Journal of Rehabilitation Medicine 51-9 | Page 54

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S. Tarvonen-Schröder et al.
Table II. World Health Organization (WHO) Minimal Generic Set scores in mild, moderate, and severe stroke according to the 24-h
National Institutes of Health Stroke Scale (NIHSS) assessed by a neurologist
Variable Severe with response
Mild (n  =30)
Moderate (n  = 81) (n  = 56)
All severe (n  =83)
No response (n  =28)
Median (range; IQR) Median (range; IQR) Median (range; IQR) p-value Median (range; IQR) p-value Median (range; IQR)
Generic set sum score
Energy and drive functions
Emotional functions
Sensation of pain
Daily activities
Walking
Moving around
Remunerative employment 9.5
1.0
1.0
0.0
1.0
1.0
1.0
4.0
(4–18; 7, 12)
(0–3; 1, 2)
(0–3; 0, 1)
(0–2; 0, 1)
(0–2; 1, 2)
(0–3; 0, 1)
(0–3; 1, 2)
(2–4; 3, 4)
12.0 (4–21; 8, 14)
1.0 (0–3; 1, 2)
1.0 (0–3; 0, 1)
0.0 (0–3; 0, 1)
2.0 (0–3; 1, 2)
2.0 (0–4; 1, 3)
2.0 (0–4; 1, 3)
4.0 (1–4; 3, 4)
16.0 (6–26; 12.5, 19) < 0.0001 17.0 (6–27; 14, 20) < 0.0001 18.0 (11–27; 16, 23)
2.0 (0–3; 1, 2)
< 0.0001 2.0 (0–4; 1, 3)
< 0.0001 3.0 (0–4; 2, 3)
1.0 (0–3; 1, 2)
0.005 2.0 (0–3; 1, 2)
< 0.0001 2.0 (0–3; 1, 3)
0.0 (0–3; 0, 1)
0.057 0.0 (0–4; 0, 1)
0.004
1.0 (0–4; 0, 2)
3.0 (1–4; 2, 3)
< 0.0001 3.0 (1–4; 2, 3)
< 0.0001 3.0 (2–4; 2, 3)
3.0 (0–4; 2, 4)
< 0.0001 3.0 (0–4; 2, 4)
< 0.0001 3.0 (1–4; 3, 4)
3.0 (0–4; 2, 4)
< 0.0001 3.0 (0–4; 3, 4)
< 0.0001 4.0 (1–4; 3, 4)
4.0 (3–4; 4, 4)
0.0003 4.0 (3–4; 4, 4)
< 0.0001 4.0 (4–4; 4, 4)
IQR: 25 th and 75 th percentile.
according to 24-h NIHSS, i.e. including also the 27 reha-
bilitants without a WHODAS patient response. Finally,
a group of “patients not able to respond to WHODAS”
questionnaire (n = 28, i.e. 27 with severe and one with
moderate stroke at 24 h NIHSS assessment) with only
significant others’ responses was formed.
When disability was rated by a physician (Table II),
the overall disability and difficulties in all single items
were found to increase from mild to severe stroke.
Working ability was rated most affected, being very
severely impaired in all subgroups.
When functioning was rated by patients and their
significant others (WHODAS 2.0, Table III), the total
disability score (median) showed severe impairment in
all severity groups. Between-group differences, with
increasing impairment from mild to severe stroke, were
found in all other items, except for concentrating. The
most severely rated item was working ability, which
was severely to very severely impaired in all groups;
the only other items rated as severely affected were
mobility and household tasks in the “severe stroke”
group. Both significant others and a neurologist rated
non-respondent patients as having severe difficulties in
all assessed functions expect for moderate difficulties
in emotions and concentrating (Tables II and III).
The correlation coefficient between patient and
proxy WHODAS sum scores was strong (0.62, Table
IV). The correspondence between the answers of pa-
tients and their significant others was very strong to
strong for mobility, self-care and household tasks, and
moderate for all other functions, but weak for friend-
ships. Significant others rated standing (wK 0.53, 95%
confidence interval (95% CI) 0.43–0.62), learning (wK
0.35, 95% CI 0.25–0.46), joining in community (wK
0.41, 95% CI 0.30–0.51), concentrating (wK 0.26, 95%
CI 0.15–0.37), washing (wK 0.55, 95% CI 0.47–0.64),
and getting along (wK 0.25 95% CI 0.14–0.37) more
impaired than did the patients themselves.
