Purpose
To assess physical function following stroke.
Link to Instrument
Acronym
SIS-16
Primary Image
Stroke Impact Scale-- 16
Populations
Key Descriptions
- The SIS-16 consists of 16 items from the 4 physical domains (strength, hand function, mobility, and ADL/IADL) on the SIS 3.0
- Request permission: http://www.kumc.edu/school-of-medicine/preventive-medicine-and-public-health/research-and-community-engagement/stroke-impact-scale/sis-download.html
Number of Items
16
Equipment Required
- Standardized form (and permission to access)
Time to Administer
5-10 minutes
Required Training
Reading an Article/ManualInstrument Reviewers
Initial review completed by Karen Vizaniaris, Jacqueline Kendona, and Tara Ruppert, December 2016. Reviewed and revised by Edeth Engel, October 2017.
ICF Domain
ActivityMeasurement Domain
Activities of Daily LivingConsiderations
-
The SIS-16 measures only physical domains of functional status. The SIS 3.0 may be more appropriate if measuring overall HRQOL.
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More sensitive than Barthel Index for differentiating and identifying deficits with mild strokes
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SIS-16 has a larger spread of item difficulty for more severe stroke than the Short Form - 36 Physical Functioning scale (Lai, et al, 2003)
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Can be completed by proxy
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Can be used to guide clinical intervention due to established MCID
Stroke
back to PopulationsStandard Error of Measurement (SEM)
Acute and Chronic Stroke:
(Chou et al, 2015, n = 263; mean age = 59.8 (13) years; time since stroke <3mo = 47% of n; Acute and Chronic Stroke)
-
SEM = 4.8
Minimal Detectable Change (MDC)
Acute and Chronic Stroke:
(Chou e al, 2015)
-
SRD = 13.2
Ischemic Stroke:
(Katzan et al, 2016; n = 3308; other demographics unavailable; ischemic stroke)
-
MDC >= 8
Minimally Clinically Important Difference (MCID)
Subacute Stroke:
(Fulk et al, 2010. n = 36; mean age = 60.9 (15.6) years); mean time since stroke = 58.9 (47.1) days; Subacute Stroke)
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MCID between 9.4 - 14.1
Normative Data
Acute and Chronic Stroke:
(Chou et al, 2015)
-
Mean = 71.8 (25.1)
Acute Stroke:
(Vellone et al, 2015; n = 392; mean age = 71.2 (11.0); mean time since stroke = 20 (12-38) days)
|
SIS 3.0 Factors |
Mean (SD) |
|
Physical |
32.7±25.3 |
|
Cognitive |
63.3±24.3 |
|
Emotional |
53.9±19.9 |
|
Social Participation |
35.6±23.3 |
|
Stroke Global Recovery |
40.9±22.5 |
Chronic Stroke:
(Edwards and O'Connell, 2003; n = 74; mean age = 58.35 (14.80) years; mean time since stroke = 56.8 months; Anglo-Saxon Australian sample)
-
Mean = 74.1 (21.1)
Subacute Stroke:
(Huang et al, 2010; n = 58; mean age = 56.42 (11.67) years; mean time since stroke = 17.85 (7-88) months)
-
Mean = 61.97 98 (12.27)
Test/Retest Reliability
Acute and Chronic Stroke:
(Chou et al, 2015)
- Excellent: ICC = 0.95
Internal Consistency
Acute and Chronic Stroke:
(Chou et al, 2015)
-
Excellent: Cronbach’s alpha = 0.94
Ischemic Stroke:
(Katzan et al, 2016; n=1,946; mean age = 63.1 (14.2) years; 31% within 90 days of stroke)
-
Excellent: Cronbach’s alpha = 0.96; 95% CI
Acute Stroke:
(Duncan et al, 2003; n = 621; mean age = 68 (12.4) years; mean time since stroke = 1-3 months)
-
Excellent: Cronbach’s alpha = 0.94
Chronic Stroke:
(Edwards and O’Connell, 2003)
-
Excellent: Cronbach’s alpha = 0.92
Criterion Validity (Predictive/Concurrent)
Acute stroke:
(Ward et al, 2011; n=30; mean age = 66.5 (13.7) years; mean time since stroke = 7.8 (3.5) days)
- SIS-16 and STREAM both predictive of length of stay in inpatient rehabilitation facility
Construct Validity
Acute Stroke
(Ward et al, 2011)
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Stroke Rehabilitation Assessment of Movement Scale (STREAM)
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Admission scores = good (r=0.7073)
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Discharge scores = good (r=0.7153)
