Stroke impact scale: Free PDF, scoring and MCID by domain

The stroke impact scale (SIS) is a 59-item questionnaire in which stroke survivors rate how much difficulty they have across eight areas of daily life. Each domain is scored from 0 to 100, and a higher score means better function.

Pamela Duncan and colleagues at the University of Kansas Medical Center developed the scale, and version 3.0 is the one in use today. A 16-item short form, the SIS-16, covers only the four physical domains for quicker checks.

The NIH Stroke Scale (NIHSS) grades the acute neurological deficit. The SIS instead tracks recovery from the patient’s side over the weeks and months that follow.

Key takeaways

The stroke impact scale measures eight domains of stroke recovery: strength, hand function, ADL/IADL, mobility, communication, emotion, memory and thinking, and participation.

The full SIS 3.0 has 59 items rated on a five-point scale, while the SIS-16 uses 16 items drawn from the four physical domains only.

Domain scores run from 0 to 100, and higher scores mean better function. A meaningful change ranges from about 4.5 points for mobility to 17.8 for hand function.

Reliability is strong for most domains, but the emotion domain is the least stable, so read changes there with extra caution.

Pabau, the practice management platform we build, sends the questionnaire before each visit and saves every completed form to the patient record.

What is the stroke impact scale?

The SIS is a self-report health status measure, built from interviews with stroke survivors and their caregivers. It can be completed in person, by a proxy, by mail or over the phone.

Rehab teams give it at baseline, at routine follow-ups, and before and after a targeted intervention. It captures how patients see their own recovery, which often differs from what the clinician observes. That view helps decide on discharge, progression to harder activities, or more intensive therapy.

SIS 3.0 vs the SIS-16 short form

Two versions exist, trading depth for speed. The full SIS 3.0 remains the standard for research and detailed outcome tracking. The SIS-16 speeds up screening in busy or time-limited settings, but it only looks at physical function.

That limit matters in practice. A patient whose main problem is low mood or memory can still score well on the SIS-16. Use the full version whenever those domains are in question.

The eight domains it measures

Each domain measures a separate consequence of stroke, so the scale looks well beyond motor recovery.

• Strength. Upper and lower limb muscle power and endurance during functional tasks.
• Hand function. Fine motor control, grip and two-handed coordination for dressing, grooming and eating.
• Activities of daily living (ADL) and instrumental ADL (IADL). Self-care such as bathing and toileting, plus household tasks like cooking, shopping and managing money.
• Mobility. Moving in bed, transfers, walking and stairs.
• Communication. Speech clarity, understanding language and expressing thoughts.
• Emotion. Mood, anxiety, frustration and emotional control after the stroke.
• Memory and thinking. Attention, recall, decision-making and processing speed.
• Participation. Return to work, leisure, social roles and community life.

How to administer the questionnaire

The SIS is designed for self-report. A caregiver or family member may complete it as a proxy when aphasia, cognitive impairment or severe disability stops the patient answering alone.

1. Prepare the setting. Use a quiet, private room. Allow 15-20 minutes for the full SIS 3.0, or 5-10 minutes for the SIS-16.
2. Explain the response scale. Read the instructions aloud and check the patient understands the five difficulty levels, from “not difficult at all” to “could not do it at all”.
3. Let the patient answer. The patient rates each item alone. You may clarify wording, but never suggest an answer.
4. Note any proxy completion. Mark it clearly on the form. Proxies tend to rate the patient as slightly more impaired, so flag these forms when comparing scores.
5. Record the date and format. Note whether the form was self-report or proxy, on paper or digital. This context helps when you read score changes later.

How to score each domain

Scoring turns raw five-point responses into a 0 to 100 score for each domain. One fixed formula keeps scores comparable across visits and between patients.

1. Sum the raw responses per domain. Add the item scores (1-5) for every item within each of the eight domains.
2. Apply the transformation formula. Use (raw sum – lowest possible raw score) / (highest possible raw score – lowest possible raw score) × 100. Use the formula exactly as the SIS 3.0 manual publishes it.
3. Report each domain separately. The eight transformed domain scores are the clinical output. The SIS does not produce one total score.
4. Record the recovery rating. SIS 3.0 ends with one extra question asking patients to rate their overall recovery from 0 to 100. Report it alongside the domain scores.
5. For the SIS-16, sum all 16 items. The SIS-16 adds its 16 physical-domain items into one physical-function composite score, which ranges from 16 to 80. It does not give per-domain scores comparable with the eight SIS 3.0 domains.
6. Track the trend. Plot domain scores across visits, weekly or monthly or after an intervention, to see the recovery path and adjust treatment.

