Short ICF-based measures in subacute stroke
677
Minimal means that the scale consists of the least number of
domains of functioning that can be used to explain significant
differences between people with health issues. The scoring
system is similar to WHODAS, the sum score ranging from
0 to 28, with lower scores indicating better functioning (25).
The ethics committee of the University of Turku and Turku
University Hospital approved the study (19.5.2015, 73/2015).
The ethical standards of the World Medical Association Declara-
tion of Helsinki 1975, revised 1983, were followed. kappa (wK) coefficient to evaluate the correspondence of the
answers of a patient and his or her proxy. Cronbach’s alpha was
calculated to evaluate the reliability of WHODAS and the WHO
Minimal Generic Set questionnaires. Statistical analyses were
performed using SAS 9.4 for Windows. p-values below 0.05
(2-tailed) were considered statistically significant.
Statistical analysis Demographic and clinical background data for all 195
patients are shown in Table I. Responses to the WHO-
DAS questionnaire were received from 167 patients
and from all 195 significant others. When comparing
background data in different severity groups of stroke,
rehabilitants with a WHODAS patient response were
divided into 3 groups: 1: mild (n = 30), 2: moderate
(n = 81), and 3: severe stroke (n = 56). Since the inten-
tion was for the study to cover all levels of severity of
patients in intensive post-acute rehabilitation, including
those with the most severe stroke and aphasia, an “all se-
vere” group (n = 83) of significant others’ responses was
also formed, consisting of all patients with severe stroke
Categorical variables were described using frequencies and
percentages and, for continuous variables, medians with range
of values and 25 th and 75 th percentiles were used. The compari-
son between different severity groups of stroke was carried out
within categorical variables using χ 2 test, or, in the case of small
cell frequencies, Fisher’s exact test. In numerical variables the
comparisons between the patient groups were carried out either
by one-way analysis of variance, or by the non-parametric Krus-
kal–Wallis test when the distribution of an outcome variable was
skewed. The Spearman correlation coefficient was used to test
the correlation between variables. Correlations of 0–0.29 were
considered weak, 0.30–0.49 moderate, 0.50–0.69 strong, and
0.70–1.00 very strong. Patient and proxy WHODAS responses
were analysed pairwise using test of symmetry and weighted
RESULTS
Table I. Demographic and clinical data of the patients with mild, moderate, and severe stroke (according to the 24-h National Institutes
of Health Stroke Scale; NIHSS)
Variables
Mild
(n = 30)
Age at stroke onset, years, median (range) 58.9 (31.6–77.6)
Stroke type, n (%)
Infarction
18 (60.0)
Intracerebral haemorrhage
4 (13.3)
Subarachnoid haemorrhage
8 (26.7)
Stroke localization, n (%)
Left hemisphere
7 (23.3)
Right hemisphere
7 (23.3)
Both sides
