Rasch validation of a combined measure of basic and extended daily life functioning after stroke

Background: Tools used to measure poststroke functional status must include basic and instrumental activities of daily living (ADL) and reflect both the patient’s and the clinician’s perspectives. Aims and Keywords: This study combined the Functional Independence Measure (FIM) and the Nottingham Extended Activities of Daily Living (NEADL) to create a scale providing objective and subjective evaluations of ADL function after stroke. Samples: A total of 188 participants, who completed the NEADL and the FIM, was included in the present study. Those patients met the inclusion criteria: (1) first-ever stroke, (2) Brunnstrom stage II or above for the proximal and distal upper extremity, (3) no severe physical conditions and medical problems, (4) no cognitive impairment, and (5) no excessive spasticity at any joint of the arm. Methods: Rasch analysis was conducted to investigate the psychometric properties of the new scale. Results: A 3-point and a dichotomous scale were suggested for use in the FIM and the NEADL, respectively. The combined 40 items worked consistently to reflect a single construct, and “bladder management” and “bowel management” were highly related. After “bowel management” was removed, all but 3 items fit the model’s expectations and showed reasonable item difficulty hierarchy with high reliability. However, the 3 misfit items were removed, and no differences were found between the 36-item and 39-item scales. Conclusions: The combined measure provides a comprehensive picture of ADL from patients’ and clinicians’ perspectives. It extends the utility of the FIM and the NEADL and is recommended for use to measure independence of stroke patients.