title: The Burden of Stroke Scale (BOSS) provides valid and reliable score estimates of functioning and well-being in stroke survivors with and without communication disorders.
abstract: OBJECTIVE
  This study describes the conceptual foundation and psychometric properties of the Burden of Stroke Scale (BOSS), a patient-reported health status assessment designed to quantify the physical, cognitive, and psychological burden of stroke.
  
  
  METHODS
  Qualitative research methods were used to develop a 112-item pilot version of the instrument. The pilot version was administered to healthy controls (n=251) and stroke survivors with (n=135) and without (n=146) communication disorders on a single occasion for the purposes of reducing the global item pool, describing the resulting scale properties, examining the dimensionality of the burden of stroke construct, and examining the known-groups validity of the instrument.
  
  
  RESULTS
  Sixty-four items were retained, comprising 12 internally consistent and unidimensional scales. Principal components analysis revealed three second-order factors (Physical Activity Limitations, Cognitive Activity Limitations, and Psychological Distress) comprising the Burden of Stroke construct. Comparisons between groups revealed that stroke survivors reported greater activity limitations and psychological distress on all scales relative to controls, and that stroke survivors with communication disorders reported greater activity limitations on swallowing, communication, cognition, and social relations scales relative to non-communicatively disordered stroke survivors.
  
  
  CONCLUSIONS
  These findings support the internal consistency of the BOSS scales, the hypothesized dimensionality of the burden of stroke construct, and the known-groups validity of the instrument.
authors.affiliation: Geriatric Research Education & Clinical Center, VA Pittsburgh Healthcare System, 7180 Highland Drive, Pittsburgh, PA 15206, USA. patrick.doyle@med.va.gov
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Doyle
authors.forename: Malcolm R
authors.initials: MR
authors.lastname: McNeil
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Mikolic
authors.forename: Luis
authors.initials: L
authors.lastname: Prieto
authors.forename: William D
authors.initials: WD
authors.lastname: Hula
authors.forename: Amy P
authors.initials: AP
authors.lastname: Lustig
authors.forename: Katherine
authors.initials: K
authors.lastname: Ross
authors.forename: Julie L
authors.initials: JL
authors.lastname: Wambaugh
authors.forename: Leslie J
authors.initials: LJ
authors.lastname: Gonzalez-Rothi
authors.forename: Roberta J
authors.initials: RJ
authors.lastname: Elman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life; D012647:Self-Assessment; D020521:Stroke / Q000503:physiopathology* / Q000523:psychology