BackgroundReliable and valid outcome measures are needed to be able to evaluate recovery, effects of rehabilitation interventions, and changes over time. The ABILHAND Questionnaire is a measure of a patient's self‐reported ability to perform complex daily activities involving use of the hand. This instrument is commonly used in stroke rehabilitation settings, but data about the measurement variability are missing.ObjectiveTo assess the test‐retest reliability of the ABILHAND Questionnaire in persons with chronic stroke and to define limits for the smallest change that indicates a real change, both for a group of individuals and for a single individual.DesignA test‐retest reliability study.SettingsUniversity hospital.ParticipantsA convenience sample of 43 persons (11 women and 32 men; mean age 64 years) with mild to moderate impairments of hand function 6‐48 months after sustaining a stroke.InterventionNot applicable.Main Outcome MeasurementsThe ABILHAND Questionnaire is Rasch analyzed, enabling ordinal data to be converted into an interval scale (logits) and the use of parametric statistical analyses. The participants responded to 23 items in the ABILHAND Questionnaire on 2 occasions, 2 weeks apart. Reliability was assessed with the intraclass correlation coefficient (ICC22.1), the mean difference between the test sessions (đ) together with the 95% confidence intervals for đ, the standard error of measurement (SEM and SEM%), the smallest real difference (SRD and SRD%), and a Bland and Altman graph.ResultsFour outliers with high mean logit scores (>4.0) were identified in the sample. The results therefore are presented both for the entire sample (n = 43) and without the 4 outliers (n = 39). The test‐retest agreement was high: ICC2,1 = 0.85 (n = 43) and 0.91 (n = 39). The SEM%, which represents the smallest change that indicates a real improvement for a group of individuals, was 21% (n = 43) and 15% (n = 39). The SRD%, which represents the smallest change that indicates a real clinical improvement for a single individual, was 59% (n = 43) and 42% (n = 39), respectively.ConclusionThe ABILHAND Questionnaire is reliable in persons with chronic stroke and can be recommended to evaluate recovery, rehabilitation interventions, and changes over time in a group of individuals but is less suitable for a single individual.
BackgroundDespite that disability of the upper extremity is common after stroke, there is limited knowledge how it influences self-perceived ability to perform daily hand activities. The aim of this study was to describe which daily hand activities that persons with mild to moderate impairments of the upper extremity after stroke perceive difficult to perform and to evaluate how several potential factors are associated with the self-perceived performance.MethodsSeventy-five persons (72 % male) with mild to moderate impairments of the upper extremity after stroke (4 to 116 months) participated. Self-perceived ability to perform daily hand activities was rated with the ABILHAND Questionnaire. The perceived ability to perform daily hand activities and the potentially associated factors (age, gender, social and vocational situation, affected hand, upper extremity pain, spasticity, grip strength, somatosensation of the hand, manual dexterity, perceived participation and life satisfaction) were evaluated by linear regression models.ResultsThe activities that were perceived difficult or impossible for a majority of the participants were bimanual tasks that required fine manual dexterity of the more affected hand. The factor that had the strongest association with perceived ability to perform daily hand activities was dexterity (p < 0.001), which together with perceived participation (p = 0.002) explained 48 % of the variance in the final multivariate model.ConclusionPersons with mild to moderate impairments of the upper extremity after stroke perceive that bimanual activities requiring fine manual dexterity are the most difficult to perform. Dexterity and perceived participation are factors specifically important to consider in the rehabilitation of the upper extremity after stroke in order to improve the ability to use the hands in daily life.
BackgroundDifferences in stroke care and health outcomes between men and women are debated. The objective of this study was to explore the relationship between patients’ sex and post-stroke health outcomes and received care in a Swedish setting.MethodsPatients with a registered diagnosis of acute intracerebral hemorrhage (ICH) or ischemic stroke (IS) within regional administrative systems (ICD-10 codes I61* or I63*) and the Swedish Stroke Register during 2010–2011 were included and followed for 1 year. Data linkage to multiple other data sources on individual level was performed. Adjustments were performed for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity in multivariate regression analyses of health outcomes and received care. Health outcomes (e.g., survival, functioning, satisfaction) and received care measures (regional and municipal resources and processes) were studied.ResultsStudy population: 13,775 women and 13,916 men. After case-mix adjustments for the above factors, we found women to have higher 1-year survival rates after both IS (ORfemale = 1.17, p < 0.001) and ICH (ORfemale = 1.65, p < 0.001). Initial inpatient stay at hospital was, however, shorter for women (βfemale, IS = − 0.05, p < 0.001; βfemale, ICH = − 0.08, p < 0.005). For IS, good function (mRS ≤ 2) was more common in men (ORfemale = 0.86, p < 0.001) who also received more inpatient care during the first year (βfemale = − 0.05, p < 0.001).ConclusionsA lower proportion of women had good functioning, a difference that remained in IS after adjustments for age, socioeconomic factors, living arrangements, ADL dependency, and stroke severity. The amount of received hospital care was lower for women after adjustments. Whether shorter hospital stay results in lower function or is a consequence of lower function cannot be elucidated. One-year survival was higher in men when no adjustments were made but lower after adjustments. This likely reflects that women were older at time of stroke, had more severe strokes, and more disability pre-stroke—factors that make a direct comparison between the sexes intricate.Electronic supplementary materialThe online version of this article (10.1186/s13293-018-0170-1) contains supplementary material, which is available to authorized users.
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