Duncan Pamela W, Lai Sue Min, Tyler Denise, Perera Subashan, Reker Dean M, Studenski Stephanie
Brooks Center for Rehabilitation Studies, University of Florida, and Rehabilitation Outcomes Research Center, North Florida/South Georgia Department of Veteran Affairs, Gainesville, Fla 32610-0185, USA.
Stroke. 2002 Nov;33(11):2593-9. doi: 10.1161/01.str.0000034395.06874.3e.
The purposes of this study were to compare proxy-patient responses on each domain of the Stroke Impact Scale (SIS) and the SIS-16, estimate the bias, and evaluate the validity of proxy scores.
Two hundred eighty-seven patient and proxy pairs from the Kansas City Stroke Registry participated in the study. All patients were assessed in their home or nursing facility between 90 and 120 days after stroke with the use of the modified Rankin Scale Motricity Index (strength), Barthel Index (activities of daily living), Lawton assessment (instrumental activities of daily living), Folstein Mini-Mental State Examination (cognition), and the SIS. Eligible proxies were individuals who were aged > or =18 years, had known the patient for at least 1 year, and saw the patient at least once each week. All proxy interviews were conducted within 7 days of (before or after) the patient's interview.
Three hundred seventy-seven patients from the Kansas City Stroke Registry were eligible for the study. Seventy-seven patients or proxies refused participation. Thirteen patients of the consenting patient-proxy pairs were too aphasic or cognitively impaired to complete the interviews and were dropped from the study. Proxies scored patients as more severely affected than patients scored themselves on the SIS-16 and in 7 of 8 domains of the full SIS (5 were statistically significant at alpha=0.05). The proxy bias toward overrating the severity of the patient's condition tended to increase as the severity of the stroke increased. However, the magnitude of the biases between patient and proxy means, as measured by effect size, was small (range, -0.1 to 0.4). The strength of the agreement, as measured by intraclass correlation coefficients, between proxy and patient ranged from 0.50 to 0.83. Agreement was best for the observable physical domains. Both patient and proxy scores in all domains were significantly different across Rankin categories. Concurrent validity for both patient and proxy correlations with the Folstein Mini-Mental State Examination, Barthel Index, Lawton instrumental activities of daily living, and Motricity Index was good to excellent (range, 0.37 to 0.78).
Proxies provide valid information for assessment of stroke outcomes. There are significant differences between patient and proxy reporting on SIS domains and the SIS-16. However, the observed biases are small and not clinically meaningful.
本研究旨在比较中风影响量表（SIS）各领域及SIS - 16中代理人与患者的回答，估计偏差，并评估代理人评分的有效性。
来自堪萨斯城中风登记处的287对患者与代理人参与了本研究。所有患者在中风后90至120天于家中或护理机构接受评估，评估内容包括改良Rankin量表运动指数（力量）、Barthel指数（日常生活活动）、Lawton评估（工具性日常生活活动）、Folstein简易精神状态检查表（认知）以及SIS。符合条件的代理人是年龄大于或等于18岁、认识患者至少1年且每周至少看望患者一次的个体。所有代理人访谈在患者访谈的7天内（之前或之后）进行。
堪萨斯城中风登记处的377名患者符合研究条件。77名患者或代理人拒绝参与。同意参与的患者 - 代理人对中有13名患者因失语或认知障碍严重而无法完成访谈，被排除在研究之外。在SIS - 16以及完整SIS的8个领域中的7个领域，代理人对患者的评分比患者自评显示患者受影响更严重（5个在α = 0.05时具有统计学意义）。随着中风严重程度增加，代理人高估患者病情严重程度的偏差倾向于增大。然而，通过效应量衡量的患者与代理人均值之间的偏差幅度较小（范围为 - 0.1至0.4）。通过组内相关系数衡量的代理人与患者之间的一致性强度范围为0.50至0.83。在可观察的身体领域一致性最佳。所有领域中患者和代理人的评分在Rankin类别间均存在显著差异。患者和代理人与Folstein简易精神状态检查表、Barthel指数、Lawton工具性日常生活活动以及运动指数的相关性的同时效度良好至优秀（范围为0.37至0.78）。
代理人可为中风结局评估提供有效信息。在SIS领域及SIS - 16方面，患者与代理人的报告存在显著差异。然而，观察到的偏差较小且无临床意义。
