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BACKGROUND: SATIS-Stroke questionnaire has been translated and adapted for use in the Brazilian population, however, it is necessary to test the measurement properties in Brazilian population. OBJECTIVE: To test the reliability, agreement, concurrent validity, and diagnostic accuracy of the SATIS-Stroke. METHODS: Chronic stroke survivors were included. The calculations were made using scores in logits (Rasch Model). Reliability was tested using the intraclass correlation coefficient (ICC(2,1)), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman plots. Concurrent validity was analyzed using Spearman's correlation coefficient. For such, the correlation between SATIS-Stroke and Stroke Specific Quality of Life (SS-QOL) questionnaires was determined. Diagnostic accuracy was estimated based on the area under the receiver operating characteristic (ROC) curve with a 95% confidence interval and considering the sensitivity and specificity of SATIS-Stroke in differentiating different types of activity and participation. RESULTS: Eighty stroke survivors were analyzed. Mean age was 57.98±13.85 years and 45.2% had severe impairment. Excellent reliability was found (intra-observer ICC(2,1) = 0.90; 95% CI: 0.84, 0.93; inter-observer ICC(2,1) = 0.89; 95% CI: 0.83, 0.93). The Bland-Altman plot demonstrated satisfactory agreement. In the analysis of concurrent validity, a strong, positive, significant correlation was found between SATIS-Stroke and SS-QOL (r(s) = 0.74; p

Background/aims This study aimed to estimate the discriminatory power of 26 items on the Stroke Specific Quality of Life Scale questionnaire to evaluate the participation component of the International Classification of Functioning, Disability and Health. Methods A prospective study was conducted using accuracy procedures based on the Standards for Reporting Diagnostic Accuracy Studies to evaluate individuals with hemiparesis stemming from a stroke. Discriminatory power was estimated based on the area under the receiver operating characteristic curve with a 95% confidence interval. Two groups were defined for the analysis: community-dwelling and institutionalised individuals. A 5% level of significance (α=0.05) was considered for all analyses. Results The area under the receiver operating characteristic curve was 0.888 (95% confidence interval: 0.794–0.949; P=0.001). Analysis indicated a cut-off point of ≥80 with 73.9% sensitivity and 100% specificity. Conclusions The 26 items of the Stroke Specific Quality of Life questionnaire that evaluate the participation component of the International Classification of Functioning, Disability and Health demonstrate adequate discriminatory power. A cut-off point of ≥80 seems to best discriminate the perception of participation between community-dwelling and institutionalised stroke survivors.

Propose a way of coding and qualifying HRQoL following a stroke using the codes and qualifiers of the International Classification of Functioning, Disability and Health (ICF).An observational, cross-sectional study was conducted involving 51 individuals with hemiparesis resulting from a stroke. ICF codes related to the Stroke Specific Quality of Life (SS-QOL) scale were listed and subsequently classified using the generic ICF qualifiers, which range from .0 - no impairment to .4 - complete impairment. A simple mathematic calculation was proposed to convert the SS-QOL scores into ICF qualifiers.The use of the ICF qualifiers revealed that the individuals exhibited a moderate level (.2) of quality of life, with mild impairment (.1) regarding upper limb function, language, self-care, and vision as well as severe impairment (.3) regarding social relations.The proposal presented in this study allowed qualifying 43 ICF codes related to quality of life after a stroke in a simple, standardized manner, enabling the identification of different levels of impairment on each of the domains of the SS-QOL scale. This coding standardizes the evaluation, facilitates communication between healthcare providers, and systematizes the collection of data and information on health.Implications for rehabilitationProposal for qualifying concepts related to body functions, activityparticipation, and environmental factors in a simple, standardized manner.The proposed mathematic calculation is simple and easy to understand, which minimizes the occurrence of errors.Possibility to identify different levels of impairment in each of the domains of the Stroke Specific Quality of Life scale, facilitating the establishment of individualized, longitudinal care.The ICF codes standardize the evaluation, facilitate communication between healthcare providers, and systematize the collection of data and information on health and functioning.

