 12 subscales and the 136 items of the original SIP were reduced to 8 subscales with 30 items in a three step procedure, on the basis of relevancy and homogeneity. Reliability of the SA-SIP30 was evaluated by means of an analysis of homogeneity (Cronbach's alpha coefficient). Different types of validity were assessed: construct, clinical, and external validities.

RESULTS

Homogeneity of the SA-SIP30 was demonstrated by a high Cronbach's alpha (0.85). Principal component analyses revealed the same two dimensions as in the original SIP (a physical and a psychosocial dimension). The SA-SIP30 could explain 91% of the variation in scores of the original SIP in the same cohort of patients, and 89% in a different cohort. Furthermore, the SA-SIP30 was related to other functional health measures similar to how the original SIP was. We could demonstrate that the SA-SIP30 was able to distinguish patients with lacunar infarctions from patients with cortical or subcortical lesions.

CONCLUSIONS

We conclude that the SA-SIP30 is a feasible and clinimetrically sound measure to assess quality of life after stroke.

Therapeutic footwear: enhanced function in people with diabetes and transmetatarsal amputation

OBJECTIVE

Patients with diabetes mellitus (DM) and a transmetatarsal amputation (TMA) have considerable deficits in function compared with age-matched controls. The purpose of this study was to determine if therapeutic footwear could improve the functional mobility of patients with DM and TMA.

STUDY DESIGN

Repeated-measures design.

SETTING

Academic medical center.

PATIENTS

Thirty subjects (10 women, 20 men) with DM and a TMA, with a mean age of 61.7 +/- 4.0 yrs.

INTERVENTIONS

Six types of footwear evaluating the following components: length of shoe (full-length or short shoe), a rigid rocker-bottom sole, and an ankle-foot-orthosis.

OUTCOME MEASURES

Physical Performance Test (PPT), functional reach, and walking speed. Measurements in each footwear condition occurred after a 1-month adjustment period.

RESULTS

Patients wearing full-length custom-made shoes with a total-contact insert, a rigid rocker-bottom sole or a short shoe with a rigid rocker-bottom sole (with or without an ankle-foot-orthosis) had similar and significantly higher scores in the PPT and faster walking speed than when wearing regular shoes with a toe filler (p < .05). The short shoe and the ankle-foot-orthosis, however, generated many patient complaints about cosmesis and restriction at the ankle, respectively. There were no differences in any of the measures of functional reach.

CONCLUSION

Although there are individual exceptions, we recommend the full-length shoe, total-contact insert, and a rigid rocker-bottom sole for most patients with DM and a TMA.

Health status of individuals with mild stroke

BACKGROUND AND PURPOSE

Diminished quality of life and limitations in higher levels of physical functioning are often underestimated in stroke and are not fully captured by measures such as the Barthel Index and the Rankin Outcome Scale. This study used additional measures to assess the health status of 304 persons with mild stroke and to compare these individuals with 184 persons with transient ischemic attack and 654 persons without history of stroke/transient ischemic attack but at elevated risk for stroke (asymptomatic group).

METHODS

Subjects were recruited from the Academic Medical Center Consortium (inpatients), the Cardiovascular Health Study (population-based sample of community-dwelling persons 65 years and older), and United HealthCare (inpatients and outpatients typically younger than 65 years). Subjects were interviewed by telephone or in person to assess activities of daily living (Barthel Index), depression (Center for Epidemiological Studies Depression Scale), health status (MOS-36), and utility for current health state.

RESULTS

Most respondents were independent on all Barthel items. The stroke group was more impaired on the MOS-36 than the asymptomatic group but similar to the group with transient ischemic attack. Health-related quality of life was lowest for persons with stroke. While symptom status and Barthel Index score were the strongest predictors of health status, the Barthel Index showed a consistent ceiling effect when compared with the physical function subscale of the MOS-36.

