title: Poor concurrence between disabilities as described by patients and established assessment tools three months after stroke: a mixed methods approach.
abstract: BACKGROUND
  Disability/problems, one phenomenon underlying people's need for health care services, can be viewed both from the perspectives of people with stroke (felt problems), and the health professionals (assessed problems).
  
  
  OBJECTIVE
  The aim was to describe felt problems three months after stroke and to explore the concurrence between felt problems and assessed problems.
  
  
  METHODS
  The patients (n=203) received care in the stroke units at Karolinska University Hospital, Sweden. Felt problems, drawn from an open question, were categorized. Results from established assessment tools: Katz Extended Index of ADL (KI); Barthel Index (BI) and Stroke Impact Scale (SIS) represented assessed problems. Items/domains in the assessment tools that corresponded to the categories of felt problems were identified and comparisons performed.
  
  
  RESULTS
  The category Fatigue had the largest number of felt problems (n=58, 28%). Fourteen out of the 24 categories of felt problems had corresponding items/domains in the assessment tools. KE/BI failed to identify 16-57% and SIS 0-33% of the felt problems.
  
  
  CONCLUSIONS
  There was a substantial lack of concurrence between felt and assessed problems. The results indicate that the use of standardized instruments should be complemented by a dialog if health services are to be based on problems experienced by the patients.
authors.affiliation: Karolinska Institutet, Department of Neurobiology, Care Sciences and Society, Division of Occupational Therapy, Fack 23 200, 141 83 Huddinge, Sweden. malin.tistad@ki.se
authors.forename: Malin
authors.initials: M
authors.lastname: Tistad
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
authors.forename: Kerstin
authors.initials: K
authors.lastname: Tham
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006233:Persons with Disabilities; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods / Q000592:standards; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D011795:Surveys and Questionnaires / Q000592:standards*; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult