Do Commonly Used Functional Outcome Measures Capture Activities that Are Relevant for People with Stroke in India?

Abstract

Objectives: In India, post-stroke outcomes are determined using functional outcome measures (FOMs), the contents of which have not been validated for their relevance to the Indian population. In this study, we aimed to evaluate the cultural validity of five frequently used stroke-specific FOMs by comparing their contents with the problems reported by patients with stroke in India.

Methods: Face-to-face structured interviews were conducted with 152 patients diagnosed with stroke in India. Problems and goals identified by the patients were compared to each item included in the FOMs used in stroke rehabilitation.

Results: The Stroke Impact Scale (SIS) and the Frenchay Activities Index (FAI) include items related to the most frequently identified problems. However, neither covers problems related to the need for squatting and sitting on the floor. Use of public transport and community walking are not included in the SIS. Leisure and recreational activities (e.g. gardening, reading books), cognitive and speech functions (e.g. memory, thinking) and bowel and bladder dysfunctions were the common items identified as “not a problem” or “not relevant” by the patients.

Discussion: Our findings suggest that the SIS and FAI are the most appropriate FOMs for patients with stroke in India as they include items related to the majority of problems identified by study participants. Many items on both measures, however, were identified as not a problem or not relevant. There is a need for developing culture-specific FOMs that incorporate all major concerns expressed by patients with stroke in India.

Keywords:

• stroke
• outcome measures
• functional outcomes
• India
• cultural validity
• stroke rehabilitation
• Stroke Impact Scale
• Frenchay Activities Index

Acknowledgements

The authors thank Dr. Susan R. Harris, Ms. Sweni Shah, and Ms. Shivani Bhatt for their assistance in editing an earlier version of this article and Ms. Vandita Soni for her assistance during data collection.