title: Rasch validation of a combined measure of basic and extended daily life functioning after stroke.
abstract: BACKGROUND
  Tools used to measure poststroke functional status must include basic and instrumental activities of daily living and reflect the patient's and the clinician's perspective of the disease and its effect on daily living performance.
  
  
  OBJECTIVE
  The authors combined the Functional Independence Measure (FIM) and the Nottingham Extended Activities of Daily Living (NEADL) to create a scale providing a comprehensive evaluation of ADLs functional status in patients with stroke.
  
  
  METHODS
  The study participants were 188 patients completing the FIM and the NEADL. The psychometric properties of the combined measure were examined with Rasch analysis.
  
  
  RESULTS
  A 3-point scale and a dichotomous scale were suggested for use in the FIM and the NEADL, respectively. The combined 40 items worked consistently to reflect a single construct, and "bladder management" and "bowel management" were highly related. After "bowel management" was removed from the combined scale, all but 3 items fit the model's expectations, and the 39-item scale showed reasonable item difficulty hierarchy, with high reliability. The 3 misfit items were removed, and no differences in unidimensionality, differential item functioning, and reliability were found between the 36-item and 39-item scales.
  
  
  CONCLUSIONS
  The combined measure of the FIM and the NEADL provides a comprehensive picture of ADLs. It extends the utility of the FIM and the NEADL and is recommended for use to measure the independence of patients after discharge home.
authors.affiliation: Hong Kong Institute of Education, Hong Kong.
authors.forename: Hui-fang
authors.initials: HF
authors.lastname: Chen
authors.forename: Ching-yi
authors.initials: CY
authors.lastname: Wu
authors.forename: Keh-chung
authors.initials: KC
authors.lastname: Lin
authors.forename: Chia-ling
authors.initials: CL
authors.lastname: Chen
authors.forename: Pai-chuan
authors.initials: PC
authors.lastname: Huang
authors.forename: Ching-ju
authors.initials: CJ
authors.lastname: Hsieh
authors.forename: Jung-sen
authors.initials: JS
authors.lastname: Liu
mesh_terms: D000015:Abnormalities, Multiple / Q000209:etiology / Q000628:therapy; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D003286:Contracture / Q000209:etiology / Q000628:therapy; D004185:Disability Evaluation; D019066:Facies; D005260:Female; D005901:Glaucoma / Q000209:etiology / Q000628:therapy; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010291:Paresis / Q000209:etiology / Q000534:rehabilitation; D011594:Psychometrics; D015203:Reproducibility of Results; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications / Q000523:psychology; D000071939:Stroke Rehabilitation