Stroke Impact Scale
Original Editor - Carina Therese Magtibay
Top Contributors - Carina Therese Magtibay
Objective[edit | edit source]
The Stroke Impact Scale (SIS) is a patient-reported outcome measure that evaluates the biopsychosocial aspects of life after stroke. [1] It is designed by Duncan et al at the University of Kansas Medical Center (KUMC) in 1999, first published as version 2.0.[2] The original 64-item tool was shortened to be 59-item after a Rasch analysis process, creating the current version 3.0.[3]
For patients who are unable to answer, there is a proxy version available called Stroke Impact Scale-16.[4]
Intended Population[edit | edit source]
The tool is intended for post-stroke patients, administered repeatedly over time to track changes.
Method of Use[edit | edit source]
Equipment required: Questionnaire and pen
Time to administer: 15-20 minutes
Instructions: Rate the level of difficulty of completing an item in the past 2 weeks following a 5-point Likert scale:
- 1 = could not do it at all
- 2= very difficult
- 3= somewhat difficult
- 4= a little difficult
- 5= not difficult at all
Domains:
The questionnaire consists of 59 items that assess 8 domains:
- Strength (4 items)
- Hand function (5 items)
- ADL/IADL (10 items)
- Mobility (9 items)
- Communication (7 items)
- Emotion (9 items)
- Memory and thinking (7 items)
- Participation/Role function (8 items)
There is an extra question that asks "On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?"
Scoring:
- Summative scores are generated for each domain, scores ranging from 0-100.
- Formula for each scale:
- Transformed Scale = [(Actual raw score - lowest possible raw score) / Possible raw score range] x 100
Note: There are three items under emotion domain (3f, 3h and 3i) that must be reverse-scored
Evidence[edit | edit source]
Reliability[edit | edit source]
Test/Retest Reliability[edit | edit source]
- Duncan et al (1999) at 1, 3 and 6 months post-stroke findings for SIS 2.0:[2]
- Adequate to Excellent test-retest reliability (ICC = 0.70 to 0.92), with exception of emotion domain having moderate reliability (ICC=0.57).[2]
- Edwards and O'connell (2003) supports the findings of Duncan et al for SIS 2.o and SIS-16:[5]
- Adequate to Excellent test-retest reliability in all domains except for the emotion domain that showed Poor test-retest reliability.
- Vellone et al (2015) findings for SIS 3.0:[6]
- Good test-retest reliability (ICC .79 for global stroke recovery and .98 for cognitive factor).
Interrater/Intrarater Reliability[edit | edit source]
- Carod-Artal et al (2009) for SIS 3.o:[7]
- Excellent interrater reliability for hand function (ICC = 0.82) and mobility (ICC = 0.80) domains
- Adequate interrater reliability for strength (ICC = 0.61), ADL/IADL (ICC = 0.74), and memory and thinking (ICC = 0.43) domains
- Poor interrater reliability for communication (ICC = 0.39), emotion (ICC = 0.17), and social participation (ICC = 0.29) domains
Internal Consistency[edit | edit source]
- Duncan et al (1999) SIS version 2.0, Acute Stroke:[2]
- Excellent: Cronbach's alpha range in all 8 domains: 0.83 to 0.90
- Carod-Artal et al (2009) Chronic Stroke:[7]
- Excellent internal consistency for 7 domains:
- Strength (ICC = 0.82)
- Hand function (ICC = 0.95)
- Mobility (ICC = 0.94)
- ADL/IADL (ICC = 0.87)
- Memory (ICC = 0.92)
- Communcation (ICC = 0.84)
- Social participation (ICC = 0.85)
- Adequate interrater reliability for emotion domain (ICC = 0.49)
- Excellent internal consistency for 7 domains:
- Vellone et al (2015), Chronic Stroke:[6]
- Excellent internal consistency ranging from 0.89 to 0.98.
- Richardson et al (2016), Subacute Stroke:[8]
- Excellent internal consistency at all timepoints
- Cronbach’s alpha > 0.81.
- Composite Physical Functioning score was excellent at all timepoints (Cronbach’s alpha > 0.95)
- Excellent internal consistency at all timepoints
- MacIsaac et al (2016), Acute Stroke:[9]
- Excellent internal consistency (Cronbach’s alpha > .93).
Validity[edit | edit source]
Criterion Validity[edit | edit source]
Concurrent Validity[edit | edit source]
- Vellone et al (2015), Chronic Stroke:[6]:
- Excellent correlations between the SIS 3.0 Cognitive factor and the Mini-Mental Status Exam using Pearson’s correlation coefficient (r= 0.69)
- Excellent correlations between the SIS 3.0 Physical factor and the Barthel Index and Instrumental Activities of Daily Life scale using Pearson’s correlation coefficient (r = 0.69)
- Excellent correlations between the SIS 3.0 Emotional factor and the HADS-Anxiety and HADS-Depression using Pearson’s correlation coefficient (r = 0.68 and 0.67, respectively).
- Richardson et al (2016), Subacute Stroke:[8]
- Excellent correlations: Pearson’s correlation coefficient upon admission, 6th month, and 12 month follow-up with the 5-level EuroQoL (r= 0.618 to 0.760).
