King's College, London, UK.
Stroke. 2012 May;43(5):1362-9. doi: 10.1161/STROKEAHA.111.645234. Epub 2012 Mar 29.
Basic activities of daily living measures are often supplemented by extended activities of daily living. We compared the Frenchay Activities Index (FAI) and Nottingham Extended Activities of Daily Living (NEADL) with the Barthel Index (BI) in terms of distribution of scores, concurrent validity, reliability, and their agreement and investigated the predictors of scales outcomes.
Two hundred thirty-eight patients from the population-based South London Stroke Register were assessed with the BI, FAI, and NEADL 3 months after a first-ever stroke. The pairwise relationship was studied using correlations, fractional polynomial regression, and Bland and Altman plot; the baseline predictors, for example, sociodemography, case severity: National Institutes of Health Stroke Scale, and 7-day Abbreviated Memory Test, comorbidities, and acute treatments by negative binomial regression.
The BI was highly affected by a ceiling effect (33% had the highest score), FAI was only affected by floor effect (19%), but NEADL was symmetrical with only 4% highest and lowest score. Despite high concurrent validity of the scales (r ≥0.80, P<0.001), they agreed poorly only for the highest and the lowest level of activities. The association and agreement of NEADL with BI was higher than that of FAI with BI. Severe stroke patients (National Institutes of Health Stroke Scale >13) had 28% lower BI (79% lower FAI and 62% lower NEADL) score than nonsevere patients (P≤0.001). Cognitively intact patients (Abbreviated Memory Test: 8-10) had 2.3 times greater FAI values (65% higher NEADL) compared with impaired patients (P<0.001).
The NEADL scale was symmetrical, concurrently valid with no floor and ceiling effects. It corresponded better with BI than FAI did confirming its basic activities of daily living properties, yet it is a more sensitive tool for extended activities of daily living without the floor and ceiling effects. Future functional status could be predicted by the acute stage National Institutes of Health Stroke Scale score, whereas only extended activities of daily living status could be predicted by the Abbreviated Memory Test score. Predicting future functional status at the acute stage may decrease unnecessary length of stay in acute care settings.
基本日常生活活动的测量通常需要补充扩展的日常生活活动测量。我们将 Frenchay 活动指数（FAI）和诺丁汉扩展日常生活活动（NEADL）与 Barthel 指数（BI）进行比较，比较内容包括评分分布、同期有效性、可靠性以及它们的一致性，并探讨了这些量表结果的预测因素。
在首次中风后 3 个月，从基于人群的南伦敦中风登记处招募了 238 名患者，对他们进行 BI、FAI 和 NEADL 的评估。使用相关性、分数多项式回归和 Bland 和 Altman 图研究两两之间的关系；使用负二项回归分析基线预测因素，例如社会人口统计学、病例严重程度（美国国立卫生研究院中风量表）、7 天简短记忆测试、合并症和急性治疗。
BI 受到天花板效应的高度影响（33%的患者获得最高评分），FAI 仅受到地板效应的影响（19%），但 NEADL 是对称的，仅有 4%的患者获得最高和最低评分。尽管这些量表的同期有效性很高（r≥0.80，P<0.001），但它们仅在活动的最高和最低水平上一致性较差。NEADL 与 BI 的相关性和一致性均高于 FAI 与 BI。严重中风患者（美国国立卫生研究院中风量表>13）的 BI 评分低 28%（FAI 评分低 79%，NEADL 评分低 62%），而非严重中风患者（P≤0.001）。认知正常患者（简短记忆测试：8-10 分）的 FAI 值高 2.3 倍（NEADL 高 65%），而认知受损患者（P<0.001）。
NEADL 量表是对称的，具有同期有效性，且无地板和天花板效应。与 FAI 相比，它与 BI 的一致性更好，证实了其基本日常生活活动的特性，但它是一种更敏感的工具，用于无地板和天花板效应的扩展日常生活活动。急性阶段的美国国立卫生研究院中风量表评分可以预测未来的功能状态，而简短记忆测试评分只能预测扩展日常生活活动的状态。在急性阶段预测未来的功能状态可能会减少在急性护理环境中不必要的住院时间。
