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RehabMeasures Instrument

Caregiver Strain Index

Last Updated

Purpose

A 13-item objective questionnaire designed to assess level of stress experienced by the informal caregivers.

Link to Instrument

Instrument Details

Acronym CSI

Cost

Free

Diagnosis/Conditions

  • Cancer Rehabilitation
  • Stroke Recovery

Key Descriptions

  • 13 questions based on identified common stressors.
  • Answers are in the yes/no format.
  • Scoring is 1 point for each YES and 0 for each NO.
  • Question scores are summed.
  • Maximum score = 13.

Number of Items

13

Equipment Required

  • Questionnaire
  • Pen

Time to Administer

5 minutes

5 minutes or less

Required Training

No Training

Instrument Reviewers

Initially reviewed by Jasmine M. Savla, PT in 10/2012.

Considerations

  • Mood and emotional state of caregiver can affect the outcome of the index.
  • The dichotomous (yes/no) response available on the questionnaire does not provide enough options for the long term caregivers.
  • Examples provided with some of the CSI items need more clarification.

Caregiver Strain Index (CSI) translations:

French: http://www.stresshumain.ca/documents/pdf/Mammouth%20Magazine/Mammouth_vol10_FR.pdf

Spanish: http://www.hipocampo.org/CSI.asp

These translations, and links to them, are subject to the. Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

 

Stroke

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Standard Error of Measurement (SEM)

 (Post et al, 2007; n= 26, mean age of caregivers = 55.9 years; 3 years post-stroke)

  • SEM = 1.0

Minimal Detectable Change (MDC)

(Post et al, 2007)

  • MDC (Smallest Detectable Difference (SDD)) = ±2.8

Test/Retest Reliability

(Post et al, 2007)

  • Excellent test-retest reliability (ICC= 0.93)

Construct Validity

(van Exel et al, 2004)

Measures 

SCQ 

SRB 

CRADS

CRAFP

CRAFS

CRAHP

CRASE

CSI 

0.71 

0.66 

0.41 

0.80 

0.55 

0.69 

0.15 

Correlation 

Excellent 

Excellent 

Adequate 

Excellent 

Adequate 

Excellent 

Poor

*Spearman’s Rho. Significance two tailed (p<0.01); SRB, Self-Rated Burden; CSI, Caregiver Strain Index; SCQ, Sense of Competence Questionnaire; CRA, Caregiver Reaction Assessment; DS, Disrupted Schedule Subscale; FP, Financial Problems Subscale; FS, Lack of Family Support Subscale; HP, Health Problems Subscale; SE, Self-Esteem Subscale.

Floor/Ceiling Effects

(van Exel N et al, 2004)

  • Excellent (No floor or ceiling effects seen)

Responsiveness

(Post et al, 2007)

  • Moderate responsiveness

Alzheimer's Disease and Progressive Dementia

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Internal Consistency

(Diwan, 2004; n = 150, mean age = 61.9 ±13.5 years)

  • Excellent internal consistency (Cronbach’s α = 0.81) 
  • Adequate internal consistency of adjustment or role strain subscale (Cronbach’s α = 0.72)
  • Poor internal consistency of personal strain subscale (Cronbach’s α = 0.69)
  • Poor internal consistency of emotional strain subscale (Cronbach’s α = 0.61)

Cancer

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Test/Retest Reliability

(Ugur and Fadilo?lu, 2010; n= 132)

  • Excellent test-retest reliability (ICC= 0.75)

Internal Consistency

(Ugur and Fadilo?lu, 2010)

  • Adequate internal consistency for the first administration of CSI (Cronbach’s α = 0.77) 
  • Adequate internal consistency for the second administration of CSI (Cronbach’s α = 0.73)

Older Adults and Geriatric Care

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Cut-Off Scores

(Robinson, 1983; n=85, post hospitalization)

  • A positive screen of 7 or more items indicates greater levels of stress and a need for further assessment

Test/Retest Reliability

(Thornton and Travis, 2003; n= 158, mean age of caregivers = 61 years, Long-term caregivers)

  • Excellent test-retest reliability (ICC= 0.60)

Internal Consistency

(Robinson, 1983)

  • Excellent internal consistency (Cronbach’s alpha= 0.86)

(Thornton and Travis, 2003)

  • Excellent internal consistency (Cronbach’s α = 0.90)

(Marks, 1988; n= 50, Frail elderly)

  • Excellent internal consistency (Cronbach’s α = 0.83)

Content Validity

(Robinson B, 1983)

  • Ten common stressors were identified after a thorough review of interviews of 49 adult children who were taking care of elderly parents. These interviews were taken three times in a period of 5 years. Three stressors were added later to the list with help of literature search and analysis. This list of 13 common stressors was combined to form the CSI.

Bibliography

DiBartolo, M. C. (2000). "Caregiver burden. Instruments, challenges, and nursing implications for individuals with Alzheimer's disease and their caregivers." J Gerontol Nurs 26(6): 46-53.

Diwan, S., Hougham, G. W., et al. (2004). "Strain experienced by caregivers of dementia patients receiving palliative care: findings from the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program." J Palliat Med 7(6): 797-807.

Post, M. W., Festen, H., et al. (2007). "Reproducibility of the Caregiver Strain Index and the Caregiver Reaction Assessment in partners of stroke patients living in the Dutch community." Clin Rehabil 21(11): 1050-1055.

Robinson, B. C. (1983). "Validation of a Caregiver Strain Index." J Gerontol 38(3): 344-348.

Sullivan, M. T. (2003). "Caregiver Strain Index (CSI)." Home Health Nurse 21(3): 197-198.

Thornton, M. and Travis, S. S. (2003). "Analysis of the reliability of the modified caregiver strain index." J Gerontol B Psychol Sci Soc Sci 58(2): S127-132.

Ugur, O. and Fadiloglu, C. (2010). ""Caregiver Strain Index" validity and reliability in Turkish society." Asian Pac J Cancer Prev 11(6): 1669-1675.

van Exel, N. J., Scholte op Reimer, W. J., et al. (2004). "Instruments for assessing the burden of informal caregiving for stroke patients in clinical practice: a comparison of CSI, CRA, SCQ and self-rated burden." Clin Rehabil 18(2): 203-214.