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Multiple perspectives of the functional status of stroke survivors at 3 months post-stroke

Shih, Min-Mei (2008) Multiple perspectives of the functional status of stroke survivors at 3 months post-stroke. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Stroke is one of the leading causes of disability. Using an understandable measure to describe subsequent disabilities, namely, activities of daily living (ADL), is important for clinical practice. The three studies in this dissertation describe ADL task disability of stroke survivors at 3 months post-stroke, from multiple perspectives. The first study compared the constructs of five commonly used ADL measurement tools which used different scoring systems and assessment methods. Rasch analysis, using the partial credit model, confirmed that the performance-based and task-specific (criterion-referenced) ADL assessment, Performance Assessment of Self-Care Skills (PASS), had excellent unidimensionality for measuring independence in stroke survivors. It was also more valid and reliable than the other informant-based, and global non-summative (Glasgow Outcome Scale, 5-point [GOS5], Glasgow Outcome Scale, 5-point [GOS8], Modified Rankin Scale [mRS]) and global summative (Barthel Index [BI]) measures. The second study went on to develop an item difficulty hierarchy with the combined items from the PASS and the BI, and establish the person abilities of the stroke survivors. Rasch analysis and common person equating method revealed that the PASS was more difficult for the stroke survivors than the BI, and the participants had the greatest difficulty performing PASS instrumental ADL (IADL). The third study further delineated the independence of the stroke survivors with left and right hemispheric stroke (LHS and RHS) at the overall, domain, and task levels of the PASS. Rasch analysis, differential group functioning, and differential item functioning showed that the LHS group performed significantly more independently than the RHS group in the functional mobility domain, and better, but not significantly better on the overall PASS, and the personal care, physical IADL, and cognitive IADL domains. The findings of clinically significant differences in specific tasks between the two stroke groups (side of lesion, gender, and age) will advance the knowledge related to specific disabilities of stroke survivors, especially for IADL tasks. Further studies were recommended to explore the independence of the stroke survivors in performing ADL subtasks, with more homogeneous samples and at multiple time points.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Shih, Min-Meimis32@pitt.eduMIS32
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHolm, Margo Bmbholm@pitt.eduMBHOLM
Committee MemberSkidmore, Elizabeth Rskidmore@pitt.eduSKIDMORE
Committee MemberIrrgang, James Jjirrgang@pitt.eduJIRRGANG
Committee MemberRogers, Joan Cjcr@pitt.eduJCR
Date: 19 May 2008
Date Type: Completion
Defense Date: 3 April 2008
Approval Date: 19 May 2008
Submission Date: 17 April 2008
Access Restriction: 5 year -- Restrict access to University of Pittsburgh for a period of 5 years.
Institution: University of Pittsburgh
Schools and Programs: School of Health and Rehabilitation Sciences > Rehabilitation Science
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: ADL; occupational therapy; Rasch analysis; stroke
Other ID:, etd-04172008-114046
Date Deposited: 10 Nov 2011 19:38
Last Modified: 15 Nov 2016 13:40


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