Clinical assessment of function among women with a recent cerebrovascular event: a self-reported versus performance-based measure.
BACKGROUND
Self-reported functional status is a commonly used health measure in clinical settings, yet the optimal approach for assessing function is often debated.


OBJECTIVE
To examine the agreement between a self-reported and a performance-based measure of function and the relative ability of each measure to predict long-term health outcomes.


METHODS
Prospective cohort study.


METHODS
20 hospitals in Connecticut and Massachusetts.


METHODS
620 postmenopausal women (46 to 91 years of age) who had experienced a stroke or transient ischemic attack.


METHODS
A self-reported and a performance-based measure of function were assessed at baseline (before intervention) by using the Barthel index and the Physical Performance Test.


RESULTS
Disagreement between the self-reported and performance-based measure of function was common (slight disagreement, 55.0%; substantial disagreement, 19.3%). Most women (95.4%) overreported their level of function. Women who were more clinically impaired (risk ratio [RR] for more comorbid conditions, 1.52 [95% CI, 1.17 to 1.97]; RR for recent stroke, 2.33 [CI, 1.45 to 3.73]; and RR for cognitive impairment, 1.76 [CI, 1.34 to 2.32]); who were less educated (RR = 1.30 [CI, 1.02 to 1.67]); and who were of nonwhite ethnicity (RR 1.43 [CI, 1.07 to 1.91]) were more likely to overreport their level of function. An impaired performance-based measure of function predicted subsequent stroke or death (hazard ratio, 1.50, [CI, 1.06 to 2.11]); however, an impaired self-reported measure of function was not likely to predict these outcomes.


CONCLUSIONS
Clinicians should be aware that results of self-reported and performance-based measures of function can differ in women who have experienced a recent cerebrovascular event. Although more difficult to collect, results of a performance-based measure may provide information about long-term health outcomes that is not available from a self-reported measure.
Owens
Pamela L
PL
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. POwens@ahrq.gov
Bradley
Elizabeth H
EH
Horwitz
Sarah M
SM
Viscoli
Catherine M
CM
Kernan
Walter N
WN
Brass
Lawrence M
LM
Sarrel
Philip M
PM
Horwitz
Ralph I
RI
D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000209:etiology; D015897:Comorbidity; D004522:Educational Status; D005006:Ethnicity; D005080:Exercise Test; D006801:Humans; D002546:Ischemic Attack, Transient / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology*; D008875:Middle Aged; D017698:Postmenopause; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012647:Self-Assessment; D020521:Stroke / Q000208:ethnology / Q000503:physiopathology / Q000523:psychology*