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Using an understandable measure to describe subsequent disabilities after stroke is important for clinical practice, and practitioners often use multiple measures that contain different scoring systems and scales to rate activities of daily living (ADL) independence. Therefore, we compared the construct of independence in five measures used with stroke survivors (the Glasgow Outcome Scale, 5-point version, Glasgow Outcome Scale, 8-point version, Modified Rankin Scale, Barthel Index, and the Performance Assessment of Self-Care Skills). The Rasch analysis Partial Credit Model converted items from these measures to a single metric yielding an item difficulty hierarchy of all items from the five measures. Results showed that the five measures evaluated independence of the stroke survivors somewhat differently. Data from the five measures should be interpreted carefully because other concepts or constructs in addition to ADL independence are included in some of the measures. Rasch diagnostics regarding construct validity and reliability of the combined five measures also indicated that these measures are not interchangeable. Although the items of the combined 5 ADL measures were unidimensional, they measured independence from multiple perspectives and the scale of the combined measures was not linear.

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This paper describes patterns of concordance/discordance between self-reported abilities (“can do”) and habits (“does do”) and observed task performance of daily living tasks in 3 groups of older adults: late life depression with mild cognitive impairment (n = 53), late life depression without mild cognitive impairment (n = 64), and non-depressed, cognitively normal controls (n = 31). Self-reported data were gathered by interview in participants' homes, followed by observation of task performance. Significant differences in the patterns of response were found between controls and respondents with both late life depression and mild cognitive impairment for the cognitive instrumental activities, and between the two depressed groups and controls for the physical instrumental activities. For both sets of activities, controls exhibited the greatest overestimation of task performance. No differences were found among the groups for the less complex functional mobility and personal care tasks. However, for the more complex instrumental activities, concordance was close to, or less than, chance. The findings led us to conclude that when performance testing is not feasible, self-reports of functional status that focus on habits may be more accurate than those that focus on abilities.

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