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RehabMeasure Instrument

Stroke Impact Scale-- 16

Purpose

To assess physical function following stroke.

Link to Instrument

Acronym SIS-16

Area of Assessment

Activities of Daily Living

Assessment Type

Patient Reported Outcomes

Cost

Free

Cost Description

Link to request permission in Description

Populations

Key Descriptions

  • The SIS-16 consists of 16 items from the 4 physical domains (strength, hand function, mobility, and ADL/IADL) on the SIS 3.0
  • Request permission: http://www.kumc.edu/school-of-medicine/preventive-medicine-and-public-health/research-and-community-engagement/stroke-impact-scale/sis-download.html

Number of Items

16

Equipment Required

  • Standardized form (and permission to access)

Time to Administer

5-10 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Initial review completed by Karen Vizaniaris, Jacqueline Kendona, and Tara Ruppert, December 2016. Reviewed and revised by Edeth Engel, October 2017.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living

Considerations

  • The SIS-16 measures only physical domains of functional status.  The SIS 3.0 may be more appropriate if measuring overall HRQOL.

  • More sensitive than Barthel Index for differentiating and identifying deficits with mild strokes

  • SIS-16 has a larger spread of item difficulty for more severe stroke than the Short Form - 36 Physical Functioning scale (Lai, et al, 2003)

  • Can be completed by proxy

  • Can be used to guide clinical intervention due to established MCID

Stroke

back to Populations

Standard Error of Measurement (SEM)

Acute and Chronic Stroke:

(Chou et al, 2015, n = 263; mean age = 59.8 (13) years; time since stroke <3mo = 47% of n;  Acute and Chronic Stroke)

  • SEM = 4.8

Minimal Detectable Change (MDC)

Acute and Chronic Stroke:

 (Chou e al, 2015)

  • SRD = 13.2

 

Ischemic Stroke:

(Katzan et al, 2016; n = 3308; other demographics unavailable; ischemic stroke)

  • MDC >= 8

Minimally Clinically Important Difference (MCID)

Subacute Stroke:

(Fulk et al, 2010. n = 36; mean age = 60.9 (15.6) years); mean time since stroke = 58.9 (47.1) days; Subacute Stroke)

  • MCID between 9.4 - 14.1

Normative Data

Acute and Chronic Stroke:

(Chou et al, 2015)

  • Mean = 71.8 (25.1)

Acute Stroke:

(Vellone et al, 2015; n = 392; mean age = 71.2 (11.0); mean time since stroke =  20 (12-38) days)

SIS 3.0 Factors

Mean (SD)

Physical

32.7±25.3

Cognitive

63.3±24.3

Emotional

53.9±19.9

Social Participation

35.6±23.3

Stroke Global Recovery

40.9±22.5

Chronic Stroke:

(Edwards and O'Connell, 2003; n = 74; mean age = 58.35 (14.80) years; mean time since stroke = 56.8 months; Anglo-Saxon Australian sample)

  • Mean = 74.1 (21.1)

Subacute Stroke:

(Huang et al, 2010; n = 58; mean age = 56.42 (11.67) years; mean time since stroke = 17.85 (7-88) months)

  • Mean = 61.97 98 (12.27)

Test/Retest Reliability

Acute and Chronic Stroke:

(Chou et al, 2015)

  • Excellent: ICC = 0.95

Internal Consistency

Acute  and Chronic Stroke:

(Chou et al, 2015)

  • Excellent: Cronbach’s alpha = 0.94

Ischemic Stroke:

(Katzan et al, 2016; n=1,946; mean age = 63.1 (14.2) years; 31% within 90 days of stroke)

  • Excellent: Cronbach’s alpha = 0.96; 95% CI

Acute Stroke:

(Duncan et al, 2003; n = 621; mean age = 68 (12.4) years; mean time since stroke = 1-3 months)

  • Excellent:  Cronbach’s alpha = 0.94

Chronic Stroke:

(Edwards and O’Connell, 2003)

  • Excellent: Cronbach’s alpha = 0.92

Criterion Validity (Predictive/Concurrent)

Acute stroke:

(Ward et al, 2011; n=30; mean age = 66.5 (13.7) years; mean time since stroke = 7.8 (3.5) days)

  • SIS-16 and STREAM both predictive of length of stay in inpatient rehabilitation facility

Construct Validity

Acute Stroke

(Ward et al, 2011)

  • Stroke Rehabilitation Assessment of Movement Scale (STREAM)