Identify how environmental barriers and facilitators are associated with disability in stroke survivors.An analytical, cross-sectional study was conducted involving individuals in the chronic stage of stroke. The dependent variable was disability, which was assessed using the World Health Organization Disability Assessment Schedule (WHODAS-2.0). Environmental factors (independent variable) were evaluated using the Measure of the Quality of the Environment (MQE). Multiple linear regression analysis was performed to estimate the impact of the environment on disability following a stroke.Seventy-five individuals (mean age: 54.2 + 9.8 years) were analyzed. The most frequent environmental facilitators were related to technology, social networks, and public services. The main barriers were related to the physical environment. Environmental barrier was a predictor of both overall disability [F(1.73) = 4.24; REnvironmental barriers explained 13% of the variation in restrictions to social participation and were also a significant predictor of overall disability. The main barriers were related to the physical environment. Identifying environmental factors related to disability in stroke victims can assist in the planning of guided therapy.

O fator ambiental constitui o ambiente físico, social e atitudinal em que indivíduo vive e conduz sua vida, incluindo barreiras e/ou facilitadores. A qualidade de vida é um construto amplo que envolve vários fatores, dentre eles o ambiental. A relação entre qualidade de vida relacionada à saúde (QVRS) após Acidente Vascular Cerebral (AVC) e fatores ambientais ainda é pouco explorada. Conhecer essa relação pode facilitar o processo de avaliação e planejamento de intervenções para melhora da QVRS desses indivíduos. Objetivo: Investigar a associação entre fatores ambientais e QVRS de indivíduos com AVC, na fase crônica, usuários da atenção primária à saúde de Belo Horizonte (BH)/Brasil. Métodos: Fatores ambientais foram avaliados pelo Measure of the Quality of Environment (MQE) e a QVRS pela Escala de Qualidade de Vida Específica para Acidente Vascular Encefálico (EQVE-AVE). Correlação de Spearman foi utilizada para investigar a associação entre fatores ambientais e QVRS (escore total e dos domínios do EQVE-AVE) (α=5%). Resultados: Foram encontradas associações significantes, negativas e de fraca magnitude entre fatores ambientais considerados como obstáculos com o escore total do EQVE-AVE (p =0,001; rho = -0,33) e com os domínios de mobilidade (p =0,01 rho = -0,33) e trabalho/produtividade do EQVE-AVE (p =0,03; rho = -0,28). Conclusão: Fatores ambientais e QVRS possuem associação significante, ainda que seja de fraca magnitude. Portanto, fatores ambientais considerados como obstáculos, devem ser considerados na abordagem da QVRS de indivíduos na fase crônica após AVC, usuários da atenção primária à saúde do Brasil. Quality of life is a broad and comprehensive construct that involves several factors, including the environmental factor. However, the relationship between health-related quality of life (HRQoL) of individuals after stroke and environmental factors is still poorly understood. Knowing this relationship can facilitate the process of evaluating and planning interventions to improve HRQoL of these individuals. Objective: To investigate the association between environmental factors and HRQoL of individuals after stroke who use the primary health care in Belo Horizonte/Brazil. Methods: Environmental factors were assessed by the Measure of the Quality of Environment (MQE) and the HRQoL by the Stroke Specific Quality of Life Scale (SS-QOL). Spearman's correlation was used to investigate the association between environmental factors and HRQoL (total score and SS-QOL domains) (α = 5%). Results: Significant, negative and low associations were found between environmental factors considered as obstacles with the total SS-QOL score (p = 0.001; rho = -0.33), with the mobility (p = 0.01 rho = -0.33) and work/productivity domains of the HRQoL(p = 0.03; rho = -0.28). Conclusion: Therefore, environmental factors and HRQoL have a significant association, even if it is of low magnitude. Thus, environmental factors considered as obstacles, should be considered, along with other factors related to health and functioning when addressing the HRQoL of individuals in the chronic phase after stroke who use the Brazilian primary health care system.

Purpose: Transcranial Direct Current Stimulation (tDCS) is an intervention that seems to be an ideal tool to enhance the effects of rehabilitation therapies given it facilitates generation of plasticity in the stimulated brain area. In stroke this strategy has been highly utilized; however, the results have been mixed. In this trial we have evaluated the analgesic and functional effects of Transcranial Direct Current Stimulation (tDCS) combined with physiotherapy in stroke survivors with shoulder pain.Methods: Twenty-six stroke surviving adults with shoulder pain received 10 sessions of passive mobilization and performed upper limb exercises using a cycle ergometer, combined with active or sham tDCS. The intensity of pain in the hemiplegic shoulder was measured using the Visual Analog Scale (VAS); secondary outcomes were the level of motor impairment, handgrip strength, range of motion, motor function of the upper limbs, and quality of life (QOL) assessed before and after 10 sessions and 1 month after the end of the treatment.Results: A clinically important pain reduction (3 points) was found in both groups and was maintained at follow-up; there was no significant difference between groups (p = 0.3). Similarly, the shoulder range of motion improved, motor function and quality of life improved showed no significant differences between groups. One result that needs to be underscored is that both groups had a significant effect size toward improvement in all of these outcomes.Conclusions: We discuss in this study that tDCS is not a useful combination strategy when the physical therapy has a large effect by itself and we also review other negative trials of combined therapy under this framework of ceiling effect of the main physical therapy.Trial registry: Trial registration: Brazilian Registry of Clinical Trials, RBR-8F5MNY (http://www.ensaiosclinicos.gov.br/rg/RBR-8f5mny/). Registered on June 2, 2017.Beginning of the recruitment of the volunteers: august, 2017.

