Evaluating Function in Women after a Stroke Using Two Different Types of Measures

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The summary below is from the full report titled "Clinical Assessment of Function among Women with a Recent Cerebrovascular Event: A Self-Reported versus Performance-Based Measure." It is in the 4 June 2002 issue of Annals of Internal Medicine (volume 136, pages 802-811). The authors are P Owens, EH Bradley, SM Horwitz, CM Viscoli, WN Kernan, LM Brass, PM Sarrel, and RI Horwitz.

What is the problem and what is known about it so far?

When health care providers are trying to determine how well a patient can function, they often just ask the patient about whether he or she has trouble with daily activities, such as eating, dressing, bathing, or walking. These types of measures are known as patient self-report. Other ways to evaluate a patient's function involve actually observing whether the patient can complete a task. These types of measures are known as performance-based tests. It is unknown which method is better for identifying patients who are having difficulty.

Why did the researchers do this particular study?

To compare assessments of patient physical function using patient self-report and performance-based measures.

Who was studied?

620 women aged 46 to 91 years who had suffered a stroke or a transient ischemic attack (mini-stroke). In stroke and transient ischemic attacks, a section of the brain does not get enough blood. A stroke permanently damages the brain, but a transient ischemic attack is temporary.

How was the study done?

The researchers evaluated each woman's level of function using both a self-report and a performance-based test. They then compared the results of the two tests for each woman.

What did the researchers find?

Disagreement between the self-report and performance-based tests was common. Almost all of the disagreement was related to women whose self-report test suggested better function than their performance-based test. For example, a patient said she had no trouble walking, but the performance test showed that she did have trouble walking. Poor function on the performance-based test predicted future stroke or death, whereas poor self-reported function did not.

What were the limitations of the study?

This study included only women with stroke and may not apply to other types of patients. Also, the study used only one specific self-report and one performance test of the many that exist. The results might not apply to other tests.

What are the implications of the study?

Health care providers should be aware that different tests of patient function can produce different results. Some patients may overestimate how well they are doing.