Functional assessment after stroke: Examining outcome models using the International Classification of Functioning, Disability and Health

Despite the growing body of evidence that identifies best practices in stroke management and rehabilitation, many individuals continue to experience chronic loss of function, and the secondary effects of long-term disability resulting from stroke. Therefore, the Institute of Medicine's Transforming Health Care Quality Initiative has called for improvements in the consistency and efficiency with which stroke rehabilitation services are provided (Institute of Medicine Committee on Identifying Priority Areas for Quality Improvement, 2003). Realization of this initiative begins with examining patterns of functional recovery following stroke. However, a systematic review of stroke outcome studies examining functional outcomes within the first 3 months revealed that variations in measurement constructs, measurement methods, and analysis methods yielded complex and sometimes conflicting results.; Therefore, the International Classification of Functioning, Disability and Health (ICF; (World Health Organization, 2001) was used as a framework for examining stroke-related functioning and disability to: (1) explore multiple analytical models for examining associations between activity and participation, body functions, and body structures among individuals who sustained a stroke, (2) examine the differential impact of measurement method on the assessment of activity and participation, body functions, and body structures among individuals who sustained a stroke, and (3) examine methods of analysis that may be useful for examining associations between components of functioning and disability.; Three feasibility studies were designed to address these aims. The findings of these studies support the use of analytical models based on the ICF for future studies examining the associations between body structures and body functions and activity/participation outcomes. Further, Exhaustive CHAID appears to be a promising method of data analysis for testing these models. However, the findings of this study suggest that further examination of the impact of measurement method on the outcome of these analytical models is required. Knowledge gained from further study of these models and methods may enhance efforts to improve the efficiency and consistency of stroke rehabilitation assessment practices.