Purpose: The study aimed to analyse the association between the environment in two different Brazilian metropolises (Sao Paulo and Belo Horizonte) and disability after a stroke. Method: A cross-sectional study was conducted involving individuals with chronic hemiparesis resulting from a stroke and residing in either Sao Paulo or Belo Horizonte. The environment (city of residence) was considered an independent variable and disability (modified Rankin scale) was the dependent variable. The following clinical and demographic covariates were considered: age, number of comorbidities, socio-economic class, motor impairment (Fugl-Meyer scale), emotional functioning (Geriatric Depression Scale) and walking ability (10-metre walk test). Results: A total of 114 individuals were analysed - 51 from Sao Paulo (SP) and 63 from Belo Horizonte (BH). No association was found between the environment in which the individual resides and the degree of disability (OR = 1.436; 95%CI: 0.547 - 3.770; p = 0.46). However, the following variables were predictors of post-stroke disability: motor impairment (OR = 0.216; 95% CI: 0.090 - 0.520; p Conclusion: Living in different Brazilian cities had no impact on post-stroke disability. In contrast, motor impairment and walking ability were responsible for 77.9% of the disability found in the sample. The study findings identify possible causes of disabilities after stroke; these could facilitate the most appropriate actions to be taken during rehabilitation.

RESUMO O acidente vascular encefálico pode deixar sequelas neurológicas, motoras e sensitivas. Para avaliar e acompanhar o prognóstico do paciente, são usados diversos instrumentos funcionais de medida, como a escala de Fugl-Meyer, que apesar de amplamente utilizada para estimar a recuperação sensório-motora, é uma avaliação longa e que exige treinamento. Diante disso, o objetivo deste estudo é analisar se a força de preensão manual, o timed up and go e a medida de independência funcional podem predizer os resultados da escala Fugl-Meyer, com o intuito de otimizar o tempo de avaliação da recuperação sensório-motora, tanto para o acompanhamento da resposta ao tratamento quanto para pesquisas científicas. Para tanto, avaliou-se a força de preensão manual de 35 hemiparéticos crônicos, e em seguida foram aplicadas à escala Fugl-Meyer, que avalia a recuperação motora, a medida de independência funcional nas atividades motoras e o timed up and go, indicativo de mobilidade funcional. Para análise estatística utilizou-se a regressão linear múltipla (r2). A força de preensão manual mostrou-se preditora da recuperação motora (r2=0,46; p=0,001), enquanto a mobilidade (r2=0,255; p=0,007) e a independência funcional (r2=0,054; p=0,2) não foram capazes de predizer os resultados da escala Fugl-Meyer. Após análise, pôde-se inferir que a força de preensão manual é preditora moderada da recuperação motora pós-acidente vascular encefálico, enquanto mobilidade e a independência funcional, não. RESUMEN El accidente cerebrovascular puede ocasionar secuelas neurológicas, motores y sensoriales. Para evaluar y monitorear el pronóstico del paciente, se utilizan diversos instrumentos funcionales, como la escala de Fugl-Meyer, que aunque es ampliamente utilizada para estimar la recuperación sensoriomotor, presenta una evaluación larga y que requiere entrenamiento. Teniendo en cuenta lo anterior, este estudio pretende analizar si la fuerza de prensión manual, el timed up and go y la medición de independencia funcional pueden predecir los resultados de la escala de Fugl-Meyer para que se mejore el tiempo de evaluación de la recuperación sensorial y motora, tanto para monitorear la respuesta al tratamiento como para estudios científicos. Por tanto, se evaluó la fuerza de prensión manual de 35 hemiparéticos crónicos, y luego se aplicaron a la escala de Fugl-Meyer, que evalúa la recuperación motora, las medidas de la independencia funcional en las actividades motoras y el timed up and go, indicativo de movilidad funcional. Para el análisis estadístico se utilizó la regresión lineal múltiple (r2). La fuerza de prensión manual ha demostrado ser predictiva de la recuperación motora (r2=0,46; p=0,001), mientras que la movilidad (r2=0,255; p=0,007) y la independencia funcional (r2=0,054; p=0,2) no fueron capaces de predecir los resultados de la escala de Fugl-Meyer. Del análisis se puede inferir que la fuerza de prensión manual es una predictora moderada en la recuperación motora posaccidente cerebrovascular, mientras que no lo son la movilidad y la independencia funcional. ABSTRACT Cerebrovascular accidents can leave neurological, motor and sensory sequelae. To assess and monitor the patient’s prognosis, several functional measuring instruments are used, such as the Fugl-Meyer scale, which, although widely used to estimate the sensorimotor recovery, is a long evaluation that requires training. Therefore, the objective of this study is to analyze if the handgrip strength (HGS), the Timed up and Go test (TUG) and the Functional Independence Measure (FIM) can predict the results of the Fugl-Meyer scale, in order to optimize time during sensorimotor recovery assessment, both to monitor treatment responses and for scientific research. Thus, the HGS of 35 chronic hemiparetic patients was evaluated and then applied to Fugl-Meyer Scale, which evaluates motor recovery, the FIM, which evaluates motor activities and the TUG, which is an indicative of functional mobility. Statistical analysis was performed using multiple regression (r2). The HGS was predictive of motor recovery (r2=0.46; p=0.001), while mobility (r2=0.255; p=0.007) and functional independence (r2=0.054; p=0.2) were not capable of predicting the results of the Fugl-Meyer scale. After analysis, it was concluded that HGS is a moderate predictor of motor recovery after cerebrovascular accident, while mobility and functional independence are not.

