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Protocol - Stroke Impact Scale (SIS) - Adults

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Protocol Name from Source:

This section will be completed when reviewed by an Expert Review Panel.

Availability:

Publicly available

Description:

The Stroke Impact Scale (SIS) includes 59 proxy- or self-report items in 8 domains that assess multidimensional stroke outcomes. Items 1(a-d) measure strength. Items 2(a-g) measure memory and thinking. Items 3(a-I) measure emotions. Items 4(a-g) measure ease or difficulty of communication. Items 5(a-j) measure activities of daily living/instrumental activities of daily living (ADL/IADL). Items 6(a-I) measure mobility. Items 7(a-e) measure hand function. Items 8(a-h) measure participation/role function. Item responses are scored on a 5-point Likert-style scale. A score of 1 = an inability to complete the item and a score of 5 = no difficulty experienced at all. A standardized score ranging from 0 to 100 is calculated for all domains, with higher scores indicating a higher quality of life. An extra question on stroke recovery asks that the client rate on a scale from 0 to 100 how much the client feels that he/she has recovered from his/her stroke, where 0 = "no recovery" and 100 = "full recovery."

Protocol:

Stroke Impact Scale

VERSION 3.0

The purpose of this questionnaire is to evaluate how stroke has impacted your health and life. We want to know from YOUR POINT OF VIEW how stroke has affected you. We will ask you questions about impairments and disabilities caused by your stroke, as well as how stroke has affected your quality of life. Finally, we will ask you to rate how much you think you have recovered from your stroke.

These questions are about the physical problems which may have occurred as a result of your stroke.

1. In the past week, how would you rate the strength of your....

A lot of strength

Quite a bit of strength

Some strength

A little strength

No strength at all

a. Arm that was most affected by your stroke?

5

4

3

2

1

b. Grip of your hand that was most affected by your stroke?

5

4

3

2

1

c. Leg that was most affected by your stroke?

5

4

3

2

1

d. Foot/ankle that was most affected by your stroke?

5

4

3

2

1

These questions are about your memory and thinking.

2. In the past week, how difficult was it for you to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Extremely difficult

a. Remember things that people just told you?

5

4

3

2

1

b. Remember things that happened the day before?

5

4

3

2

1

c. Remember to do things (e.g. keep scheduled appointments or take medication)?

5

4

3

2

1

d. Remember the day of the week?

5

4

3

2

1

e. Concentrate?

5

4

3

2

1

f. Think quickly?

5

4

3

2

1

g. Solve everyday problems?

5

4

3

2

1

These questions are about how you feel, about changes in your mood and about your ability to control your emotions since your stroke.

3. In the past week, how often did you...

None of the time

A little of the time

Some of the time

Most of the time

All of the time

a. Feel sad?

5

4

3

2

1

b. Feel that there is nobody you are close to?

5

4

3

2

1

c. Feel that you are a burden to others?

5

4

3

2

1

d. Feel that you have nothing to look forward to?

5

4

3

2

1

e. Blame yourself for mistakes that you made?

5

4

3

2

1

f. Enjoy things as much as ever?

5

4

3

2

1

g. Feel quite nervous?

5

4

3

2

1

h. Feel that life is worth living?

5

4

3

2

1

i. Smile and laugh at least once a day?

5

4

3

2

1

The following questions are about your ability to communicate with other people, as well as your ability to understand what you read and what you hear in a conversation.

4. In the past week, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Extremely difficult

a. Say the name of someone who was in front of you?

5

4

3

2

1

b. Understand what was being said to you in a conversation?

5

4

3

2

1

c. Reply to questions?

5

4

3

2

1

d. Correctly name objects?

5

4

3

2

1

e. Participate in a conversation with a group of people?

5

4

3

2

1

f. Have a conversation on the telephone?

5

4

3

2

1

g. Call another person on the telephone, including selecting the correct phone number and dialing?

5

4

3

2

1

The following questions ask about activities you might do during a typical day.

5. In the past 2 weeks, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Cut your food with a knife and fork?

5

4

3

2

1

b. Dress the top part of your body?

5

4

3

2

1

c. Bathe yourself?

5

4

3

2

1

d. Clip your toenails?

5

4

3

2

1

e. Get to the toilet on time?

5

4

3

2

1

f. Control your bladder (not have an accident)?

5

4

3

2

1

g. Control your bowels (not have an accident)?

5

4

3

2

1

h. Do light household tasks/chores (e.g. dust, make a bed, take out garbage, do the dishes)?

