The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10) in post-acute patients with stroke

Objective: To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation – ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores.

Setting: A post-acute stroke rehabilitation ward in the East of England.

Participants: A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia.

Main measures: Alongside the CORE-10, the Patient Health Questionnaire – 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures.

Results: To assess reliability, the internal consistency and test–retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test–retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach’s alpha) for the CORE-10 was .80, and test–retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported.

Conclusions: This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.