Objective: Perform a systematic review to identify the categories of the International Classification of Functioning, Disability and Health linked to the concepts measured by functional assessment tools validated for Brazilian Portuguese: Timed Up and Go test, Functional Independence Measure, Barthel Index, and Rivermead Mobility Index and Modified Rankin Scale.Methods: The Medline, Embase and CINAHL databases were consulted using a standardized search strategy. The studies were summarized using a pre-established set of specific criteria for the adequate linkage between the concepts identified in the assessment measures and the International Classification of Functioning, Disability and Health categories. Two independent reviewers performed the selection of the studies, data extraction and evaluation of the results.Results: The search of the databanks led to the retrieval of 99 studies. However, only six articles were included in the present review. The linkage results of the studies included in the review were divergent, likely due to the taxonomic complexity of the International Classification of Functioning, Disability and Health, the difficulty in clearly relating the concepts of the assessment measures to the classifications and the fact that not all linkage rules were followed. "Activities and participation" was the most evaluated component, with mobility the most frequently covered category in the measures, followed by self-care. Among the measures analyzed, the Functional Independence Measure addresses a greater number of categories and therefore has the most concepts related to the International Classification of Functioning, Disability and Health, followed by the Barthel Index, Modified Rankin Scale, Rivermead Mobility Index and Timed Up and Go test. The Modified Rankin Scale was the assessment tool that most evaluated categories related to environmental factors.Conclusion: The Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health, since it addresses a greater number of categories. These findings can help guide health professionals in the selection of assessment tools for the evaluation of post-stroke functioning, making viable the use of the International Classification of Functioning, Disability and Health categories in clinical practice and public health services.Implications for rehabilitationThis study standardized identification of the International Classification of Functioning, Disability and Health categories in the main outcome measures used to assess post-stroke functional capacity.Functional Independence Measure has more concepts related to the International Classification of Functioning, Disability and Health compared to other functional assessment instruments.Findings can enable physiotherapists and researchers choose the most appropriate measure that best corresponds to their field of interest.These results facilitate the implementation of the International Classification of Functioning, Disability and Health in clinical practice.Use of International Classification of Functioning, Disability and Health categories can standardize information on functional health.

