Stroke is one of the leading causes of disability. Using an understandable measure to describe subsequent disabilities, namely, activities of daily living (ADL), is important for clinical practice. The three studies in this dissertation describe ADL task disability of stroke survivors at 3 months post-stroke, from multiple perspectives. The first study compared the constructs of five commonly used ADL measurement tools which used different scoring systems and assessment methods. Rasch analysis, using the partial credit model, confirmed that the performance-based and task-specific (criterion-referenced) ADL assessment, Performance Assessment of Self-Care Skills (PASS), had excellent unidimensionality for measuring independence in stroke survivors. It was also more valid and reliable than the other informant-based, and global non-summative (Glasgow Outcome Scale, 5-point [GOS5], Glasgow Outcome Scale, 5-point [GOS8], Modified Rankin Scale [mRS]) and global summative (Barthel Index [BI]) measures. The second study went on to develop an item difficulty hierarchy with the combined items from the PASS and the BI, and establish the person abilities of the stroke survivors. Rasch analysis and common person equating method revealed that the PASS was more difficult for the stroke survivors than the BI, and the participants had the greatest difficulty performing PASS instrumental ADL (IADL). The third study further delineated the independence of the stroke survivors with left and right hemispheric stroke (LHS and RHS) at the overall, domain, and task levels of the PASS. Rasch analysis, differential group functioning, and differential item functioning showed that the LHS group performed significantly more independently than the RHS group in the functional mobility domain, and better, but not significantly better on the overall PASS, and the personal care, physical IADL, and cognitive IADL domains. The findings of clinically significant differences in specific tasks between the two stroke groups (side of lesion, gender, and age) will advance the knowledge related to specific disabilities of stroke survivors, especially for IADL tasks. Further studies were recommended to explore the independence of the stroke survivors in performing ADL subtasks, with more homogeneous samples and at multiple time points.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-04172008-114046 |
| Date | 19 May 2008 |
| Creators | Shih, Min-Mei |
| Contributors | James J. Irrgang, Joan C. Rogers, Margo B. Holm, Elizabeth R. Skidmore |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-04172008-114046/ |
| Rights | restricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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