5

4

3

2

1

i. Go shopping?

5

4

3

2

1

j. Do heavy household chores (e.g. vacuum, laundry or yard work)?

5

4

3

2

1

The following questions are about your ability to be mobile at home and in the community.

6. In the past 2 weeks, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Stay sitting without losing your balance?

5

4

3

2

1

b. Stay standing without losing your balance?

5

4

3

2

1

c. Walk without losing your balance?

5

4

3

2

1

d. Move from a bed to a chair?

5

4

3

2

1

e. Walk one block?

5

4

3

2

1

f. Walk fast?

5

4

3

2

1

g. Climb one flight of stairs?

5

4

3

2

1

h. Climb several flights of stairs?

5

4

3

2

1

i. Get in and out of a car?

5

4

3

2

1

The following questions are about your ability to use your hand that was MOST AFFECTED by your stroke.

7. In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Carry heavy objects (e.g. bag of groceries)?

5

4

3

2

1

b. Turn a doorknob?

5

4

3

2

1

c. Open a can or jar?

5

4

3

2

1

d. Tie a shoe lace?

5

4

3

2

1

e. Pick up a dime?

5

4

3

2

1

The following questions are about how stroke has affected your ability to participate in the activities that you usually do, things that are meaningful to you and help you to find purpose in life.

8. During the past 4 weeks, how much of the time have you been limited in...

None of the time

A little of the time

Some of the time

Most of the time

All of the time

a. Your work (paid, voluntary or other)

5

4

3

2

1

b. Your social activities?

5

4

3

2

1

c. Quiet recreation (crafts, reading)?

5

4

3

2

1

d. Active recreation (sports, outings, travel)?

5

4

3

2

1

e. Your role as a family member and/or friend?

5

4

3

2

1

f. Your participation in spiritual or religious activities?

5

4

3

2

1

g. Your ability to control your life as you wish?

5

4

3

2

1

h. Your ability to help others?

5

4

3

2

1

9. Stroke Recovery

On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?

_______

100 Full Recovery

____

_______

90

____

_______

80

____

_______

70

____

_______

60

____

_______

50

____

_______

40

____

_______

30

____

_______

20

____

_______

10

____

_______

0 No Recovery

Scoring: Each item is rated in a 5-point Likert scale in terms of the difficulty the patient has experienced in completing each item. A score of 1 = an inability to complete the item and a score of 5 = no difficulty experienced at all. Summative scores are generated for each domain. Domain scores range from 0-100.

The Stroke Impact Scale (SIS) is scored in the following way, for each domain:

Transformed Scale = [(Actual raw score - lowest possible raw score) / Possible raw score range] x 100

Three items in the emotion domain, 3f, 3h, and 3i, are reverse-scored, i.e., 1 becomes 5, 2 becomes 4, 3 remains the same, 4 becomes 2, and 5 becomes 1, prior to manual calculation. For these items, use the following equation to compute the individual’s score:

6 - individual’s rating = item score

The last item assesses the participant’s overall perception of recovery and is presented in the form of a visual analog scale from 0 to 100, where 0 = "no recovery" and 100 = "full recovery."

Personnel and Training Required

None.

Equipment Needs

None

Requirements

Requirement CategoryRequired
Average time of greater than 15 minutes in an unaffected individualNo
Major equipmentNo
Specialized requirements for biospecimen collectionNo
Specialized trainingNo

Mode of Administration

Self-administered

Life Stage:

Adult

Specific Instructions:

The Stroke Impact Scale (SIS) should be used with caution in individuals with mild impairment as the items in the Communication, Memory, and Emotion domains are considered easy and only capture limitations in the most impaired individuals.

Research Domain Information

Release Date:

July 30, 2015

Definition

A questionnaire to measure the health status of individuals who had a stroke.

Purpose

This measure is used to assess multidimensional stroke outcomes in both clinical and research settings.

Selection Rationale

The Stroke Impact Scale (SIS), Version 3.0 is a reliable and valid proxy- or self-administered questionnaire that is widely used to measure the quality of life in stroke survivors. In contrast to more generic quality of life instruments, the SIS is more sensitive to short-term changes in health status after a stroke.

Language

Danish, Dutch, English, French, German, Greek, Hebrew, Italian, Japanese, Norwegian, Portuguese, Russian, Spanish, Swedish, Tagalog, Thai, Turkish

Standards

StandardNameIDSource
Common Data Elements (CDE)Stroke Impact Scale Assessment Scale4924280CDE Browser

Process and Review

This section will be completed when reviewed by an Expert Review Panel.

