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Stroke Patients May Over-Report Function

Many stroke patients who considered themselves to be functionally independent were considered to be functionally dependent on a performance-based measure.

It often is said that 90% of the information needed for diagnosis is in a patient's history. Many questionnaires have been validated to supplement the standard medical history with assessments of physical function. But, are such questionnaires as useful as observations of physical performance? Researchers compared a self-report measure (Barthel index) with the Physical Performance Test in 620 postmenopausal women with recent strokes or transient ischemic attacks and, then, followed the cohort prospectively.

Agreement between the 2 measures was poor (weighted statistic, 0.28). For example, among 458 women with Barthel scores consistent with functional independence, the Physical Performance Test indicated that 97 were independent, 257 were slightly dependent, 89 were moderately dependent, and 15 were severely dependent. Almost all women whose measures disagreed had over-reported their functional levels. In a multivariable model, decreased functional level determined by the Physical Performance Test was associated significantly with time to recurrent stroke and death (hazard ratio, 1.5), whereas self-reported function was not.

Comment: These results raise questions that may have implications beyond functional capacity and prognosis for stroke patients. Whether the disagreement between self-report and direct observation applies to tests other than those studied here is unknown. Because results are more difficult to obtain from performance-based tests than from self-report measures, further research should address this issue.

— Richard Saitz, MD, MPH

Published in Journal Watch General Medicine June 18, 2002

Citation(s):

Owens PL et al. Clinical assessment of function among women with a recent cerebrovascular event: A self-reported versus performance-based measure. Ann Intern Med 2002 Jun 4; 136:802-11.

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