Evaluate, code and qualify the participation of Brazilian stroke survivors based on the international classification of functioning, disability and health (ICF) and identify predictors of post-stroke participation.An exploratory, observational, cross-sectional study was conducted involving 78 individuals with hemiparesis stemming from a stroke. The stroke specific quality of life (SS-QOL) was used to evaluate the participation component of the ICF. The geriatric depression scale was used to screen depressive symptoms; the functional independence measure (FIM) was used to measure the degree of dependence; grip strength was determined using a dynamometer; and cognitive status was evaluated using the mini mental state examination. The one-way analysis of variance followed by the Bonferroni test was used for the comparison the participation scores of different groups (age and marital status). The independent t-test was used for the comparisons of the other groups (sex, time since the occurrence of stroke (12 months or12 months) and degree of functional independence). Multiple linear regression was employed to identify measures capable of predicting participation.Based on the classification and qualifiers of the ICF, the individuals analyzed exhibited a moderate level of participation. Participation was significantly associated with time since the occurrence of stroke (F = 2.46; 95% confidence interval (CI) = -23.67-0.34; p = 0.05), degree of functional independence (F = 2.40; 95% CI = -33.0 to -18.93; p 0.001) and marital status (married or widowed) (F = 2.6; p = 0.05). No statistically significant associations were found with regard to age, sex or affected side of the body. Functional independence was the main predictor of participation (F = 99.2; rTwenty-four ICF categories were coded and qualified with the use of the SS-QOL, enabling the participation component of the ICF biopsychosocial model to be easily evaluated in clinical practice. Overall, the sample in the present study demonstrated a moderate decline in participation following a stroke and only the "social roles" domain was severely affected. The FIM was the main predictor of participation and the depression was a moderate predictor. Therefore, health professionals involved in the rehabilitation of these patients should focus on the promotion of functional independence and improvements in emotional health to optimize social participation following a stroke. Implications for Rehabilitation The Brazilian stroke individuals analyzed exhibited a moderate level of participation. Functional independence was the main predictor of participation and the occurrence of depressive symptoms was a moderate predictor. Age, sex and affected side of the body were not predictors of participation. Our findings support that twenty-four International classification of functioning, disability and health categories were coded and qualified with the use of the stroke specific quality of life. Rehabilitation of social functioning post stroke patients should be focused on the promotion of functional independence and improvement in emotional health. This study offers a participation assessment model that can facilitate the incorporation of the ICF in the clinical practice.

[Purpose] The aim of the present study was to evaluate the immediate effects of transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) on activity of the tibialis anterior muscle (TA) and static balance of individuals with hemiparesis stemming from stroke. [Subjects and Methods] A randomized, double-blind, crossover, clinical trial conducted with 30 individuals with chronic post-stroke hemiparesis. Median frequency of electrical activity of the TA were determined using electromyography in five contractions concentrics and Static balance (body sway velocity and frequency), both before and immediately after the intervention. The participants were submitted to four 20-minute intervention protocols with 48-hour interval: anodal tDCS + sham FES; sham tDCS + active FES; anodal tDCS + active FES and sham tDCS + sham FES. Anodal tDCS was administered over C3 or C4, the cathode was positioned in the supraorbital region on the contralateral side and FES was administered to the affected TA. [Results] No significant differences among the protocols were found regarding electrical activity of the TA and static balance. [Conclusion] The results demonstrate that tDCS alone or in combination with FES had no immediate effect on electrical activity of the TA and static balance of the 30 individuals analyzed.

Analyze the construct validity and internal consistency of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the ICF as well as analyze the ceiling and floor effects.One hundred subjects were analyzed: 85 community-dwelling and 15 institutionalized individuals. The analysis of construct validity was performed using classic psychometrics: (1) the comparison of known groups (individuals without restriction to participation vs. those with restriction to participation) using the Mann-Whitney test and (2) convergent validity - correlation between the scores on the SS-QOL items that address participation and the subscale scores of measures used to evaluate the similar constructs and concepts [the Short-Form Health Survey (SF-36), Functional Independence Measure (FIM) and grip strength test]. Spearman's correlation coefficients were calculated for this analysis. Cronbach's α was used for the analysis of internal consistency and both the ceiling and floor effects were analyzed. The level of significance for all analyses was α = 0.05.The a priori hypotheses regarding construct validity were partially demonstrated, as only five of the eight domains exhibited positive moderate to strong correlations (r 0.40) with measures that address constructs similar to those addressed on the SS-QOL questionnaire. The items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The ceiling and floor effects were considered adequate for the total SS-QOL score, but beyond acceptable standards for some domains.The 26 items of the SS-QOL questionnaire measure a multidimensional construct and therefore do not only address participation. However, the items demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. Implications for rehabilitation The 26 items of the SS-QOL questionnaire demonstrated adequate internal consistency and are capable of differentiating individuals with and without restriction to participation. The present findings can guide healthcare professionals regarding the selection of an assessment tool for the evaluation of post-stroke participation. The findings can lead to consistent and standardization evaluations, which facilitates comparisons and discussion on functional health and social participation after stroke.

