Development of a hierarchical activities of daily living scale for Chinese stroke patients in geriatric day hospitals

Abstract

A culture-specific 4-point hierarchical scale covering self-care, household activity and mobility was developed by modifying the River-mead ADL scale to assess the physical function of Chinese stroke patients. Self-care ability (13 items scored 0/1/2/3 with a maximum of 39) and mobility (8 items scored 0/1/2/3 with a maximum of 24) were routinely assessed by occupational therapists and physiotherapists in stroke patients on admission to and at discharge from two geriatric day hospitals (GDHs). Household activity (6 items scored 0/1/2/3 with a maximum of 18) was assessed by occupational therapists in non-institutionalized patients with self-care scores within 15% of the maximum. The scale was acceptable to patients and staff. Graphical representation in profile format facilitates the identification of items requiring special attention. Internal reliability was high; the Cronbach’s alpha for the self-care, household and mobility domains was 0.9732, 0.9530, and 0.9787, respectively. The scale was used to assess the change in physical function of 436 stroke patients discharged from two GDHs in Hong Kong over 18 months. Patients’ mean age was 73 years (SD±8.4), and the female/male ratio 1:3. On average, 38 visits (±32) were made over a mean enrollment period of 220 days (±289). Both the self-care and mobility scores showed statistically significant improvements at discharge, and changes in function exceeded 1/4 of the standard deviation of the initial scores. A substudy of 28 stroke patients, in whom household scores were assessed, revealed that for those with better initial physical function, a ceiling effect was apparent with the self-care score but not with the household or mobility scores. In conclusion, this hierarchical scale was internally reliable and sensitive to changes in physical function of stroke patients treated in GDHs. (Aging Clin. Exp. Res. 7: 173-178, 1995) © 1995, Springer Internal Publishing Switzerland. All rights reserved.