9 (30.0)
Brain-stem/cerebellum, n (%)
7 (23.3)
Comorbidities 0/1–2/3–4, n (%)
7 (23.3)/20
(66.7)/3 (10.0)
Charlson Index 0/1–2/≥3, n (%)
23 (76.7)/7
(23.3)/0 (0.0)
Time since stroke on admission, days,
median (range)
33.0 (12–139)
Length of stay, days, median (range)
15.0 (3–52)
Time since stroke at discharge, days,
median (range)
55.5 (20–157)
Education, years, median (range)
11.5 (7–20)
Sex, male, n (%)
15 (50.0)
Still working, n (%)
14 (46.7)
Cohabiting, n (%)
21 (70.0)
Discharge location, n (%)
Home, no service
19 (63.3)
Home with service
7 (23.3)
Institution
4 (13.3)
Stroke severity, median (range)
24-h NIHSS
3.5 (0–5)
Admission NIHSS
1.5 (0–4)
Admission FIM total
119.5 (59–125)
FIM motor
88.0 (44–91)
FIM cognitive
31.5 (15–35)
Discharge FIM total
120.0 (77–125)
FIM motor
89.0 (56–91)
FIM cognitive
32.0 (21–35)
Discharge mRS
2 (2–4)
Moderate with
Severe with
response (n = 81) response (n = 56) p-value All severe
(n = 83) 64.8 (25.6–83.6) 67.2 (16.3–83.4) 0.08 66.0 (16.3–83.4) 0.06 65.6 (38.2–78.4)
57 (70.4)
21 (25.9)
3 (3.7) 30 (53.6)
23 (41.1)
3 (5.4) 0.0002 48 (57.8)
29 (34.9)
6 (7.2) 19 (67.9)
6 (21.4)
3 (10.7)
33 (40.7)
29 (35.8)
8 (9.9)
11 (13.6)
7 (8.6)/63
(77.8)/11 (13.6)
53 (65.4)/18
(33.4)/1 (1.2) 26 (46.4)
19 (33.9)
8 (14.3)
3 (5.4)
8 (14.3)/40
(71.4)/8 (14.3)
36 (64.3)/18
(32.1)/2 (3.6) 0.02 48 (57.8)
0.0008
19 (22.9)
12 (14.5)
4 (4.8)
14 (16.9)/56
0.43
(67.5)/13 (15.7)
56(67.5)/25
0.88
(30.1)/2 (2.4) 30.0 (7–143)
25.0 (3–90) 50.0 (11–219)
32.0 (10–102) 0.02
57.0 (11–238)
< 0.0001 30.0 (4–102) 0.0005
67.5 (13–238)
< 0.0001 21.5 (4–84)
60.0 (15–165)
11.0 (6–25)
45 (55.6)
30 (37.0)
49 (60.5) 88.5 (25–321)
11.0 (6–20)
27 (48.2)
19 (33.9)
31 (55.4) < 0.0001 91.0 (20–321)
0.64
10.0 (6–20)
0.67
44 (53.0)
0.50
27 (32.5)
0.42
50 (60.2) < 0.0001
0.60
0.83
0.39
0.58 27 (32.9)
38 (46.3)
16 (19.6) 6 (10.7)
19 (33.9)
31 (55.4) < 0.0001 6 (7.2)
24 (28.9)
53 (63.9) < 0.0001 0 (0.0)
5 (17.8)
23 (82.1)
9.0 (6–13)
6.0 (0–16)
101.0 (46–126)
73.0 (17–91)
30.0 (10–35)
115.0 (63–126)
82.0 (32–91)
32.0 (14–35)
3 (2–4) 19.0 (15–38)
11 (0–22)
66.0 (27–123)
42.0 (13–90)
26.0 (5–29)
86.0 (29–125)
57.0 (13–91)
27.5 (8–35)
4 (2–5) < 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001 20.0 (15–38)
12 (0–23)
64.0 (18–123)
41.0 (13–92)
23.0 (5–34)
79.0 (18–125)
55.0 (13–91)
24.0 (5–35)
4 (2–5) < 0.0001
< 0.0001
< 0.0001
<0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
< 0.0001
0.35
0.69
No response
p-value (n = 28*)
0.0009
22 (78.6)
1 (3.6)
4 (14.3)
1 (3.6)
6 (21.4)/16
(57.2)/6 (21.4)
20 (71.4)/7
(25.0)/1 (3.6)
97.0 (20–242)
9.0 (6–17)
18 (64.3)
8 (28.6)
19 (67.9)
21.0 (15–34)
14 (5–23)
48.5 (18–109)
38.5 (13–90)
12.5 (5–29)
66.5 (18–114)
51 (13–90)
18 (11–27)
4 (3–5)
*27 were severe at 24-h NIHSS grading, 1 moderate, but was graded severe on admission to rehabilitation. NIHSS: National Institutes of Health Stroke Scale
(0–42); FIM: Functional Independence Measure (total 0–126, motor 13–91, cognitive 5–35). mRS: modified Rankin scale 0–6.
J Rehabil Med 51, 2019