Replication and extension of the continuity and discontinuity of self scale (CDSS)

Purpose: To replicate and extend development of an instrument to measure continuity and discontinuity of self after stroke. Design: The conceptual basis for the instrument was derived from an existential phenomenologic study of stroke survivors, which showed that life after stroke included both continuity and discontinuity of self, experienced as control, independence, and connections with others. Methods: A 45-item instrument with a three-point response set was designed with standard instrument techniques. Study instruments included the Barthel Index (measure of functional abilities), and a pre- and poststroke QoL Cantril Ladder. The sample size for the initial study was 55, and for the replication study was 50. Principal components analysis was used in both studies. Data analysis was done with both the sample of 50 and with the combined samples, N=105. Findings: The sample in the replication study had lower functional ability scores than did that of the original study; demographic characteristics were not significantly different. Factor analysis of the 50 cases robustly replicated the two-factor solution. When the samples were combined, however, a subtle pattern was detected in the "continuity" dimension, resulting in two factors for continuity and one factor for discontinuity, for an overall three-factor solution. Conclusions: Continuity appears two-dimensional, including control and independence as one dimension, and connections with others as the second. Discontinuity factored as a single dimension, indicating that perhaps loss permeates the components of discontinuity. Further study is in progress.