A brief novel questionnaire to estimate premorbid functional state in acute stroke patients

During acute stroke evaluation, knowing a patient's premorbid functional state can guide clinical decision and research considerations. The often-utilized modified Rankin scale was not designed and is not well suited for this purpose. Thus, we developed and tested a brief questionnaire to assess a patient's premorbid functional state.

The novel questionnaire scores range from 0 to 5. Scores 0-2 represent increasing degrees of independent functioning, not at all difficult (0), somewhat difficult (1), and very difficult (2). Scores 3, 4, and 5 represent moderate to severe disabilities. Paired raters independently tested the novel questionnaire on two consecutive days in patients with acute cerebrovascular events. The kappa statistic evaluated reliability of the novel questionnaire and previously established questionnaires were used for concurrent validity testing.

In 76 patients, mean age 77 (SD 14) years and 51% women, the overall agreement between the paired raters was 79%. The standard kappa was 0.62 (95% CI 0.47-0.76), p < 0.001, and the weighted kappa was 0.89 (95% CI 0.82-0.96), p < 0.001. The novel questionnaire scores correlated well with the Groningen scale (r = 0.70 and r = 0.67 for the two raters, p < 0.001 for both), and with the Lawton scale (r = -0.77 and r= -0.82 for the two raters, p < 0.001 for both).

This novel brief baseline function questionnaire for assessing a patient's premorbid functional state has acceptable clinimetric properties and could be used to rapidly and reliably score the premorbid baseline function among acute stroke patients.