Chen, H-F. †, Wu, C-Y. †, Lin, K-C.*,
Chen, C-L., Huang, P-C., Hsieh, C-J., Liu, J-S.
Cerebrovascular accident, Activities of
daily living, Validity, Rasch analysis,Composite measure
Background. Tools used to measure poststroke functional status must include
basic and instrumental activities of daily living (IADL) and reflect the
patient’s and the clinician’s perspective of the disease and its effect on
daily living performance.
Objective. We combined the Functional Independence Measure (FIM) and the
Nottingham Extended Activities of Daily Living (NEADL) to create a scale
providing a comprehensive evaluation of ADL functional status in patients
Methods. The study participants were 188 patients completing the FIM and the
NEADL. The psychometric properties of the combined measure were examined with
Results. A 3-point and a dichotomous scale were suggested for use in the FIM
and the NEADL, respectively. The combined 40 items worked consistently to
reflect a single construct, and “bladder management” and “bowel management”
were highly related. After “bowel management” was removed from the combined
scale, all but 3 items fit the model’s expectations, and the 39-item scale
showed reasonable item difficulty hierarchy with high reliability. The 3
misfit items were removed, and no differences in unidimensionality,
differential item functioning, and reliability were
found between the 36-item and 39-item scales.
Conclusions. The combined measure of the FIM and the NEADL provides a
comprehensive picture of ADL. It extends the utility of the FIM and the NEADL
and is recommended for use to measure independence of patients after
discharge to home.