CONCLUSIONS

The consequences of even mild stroke affect all dimensions of health except pain. Standardized assessment of persons with stroke must evaluate across the entire continuum of health-related functions.

Health assessment for chronic HCV infection: results of quality of life

The perception that chronic hepatitis C is an asymptomatic disease contrasts with many studies that show a strong association between chronic hepatitis C, hepatocellular cancer, and fatal liver disease. In order to resolve these issues, it is logical to directly evaluate the quality of life in patients with chronic hepatitis C and to compare this to the normal population as well as cohorts of patients with other chronic diseases. The Sickness Impact Profile was used to evaluate the impact of disease and interferon therapy on health-related quality of life in patients with chronic hepatitis C. Using this tool, patients with chronic hepatitis C had a total Sickness Impact Profile score of 9.0, compared with a score of 3.6 among the general population (P < 0.05). Patients with chronic hepatitis C also had significantly worse scores in almost every category of the Sickness Impact Profile that could be compared. However, statistically significant differences were observed only at the 24-week evaluation for work and at the end-point evaluation for the sleep and rest and recreation and pastimes categories. A more sophisticated instrument, based on the Medical Outcomes Study 36-item short-form health survey, found that patients with chronic hepatitis C scored significantly lower (P < 0.01) than the general population on each of the subscales in this survey. In addition, they scored significantly lower than patients with hypertension in seven of the subscales and two additional generic scales. Patients with chronic hepatitis C were most comparable to those with type II diabetes. A larger, more comprehensive study is underway to further evaluate these relationships.

The SIP68: a measure of health-related functional status in rehabilitation medicine

OBJECTIVE

To demonstrate the usefulness of the SIP68, a recently developed short version of the sickness impact profile (SIP), for measuring health-related functional status in rehabilitation medicine.

DESIGN

Survey, oral interviews.

SETTING

Patient's homes.

PATIENTS

315 persons (out of 423 that could be reached) with a spinal cord injury whose mean average age was 39.4 years and who were living in the community at the time of the interview.

MAIN OUTCOME MEASURES

Internal consistency is tested by computing Cronbach's alpha. Construct validity is tested by principal components analysis and computing Cattell's similarity index. Criterion validity is tested by comparing SIP68 results with the level of the spinal cord lesion and with results of specific measures of disability (Barthel Index) and life satisfaction (Life Satisfaction Questionnaire), and with vocational status.

RESULTS

SIP68 scores and subscale scores indicate that our spinal cord injured group falls well within the scope of this instrument. Internal consistency figures are good and the proposed six-dimensional structure is confirmed. Criterion validity figures are also satisfactory. Barthel Index scores show high agreement with the scores of the subscale "somatic autonomy," moderate agreement with the other physically related and socially related subscales, and low agreement with the mentally related subscales of the SIP68. LSQ scores show low agreement with the physically related subscales and moderate agreement with the mentally and socially related subscales. Figures of vocational status show strongest agreement with the socially oriented subscales.

CONCLUSION

The SIP68 is recommended as a useful generic outcome measure for research in rehabilitation medicine.

Effectiveness of an intensive outpatient rehabilitation program for postacute stroke patients

The effectiveness of ongoing rehabilitation services for postacute stroke survivors is poorly documented. We designed a randomized control, single-blinded study to demonstrate the effectiveness of intensive outpatient therapy. The treatment intervention consisted of 1 hr each of physical and occupational therapy, four times per week, for 12 wk; therapy focused on neuromuscular facilitation and functional tasks. All subjects were screened before the therapies and after 3 mo and 9 mo. Forty-nine stroke survivors, who were at least l yr (mean, 2.9 yr) poststroke, were randomized with two treated patients to each control (no treatment supplied). All patients had received inpatient rehabilitation at the time of their acute stroke, but no patient had any ongoing therapy within the last 6 mo. The outcome measures included the Functional Independence Measure (FIM), Brunnstrom stages of motor recovery, timed mobility tasks, and the Jebson hand evaluation. We also evaluated the level of depression, self-esteem, and socialization. The treated patients demonstrated an improvement of 6.6 points over the 3 mo of therapy compared with only 1.5 points in the control group in the FIM motor score transformed using Rasch analysis. The change from time 0 to 3 mo was significant in the treated group but not in the controls. Treated patients maintained their gains at the 9-mo follow-up, and controls lost ground. The treated group improved in terms of socialization and self-esteem as evidenced by a lower Sickness Impact Profile, whereas the controls tended to get worse. There was a trend toward less depression, but this did not reach a P = 0.05 level of significance. This study demonstrates that significant functional gains can still be attained in the postacute stroke survivor, despite prior inpatient rehabilitation services.

