The Sunnaas Index of Activities of Daily Living: Responsiveness and Concurrent Validity in Stroke

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Abstract
The aim of this study was to evaluate the responsiveness and concurrent validity of the Sunnaas Index of activities of daily living (ADL) as an instrument for measuring primary and instrumental ADL functions after stroke. Fifty-five consecutive stroke patients were scored using the Sunnaas ADL Index and the Barthel ADL Index on admission and at discharge after median 21 days inpatient rehabilitation. The results of the two indices were compared, and the Barthel Index was used as a gold standard for validity tests. The neurological impairments and motor functions of the patients were scored using the Scandinavian Stroke Scale and the Modified Motor Assessment Scale. The total score of the Sunnaas ADL Index and the subscores reflecting primary and instrumental ADL functions increased significantly (p < 0.0001) during rehabilitation. The Sunnaas score correlated significantly with the scores of the Barthel Index (Spearman correlation coefficient r = 0.83 on admission and 0.88 at discharge), the Scandinavian Stroke Scale (r = 0.81 on admission) and the Modified Motor Assessment Scale (r = 0.79 on admission and 0.76 at discharge). The Sunnaas ADL Index seems able to detect clinically important improvements of primary and instrumental ADL functions after stroke, i.e. its responsiveness is good. These results provide further evidence for the concurrent validity of the Sunnaas Index for measuring functional recovery after stroke.