How to interpret the scores

Interpretation depends on the domain and the patient’s baseline. There is no single “normal” range, so clinicians track change over time. The bands below are a practical reading guide rather than published cut-offs.

The minimal clinically important difference (MCID) is the smallest change a patient would notice as meaningful. Lin et al. (2010) estimated it for the physical domains: 4.5 points for mobility, 5.9 for ADL/IADL, 9.2 for strength and 17.8 for hand function. A 6-point gain in mobility clears that bar, while the same gain in hand function does not. The chart shows how far apart those thresholds sit.

Reliability and validity

Most domains hold up well across validation studies. The emotion domain is the consistent weak spot.

• Test-retest reliability. In the original validation, intraclass correlation coefficients (ICCs) ranged from 0.70 to 0.92. The emotion domain was the exception at 0.57, and later studies report values of roughly 0.48 to 0.7.
• Internal consistency. Cronbach’s alpha ranged from 0.83 to 0.90 across domains in the original study. Several later validations found the emotion domain less consistent, with alpha well below 0.80.
• Construct validity. Scores correlate strongly with motor function on the Fugl-Meyer Assessment, self-care on the Functional Independence Measure, and quality of life on the SF-36.
• Responsiveness to change. The scale picks up meaningful improvement over 3-6 months of rehab, which supports its use as a treatment outcome measure.
• Cross-cultural adaptation. Validated translations exist in more than 15 languages.

In practice, treat a shift in the emotion score as a prompt to ask more questions, not as proof that mood has changed.

The Rehabilitation Measures Database at Shirley Ryan AbilityLab summarizes these studies. The developers at the University of Kansas Medical Center hold the official versions of the instrument.

When to use it in rehab

The SIS fits any rehab setting where patient-reported function shapes clinical decisions.

• Acute inpatient rehab. Take a baseline within 48 hours of admission, then repeat weekly to track early recovery and discharge readiness.
• Outpatient physical and occupational therapy. Use it at evaluation and discharge, plus at intervals for insurance, accreditation or quality improvement records.
• Long-term care or skilled nursing. Repeat it monthly to spot a plateau or decline in chronic stroke survivors and to guide caregiver education.
• Telehealth follow-up. Send it as a digital form to patients who live far from the practice, or across high-volume practice networks.
• Research and clinical trials. It works as a primary or secondary outcome in rehab intervention studies.

Stroke impact scale vs other stroke outcome measures

Clinicians often use the SIS alongside other scales. Knowing what each one captures prevents duplicate testing.

The NIHSS grades acute neurological severity, while the SIS measures recovery and quality of life weeks to months later. The Barthel Index is clinician-rated and quicker, whereas the SIS is patient-reported and broader. Many stroke programs use several of these scales at different points in recovery.

How Pabau keeps every SIS score on one patient record

On paper, the SIS is filled in at the front desk, scored by hand and filed. Comparing this month’s mobility score with the baseline then means finding two sheets and redoing the math.

With Pabau’s physical therapy EMR, you build the questionnaire once in the digital forms builder. Then you attach it to the appointments where it belongs, such as a rehab intake or a four-week review.

Patients complete it through the patient portal before they arrive, so the session starts with the answers already in. Each completed form is saved to the patient’s clinical record, next to their treatment notes.

Open the baseline and the latest form side by side. You can then see whether a domain moved past its MCID before you change the plan.

Track stroke recovery scores in one record

Pabau sends the stroke impact scale before each session and saves every completed form to the patient record. Your team compares scores across visits without hunting for paper.

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Conclusion

Use the full SIS 3.0 at baseline and discharge, when you need the whole picture, including mood, memory and participation. Use the SIS-16 for quick physical checks in between, knowing it cannot see those other four domains.

Judge each domain against its own threshold, not one blanket number. A 6-point gain means progress in mobility but sits inside the noise for hand function. Give emotion scores extra caution, since that domain is the least reliable.

Book a demo to see how Pabau keeps every SIS form on the patient record, so progress reviews take minutes instead of a paper hunt.

Continue your research

Need a finer self-care score? Modified Barthel Index rates 10 daily activities with more levels of assistance than the original index.

Tracking motor recovery after stroke? Motor Assessment Scale scores everyday motor tasks such as sitting, standing and walking.

Is spasticity holding back hand function? Modified Ashworth Scale grades muscle tone from 0 to 4.

Want an objective mobility measure? 10-meter walk test times gait speed to sit alongside the SIS mobility score.

Need a broader function check? Functional Status Questionnaire covers physical, psychological and social role function.

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