Validation of the Frenchay activity index on stroke victims

One hundred sixty-one patients were selected for consecutive application of the FAI and National Institutes of Health Stroke Scale (NIHSS). Spearman’s test was used for correlation between different scales. The FAI and NIHSS association was evaluated using ordinal logistic regression. Additionally, 36 patients underwent FAI rating on the same day by two independent evaluators.

Results

A negative correlation between the FAI and the NIHSS scores (p = 0.017 r = -0.22) was found. Adjusting all variables with possible association with the NIHSS, ordinal logistic regression showed that the FAI had a significant association with NIHSS scores (OR 0.93, 95% CI 0.87 to 0.99, p: 0.033). The inter-rater agreement was considered good, k = 0.66 (0.54 to 0.78), p < 0.001.

Conclusions

The FAI is a valid and useful method to assess instrumental activities before acute stroke in a Brazilian population.

stroke; activities of daily living; validation studies

Variables	Patients (n = 161)
Age mean (SD)	57.3 (17.0)
Gender: Female n (%)	111 (68.9)
Ethnicity n (%)
African-American	135 (83.8)
White	17 (10.6)
Others	9 (5.6)
Education n (%)
Illiterate	31 (19.3)
Elementary School	80 (49.7)
High School	40 (24.8)
Others	10 (6.2)
Income ≤ 1 minimum wage n (%)	105 (65.2)
Ischemic stroke n (%)	98 (60.9)
NHISS score median (IQ)	8 (2–15)
Comorbidities n (%)
Hypertension	129 (80.1)
Diabetes	27 (16.8)
Heart disease	30 (18.6)
Atrial Fibrillation	12 (7.5)
Depression	3 (1.9)
Interval of time from stroke (days) median (IQ)	6 (4–12)
Previous lifestyle n (%)
Smoker or ex-smoker	63 (39.2)
Alcohol consumption	75 (46.6)
Physical exercise	26 (16.1)
Reading	37 (23.0)
FAI prior median	21 (16–24)
Admission MBI median (IQ)	32 (23–45)

Variables	Odds ratio	95%CI	p
Age	1.02	1.01–1.04	0.002
Gender	0.54	0.27–1.04	0.067
Education (for increasing categories of higher education)	0.52	0.34–0.79	0.002
Income	1.01	0.62–1.64	0.962
Comorbidities
Hypertension	1.29	0.62–2.69	0.493
Diabetes	3.43	1.19–6.89	0.019
Heart disease	1.96	0.90–5.26	0.083
Atrial Fibrillation	2.47	0.67–9.43	0.170
Obesity	2.92	0.86–10.75	0.090
Interval of time from stroke (days)	0.97	0.91–1.02	0.278
Previous lifestyle
Smoker or ex-smoker	1.75	0.65–4.79	0.266
Alcohol consumption	1.69	0.92–3.14	0.090
FAI (for every increase in 1 point)	0.91	0.86–0.96	0.002

Variable	Unadjusted	Adjusted	p

	OR; 95%CI	OR; 95%CI
FAI* (for every increase in 1 point)	0.91; 0.86–0.96	0.93; 0.87–0.99	0.033

FAI score	ICC	95%ic	P
Total	0.827	0.69–0.91	< 0.001
Domestic	0.875	0.77–0.93	< 0.001
Work/leisure	0.735	0.54–0.86	< 0.001
Outdoor activities	0.752	0.57–0.87	< 0.001

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[1] Correspondence: Elen Beatriz Pinto; Escola Bahiana de Medicina e Saúde Pública (EBMSP); Avenida D. João VI, 275; 40290-000 Salvador BA, Brasil; Email: elen.neuro@gmail.com