Short ICF-based measures in subacute stroke
Table IV. Spearman’s correlation coefficients of sum scores of the measures used (n = 195, only in World Health Organization Disability
Assessment Schedule (WHODAS) patient n = 167)
Discharge
24-h
NIHSS
NIHSS 24-h
NIHSS admission
WHODAS patient sum
Proxy sum
WHO Minimal Generic Set
mRS
0.63
0.30
0.44
0.55
0.52
Discharge/admission
Admission WHODAS
NIHSS
patient sum WHODAS
proxy sum WHO Minimal
Generic Set
0.63 0.44
0.50
0.62 0.55
0.64
0.60
0.72
0.42
0.50
0.64
0.69
0.30
0.42
0.62
0.60
0.49
0.72
0.67
0.79
mRS FIM total FIM motor FIM
cognitive
0.52
0.69
0.49
0.67
0.79 –0.58
–0.64/–0.77
–0.51
–0.70
–0.82
–0.77 –0.55
–0.63/–0.75
–0.52
–0.70
–0.81
–0.77 –0.51
–0.49/–0.51
–0.31
–0.53
–0.62
–0.55
All correlations were significant at the level of p < 0.001.
NIHSS: National Institutes of Health Stroke Scale; mRS: modified Rankin scale; FIM: Functional Independence Measure; WHO: World Health Organization.
cant others rated standing (wK=0.39, 95% CI 0.22–0.55),
and working ability (wK=0.26, 95% CI 0.09–0.44) more
impaired than the patients; otherwise we did not find any
systematic differences in the levels of ratings by patients
and proxies in different severity groups.
The Spearman’s correlation coefficients between
different measures (WHODAS, the WHO Minimal Ge-
neric Set, NIHSS, FIM and mRS) were mostly strong
to very strong, except for patient-rated WHODAS and
NIHSS, or FIM cognitive sub-score (Table IV). The 6
WHODAS life domains’ and the 2 components´ corre-
lations with sum scores of other measures were mostly
strong (Table V). Cronbach’s alpha value for reliability
of the sum scores of patient-rated WHODAS, proxy-
rated WHODAS, and physician-rated WHO Minimal
Generic Set were 0.88, 0.93 and 0.85, respectively.
DISCUSSION
679
This study compared the shortest generic ICF-based
measures of functioning (the 12-item WHODAS 2.0
and the WHO Minimal Generic Set of domains of fun-
ctioning and health) with traditionally used measures of
dependence and severity of stroke. The results support
the utility of both generic measures in subacute stroke
rehabilitants. The degree of impairment was found
to increase from mild to severe stroke. Both short
measures were strongly associated with conventional
measures of stroke severity and dependence. Patient
and proxy WHODAS ratings also mostly correlated
well with each other, better in activities such as mobi-
lity, household tasks and self-care than in participation,
relationships and cognition. In severe stroke, working
ability was rated more impaired according to signifi-
cant others and a physician than according to patients
themselves.
The relationship between the stroke severity scale
NIHSS and different dependence measures has been
poorly understood (11). The results of the current study,
which show a strong inverse relationship between
NIHSS and FIM scores, are in line with a recent study
of patients with acute stroke (8). In previous stroke tri-
als, NIHSS score has also been associated with scores
of dependence measures, such as BI and mRS, as well
as the Glasgow Outcome Scale at 90 days (11, 32). In
the same way, the current study found clear correlations
between different outcome measures in subacute phase
of stroke. In addition to cross-sectional correlations,
a clear relationship was found between acute phase
NIHSS and other outcome measures 2–3 months later:
dependence measures FIM and mRS, but also the fun-
ctioning measures WHODAS and the WHO Minimal
Generic Set ratings. These results suggest that using the
shortest form of WHODAS is in agreement with other
Table V. Spearman correlation coefficients between patient (n = 167) and proxy (n = 195) World Health Organization Disability Assessment
Schedule (WHODAS) domains and components and sum scores of the other measures used
Discharge
24-h
NIHSS
WHODAS domains (patient/proxy)
Understanding and communicating 0.20*/0.33
Getting around
0.26***/0.37
Self-care
Getting along with people
Life activities
Participation in society
WHODAS components
Activities
Participation
Admission
NIHSS
FIM total
FIM motor
FIM cognitive mRS WHO Minimal
Generic Set
–0.32/–0.45 0.14 a /0.24*** –0.20*/–0.43 –0.11 a /–0.39 0.24**/0.43
0.45/0.50 –0.20*/–0.60
–0.66/–0.78 –0.60/–0.63
–0.67/–0.82 –0.10 a /–0.33
–0.33/–0.42 0.16*/0.37 0.40/0.44
0.53/0.60 0.55/0.69
0.63/0.75 0.61/0.70
0.71/0.79
0.14 a /0.37
0.21**/0.48
0.30/0.37 0.11 a /0.35
0.33/0.58
0.27***/0.39 –0.15 a /–0.41
–0.40/–0.71
–0.29/–0.53 –0.09 a /–0.35
–0.47/–0.73
–0.25**/–0.52 –0.33/–0.49
–0.09a/–0.47
–0.26***/–0.44 0.09 a /0.41
0.41/0.69
0.27***/0.51 0.11 a /0.43
0.49/0.73
0.41/0.54
0.39/0.48
0.26***/0.48 0.46/0.52
0.29***/0.51 –0.59/–0.74
–0.32/–0.63 –0.61/–0.78
–0.32/–0.61 –0.28***/–0.45
–0.21**/–0.53 0.58/0.72
0.33/0.60 0.66/0.76
0.45/0.65
a
Not significant. *p < 0.05, **p < 0.01, ***p < 0.001, otherwise p < 0.0001.
NIHSS: National Institutes of Health Stroke Scale; FIM: Functional Independence Measure; mRS: modified Rankin Scale; WHO: World Health Organization.
J Rehabil Med 51, 2019