Clinical Assessment of Function among Women with a Recent Cerebrovascular Event: A Self-Reported versus Performance-Based Measure

4 June 2002 | Volume 136 Issue 11 | Pages 802-811

Background: Self-reported functional status is a commonly used health measure in clinical settings, yet the optimal approach for assessing function is often debated.

Objective: To examine the agreement between a self-reported and a performance-based measure of function and the relative ability of each measure to predict long-term health outcomes.

Design: Prospective cohort study.

Setting: 20 hospitals in Connecticut and Massachusetts.

Participants: 620 postmenopausal women (46 to 91 years of age) who had experienced a stroke or transient ischemic attack.

Measurements: A self-reported and a performance-based measure of function were assessed at baseline (before intervention) by using the Barthel index and the Physical Performance Test.

Results: Disagreement between the self-reported and performance-based measure of function was common (slight disagreement, 55.0%; substantial disagreement, 19.3%). Most women (95.4%) overreported their level of function. Women who were more clinically impaired (risk ratio [RR] for more comorbid conditions, 1.52 [95% CI, 1.17 to 1.97]; RR for recent stroke, 2.33 [CI, 1.45 to 3.73]; and RR for cognitive impairment, 1.76 [CI, 1.34 to 2.32]); who were less educated (RR = 1.30 [CI, 1.02 to 1.67]); and who were of nonwhite ethnicity (RR 1.43 [CI, 1.07 to 1.91]) were more likely to overreport their level of function. An impaired performance-based measure of function predicted subsequent stroke or death (hazard ratio, 1.50, [CI, 1.06 to 2.11]); however, an impaired self-reported measure of function was not likely to predict these outcomes.

Conclusions: Clinicians should be aware that results of self-reported and performance-based measures of function can differ in women who have experienced a recent cerebrovascular event. Although more difficult to collect, results of a performance-based measure may provide information about long-term health outcomes that is not available from a self-reported measure.

Editors' Notes Context Assessment of patients' functional capacity is essential to identify needs for care after a cerebrovascular event. Although often used, measures based on patient report of functional status may not adequately assess some patients' function. Contribution Researchers compared function measured by self-report and by a clinician watching the patients perform standardized activities. The two measures often disagreed. Women tended to report better function than the performance measure showed. A performance-based test predicted future stroke or death. A self-reported measure of function did not. Implications Clinicians should be aware that women may report better function after a cerebrovascular event than a performance test would show. –The Editors

 

Author and Article Information

From Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland; Yale University School of Medicine, New Haven, Connecticut; and the Veterans Administration Connecticut Healthcare System, West Haven, Connecticut.

Note: Dr. Ralph I. Horwitz is a member of John D. and Catherine T. MacArthur Foundation Network on Socioeconomic Status and Health.

Disclaimer: Although the principal author is currently employed at the Agency for Healthcare Research and Quality, this study was conceived and designed, the data were analyzed, and the manuscript was written while the principal author was a doctoral student at Yale University and postdoctoral fellow at Johns Hopkins University.

Grant Support: By a grant from the National Institute of Neurological Diseases and Stroke (RO1-N531251), a grant from Meade Johnson Laboratories, and training grants from the National Institute of Mental Health (5T32-MH15783 and 5T32-MH19545).

Requests for Single Reprints: Pamela L. Owens, PhD, Agency for Healthcare Research and Quality, 2101 East Jefferson, Suite 605, Rockville, MD 20852; e-mail, POwens{at}ahrq.gov.

Current Author Addresses: Dr. Owens: Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, 2101 East Jefferson, Suite 605, RM 6W42, Rockville, MD 20852.

Drs. S.M. Horwitz and Bradley: Yale University School of Public Health, 60 College Street, New Haven, CT 06520-8034.

Drs. Kernan, Viscoli, and R.I. Horwitz: Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, PO Box 208056, New Haven, CT 06520-8056.

Dr. Sarrel: Departments of Psychiatry and Obstetrics and Gynecology, Yale University School of Medicine, 333 Cedar Street, PO Box 208063, New Haven, CT 06520-8063.

Dr. Brass: Department of Neurology, LCI-700, Yale University School of Medicine, 20 York Street, Box 208018, New Haven, CT 06520-8018.

Author Contributions: Conception and design: P. Owens, S.M. Horwitz, W.N. Kernan, P.M. Sarrel, R.I. Horwitz.

Analysis and interpretation of the data: P. Owens, S.M. Horwitz, C.M. Viscoli, W.N. Kernan, P.M. Sarrel, R.I. Horwitz.

Drafting of the article: E.H. Bradley, S.M. Horwitz, C.M. Viscoli, R.I. Horwitz.

Critical revision of the article for important intellectual content: P. Owens, E.H. Bradley, S.M. Horwitz, C.M. Viscoli, W.N. Kernan, L.M. Brass, P.M. Sarrel, R.I. Horwitz.

Final approval of the article: P. Owens, E.H. Bradley, S.M. Horwitz, C.M. Viscoli, W.N. Kernan, L.M. Brass, P.M. Sarrel, R.I. Horwitz.

Provision of study materials or patients: C.M. Viscoli, W.N. Kernan, L.M. Brass, P.M. Sarrel, R.I. Horwitz.

Statistical expertise: P. Owens, C.M. Viscoli.

Obtaining of funding: L.M. Brass, R.I. Horwitz.

Administrative, technical, or logistic support: W.N. Kernan, L.M. Brass.

Collection and assembly of data: C.M. Viscoli, W.N. Kernan, L.M. Brass, P.M. Sarrel.