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RehabMeasures Instrument

Rehabilitation Measure

Caregiver Strain Index

Last Updated


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

Link to Instrument

Instrument Details

Acronym CSI




  • 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


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.


  • 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:



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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)

























*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)


(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)


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Test/Retest Reliability

(Ugur and Fadiloğlu, 2010; n= 132)

  • Excellent test-retest reliability (ICC= 0.75)

Internal Consistency

(Ugur and Fadiloğlu, 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.


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. Find it on PubMed

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. Find it on PubMed

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. Find it on PubMed

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

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

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. Find it on PubMed

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

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. Find it on PubMed

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