DETERMINING FUNCTIONAL HEALTH-STATUS AND ITS RELATION TO DISABILITY IN STROKE SURVIVORS

Background and Purpose Determining the functional/health status of str oke survivors poses special difficulties because of cognitive impairme nts that frequently result from stroke. A possible means of assessing the status of stroke survivors who are cognitively impaired is getting proxy responses from a family member or other caregiver. Proxy agreem ent was evaluated for two measures of functional/health status, the Fr enchay Activities Index (FAI) and the Health Status Questionnaire (HSQ ), and a measure of disability, the Functional Independence Measure (F IM). Methods Thirty-eight stroke survivors were administered the measu res at follow-up (median time since the stroke, 6 months). Caregivers were instructed to answer as proxies for the stroke survivors in their care. Demographics on age, sex, race, marital status, educational lev el, side of lesion, and relation of stroke survivor to caregiver were collected. Results Proxy agreement was excellent for the FAI (intracla ss correlation, .85) and the FIM (.87), but poor for the HSQ scales (a verage proxy agreement,. 32). Patients' scores were low and positively skewed for the FAI but high and negatively skewed for the FIM. Althou gh Spearman rho coefficients between the measures were fairly high for both stroke survivors and proxy respondents, the correlation of score s was substantially weaker when the group of less severely impaired su rvivors (as established by FIM ratings) was considered separately. Con clusions The FAI and the FIM are useful for assessing the functional/h ealth status of stroke survivors because answers can be obtained by pr oxy. Future studies should examine the relations between disability an d functional/health status, with explicit attention paid to variations in the level of disability in the stroke survivors.