SATIS-Stroke

Purpose

The SATIS-Stroke is a questionnaire that can be used to measure satisfaction with activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. among patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The questions are tailored to assess the individual’s satisfaction with participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in their everyday activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
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In-Depth Review

Purpose of the measure

The SATIS-Stroke is a questionnaire that can be used to measure satisfaction with activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. among patients with strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain.. The questions are tailored to assess the individual’s satisfaction with participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual's involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations. in their everyday activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
. The SATIS-Stroke can be used with patients with chronic strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. regardless of their age, gender, social status, place of residence, delay since strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain. and type of strokeAlso called a "brain attack" and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a "schemic stroke", or the formation of a blood clot in a vessel supplying blood to the brain..

The SATIS-Stroke includes 36 items, covering the 9 ICF domains: learning and applying knowledge, general tasks and demands, communication, mobility, self-care, domestic life, interpersonal interactions and relationships, major life areas, and community, social and civic life. The 36 items are sorted and numbered in order of decreasing satisfactory level, meaning that the first item (moving outside your home in any circumstance) requires the highest satisfactory level in order to be performed, whereas the last item (listening to and watching television according to your needs) requires the lowest satisfactory level.

Available versions

There are no alternative versions.

Features of the measure

Items:
There are no actual items to the MTS.

Description of tasks:
The patient is asked to rate their perceived satisfaction in performing each of the following daily activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function.
and life situations using a 4-point scale.

1. Moving outside your home in any circumstances
2. Climbing and going downstairs all stages in your home according to your needs
3. Using knife, fork and spoon in all circumstances
4. Having a sexual relationship with somebody
5. Using coins and banknotes in all circumstances
6. Participating in spoken exchange of information with your entourage
7. To supplement administrative documents in all circumstances
8. Washing your hair according to your needs
9. Taking a bath or your shower according to your needs
10. Undresssing to use the toilet and redressing in your home or outside of it
11. Entering and exiting home your home according to your needs
12. Participating in arts and culture (cinema, theatre, etc.)
13. Reaching objects in your near space
14. Dressing and undressing in all circumstances and according to your needs
15. Managing your income in all circumstances
16. Getting clothes out of the closet
17. Using storage spaces in your house
18. Participating in spousal relationships
19. Ensuring that your rights are respected
20. Carrying out your personal hygiene according to your needs
21. Asking for help in an emergency situation
22. Reading and understanding a document in all circumstances
23. Moving inside your home
24. Managing your pain in all circumstances
25. Using the telephone at home according to your needs
26. Maintaining emotional relationships
27. Expressing oneself to someone
28. Having urinary continence in your home and outside of it
29. Participating in food and drink preparation in all circumstances
30. Opening and closing doors in your home
31. Co-operating with your entourage
32. Being aware of what surrounds you
33. Participating in ceremonies (marriage, gathering family, etc)
34. Choosing appropriate clothes
35. Getting feelings across
36. Listening to and watching television according to your needs

Scoring and Score Interpretation:
The 36 items are sorted and numbered in order of decreasing satisfactory level, meaning that the first item requires the most amount of satisfaction in order to perform the task, whereas the last item requires the least amount of satisfaction in order to perform the task.

Perceived satisfaction is rated on a 4-point scale.

1. Very dissatisfied
2. Dissatisfied
3. Satisfied
4. Very Satisfied

Scores range from 0 to 105 with a higher score indicating greater perceived satisfaction with tasks.

Information on score interpretation is not yet available.

Time:
Not reported.

Training requirements:
No training requirements have been reported.

Subscales:
None reported.

Equipment:
None required.

Alternative forms of the SATIS-Stroke

There are no alternative forms of the SATIS-Stroke.

Client suitability

Can be used with:

• Patients with chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. regardless of their age, gender, social status, place of residence, delay since strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. and type of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain. (Bouffioulx et al., 2008).

Should not be used with:

• Patients with cognitive deficits, as these patients were excluded from the original validation study (Bouffioulx et al., 2008).

In what languages is the measure available?

English, french.

