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Stroke Impact Scale Questionnaire: Self-Evaluation of Functionality and Recovery, Lecture notes of Personal Health

A questionnaire for evaluating the impact of a stroke on an individual's health and life. The Stroke Impact Scale (SIS) assesses physical impairments, memory and thinking abilities, mood and emotional control, communication skills, and daily activities. The questionnaire consists of 90 items rated on a 5-point Likert scale, with higher scores indicating better functioning and recovery.

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2021/2022

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PhenX Measure: Functionality after Stroke (#820700)
PhenX Protocol: Stroke Impact Scale (SIS) - Adults (#820701)
Date of Interview/Examination (MM/DD/YYYY): _____________________
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
pf3
pf4
pf5

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Download Stroke Impact Scale Questionnaire: Self-Evaluation of Functionality and Recovery and more Lecture notes Personal Health in PDF only on Docsity!

PhenX Measure: Functionality after Stroke (#820700) PhenX Protocol: Stroke Impact Scale (SIS) - Adults (#820701)

Date of Interview/Examination (MM/DD/YYYY): _____________________ Stroke Impact Scale

VERSION 3.

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?

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

c. Leg that was most affected by your stroke?

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

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?

b. Remember things that happened the day before?

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

d. Remember the day of the week?

e. Concentrate? 5 4 3 2 1

f. Think quickly? 5 4 3 2 1

g. Solve everyday problems?

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?

c. Feel that you are a burden to others?

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

e. Blame yourself for mistakes that you made?

f. Enjoy things as much as ever?

g. Feel quite nervous? 5 4 3 2 1

at all at all

a. Cut your food with a knife and fork?

b. Dress the top part of your body?

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)?

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

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

i. Go shopping? 5 4 3 2 1

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

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?

b. Stay standing without losing your balance?

c. Walk without losing your balance?

d. Move from a bed 5 4 3 2 1

to a chair?

e. Walk one block? 5 4 3 2 1

f. Walk fast? 5 4 3 2 1

g. Climb one flight of stairs?

h. Climb several flights of stairs?

i. Get in and out of a car?

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)?

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)?

b. Your social activities? 5 4 3 2 1

_______ 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."