Introduction. SATIS-Stroke was developed to measure satisfaction regarding activities and participation among stroke survivors based on the concepts contained in the International Classification of Functioning, Disability, and Health. However, this measure is only available in English and French. Objective. Perform the translation and cross-cultural adaptation of SATIS-Stroke to Brazilian Portuguese and test the preliminary reliability of this measure. Methods. The translation process followed standardized guidelines and consisted of six phases: initial translation, back-translation, analysis of expert committee, test of final version, submission, and assessment of all written reports. To test the preliminary test-retest reliability, the measure was administered by a single observer on two occasions with an interval of 7 to 14 days for the determination of intraobserver agreement and administered again by a second observer for the determination of interobserver agreement. Reliability was analyzed using the intraclass correlation coefficient (ICC2,1) and respective 95% confidence intervals (CI). Results. All stages of the cross-cultural adaptation process were respected and the final translated version of SATIS-Stroke exhibited semantic, idiomatic, cultural, and conceptual equivalence to the original version. The preliminary analysis revealed excellent intraobserver and interobserver reliability (ICC = 0.93; 95% CI: 0.83-0.97, p = 0.001 and ICC = 0.90; 95% CI: 0.74-0.96; p = 0.001, respectively). The items demonstrated adequate internal consistency, although ceiling and floor effects were considered beyond acceptable standards for some items. In the exploratory factor analysis, three factors were extracted that aggregated more than one construct to each component, but all were related to the “Activities and Participation” component of the International Classification of Functioning, Disability, and Health. Conclusion. The final version of the SATIS-Stroke scale in Brazilian Portuguese proved to be adequate and reliable for use on the Brazilian population. Further studies are underway to give continuity to the validation process and analyze the others measurement properties of the scale in the Brazilian population.

To assess the impact of post-stroke depression on the participation component of the International Classification of Functioning, Disability and Health (ICF).Thirty-five stroke survivors with chronic hemiparesis were divided into two groups: those with and without depression. The Geriatric Depression Scale (GDS) was used for the analysis of depressive symptoms. Participation was analysed using the Stroke Specific Quality of Life scale. The Mann-Whitney test was used to compare the participation scores between the two groups. Spearman's correlation coefficients were calculated to determine the strength of the association between the assessment tools. Simple linear regression was used to determine the impact of depression on participation. An alpha risk of 0.05 was considered indicative of statistical significance.The group with depression had low participation scores (p = 0.04). A statistically significant negative correlation of moderate magnitude was found between depression and participation (r = -0.6; p = 0.04). The linear regression model demonstrated that depression is a moderate predictor of participation (r(2) = 0.51; p = 0.001).Depression is a moderate predictor of participation among stroke survivors, explaining 51% of the decline of this aspect. Thus, depression should be diagnosed, monitored and treated to ensure a better prognosis regarding social participation following a stroke. Implications for Rehabilitation Individuals with post-stroke depression experience a lower degree of social participation. Depression explains 51% of the decline in participation following a stroke. The present findings can serve as a basis to assist healthcare professionals involved in the rehabilitation of stroke survivors and can assist in the establishment of adequate treatment plans in stroke rehabilitation.

[Purpose] The aim of the present study was to analyze the psychometric properties of the Stroke Specific Quality of Life (SS-QOL) scale for the assessment of social participation following a stroke. [Methods] A preliminary analysis was performed of the SS-QOL items that address the participation category. For this, the scoring patterns of the answers of individuals and internal consistence were determined using the Rasch model. Reliability was assessed by intraclass correlation coefficients (ICC). [Results] The reliability coefficients analyzed by the Rasch model were 0.91 for the items and 0.87 for the patients. The separation index was 3.19 for the items and 2.58 for the patients. The findings indicate that the items separated the patients into three levels of participation: low, medium, and high. Among the 26 items addressing participation, three did not fit the model. All items showed adequate reliability (ICC ≥ 0.60). [Conclusion] The Rasch analysis detected three items with erratic behavior; however, the erratic patterns of these items may be explained by individual peculiarities among the patients. These items should be monitored to determine if the problems found in the present study persist. If so, the items should also be revised or possibly even eliminated.