Summary

What does the tool measure?	Patients’ perceived satisfaction with activitiesAs defined by the International Classification of Functioning, Disability and Health, activity is the performance of a task or action by an individual. Activity limitations are difficulties in performance of activities. These are also referred to as function. and participationAs defined by the International Classification of Functioning, Disability and Health, participation is an individual’s involvement in life situations in relation to health conditions, body functions or structures, activities, and contextual factors. Participation restrictions are problems an individual may have in the manner or extent of involvement in life situations..
What types of clients can the tool be used for?	Clients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Is this a screeningTesting for disease in people without symptoms. or assessment tool?	Assessment tool.
Time to administer	Not reported.
Versions	None reported.
Other Languages	English and French.
Measurement Properties
ReliabilityReliability can be defined in a variety of ways. It is generally understood to be the extent to which a measure is stable or consistent and produces similar results when administered repeatedly. A more technical definition of reliability is that it is the proportion of “true” variation in scores derived from a particular measure. The total variation in any given score may be thought of as consisting of true variation (the variation of interest) and error variation (which includes random error as well as systematic error). True variation is that variation which actually reflects differences in the construct under study, e.g., the actual severity of neurological impairment. Random error refers to “noise” in the scores due to chance factors, e.g., a loud noise distracts a patient thus affecting his performance, which, in turn, affects the score. Systematic error refers to bias that influences scores in a specific direction in a fairly consistent way, e.g., one neurologist in a group tends to rate all patients as being more disabled than do other neurologists in the group. There are many variations on the measurement of reliability including alternate-forms, internal consistency , inter-rater agreement , intra-rater agreement , and test-retest .	Test-retest: One study examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). of the SATIS-Stroke and found excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society). .
ValidityThe degree to which an assessment measures what it is supposed to measure.	Criterion: Concurrent: One study examined the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.” between the SATIS-Stroke and the Barthel Index and found excellent correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation. between the two measures.
Floor/Ceiling Effects	No studies have examined the floor or ceiling effects of the SATIS-Stroke.
Does the tool detect change in patients?	One study examined the ability of the SATIS-Stroke to detect change and reported that the SATIS-Stroke had a large ability to detect change from the acute to chronic phase of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain..
Acceptability	Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for use clinically.
Feasibility	The administration of the SATIS-Stroke is easy and simple to administer.
How to obtain the tool?	Information on the SATIS-Stroke can be obtained from the article by Bouffioulx, Arnould and Thonnard (2008).

Psychometric Properties

Overview

A literature search was conducted to identify all relevant publications on the psychometric properties of the SATIS-Stroke and revealed only the initial validation study. Results support preliminary validation of the psychometric properties, however further research is needed before the tool is ready for clinical use.

Floor/Ceiling Effects

Floor or ceiling effects of the SATIS-Stroke have not been examined.

Reliability

Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency.:
Internal consistencyA method of measuring reliability . Internal consistency reflects the extent to which items of a test measure various aspects of the same characteristic and nothing else. Internal consistency coefficients can take on values from 0 to 1. Higher values represent higher levels of internal consistency. of the SATIS-Stroke has not been examined.

Test-retest:
Bouffioulx, Arnould and Thonnard (2008) examined the test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
of the SATIS-Stroke in 101 patients with strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The SATIS-Stroke was administered two times, with an interval of 32 days between each administration. Excellent test-retest reliabilityA way of estimating the reliability of a scale in which individuals are administered the same scale on two different occasions and then the two scores are assessed for consistency. This method of evaluating reliability is appropriate only if the phenomenon that the scale measures is known to be stable over the interval between assessments. If the phenomenon being measured fluctuates substantially over time, then the test-retest paradigm may significantly underestimate reliability. In using test-retest reliability, the investigator needs to take into account the possibility of practice effects, which can artificially inflate the estimate of reliability (National Multiple Sclerosis Society).
was found, as calculated using Intraclass CorrelationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
Coefficient (ICC=0.98, p<0.001).

Intra-rater:
Intra-rater reliabilityThis is a type of reliability assessment in which the same assessment is completed by the same rater on two or more occasions. These different ratings are then compared, generally by means of correlation. Since the same individual is completing both assessments, the rater’s subsequent ratings are contaminated by knowledge of earlier ratings.
of the SATIS-Stroke has not been examined.

Inter-rater:
Inter-rater reliabilityA method of measuring reliability . Inter-rater reliability determines the extent to which two or more raters obtain the same result when using the same instrument to measure a concept.
of the SATIS-Stroke has not been examined.

Validity

Content:
Content validityRefers to the extent to which a measure represents all aspects of a given social concept. Example: A depression scale may lack content validity if it only assesses the affective dimension of depression but fails to take into account the behavioral dimension.
of the SATIS-Stroke has not been examined.