Source

Duncan, P. W., Bode, R. K., Min Lai, S., & Perera, S. (2003). Rasch analysis of a new stroke-specific outcome scale: The Stroke Impact Scale. Archives of Physical Medicine and Rehabilitation 84(7), 950-963.

General References

Duncan, P. W., Wallace, D., Lai, S. M., Johnson, D., Embretson, S., & Laster, L. J. (1999). The Stroke Impact Scale version 2.0. Evaluation of reliability, validity, and sensitivity to change. Stroke, 30(10), 2131-2140.

Lai, S. M., Studenski, S., Duncan P. W., & Perera, S. (2002). Persisting consequences of stroke measured by the Stroke Impact Scale. Stroke, 33(7), 1840-1844.

Duncan, P. W., Lai, S. M., Tyler, D., Perera, S., Reker, D. M., & Studenski, S. (2002). Evaluation of proxy response to the Stroke Impact Scale. Stroke, 33(11), 2593-2599.

Lai, S. M., Perera, S., Duncan, P. W., & Bode, R. (2003). Physical and social functioning after stroke: Comparison of the Stroke Impact Scale and Short Form-36. Stroke, 34(2), 488-493.

Duncan, P. W., Reker, D. M., Horner, R. D., Samsa, G. P., Hoenig, H., LaClair, B. J., & Dudley, T. K. (2002). Performance of a mail-administered version of a stroke-specific outcome measure, the Stroke Impact Scale. Clinical Rehabilitation 16(5), 493-505.

Kwon, S., Duncan, P., Studenski, S., Perera, S., Lai, S. M.,& Reker, D. (2006). Measuring stroke impact with SIS: Construct validity of SIS telephone administration. Quality of Life Research 15(3), 367-376.

Duncan, P. W., Lai, S. M., Bode, R. K., Perea, S., & DeRosa, J. T. (2003). Stroke Impact Scale-16: A brief assessment of physical function. Neurology, 60, 291-296.

Protocol ID:

820701

Variables:

Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX820701_FunctionalityAfterStrokeAdult_Strength_Past7days_ArmPX820701010100In the past week, how would you rate the strength of your arm that was most affected by your stroke?4N/A
PX820701_FunctionalityAfterStrokeAdult_Strength_Past7days_GripPX820701010200In the past week, how would you rate the strength of your grip of your hand that was most affected by your stroke?4N/A
PX820701_FunctionalityAfterStrokeAdult_Strength_Past7days_LegPX820701010300In the past week, how would you rate the strength of your leg that was most affected by your stroke?4N/A
PX820701_FunctionalityAfterStrokeAdult_Strength_Past7days_Foot_AnklePX820701010400In the past week, how would you rate the strength of your foot/ankle that was most affected by your stroke?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Remember_ThingsPX820701020100In the past week, how difficult was it for you to remember things that people just told you?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Remember_PreviousDayPX820701020200In the past week, how difficult was it for you to remember things that happened the day before?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Remember_DoThingsPX820701020300In the past week, how difficult was it for you to remember to do things (e.g., keep scheduled appointments or take medication)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Remember_WeekdayPX820701020400In the past week, how difficult was it for you to remember the day of the week?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_ConcentratePX820701020500In the past week, how difficult was it for you to concentrate?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_ThinkPX820701020600In the past week, how difficult was it for you to think quickly?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_ProblemsPX820701020700In the past week, how difficult was it for you to solve everyday problems?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelSadPX820701030100In the past week, how often did you feel sad?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelNobody_ClosePX820701030200In the past week, how often did you feel that there is nobody you are close to?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelBurden_OthersPX820701030300In the past week, how often did you feel that you are a burden to others?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelNothing_ForwardPX820701030400In the past week, how often did you feel that you have nothing to look forward to?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_Blame_MistakesPX820701030500In the past week, how often did you blame yourself for mistakes that you made?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_EnjoyThingsPX820701030600In the past week, how often did you enjoy things as much as ever?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelNervousPX820701030700In the past week, how often did you feel quite nervous?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_FeelWorth_LivingPX820701030800In the past week, how often did you feel that life is worth living?4N/A
PX820701_FunctionalityAfterStrokeAdult_Did_Past7days_Smile_LaughPX820701030900In the past week, how often did you smile and laugh at least once a day?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Name_SomeonePX820701040100In the past week, how difficult was it to say the name of someone who was in front of you?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Understand_ConversationPX820701040200In the past week, how difficult was it to understand what was being said to you in a conversation?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_ReplyTo_QuestionsPX820701040300In the past week, how difficult was it to reply to questions?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_Name_ObjectsPX820701040400In the past week, how difficult was it to correctly name objects?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_ParticipateIn_ConversationPX820701040500In the past week, how difficult was it to participate in a conversation with a group of people?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_HaveConversation_TelephonePX820701040600In the past week, how difficult was it to have a conversation on the telephone?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past7days_CallPerson_TelephonePX820701040700In the past week, how difficult was it to call another person on the telephone, including selecting the correct phone number and dialing?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Cut_FoodPX820701050100In the past 2 weeks, how difficult was it to cut your food with a knife and fork?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_DressTop_BodyPX820701050200In the past 2 weeks, how difficult was it to dress the top part of your body?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Bathe_YourselfPX820701050300In the past 2 weeks, how difficult was it to bathe yourself?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_ClipToenailsPX820701050400In the past 2 weeks, how difficult was it to clip your toenails?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_ToiletOn_TimePX820701050500In the past 2 weeks, how difficult was it to get to the toilet on time?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Control_BladderPX820701050600In the past 2 weeks, how difficult was it to control your bladder (not have an accident)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Control_BowelsPX820701050700In the past 2 weeks, how difficult was it to control your bowels (not have an accident)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_LightChores_TasksPX820701050800In the past 2 weeks, how difficult was it to do light household tasks/chores (e.g., dust, make a bed, take out garbage, do the dishes)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Go_ShoppingPX820701050900In the past 2 weeks, how difficult was it to go shopping?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Heavy_ChoresPX820701051000In the past 2 weeks, how difficult was it to do heavy household chores (e.g., vacuum, laundry or yard work)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Stay_SittingPX820701060100In the past 2 weeks, how difficult was it to stay sitting without losing your balance?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Stay_StandingPX820701060200In the past 2 weeks, how difficult was it to stay standing without losing your balance?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_WalkWithout_LosingBalancePX820701060300In the past 2 weeks, how difficult was it to walk without losing your balance?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_MoveBedTo_ChairPX820701060400In the past 2 weeks, how difficult was it to move from a bed to a chair?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Walk_OneBlockPX820701060500In the past 2 weeks, how difficult was it to walk one block?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Walk_FastPX820701060600In the past 2 weeks, how difficult was it to walk fast?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Climb_OneFlightStairsPX820701060700In the past 2 weeks, how difficult was it to climb one flight of stairs?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_Climb_SeveralFlightsStairsPX820701060800In the past 2 weeks, how difficult was it to climb several flights of stairs?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Past2weeks_GetInOut_CarPX820701060900In the past 2 weeks, how difficult was it to get in and out of a car?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Hand_Past2weeks_CarryObjectsPX820701070100In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to carry heavy objects (e.g., bag of groceries)?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Hand_Past2weeks_TurnDoorknobPX820701070200In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to turn a doorknob?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Hand_Past2weeks_OpenCanJarPX820701070300In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to open a can or jar?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Hand_Past2weeks_TieShoeLacePX820701070400In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to tie a shoe lace?4N/A
PX820701_FunctionalityAfterStrokeAdult_Difficult_Hand_Past2weeks_PickUpDimePX820701070500In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to pick up a dime?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_WorkPX820701080100During the past 4 weeks, how much of the time have you been limited in your work (paid, voluntary or other)?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Social_ActivitiesPX820701080200During the past 4 weeks, how much of the time have you been limited in your social activities?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Quiet_RecreationPX820701080300During the past 4 weeks, how much of the time have you been limited in quiet recreation (crafts, reading)?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Active_RecreationPX820701080400During the past 4 weeks, how much of the time have you been limited in active recreation (sports, outings, travel)?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Role_FamilyFriendPX820701080500During the past 4 weeks, how much of the time have you been limited in your role as a family member and/or friend?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_SpiritualReligous_ActivitiesPX820701080600During the past 4 weeks, how much of the time have you been limited in your participation in spiritual or religious activities?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Control_LifePX820701080700During the past 4 weeks, how much of the time have you been limited in your ability to control your life as you wish?4N/A
PX820701_FunctionalityAfterStrokeAdult_TimeLimited_Past4weeks_Help_OthersPX820701080800During the past 4 weeks, how much of the time have you been limited in your ability to help others?4N/A
PX820701_FunctionalityAfterStrokeAdult_Representing_Stroke_RecoveryPX820701090000On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?4N/A