    • Admission scores = good (r=0.7073)

    • Discharge scores = good (r=0.7153)

    • Change scores = adequate (r=0.4456)

Chronic stroke:

(Edwards and O’Connell, 2003)

  • WHOQOL-BREF domains:

  • Physical - good (r=0.65)

  • Psychological - adequate (r=0.42)

  • Social Relationships - poor (r=0.18)

  • Environment - adequate (r=0.50)

  • Zung Self-rating Depression Scale = poor (r=-0.33)

(Lai et al, 2003; n=278; mean age = 72.5 (10.1) years; mean time since stroke = 90-120 days)

  • Barthel Index = good (r= 0.75)

Acute and Chronic Stroke:

(Chou et al, 2015)

  • NIHSS = good (r=-0.62)

  • MMSE = poor (r=0.24)

(Katzan et al, 2016)

  • Patient Reported Outcomes Measurement Information System physical function (PROMIS PF) = excellent (r=0.90; 95% CI)

  • NIH Stroke Scale (NIHSS) = adequate (r=-0.45)

  • EuroQol-5 dimensions (EQ-5D) = good (r=0.78)

  • Patient Health Questionnaire-9 (PHQ-9) = good (r=0.60)

  • Modified Rankin Scale (mRS) = adequate (r=0.63)

  • SIS-16 able to discriminate across mRS categories

Content Validity

(Duncan et al, 2003) Rasch analysis was used to select 16 items from the physical composite domain of the Stroke Impact Scale 3.0 to create the SIS-16.  Items for the Stroke Impact Scale were developed through focus groups and expert review.)

Face Validity

Items consist of ADLs and IADLs directly impacted by physical functioning.

Floor/Ceiling Effects

Acute and Chronic Stroke:

(Chou et al, 2015)

  • Adequate = ceiling 14%

(Katzan et al, 2016)

  • Adequate = ceiling 19.6%

  • Excellent = floor 0.36%

Acute Stroke:

(Duncan et al, 2003)

  • Excellent = no floor/ceiling effects

Chronic Stroke:

(Lai et al, 2003)

Excellent = no floor/ceiling effects

Bibliography

Chou, C., Ou, Y., & Chiang, T. (2015). “Psychometric comparisons of four disease-specific health-related quality of life measures for stroke survivors.” Clinical Rehabilitation 29(8):  816-829. 

Duncan, P. W., Lai, S. M., et al.  (2003).  “Stroke Impact Scale-16:  A brief assessment of physical function.”  Neurology 60(2): 291-296.  

Edwards, B., and O’Connell, B.  (2003).  “Internal consistency and validity of the Stroke Impact Scale 2.0 and SIS 16 in an Australian sample.”  Quality of Life Research 12(8): 1127-1135. 

Fulk, G. D., Ludwig, M., et al.  (2010).  “How much change in the stroke impact scale-16 is important to people who have experienced a stroke?”  Topics in Stroke Rehabilitation 17(6): 477-483. 

Huang, Y. H., Wu, C. Y., et al. (2010). "Predictors of change in quality of life after distributed constraint-induced therapy in patients with chronic stroke." Neurorehabil Neural Repair 24(6): 559-566.

Katzan, I. L., Fan, Y., Uchino, K., and Griffith, S. D.  (2016).  “The PROMIS physical function scale: A promising scale for use in patients with ischemic stroke.”  Neurology 86: 1801-1807. 

Katzan, I., Thompson, N., and Uchino, K. (2016).  “Abstract 186: PROs in Clinical Practice: SIS-16 Better at Detecting Change in Functional Status than the Modified Rankin.”  Stroke 47(Suppl 1):  A186. 

Lai, S. M., Perera, S., Duncan, P. W., and Bode, R.  (2003).  “Physical and social functioning after stroke: Comparison of the Stroke Impact Scale and Short Form-36.”  Stroke 34(2): 488-493.

Vellone, E., Savini, S., et al.  (2015).  “Psychometric evaluation of the Stroke Impact Scale 3.0.”  Journal of Cardiovascular Nursing 30(3): 229-241. 

Ward, I., Pivko, S., Brooks, G., and Parkin, K.  (2011).  “Validity of the Stroke Rehabilitation Assessment of Movement Scale in acute rehabilitation:  A comparison with the Functional Independence Measure and Stroke Impact Scale-16.”  Physical Medicine & Rehabilitation 3:  1013-1021.