Review article (meta-analysis)
Measuring Participation After Stroke: A Review of Frequently Used Tools

Presented to the Stroke Society of Australasia, September 15, 2011, Adelaide, South Australia.
https://doi.org/10.1016/j.apmr.2012.09.002Get rights and content

Abstract

Objective

To identify and critique the measures currently used to assess participation in clinical stroke studies.

Data Sources

Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases.

Study Selection

Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included.

Data Extraction

The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories.

Data Synthesis

Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered.

Conclusions

This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.

Section snippets

Methods

This systematic review was restricted to published research articles on patients with a diagnosis of stroke and a reported assessment of participation. The review included case studies, cohort studies, and randomized controlled trials. Because the aim of the review was to identify the tools that are currently being used to measure participation in clinical stroke studies, we excluded validation studies. We also excluded multiple reports of the same study, although 1 study was included twice

Results

This review identified 36 different participation measures. The 5 most frequently used measures were the SIS,24, 25 London Handicap Scale (LHS),26, 27 the Assessment of Life Habits (LIFE-H),28, 29 the Frenchay Activities Index (FAI),30 and the ACS,31 accounting for 53% of the studies reporting to measure participation (table 1).

The psychometric properties of each of the most frequently used tools identified are outlined in table 2. Not one measure met all psychometric criteria. The interrater

Discussion

In this review, we identified and critically evaluated the most frequently used measures of participation in clinical stroke studies. Past reviews of participation measures have been conducted, but this review is unique in that it focused specifically on participation measures used with stroke survivors, and it identified new participation measures that have been developed and used in recent years. Further, the constructs of the most frequently used tools were evaluated relative to the ICF

Conclusions

This review identified and critically evaluated 5 participation measures used frequently in clinical stroke studies. The 5 participation measures were systematically linked to the ICF Activities and Participation domains. The LIFE-H, the ACS, and the SIS covered the most ICF domains of Activities and Participation. The domains covered most frequently belonged to the Community, Social and Civic Life, Domestic Life, and Mobility. The domains covered least were Learning and Applying Knowledge,

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    Supported by a La Trobe University Postgraduate Research Scholarship, a Florey Institute of Neuroscience and Mental Health Top-up Scholarship, and a Stroke Society of Australasia Scientific Award; and by an Australian Research Council Future Fellowship (FT0992299) and the Victorian Government’s Operational Infrastructure Support Program. The funding sources had no role in conduct of the study or writing of the report.

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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