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a Department of
Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle
upon Tyne NE1 4LP, UK, b Department of Clinical Neuroscience, University
of Edinburgh, Scotland
Correspondence to: Dr Paul Dorman pauljdorman{at}hotmail.com
Received 10 November
1999 and in revised form 10 April 2000;
Accepted 20 April
2000
OBJECTIVES
Two
"simple questions" were developed as a minimalist measurement tool
to assess outcome in large trials and epidemiological studies after
stroke. A previous study of their validity had disclosed ambiguities in
their wording. In this study, the clarity, validity, and reliability of
a modified version of these simple questions were examined. The
relation between patients' responses to these questions and two widely
used generic measures of health related quality of life were also studied.
METHODSA hospital
based stroke register cohort of 152 patients, who were all visited at
home by a study nurse, was used to study validity. A cohort of 1753 patients derived from the International Stroke Trial was used to study
the relation with measures of quality of life. The sensitivity,
specificity, and accuracy with which responses to each question
predicted the patients' outcome measured using standard instruments
was assessed. The distribution of scores for the EuroQol and SF-36 was
examined for patients classified as dependent, independent, and fully
recovered by the combined use of the modified simple questions.
RESULTSThe modified
"dependency" question had excellent sensitivity (>85%),
specificity (>79%), and accuracy (>82%) for identifying dependency
after stroke. The "problems" question had good sensitivity (65-88%) and moderate specificity (36-72%) for the detection of problems in a broad range of domains. The combined use of the modified
dependency and problems questions provided a valid, simple, and
reliable overall indicator of health related quality of life after stroke.
CONCLUSIONSThe
modified simple questions have excellent face validity and good
measurement properties for the assessment of outcome after stroke. They
are particularly well suited for large epidemiological studies and
randomised trials.
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