Criterion:
Concurrent:
Bouffioulx, Arnould and Thonnard (2008) investigated the concurrent validityTo validate a new measure, the results of the measure are compared to the results of the gold standard obtained at approximately the same point in time (concurrently), so they both reflect the same construct. This approach is useful in situations when a new or untested tool is potentially more efficient, easier to administer, more practical, or safer than another more established method and is being proposed as an alternative instrument. See also “gold standard.”
between the SATIS-Stroke and the Barthel Index. An excellent (r=0.74, p<0.05) correlationThe extent to which two or more variables are associated with one another. A correlation can be positive (as one variable increases, the other also increases – for example height and weight typically represent a positive correlation) or negative (as one variable increases, the other decreases – for example as the cost of gasoline goes higher, the number of miles driven decreases. There are a wide variety of methods for measuring correlation including: intraclass correlation coefficients (ICC), the Pearson product-moment correlation coefficient, and the Spearman rank-order correlation.
was found between the two measures. Results from this study suggest that independence in activity and life situations is related to patient ratings of perceived satisfaction.

Predictive:
Predictive validityA form of criterion validity that examines a measure’s ability to predict some subsequent event. Example: can the Berg Balance Scale predict falls over the following 6 weeks? The criterion standard in this example would be whether the patient fell over the next 6 weeks.
of the SATIS-Stroke has not been examined.

Construct:
Convergent/Discriminant:
The convergent or discriminant of the SATIS-Stroke validityThe degree to which an assessment measures what it is supposed to measure.
has not been examined.

Known groups:
The known groups validityKnown groups validity is a form of construct validation in which the validity is determined by the degree to which an instrument can demonstate different scores for groups know to vary on the variables being measured.
of the SATIS-Stroke has not been examined.

SensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also “Specificity.”
/ SpecificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
:
The sensitivitySensitivity refers to the probability that a diagnostic technique will detect a particular disease or condition when it does indeed exist in a patient (National Multiple Sclerosis Society). See also "Specificity."
or specificitySpecificity refers to the probability that a diagnostic technique will indicate a negative test result when the condition is absent (true negative).
of the SATIS-Stroke has not been examined.

Responsiveness

Bouffioulx, Arnould, Vandervelde and Thonnard (2010) examined the responsivenessThe ability of an instrument to detect clinically important change over time.
of the SATIS-Stroke in 45 patients with acute, subacute or chronic strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The SATIS-Stroke was administered at 1 week (acute), 3 months (subacute) and six months (chronic) following onset of strokeAlso called a “brain attack” and happens when brain cells die because of inadequate blood flow. 20% of cases are a hemorrhage in the brain caused by a rupture or leakage from a blood vessel. 80% of cases are also know as a “schemic stroke”, or the formation of a blood clot in a vessel supplying blood to the brain.. The patients were also asked to subjectively rate their perceptions of change in overall functional status at the three time points, which was then used to classify their status as ‘deteriorating’, ‘stable’ or ‘improved’. The SATIS-Stroke was found to have the greatest responsivenessThe ability of an instrument to detect clinically important change over time.
for detecting change in patients’s function from the acute to chronic phase, demonstrating a large effect sizeEffect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. The ES is generally measured in two ways: as the standardized difference between two means, or as the correlation between the independent variable classification and the individual scores on the dependent variable. This correlation is called the “effect size correlation”.
(effect size=1.12, standardized response mean=0.62). The SATIS-Stroke was found to be less responsive from the acute to subacute phase (effect size=0.76, standardized response meanThe standardized response mean (SRM) is calculated by dividing the mean change by the standard deviation of the change scores.
0.59) and from the sub-acute to chronic phase (effect size=0.42, standardized response mean=0.27); however, it may be that less drastic changes in satisfaction may be occurring during these time periods. This study also reviewed the minimal clinically important difference but concluded that further investigate is necessary.

References

• Bouffioulx, E., Arnould, C. & Thonnard, J-L. (2008). SATIS-Stroke: A satisfaction measure of activities and participation in the actual environment experienced by patients with chronic stroke. Journal of Rehabilitation Medicine, 40, 836-843.
• Bouffioulx, E., Arnould, C. Vandervelde, L. & Thonnard, J-L. (2010). Changes in satisfaction with activities and participation between acute, post-acute and chronic stroke phases: A responsiveness study of the SATIS-Stroke questionnaire. Journal of Rehabilitation Medicine, 42, 944-948.

See the measure

How to obtain the SATIS-Stroke?

Information on the SATIS-Stroke can be obtained from the Bouffioulx, Arnould and Thonnard (2008) article.