Aging Clinical and Experimental Research

, Volume 7, Issue 4, pp 228–233 | Cite as

Classifying change with the Sickness Impact Profile for Nursing Homes (SIP-NH)

  • Rahul Dhanda
  • C. D. Mulrow
  • M. B. Gerety
  • S. Lee
  • J. E. Cornell
Original Article


The aim of this cohort study was to evaluate the concordance of the Sickness Impact Profile for Nursing Homes (SIP- NH) and Sickness Impact Profile (SIP) in classifying change. Subjects consisted of 194 consecutive long- stay nursing home residents at one academic department of the V.A. and in 8 community proprietary nursing homes in San Antonio, Texas. They were to have more than 3 months residency; to be ⩾61 years; and to be dependent in at least 2 ADLs with an MMSE score of ⩾15. Subjects were administered a 128- item SIP and a reduced 66- item SIP- NH at baseline and 4, 8, and 12- month follow- up. At each follow- up, subjects were classified into 3 mutually exclusive change categories using a change score of ⩾5 points. Concordance of the classification of subjects by the SIP- NH and SIP was evaluated. The misclassification rate as well as its direction was also assessed. Both instruments classified a little over one- quarter of the subjects as better, over a third as being unchanged, and another third as being worse at the four- month follow- up. More subjects were classified as worse by both instruments at 8 and 12 months. All kappas ranged from 0.52 to 0.78, indicating good to excellent agreement. Overall, the SIP- NH characterized persons as changed more often than the SIP with no systematic directional bias. In conclusion, the SIP- NH was concordant with the SIP in classifying change in subjects. However, we cannot say which of the two is better for detecting change. Future research must focus on defining a change score which has clinical meaning, and evaluate responsiveness to change. (Aging Clin. Exp. Res. 7: 228–233, 1995)


Frail elderly functional status health status measures nursing homes questionnaires 


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  1. 1.
    Bergner M., Bobbitt R.A., Pollard W.E., Martin DP., Gilson B.S.: The Sickness Impact Profile: Validation of a health status measure. Med. Care 14: 57–67, 1976.PubMedCrossRefGoogle Scholar
  2. 2.
    Rothman M.L., Hedrick S., Inui T.: The Sickness Impact Profile as a measure of the health status of non-cognitively impaired nursing home residents. Med. Care 27: S157–S167, 1989.PubMedCrossRefGoogle Scholar
  3. 3.
    Granger C.V., Cotter A.C., Hamilton B.B., Fiedler R.C.: Functional assessment scales: a study of persons after stroke. Arch. Phys. Med. Rehabil. 74: 133–138, 1993.PubMedGoogle Scholar
  4. 4.
    Laupacis A., Bourne R., Rorabeck C., Feeny D., Wong C., Tugwell P., Leslie K., Bullas R.: The effect of elective total hip replacement on health-related quality of life. J. Bone Joint Surg. Am. 75: 1619–1626, 1993.PubMedGoogle Scholar
  5. 5.
    Chapko M., Rothman M.L., Eherth J., Hedrick S.C., Sullivan J., Erdly W., Cooper S.: Data collection in Adult day health study. Med. Care 31: SS3–SS14, 1993.PubMedGoogle Scholar
  6. 6.
    Mackenzie R.C., Charlson M.E., DiGioia D., Kelley K.: A patient-specific measure of change in maximal function. Arch. Intern. Med. 146: 1325–1329, 1986.PubMedCrossRefGoogle Scholar
  7. 7.
    Mackenzie R.C., Charlson M.E., DiGioia D., Kelley K.: Can the Sickness Impact Profile measure change? An example of scale assessment. J. Chronic Dis. 39: 429–438, 1986.PubMedCrossRefGoogle Scholar
  8. 8.
    Gerety M.B., Cornell J.E., Mulrow C.D., Tuley M., Hazuda H.P., Lichtenstein M., Kanten D.N., Aguilar C., Kadri A.A., Rosenberg J.: The Sickness Impact Profile for nursing homes (SIP-NH). J. Gerontol. 49: M2–M8, 1994.PubMedCrossRefGoogle Scholar
  9. 9.
    Mulrow C.D., Gerety M.B., Kanten D.N., DeNino L.A., Cornell J.E.: Effects of physical therapy on functional status of nursing home residents. J. Am. Geriatr. Soc. 41: 326–328, 1993.PubMedGoogle Scholar
  10. 10.
    Mulrow C.D., Gerety M.B., Kanten D.N., Cornell J.E., De Nino L.A., Chiodo L., Aguilar C., O’Neil M.B., Rosenberg J., Solis R.M.: A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 271: 519–524, 1994.PubMedCrossRefGoogle Scholar
  11. 11.
    Katz S., Ford A.B., Moskowitz R.W., Jackson B.A., Jaffee M.W.: Studies of illness in the aged: The index of ADL — a standardized measure of biological and psychosocial function. JAMA 185: 914–919, 1963.PubMedCrossRefGoogle Scholar
  12. 12.
    Folstein M.F., Folstein S.E., McHugh P.R.: “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.PubMedCrossRefGoogle Scholar
  13. 13.
    Cohen J.: A coefficient of agreement for nominal scale. Educ. Psychol. Meas. 20: 37–46, 1960.CrossRefGoogle Scholar
  14. 14.
    Landis J.R., Koch G.G.: The measurement of observer agreement for categorical data. Biometrics 33: 671–679, 1977.CrossRefGoogle Scholar
  15. 15.
    Lewis M.A., Kane R.L., Cretin S., Clark V.: The immediate and subsequent outcomes of nursing home care. Am. J. Public Health 75: 758–762, 1985.PubMedCrossRefGoogle Scholar
  16. 16.
    Roher J.E., Yasalis C., Laughlin P.R., Wiley R.: Patterns of change in functional status in long-term care. Health Serv. Res. 23: 495–509, 1988.Google Scholar
  17. 17.
    Deyo R.A.: Measuring functional outcomes in therapeutic trials for chronic disease. Control Clin. Trials 5: 223–240, 1984.PubMedCrossRefGoogle Scholar
  18. 18.
    Fiatarone M.A., O’Neill E.F., Tyan N.D., Clements K.M., Solares G.R., Nelson M.E., Roberts S.B., Kehayias J.J., Lipsitz L.A., Evans W.J.: Exercise training and nutritional supplementation for physical frailty in very elderly people. N. Engt. J. Med. 330: 1769–1775, 1994.CrossRefGoogle Scholar

Copyright information

© Springer Internal Publishing Switzerland 1995

Authors and Affiliations

  • Rahul Dhanda
    • 1
    • 4
  • C. D. Mulrow
    • 1
    • 2
    • 3
  • M. B. Gerety
    • 1
    • 2
    • 3
  • S. Lee
    • 4
  • J. E. Cornell
    • 2
    • 3
  1. 1.Division of General MedicineUniversity of Texas Health Science CenterUSA
  2. 2.Division of Geriatrics and GerontologyUniversity of Texas Health Science CenterUSA
  3. 3.Geriatric Research, Education and Clinical CenterAudie L. Murphy Memorial Veterans HospitalSan Antonio
  4. 4.The Aging Research and Education CenterUniversity of Texas Health Science CenterSan AntonioUSA

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