In mild, moderate, and severe stroke groups, the corre-
lations between WHODAS patient and proxy sum scores
varied between moderate and very strong, being 0.39,
0.66, and 0.55, respectively. In severe stroke, the signifi-
Table III. Functioning assessed with patient and proxy World Health Organization Disability Assessment Schedule (WHODAS 2.0) (12
items) in mild, moderate, and severe stroke according to the 24-h National Institutes of Health Stroke Scale (NIHSS)
Patients
Variables
Mild
(n  = 30)
Significant others
Moderate
(n  = 81) Severe
n  = 56
15.0
(9, 23)
2.0 (0,
2.0 (1,
1.0 (1,
1.0 (0, 21.0
(17, 27)
2.0 (1, 4)
3.0 (1.5, 4)
1.0 (0, 2)
1.5 (0, 3)
Median (IQR) Median (IQR) Median (IQR) p-value
Total score
13.5
(0–48)
(7, 19)
Standing (0–4)
2.0 (0, 2)
Household tasks 1.0 (0, 3)
Learning
0.5 (0, 2)
Community life
0.0 (0, 1)
Emotional
functions
1.0 (1, 2)
Concentrating
1.0 (0, 2)
Walking
2.0 (0, 3)
Washing oneself 0.0 (0, 1)
Dressing oneself 0.0 (0, 1)
Dealing with
strangers
0.0 (0, 1)
Maintaining
friendships
0.0 (0, 1)
Working ability
4.0 (2, 4)
1.0
0.0
2.0
1.0
1.0
(0,
(0,
(0,
(0,
(0,
3)
3)
3)
2)
2)
2)
2)
4)
2)
2.0
1.0
4.0
2.0
2.0
(1,
(0,
(2,
(1,
(1,
Mild
(n  = 30)
Severe with
response
( n  =  56)
17.0
(10, 27)
2.0 (0, 4)
2.0 (1, 4)
1.0 (0, 2)
1.0 (0, 3) 28.5
(18, 35)
4.0 (1.5, 4)
4.0 (2, 4)
2.0 (0.5, 4)
2.0 (1, 4)
All severe
(n  = 83)
No response
(n  = 28)
Median (IQR) Median (IQR) Median (IQR) p-value Median (IQR) p-value Median (IQR)
13.0
0.0003 (7, 26)
0.21
1.5 (0,
0.001
1.0 (0,
0.38
1.0 (0,
0.02
1.0 (0,
2)
0.02
2)
0.38
4)
0.0004
3.5) < 0.0001
3)
< 0.0001
Moderate
(n  = 81)
1.0
1.0
1.5
0.0
0.0
(1,
(0,
(0,
(0,
(0,
3)
3)
2)
2)
2)
1)
3)
1)
1)
2.0
1.0
2.0
1.0
1.0
(1,
(0,
(0,
(0,
(0,
3)
2)
4)
3)
2)
2.0
1.0
4.0
3.0
2.5
(1,
(0,
(3,
(1,
(1,
< 0.0001
< 0.0001
< 0.0001
0.0004
< 0.0001
32.0
(22, 38)
4.0 (2, 4)
4.0 (3, 4)
2.0 (1, 3)
3.0 (1, 4)
4)
0.007
2.0 (1,
2.5) 0.24
1.0 (0,
4)
< 0.0001 4.0 (3,
4)
< 0.0001 3.0 (1,
4)
< 0.0001 3.0 (2,
3)
3)
4)
4)
4)
< 0.0001
< 0.0001
< 0.0001
0.0004
< 0.0001
0.007
0.08
< 0.0001
< 0.0001
< 0.0001
37.0
(36, 40)
4.0 (3, 4)
4.0 (4, 4)
3.0 (2, 3)
3.0 (2, 4)
3.0
2.0
4.0
3.0
3.0
(2,
(0,
(4,
(2,
(2,
3)
3)
4)
4)
3)
0.0 (0, 2) 0.0 (0, 1) 0.78 0.0 (0, 1) 1.0 (0, 2) 1.0 (0, 2) 0.0008 2.0 (0, 3) 0.0008 3.0 (2, 3)
0.0 (0, 1)
3.0 (2, 4) 0.0 (0, 1)
3.0 (2, 4) 0.86
0.17 0.5 (0, 1)
3.0 (2, 4) 0.0 (0, 1)
3.0 (1, 4) 1.0 (0, 2)
4.0 (3, 4) < 0.0001 2.0 (0, 3)
< 0.0001 4.0 (4, 4) < 0.0001 3.0 (2, 3)
< 0.0001 4.0 (4, 4)
IQR: 25 th and 75 th percentile.
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