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Change scores = adequate (r=0.4456)
-
Chronic stroke:
(Edwards and O’Connell, 2003)
-
WHOQOL-BREF domains:
-
Physical - good (r=0.65)
-
Psychological - adequate (r=0.42)
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Social Relationships - poor (r=0.18)
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Environment - adequate (r=0.50)
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Zung Self-rating Depression Scale = poor (r=-0.33)
(Lai et al, 2003; n=278; mean age = 72.5 (10.1) years; mean time since stroke = 90-120 days)
-
Barthel Index = good (r= 0.75)
Acute and Chronic Stroke:
(Chou et al, 2015)
-
NIHSS = good (r=-0.62)
-
MMSE = poor (r=0.24)
(Katzan et al, 2016)
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Patient Reported Outcomes Measurement Information System physical function (PROMIS PF) = excellent (r=0.90; 95% CI)
-
NIH Stroke Scale (NIHSS) = adequate (r=-0.45)
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EuroQol-5 dimensions (EQ-5D) = good (r=0.78)
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Patient Health Questionnaire-9 (PHQ-9) = good (r=0.60)
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Modified Rankin Scale (mRS) = adequate (r=0.63)
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SIS-16 able to discriminate across mRS categories
Content Validity
(Duncan et al, 2003) Rasch analysis was used to select 16 items from the physical composite domain of the Stroke Impact Scale 3.0 to create the SIS-16. Items for the Stroke Impact Scale were developed through focus groups and expert review.)
Face Validity
Items consist of ADLs and IADLs directly impacted by physical functioning.
Floor/Ceiling Effects
Acute and Chronic Stroke:
(Chou et al, 2015)
-
Adequate = ceiling 14%
(Katzan et al, 2016)
-
Adequate = ceiling 19.6%
-
Excellent = floor 0.36%
Acute Stroke:
(Duncan et al, 2003)
-
Excellent = no floor/ceiling effects
Chronic Stroke:
(Lai et al, 2003)
Excellent = no floor/ceiling effects
Bibliography
Chou, C., Ou, Y., & Chiang, T. (2015). “Psychometric comparisons of four disease-specific health-related quality of life measures for stroke survivors.” Clinical Rehabilitation 29(8): 816-829. Find it on PubMed
Duncan, P. W., Lai, S. M., et al. (2003). “Stroke Impact Scale-16: A brief assessment of physical function.” Neurology 60(2): 291-296. Find it on PubMed
Edwards, B., and O’Connell, B. (2003). “Internal consistency and validity of the Stroke Impact Scale 2.0 and SIS 16 in an Australian sample.” Quality of Life Research 12(8): 1127-1135. Find it on PubMed
Fulk, G. D., Ludwig, M., et al. (2010). “How much change in the stroke impact scale-16 is important to people who have experienced a stroke?” Topics in Stroke Rehabilitation 17(6): 477-483. Find it on PubMed
Huang, Y. H., Wu, C. Y., et al. (2010). "Predictors of change in quality of life after distributed constraint-induced therapy in patients with chronic stroke." Neurorehabil Neural Repair 24(6): 559-566. Find it on PubMed
Katzan, I. L., Fan, Y., Uchino, K., and Griffith, S. D. (2016). “The PROMIS physical function scale: A promising scale for use in patients with ischemic stroke.” Neurology 86: 1801-1807. Find it on PubMed
Katzan, I., Thompson, N., and Uchino, K. (2016). “Abstract 186: PROs in Clinical Practice: SIS-16 Better at Detecting Change in Functional Status than the Modified Rankin.” Stroke 47(Suppl 1): A186. Find it on AHA journals
Lai, S. M., Perera, S., Duncan, P. W., and Bode, R. (2003). “Physical and social functioning after stroke: Comparison of the Stroke Impact Scale and Short Form-36.” Stroke 34(2): 488-493.
Vellone, E., Savini, S., et al. (2015). “Psychometric evaluation of the Stroke Impact Scale 3.0.” Journal of Cardiovascular Nursing 30(3): 229-241. Find it on PubMed
Ward, I., Pivko, S., Brooks, G., and Parkin, K. (2011). “Validity of the Stroke Rehabilitation Assessment of Movement Scale in acute rehabilitation: A comparison with the Functional Independence Measure and Stroke Impact Scale-16.” Physical Medicine & Rehabilitation 3: 1013-1021. Find it on PubMed