Wondergem R1,2,3, Pisters M1,3,4, Wouters E3,5, de Bie R6, Visser-Meily J4,7, Veenhof C1,4,8
1Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands, 2University Medical Center Utrecht, Physical Therapy Research, Department of Rehabilitation, Physical Therapy and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, The Netherlands, Utrecht, Netherlands, 3Fontys University of Applied Sciences, Department of Health Innovations and Technology, Eindhoven, Netherlands, 4Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 5Tilburg University, School of Social and Behavioral Sciences, Department of Tranzo, Tilbrug, Netherlands, 6Maastricht University, Department of Epidemiology and Caphri Research School, Maastricht, Netherlands, 7Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, Netherlands, 8Expertise Center Innovation of Care, Research Group Innovation of Mobility Care, University of Applied Sciences Utrecht, Utrecht, Netherlands

Background: The majority of people with stroke will return to the home setting after their first-ever stroke. Over forty percent of the population reports limitation in activities of daily living (ADL) and a substantial part of the population report restrictions in participation compared with life before a stroke. Furthermore, in a substantial part of people with stroke decline in ADL is observed within the first three years after a first-ever stroke. Therefore, follow-up assessments of people with stroke are important to objectify activity limitations and/or restrictions in participation. Responsive measurement tools are needed with a low burden for patients and professionals. Computerized Adaptive Testing (CAT) instruments use the response to an initial question to select the subsequent question. CAT instruments reduce the number of questions needed, increase measurement precision, and decrease respondent burden. A promising CAT is the Long-Life Function and Disability Instrument - CAT version (LLFDI-CAT).

Purpose: To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting.

Methods: Participants were visited within three weeks after discharge and six months later. Stroke impact scale (SIS 3.0) and five-meter walk test (5MWT) outcomes were used to investigate the concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with a change score of related measures, unrelated measures and differences between groups were formulated.

Results: 105 participants were included in this study. Concurrent validity of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. Concurrent validity of the LLFDI-CAT participation restriction domain compared with the participation domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (for 15% of the participants) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: respectively, 100% (12/12) and 91% (12/11) of the predefined hypotheses were confirmed.

Conclusion(s): The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFDI-CAT is a promising tool to use both in practice and in research to objective activity limitations and participation restrictions in mild to moderate people with stroke.

Implications: The LLFDI-CAT can be used in practice and research in mild to moderate people with stroke. Computerized Adaptive Testing has multiple advantages. Besides individualizing the measurement process, the measurement precision and burden can be adjusted to the user´s preferences and contextual requirements by changing the stopping rules if needed.

Keywords: Stroke, Computerized Adaptive Testing, Activities of Daily Living & Participation

Funding acknowledgements: Netherlands Organization for Scientific Research (NWO)

Topic: Neurology: stroke; Outcome measurement; Disability & rehabilitation

Ethics approval required: Yes
Institution: University Medical Centre, Utrecht, The Netherlands
Ethics committee: The Medical Ethics Committee of the University Medical Centre Utrecht
Ethics number: NL14-076

All authors, affiliations and abstracts have been published as submitted.

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