BACKGROUND: According to the International Classification of Functioning, Disability and Health (ICF), the participation component is considered to be the most complex component characterized in existing instruments that assess quality of life related to health (HRQoL). Questionnaires such as the Nottingham Health Profile (NHP) and the Stroke-Specific Quality of Life (SS-QOL) are currently used to evaluate the participation of individuals in life activities after stroke. However, because participation and HRQoL are different constructs, it is unclear whether these instruments are best suited to this evaluation. OBJECTIVE: To investigate whether the NHP and SS-QOL are suitable instruments for assessing the participation component of ICF. METHOD: A cross-sectional study was conducted in which a sample of 35 individuals completed the SS-QOL and NHP. The study correlated the total score on the questionnaires with the scores on items that evaluate the participation component of the ICF. Both analyses used the Spearman correlation coefficient (r). RESULTS: There was a statistically significant, positive and strong correlation between total score on the SS-QOL and NHP and the score on specific components related to participation (r=0.8, p=0.001 and r=0.9, p=0.001, respectively). CONCLUSIONS: Both the NHP and the SS-QOL show strong correlations between the total score and the score on items that assess the participation categories of the ICF. However, the SS-QOL questionnaire appeared to be the most complete for this assessment because it evaluates more distinct domains and contains the largest number of items related to participation. CONTEXTUALIZAÇÃO: O componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) foi apontado como o mais complexo de ser caracterizado a partir de instrumentos já existentes. Atualmente, indica-se o uso de questionários de qualidade de vida relacionada à saúde (QVRS) para avaliação da participação após acidente vascular encefálico (AVE), sendo indicado o Nottingham Health Profile (NHP) e o Stroke Specific Quality of Life (SS-QOL). No entanto, QVRS e participação são construtos distintos, assim, não está claro se esses instrumentos são os mais adequados para essa avaliação. OBJETIVO: Investigar se o NHP e SS-QOL são apropriados para avaliação do componente de participação da CIF. MÉTODO: Estudo transversal com amostra de 35 indivíduos nos quais foram aplicados o SS-QOL e o NHP com intuito de correlacionar o escore total dos questionários com o escore dos itens que avaliam os códigos do componente de participação da CIF utilizando o Coeficiente de Correlação Spearman (r). RESULTADOS: Houve correlação estatisticamente significante, positiva e de forte magnitude entre o escore total do SS-QOL e do NHP com os escores específicos do componente de participação, (r=0,8; p=0,001) e (r=0,9; p=0,001), respectivamente. CONCLUSÕES: Tanto o NHP quanto o SS-QOL apresentaram correlação forte entre o escore total e o escore dos itens que avaliam as categorias de participação da CIF. No entanto, o SS-QOL pareceu ser o questionário mais completo para essa avaliação por avaliar mais domínios distintos e apresentar o maior número de itens relacionados à participação.

OBJETIVO: Identificar categorias do componente de participação da Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) que já foram sistematicamente relacionadas aos instrumentos de Qualidade de Vida Relacionada à Saúde (QVRS) comumente utilizados em indivíduos acometidos pelo acidente vascular encefálico (AVE) - Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36) e Stroke Specific Quality of Life (SS-QOL) - e sugerir a utilização dos mesmos para avaliar e/ou caracterizar tal componente nessa população. MÉTODOS: Por meio de busca nas bases de dados Medline, SciELO e Lilacs, foi realizado levantamento dos estudos que associavam os conceitos mensurados pelos itens do NHP, SF-36 e SS-QOL com os componentes e categorias da CIF. RESULTADOS: Dos 24 estudos identificados, quatro atenderam aos critérios estabelecidos: dois avaliaram os três instrumentos de QVRS, um avaliou o NHP e SF-36, e outro apenas o SS-QOL. Para cada instrumento, foram encontrados três estudos que associaram seus conceitos até, no mínimo, o segundo nível de hierarquia das categorias da CIF. Considerando os resultados concordantes entre os três estudos que avaliaram o mesmo instrumento, nove categorias de participação foram associadas ao NHP, sete ao SF-36 e 15 ao SS-QOL, sendo que apenas uma foi específica para o NHP, uma para o SF-36, e sete para o SS-QOL. CONCLUSÕES: Para a avaliação da participação de indivíduos acometidos pelo AVE segundo a estrutura da CIF, o SS-QOL pareceu ser o instrumento mais adequado, pois, além de avaliar o maior número de categorias, também avalia o maior número de categorias distintas quando comparado aos outros dois instrumentos de QVRS, que acrescentam apenas uma categoria àquelas mensuradas pelo SS-QOL.OBJECTIVE: To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population. METHODS: Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out. RESULTS: Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL. CONCLUSIONS: To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.

