Measurement of Instrumental Activities of Daily Living in Stroke

BACKGROUND: Functional assessment in stroke patients is critical in both clinical practice and outcome studies. Ability in the areas relating to instrumental activities of daily living (IADL) that require increased interaction with the environment, whether household or community, appears to be a prerequisite for independent living in the community. The majority of the research in this area has been in the geriatric population. A literature review was undertaken to answer the following questions: What is a working definition of IADL? What are the criteria that determine inclusion with specific applicability in the stroke population? What are the reliability and validity of available measures in the stroke population? What is the relevance of IADL to functional outcome? SUMMARY OF REVIEW: The findings at this time indicate that there is no consensus for a clear definition of IADL. The terminology used includes the original IADL as described by Lawton and Brody, extended ADL, social ADL, and advanced ADL. Four scales that were designed primarily for use in the stroke population were identified: the Nottingham Extended ADL (a self-report scale), the Hamrin Activity Index and the Frenchay Activities Index (both based on patient interviews), and the Household section of the Rivermead ADL Assessment (a performance index). CONCLUSIONS: There is some published evidence concerning the validity, reliability, utility, sensitivity, or hierarchical nature of these indexes, and further testing is needed. The items in each index, however, have inherent relevance with potential for use in future clinical research.