Original article
Functional Measures Across Neurologic Disease States: Analysis of Factors in Common

https://doi.org/10.1016/j.apmr.2005.06.010Get rights and content

Abstract

McNaughton HK, Weatherall M, McPherson KM. Functional measures across neurologic disease states: analysis of factors in common.

Objective

To describe the underlying dimensions for a range of functional measures across 3 neurologic diseases at different time points.

Design

Multiple cohort study.

Setting

Combination of public hospital wards and community.

Participants

Patients (N=308) from 3 cohorts: paralytic poliomyelitis (n=38), mean of 25 years previously, assessed once; acute stroke admitted to hospital and followed up for 12 months postdischarge (n=181); and traumatic brain injury (TBI), admitted to hospital and followed up for 12 months postdischarge (n=89).

Interventions

Not applicable.

Main Outcome Measures

The Barthel Index, FIM instrument, Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) physical component score (PCS) and mental component score (MCS), Community Integration Questionnaire (CIQ), and the London Handicap Score (LHS). Measures were compared at 2 time points: pre-event status for stroke, TBI and the polio cohort, and 12-month postdischarge status for stroke and TBI.

Results

The different measures generally correlated highly within disease states at each time point. Principal components analysis revealed 2 underlying dimensions, a physical dimension onto which loaded the Barthel Index, FIM, PCS, and LHS and a cognitive/emotional dimension onto which loaded the MCS and, for subjects with polio, the CIQ. These 2 dimensions accounted for 69% of the variance in measures at the pre-event time point and 85% of the variance at the 12-month time point.

Conclusions

These data suggest 2 basic underlying dimensions across a wide range of measures in 3 different neurologic conditions even at different time points. Most of the variation in the measures can be captured using the 2 component summary scores (PCS, MCS) of the SF-36.

Section snippets

Participants

Participants with stroke were patients consecutively admitted to any of the 3 general hospitals in a single region meeting the World Health Organization (WHO) definition for acute stroke5 (but not including subarachnoid hemorrhage). Participants with TBI were patients consecutively admitted to any of 3 general hospitals in the same region meeting the definition of TBI adopted by the Traumatic Brain Injury Model Systems Database project6 and staying at least 24 hours in hospital. Patients who

Results

One hundred seventy-nine patients with stroke and 89 patients with TBI had an assessment of pre-event functioning. One hundred twenty-three patients with stroke (69%) also had a 12-month follow-up assessment (follow-up rate to death or 12-month assessment was 95%). Sixty-eight patients with TBI (76%) had a 12-month community assessment. Thirty-eight patients with polio a mean of 25 years previously were assessed at a single visit.

Demographic details of subjects in each cohort are described in

Discussion

The main findings from this study were that across 3 diagnostic groups and different time points, measures spanning disability, handicap, community integration, and health status correlated highly and effectively measured only 2 principal components: one that is dominantly physical and one that has more of an emotional/cognitive flavor. This relation holds whether the time point of interest is pre-event functioning or 12 months postevent. It also appears to hold over a wide range of impairment

Conclusions

These data suggest 2 basic underlying dimensions across a wide range of measures in 3 different neurologic conditions at different time points. Most of the variation in the measures can be captured using the 2 component summary scores (PCS, MCS) of the SF-36.

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