Purpose: To evaluate the reproducibility of the Stroke Specific Quality of Life (SS-QOL) items that address the participation component of the International Classification of Functioning, Disability and Health (ICF) and analyse the correlation between the subscore of these 26 items and the total SS-QOL score. Methods: Seventy-five stroke survivors participated in this study. Reproducibility was evaluated using the intraclass correlation coefficient (ICC2,1), standard error of measurement (SEM), minimum detectable change (MDC) and the Bland–Altman plot. The correlation between the subscore of the 26 items and the total SS-QOL score was analysed using Spearman’s correlation coefficients (rho) and simple linear regression. An alpha risk ≤ 0.05 was considered for all analyses. Results: The SS-QOL items that address the participation component of the ICF demonstrated excellent reliability (intra-rater ICC2,1 = 0.96; inter-rater ICC2,1 = 0.95). The SEM and MDC were adequate. The Bland–Altman plot demonstrated satisfactory agreement. A significant and strong correlation (rho = 0.83) was found between the 26 SS-QOL items that address participation and the total SS-QOL score. Moreover, the evaluation of participation was found to explain 73% of the evaluation of health-related quality of life. Conclusion: The 26 SS-QOL items that address the participation component of the ICF demonstrated adequate reproducibility. Thus, participation, which represents the social aspects of functionality, can be adequately evaluated with these items. Implications for RehabilitationThe 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke.The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals.The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke. The 26 Stroke Specific Quality of Life items that address participation proved to be reproducible for the analysis of social participation following a stroke. The findings can lead to a better understanding of the social participation of individuals with chronic hemiparesis and assist in the establishment of adequate treatment for such individuals. The rehabilitation process can be directed towards more specific goals focused on the patient expectations, thereby contributing to greater humanization and effectiveness of treatment to improve social participation following a stroke.

This study aimed to identify the International Classification of Functioning, Disability, and Health categories addressed by the assessment tools commonly used in post-stroke rehabilitation and characterize patients based on its evaluation model. [Subjects and Methods] An exploratory, descriptive, cross-sectional study was conducted involving 35 individuals with chronic post-stroke hemiparesis. Handgrip strength was assessed to evaluate body functions and structures. The 10-meter gait speed test and Timed Up and Go test were administered to evaluate activity. The Stroke Specific Quality of Life scale was used to evaluate participation. Moreover, a systematic review of the literature was performed to identify studies that have associated these assessment tools with the International Classification of Functioning, Disability, and Health categories. [Results] The tools employed in this study for evaluating function addressed 63 International Classification of Functioning, Disability, and Health categories: 24 related to body functions and structures; 36 related to activity and participation; and 3 related to environmental factors. [Conclusion] The assessment tools employed in this study addressed 63 International Classification of Functioning, Disability, and Health categories and allowed a more complete evaluation of stroke survivors with hemiparesis. Use of this classification can therefore be more easily incorporated into clinical practice.

To identify the categories of the participation component of the International Classification of Functionality, Incapacity, and Health (ICF) which are currently related to Health-related Quality of Life (HRQOL) instruments commonly used in cerebrovascular accident (CVA) victims-Nottingham Health Profile (NHP), Short-Form Health Survey (SF-36), and Stroke Specific Quality of Life (SS-QOL)-and suggest the utilization of these instruments to assess and/or characterize that component in that population.Through searches in the Medline, SciELO, and Lilacs databases, a compilation of studies which associated the concepts measured by the NHP, SF-36, and SS-QOL items with the ICF components and categories, was carried out.Of the 24 identified studies, four met the established criteria: two assessed the three HRQOL instruments, one assessed the NHP and SF-36, and the other just the SS-QOL. For each instrument, three studies were found which associated their concepts up to, at least, the second hierarchical level of the ICF categories. Considering the results that were in agreement between the three studies that assessed the same instrument, nine participation categories were associated with the NHP, seven with the SF-36, and 15 with the SS-QOL, although just one was specific to the NHP, one to the SF-36, and seven to the SS-QOL.To assess the participation of CVA victims based upon the ICF framework, the SS-QOL appeared to be the most suitable instrument in that, in addition to assessing the greatest number of categories, it also assesses the greatest number of distinct categories, when compared to the other two HRQOL instruments, which added just one category to those measured by SS-QOL.