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Measuring Health Related Quality of Life in Veterans with Stroke

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.


Objectives: The study purpose was to examine response rate, response bias, reliability, and the validity of the Stroke Impact Scale (SIS) in a veteran stroke population using two modes of administration: mail and telephone.Methods: Stroke patients were identified using national VA administrative data and ICD-9 diagnosis codes in 13 participating VA sites of care. Stroke was confirmed by reviewing electronic medical records. Each patient was randomized to SIS administration of telephone or mail mode at 12 weeks post stroke. The FIM and SF-36V were administered at 16 weeks post stroke via telephone in both groups.Results: A total of 943 patients were screened for a valid stroke diagnosis; 458 individuals were validated and randomized into two administration groups. Response rate for mail was 45%, and 69% for the telephone. Mail non-responders had more severe stokes, more cognitive deficits, and more often were unmarried. No differences were observed between telephone responders and non-responders. Test-retest reliability was good to excellent in the mail group (.77-.99), except participation (.62) and excellent in the telephone mode (.90-.99), except emotion (.68). Concurrent and discriminant validity of SIS when compared to Rankin, SF-36V, and FIM was better in the telephone group.Conclusions: This research supports that telephone mode of survey administration yielded a higher response rate, lower bias, and stronger validity estimates. However, the costs for telephone administration are three times the cost of mail.Impact: This research suggests telephone survey of the SIS as a reliable and valid instrument for stroke outcomes assessment in the VA.

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