Predictive Validity[edit | edit source]
- Lee et al (2015), Subacute Stroke:[10]
- When compared with other personal parameters and functional outcomes, SIS showed greatest accuracy (70%) and highest cross-validated accuracy (81.43%) in predicting QOL post stroke.
Construct Validity[edit | edit source]
- MacIsaac et al (2016):[9]
- For acute stroke, Excellent correlations with the following measures:
- mRS (p=-0.87, -0.80, respectively)
- BI (p=0.89, 0.80)
- NIHSS (p=-0.77, -0.73)
- EQ-5D (p=0.88, 0.82)
- EQ-VAS (p=0.73, 0.72)
- For subacute stroke, Excellent correlations with the following measures:
- BI (p=0.72, 0.65, respectively)
- EQ-5D (p=0.69, 0.69)
- For subacute stroke, Moderate correlations with the following measures:
- SIS-VAS (p=0.56, 0.57)
- EQ-VAS (p=0.46, 0.40)
- For acute stroke, Excellent correlations with the following measures:
Content Validity[edit | edit source]
The Landon Center on Aging KUMC developed SIS with the input from patients, caregivers and healthcare professionals.[2]
Responsiveness[edit | edit source]
- Lin, Fu, et al (2010), Chronic Stroke:[11]
- Medium responsiveness found for hand function subscale (SRM = 0.52; Wilcoxon Z = 4.24; p < 0.05)
- Compared to Stroke Specific Quality of Life Scale, SIS total score was significantly larger (SRM difference = 0.36; 95% CI, 0.02-0.71)
- Guidetti et al (2014), Chronic Stroke:[12]
Clinically significant positive and negative change from 3 to 12 months post stroke:
| Domain | positive change | negative change |
|---|---|---|
| Participation | 27.5% | 20% |
| Recovery | 29.4% | 10.3% |
| Strength | 23% | 14.7% |
| Hand Function | 18% | 14.2% |
Links[edit | edit source]
Stroke Impact Scale version 3.0
References[edit | edit source]
- ↑ Mulder M, Nijland R. Stroke impact scale. Journal of physiotherapy. 2016;2(62):117.
- ↑ 2.0 2.1 2.2 2.3 2.4 Duncan PW, Wallace D, Lai SM, Johnson D, Embretson S, Laster LJ. The stroke impact scale version 2.0: evaluation of reliability, validity, and sensitivity to change. Stroke. 1999 Oct;30(10):2131-40.
- ↑ Duncan PW, Bode RK, Lai SM, Perera S, Glycine Antagonist in Neuroprotection Americas Investigators. Rasch analysis of a new stroke-specific outcome scale: the Stroke Impact Scale. Archives of physical medicine and rehabilitation. 2003 Jul 1;84(7):950-63. BibTeXEndNoteRefManRefWorks
- ↑ Duncan PW, Lai SM, Tyler D, Perera S, Reker DM, Studenski S. Evaluation of proxy responses to the Stroke Impact Scale. Stroke. 2002 Nov 1;33(11):2593-9.
- ↑ Edwards B, O'connell B. Internal consistency and validity of the Stroke Impact Scale 2.0 (SIS 2.0) and SIS-16 in an Australian sample. Quality of Life Research. 2003 Dec;12:1127-35.
- ↑ 6.0 6.1 6.2 Vellone E, Savini S, Fida R, Dickson VV, Melkus GD, Carod-Artal FJ, Rocco G, Alvaro R. Psychometric evaluation of the stroke impact scale 3.0. Journal of Cardiovascular Nursing. 2015 May 1;30(3):229-41.
- ↑ 7.0 7.1 Carod-Artal FJ, Coral LF, Trizotto DS, Moreira CM. Self-and proxy-report agreement on the Stroke Impact Scale. Stroke. 2009 Oct 1;40(10):3308-14.
- ↑ 8.0 8.1 Richardson M, Campbell N, Allen L, Meyer M, Teasell R. The stroke impact scale: performance as a quality of life measure in a community-based stroke rehabilitation setting. Disability and rehabilitation. 2016 Jul 2;38(14):1425-30.
- ↑ 9.0 9.1 MacIsaac R, Ali M, Peters M, English C, Rodgers H, Jenkinson C, Lees KR, Quinn TJ, VISTA Collaboration. Derivation and validation of a modified short form of the stroke impact scale. Journal of the American Heart Association. 2016 May 20;5(5):e003108.
- ↑ Lee HJ, Song JM. The Korean language version of stroke impact scale 3.0: Cross-cultural adaptation and translation. Journal of the Korean Society of Physical Medicine. 2015;10(3):47-55.
- ↑ Lin KC, Fu T, Wu CY, Hsieh YW, Chen CL, Lee PC. Psychometric comparisons of the stroke impact scale 3.0 and stroke-specific quality of life scale. Quality of Life Research. 2010 Apr;19:435-43.
- ↑ Guidetti S, Ytterberg C, Ekstam L, Johansson U, Eriksson G. Changes in the impact of stroke between 3 and 12 months post-stroke, assessed with the Stroke Impact Scale. J Rehabil Med. 2014 Nov 1;46(10):963-8.
