Review article (meta-analysis)| Volume 94, ISSUE 1, P177-192, January 2013

Measuring Participation After Stroke: A Review of Frequently Used Tools

  • Tamara Tse
    Corresponding author Tamara Tse, MGer, The Florey Institute of Neuroscience and Mental Health, Melbourne Brain Centre–Austin Campus, 245 Burgundy St, Heidelberg, Vic 3084, Australia.
    The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia

    Department of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
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  • Jacinta Douglas
    The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia

    Department of Human Communication Sciences, La Trobe University, Bundoora, Victoria, Australia
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  • Primrose Lentin
    Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
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  • Leeanne Carey
    The Florey Institute of Neuroscience and Mental Health, Neurorehabilitation and Recovery, Stroke Division, Heidelberg, Victoria, Australia

    Department of Occupational Therapy, La Trobe University, Bundoora, Victoria, Australia
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Published:September 13, 2012DOI:



      To identify and critique the measures currently used to assess participation in clinical stroke studies.

      Data Sources

      Relevant articles published between January 2001 and April 2012 identified through Medline, CINAHL, and ProQuest Central databases.

      Study Selection

      Published articles involving poststroke assessment of participation. Case studies, cohort studies, and randomized controlled trials were included.

      Data Extraction

      The most frequently used measures were identified and the psychometric properties evaluated. Three raters independently evaluated each measure relative to the first and second coding levels of the International Classification of Functioning, Disability and Health (ICF) Activities and Participation domain categories.

      Data Synthesis

      Thirty-six measures were identified. The Stroke Impact Scale (SIS), London Handicap Scale, Assessment of Life Habits (LIFE-H), Frenchay Activities Index, and Activity Card Sort (ACS) were used most frequently. No single measure met criteria across all psychometric indices, and not one covered all 9 of the ICF Activities and Participation domains. The SIS, LIFE-H, and ACS covered the widest range. The domains covered most frequently were Community, Social and Civic Life, Domestic Life, and Mobility. Learning and Applying Knowledge, General Tasks and Demands, and Communication were the domains less frequently covered.


      This review identified and evaluated the most frequently used participation measures in clinical stroke studies. The SIS, LIFE-H, and ACS covered the ICF Activities and Participation domain categories most comprehensively. However, none of the measures covered all the ICF Activities and Participation domain categories. The information provided in this systematic review can be used to guide the selection of participation measures to meet specific clinical and research purposes.


      List of abbreviations:

      ACS (Activity Card Sort), ACS-Aus (Activity Card Sort Australian version), ACS-HK (Activity Card Sort Hong Kong version), ACS-Israeli (Activity Card Sort Israeli version), ADL (activities of daily living), BI (Barthel Index), FAI (Frenchay Activities Index), IADL (instrumental activities of daily living), ICC (intraclass correlation coefficient), ICF (International Classification of Functioning, Disability and Health), ICIDH (International Classification of Impairments, Disabilities and Handicaps), LHS (London Handicap Scale), LIFE-H (Assessment of Life Habits), NEADL (Nottingham Extended Activities of Daily Living scale), SIS (Stroke Impact Scale), SMAF (Functional Autonomy Measurement System)
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