Activity among long-term stroke survivors. A study based on an ICF-oriented analysis of two established ADL and social activity instruments

Abstract

Purpose: To describe activity in different aspects of daily life among long-term stroke survivors, and conceptualise the content of the Barthel Index (BI) and the Swedish extended and modified Frenchay Activities Index (mFAI) using the ICF framework.

Method: Assessments were performed by means of the BI and the mFAI at a 10-year follow-up of 145 consecutive stroke survivors from Lund Stroke Register, Sweden. After linking the two instruments to the ICF core set for stroke, data were analysed and presented in terms of activity-specific domain-scores for the total sample and sub-groups according to gender and age.

Results: Together the two instruments covered 69% of the Activities and participation component of the ICF core set for stroke. Two activity-specific domains were identified within the BI and six within the mFAI. Most participants reported a high overall activity level. Inactivity was most common among those ≥80 years. Men and women participated in different types of activities and used different modes of transport.

Conclusions: Long-term stroke survivors have a high activity level in daily life, though individual variation is considerable. The structure provided by linking instruments to the ICF core set for stroke can be used for more fine-tuned descriptions of activity.

Implications for Rehabilitation

• Since most long-term stroke survivors are independent in ADL but may have limitations in other activity domains such as social and leisure activities, these aspects should be considered in the rehabilitation process.

• Older stroke survivors deserve special attention due to their higher risk of long-term inactivity.

• The Barthel Index and the Swedish extended and modified Frenchay Activities Index are complementary for assessments of ADL and social activity after stroke and cover over two thirds of the Activities and participation component in the ICF core set for stroke.

Keywords:

• Activities of daily living
• ageing
• Frenchay Activities Index
• International Classification of Functioning
• Disability and Health
• stroke
• 10-year follow-up

Acknowledgements

We thank the participants who willingly participated in the follow-up. Thanks are extended to LicSc V. Horstmann for valuable statistical advice.

Declaration of interest

The authors report no declarations of interest.

Funding was provided from the Freemasons Lodge of Instruction EOS in Lund, King Gustaf V and Queen Victoria’s Foundation; Faculty of Medicine, Lund University; Skåne University Hospital; Region Skåne; the Ribbingska Foundation in Lund; the Swedish Heart and Lung Foundation; the Swedish Stroke Association. This study was accomplished in the context of Centre for Ageing and Supportive Environments (CASE), financed by the Swedish Research Council for Health, Working Life and Welfare (Forte).