Functional status and health status

Functional status assessment originated in clinical practice in rehabilitation. Health status assessment, a growing part of health services research, grew from the need to survey the health of large populations. In spite of many common interests, the two fields have had little cross-fertilization. The origins and current status of health status measurement are described, including examples of the most frequently used instruments. Conceptual and methodological issues shared by the two fields are examined with the aim of determining what might be of value to rehabilitation. Health-related quality of life provides a conceptual framework that could broaden the rehabilitation perspective. Health status measures may not be appropriate for clinical management but might be useful as quality of care and outcome indicators.

Functional outcome of rehabilitated bilateral lower limb amputees

The functional outcome of rehabilitated bilateral lower limb amputees was studied. The study included 31 amputees who were admitted during 1980-1990 to a rehabilitation centre in the north of the Netherlands. The clinical notes made during the patients' admission were studied to obtain information about their characteristics, while mobility and prosthetic use were studied at discharge. The patients who were alive and willing to participate in the study were interviewed by a physician at their residence in November 1992, using among other things, the Sickness Impact Profile (SIP) and the Life Satisfaction questionnaire. Some 25 of the 31 patients were amputated for vascular reasons, 1 patient primarily for traumatic reasons and secondarily for vascular reasons, 5 patients for traumatic reasons. Eight patients had a bilateral trans-femoral amputation, 18 patients a bilateral trans-tibial amputation, 2 patients a combination of trans-tibial and knee-disarticulation amputation, 3 patients a trans-femoral/trans-tibial amputation. Mean age at second amputation was 66.3 years. Of the 31 amputees 21 were men and 10 women, 25 amputees were prosthetically rehabilitated during admission, 3 of them died during admission and 5 did not achieve mobility at discharge. In their activities of daily life 22 of the 28 patients alive at discharge were almost independent. At the time of the follow-up evaluation 17 of the 31 patients had died. For several reasons only 8 patients could be included in the follow-up, 6 vascular amputees and 2 traumatic amputees.(ABSTRACT TRUNCATED AT 250 WORDS)

Critical review of the international assessments of health-related quality of life

This paper reviews the international adaptation and use of generic health quality of life measures over the last several years, including the Nottingham Health Profile (NHP) the Sickness Impact Profile (SIP), the Medical Outcomes Short-Form 36 (MOS SF-36), the EuroQol, and Dartmouth COOP Charts. International work with disease or condition specific HRQL measures is exemplified with the European Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ), and the Spitzer Quality of Life (QL) Index. Progress towards cross national measurement equivalence in HRQL measures reported in the literature has been uneven. Results show that the development of language-adapted versions of HRQL measures to date have mostly concerned translation issues, within the context of independently conducted studies. Substantially less focus has been placed on psychometric equivalence across language versions necessary for coordinated international studies, such as multi-national clinical trials. However, this picture is rapidly changing with recent projects underway to develop and refine new or existing HRQL measures. Overall, the lack of prominent differences found between countries in ranking of health states in major HRQL measures supports the feasibility of developing internationally applicable HRQL instruments. Recommendations are made for additional data needed to better ascertain the degree of measurement equivalence developed in the various versions of each instrument reviewed.