Dynamic interactions between impairment and activity after stroke: examining the utility of decision analysis methods.
OBJECTIVE
To examine the utility of decision analysis methods for examining the dynamic nature of impairment-activity interactions following stroke.


METHODS
Decision analyses (Chi-squared Automatic Interaction Detector) of a prospective cohort study.


METHODS
Community and institutional settings based on the location of participants three months after stroke.


METHODS
Individuals were recruited from consecutive admissions to a regional academic health center and were assessed three months after stroke (N= 67).


METHODS
Neurological impairment was measured with the National Institutes of Health Stroke Scale (NIHSS). Mobility, self-care and instrumental activities of daily living (instrumental ADL) performance were assessed with a performance observation measure, the Performance Assessment of Self-care Skills (PASS). Decision analysis methods were used to examine interactions between neurological impairments and activity outcomes.


RESULTS
Unique neurological impairments were associated with each activity outcome (bowel and bladder urgency interacted with mobility; hand function interacted with self-care; mental functions interacted with instrumental ADL), and these findings are supported by previous studies. The predictive validity of mobility and self-care analyses was stronger than the instrumental ADL analyses.


CONCLUSIONS
Decision analysis methods show promise for understanding dynamic impairment--activity interactions. This understanding may enhance methods for informing rehabilitation decisions.
Skidmore
Elizabeth R
ER
Department of Occupational Therapy, University of Pittsburgh, 5012 Forbes Tower, Pittsburgh, PA 15260, USA. skidmore@pitt.edu
Rogers
Joan C
JC
Chandler
Lynette S
LS
Holm
Margo B
MB
D000203:Activities of Daily Living; D003661:Decision Support Techniques; D003663:Decision Trees; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012648:Self Care; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome