BACKGROUND/RATIONALE:
Approximately 11,000 veterans annually are hospitalized with a newly acquired incident stroke. Based on American Heart Association ratios of stroke incidence and prevalence, up to 80,000 veterans may be stroke survivors. The assessment of outcomes in stroke survivors is important for clinical practice and research, yet there is no consensus on the best measures of stroke outcome in either clinical practice or research. We have developed a new stroke-specific outcome measure, the Stroke Impact Scale (SIS), to capture physical function and other dimensions of health-related quality of life.

OBJECTIVE(S):
The major research questions in this investigation are: 1) Does the SIS have concurrent and discriminate validity in a veteran stroke population when compared to the FIM, Rankin, and the SF-36V? 2) What effect does mode of administration have on response rates, bias, data quality, reliability and validity, SIS domain scores, and cost of data collection? 3) What factors differentiate responders and non-responders? 4) Will the SIS scores predict health care costs and utilization?

METHODS:
Using ICD-9 discharge codes and electronic medical records, patients were screened for a valid diagnosis of stroke. At three months post-stroke, patients were randomly assigned to receive a mailed SIS instrument or SIS via telephone interview. At four months post-stroke, all respondents were evaluated using the Functional Independence Measure and SF-36V by telephone.

FINDINGS/RESULTS:
Four hundred fifty-eight of 943 screened subjects in 13 VA sites of care were identified to have stroke and were randomly assigned to either a mail (n=223) or telephone survey (n=235). Response rate to the mailed survey was 44 percent and 58 percent for the telephone survey.

IMPACT:
Establishing the feasibility and use of the SIS in a veteran population is the first step in quantifying meaningful outcomes for VA stroke patients. Once established, the SIS could be used as a universal, multi-dimension stroke outcome tool to assess patient outcomes and assist in the measurement of provider performance, best practices, cost-effectiveness of stroke interventions, and quality of care.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Kwon S, Hartzema AG, Duncan PW, Min-Lai S. Disability measures in stroke: relationship among the Barthel Index, the Functional Independence Measure, and the Modified Rankin Scale. Stroke; A Journal of Cerebral Circulation. 2004 Apr 1; 35(4):918-23. [view]
2. Hayes J, Vogel B, Reker DM. Factors associated with VHA costs of care for first 12 months after first stroke. Journal of rehabilitation research and development. 2008 Jan 1; 45(9):1375-84. [view]
3. Jia H, Uphold CR, Wu S, Reid K, Findley K, Duncan PW. Health-related quality of life among men with HIV infection: effects of social support, coping, and depression. AIDS Patient Care and Stds. 2004 Oct 1; 18(10):594-603. [view]
4. Kwon S, Duncan P, Studenski S, Perera S, Lai SM, Reker D. Measuring stroke impact with SIS: construct validity of SIS telephone administration. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2006 Apr 1; 15(3):367-76. [view]
5. Duncan P, Reker D, Kwon S, Lai SM, Studenski S, Perera S, Alfrey C, Marquez J. Measuring stroke impact with the stroke impact scale: telephone versus mail administration in veterans with stroke. Medical care. 2005 May 1; 43(5):507-15. [view]
6. Duncan PW, Reker DM, Horner RD, Samsa GP, Hoenig H, LaClair BJ, Dudley TK. Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale. Clinical rehabilitation. 2002 Aug 1; 16(5):493-505. [view]

Conference Presentations

1. Jia H, Uphold CR, Findley K, Wu SS, Reid KJ, Duncan PW. Health-Related Quality of Life in Veterans Living with HIV: The Role of Coping, Social Support, and Depression. Paper presented at: VA HSR&D National Meeting; 2003 Feb 14; Washington, DC. [view]
2. Kwon S, Duncan PW, Reker DM, Lai SM, Studenski SA, Perera S, Alfrey C, Marquez J. Measuring Health Related Quality of Life in Veterans with Stroke. Poster session presented at: American Heart Association Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke Annual Scientific Sessions; 2004 May 1; Washington, DC. [view]
3. Kwon S, Reker DM, Lai SM, Perera S, Studenski SA, Alfrey C, Marquez J, Duncan PW. Measuring Health Related Quality of Life in Veterans with Stroke. Paper presented at: VA HSR&D National Meeting; 2004 Mar 11; Washington, DC. [view]
4. Kwon S, Duncan PW, Reker DM, Lai SM, Studenski SA, Perera S, Alfrey C, Marquez J. Measuring Health Related Quality of Life in Veterans with Stroke. Poster session presented at: VA HSR&D National Meeting; 2005 Feb 13; Baltimore, MD. [view]
5. Kwon S, Reker DM, Lai SM, Studenski SA, Perera S, Duncan PW. Measuring Stroke Impact With SIS: Validity of SIS Telephone Administration. Paper presented at: VA HSR&D National Meeting; 2005 Feb 18; Baltimore, MD. [view]

DRA: Health Systems
DRE: Epidemiology
Keywords: Chronic disease (other & unspecified), VA/non-VA comparisons
MeSH Terms: none