Smallest Real Difference of 2 Instrumental Activities of Daily Living Measures in Patients With Chronic Stroke

Lu W-S, Chen CC, Huang S-L, Hsieh C-L. Smallest real difference of 2 instrumental activities of daily living measures in patients with chronic stroke. Arch Phys Med Rehabil 2012;93:1097-1100. Objective: To estimate the smallest real difference (SRD) values of 2 instrumental activities of daily living measures (the Nottingham Extended Activities of Daily Living [NEADL] and the Frenchay Activities Index [EAU]) in patients with chronic stroke. Design: Test-retest reliability study. Setting: Physical rehabilitation units of 5 hospitals. Participants: Chronic stroke patients (N=52; 37 men, 15 women) who were discharged from the hospital for more than 6 months. Interventions: Not applicable. Main Outcome Measures: Both measures were administered twice about 2 weeks apart to participants. The SRD was calculated on the basis of standard error of measurement: SRD = 1.96 X root 2 x Standard error of measurement. SRD% (the value of SRD divided by total score of a measure) was used to compare measurement errors across both measures. Reproducibility between successive measurements of the measures was investigated with intraclass correlation coefficients (ICCs). Results: The SRD (SRD%) values of the NEADL and the FAI were 12.0 (21.1%) and 6.7 (14.9%), respectively. Test-retest reproducibility of both measures was high (ICC: NEADL=.89, FAI=.89). Conclusions: Because of substantial SRD values of the NEADL and the FAT, prospective users should be cautious in using both measures to detect real change for a single subject.