Good inter-rater reliability of the Frenchay Activities Index in stroke patients

To assess inter-rater reliability of the Frenchay Activities Index (FAI) when used by occupational therapists in stroke patients.

Independent administration of the FAI by occupational therapists in 45 stroke outpatients.

Outpatient departments of two Dutch rehabilitation centres.

Agreement between pairs of raters was assessed at item level using weighted Kappa and the percentage absolute agreement and for the total score using intra-class correlations (ICC), Bland-Altman plots and computation of the smallest real difference (SMR).

ICC of the total score was good (0.90; 95% confidence interval (95% CI): 0.82-0.94). The Bland-Altman plot did not reveal relationships between agreement and height of scores. Reliability at item level was good (kappa >0.60) in 11 out of 15 items. The item 'gainful work' showed high agreement but a low kappa due to an extremely skewed score distribution. Reliability was insufficient in three items: 'local shopping', 'social occasions' and 'actively pursuing hobby'. Clarification of scoring instructions of these items might further improve the inter-rater reliability of the FAI.

The FAI is a reliable instrument to measure outcomes of outpatient rehabilitation in patients with stroke.