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Rehab Measures: Caregiver Strain Index

Link to instrument

Link to instrument at NYU Hartford Institute for Geriatric Nursing (other languages available below) 

Title of Assessment

Caregiver Strain Index 



Instrument Reviewer(s)

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

Summary Date



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


  • 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

Area of Assessment


Body Part


ICF Domain




Assessment Type


Length of Test

05 Minutes or Less 

Time to Administer

Not specified (Time needed for Modified CSI with same number of questions is estimated to be 5 minutes):

Number of Items


Equipment Required

  • Questionnaire
  • Pen

Training Required

No training

Type of training required

No Training 



Actual Cost


Age Range


Administration Mode



Geriatrics; Parkinson’s Disease; Stroke 

Populations Tested

Caregivers of patients with:
  • Stroke
  • Parkinson's Disease
  • Alzheimer's Disease
  • Elderly
  • Cancer patients

Standard Error of Measurement (SEM)

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

  • SEM = 1.0

Minimal Detectable Change (MDC)

Caregivers of stroke patients: (Post et al, 2007)

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

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Caregivers of Elderly: (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

Normative Data

Not Established

Test-retest Reliability

Caregivers of stroke patients: (Post et al, 2007)

  • Excellent test-retest reliability (ICC= 0.93)

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

  • Excellent test-retest reliability (ICC= 0.60)

Caregivers of Cancer patients: (Ugur and Fadiloğlu, 2010; n= 132)

  • Excellent test-retest reliability (ICC= 0.75)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Caregivers of Elderly: (Robinson, 1983)

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

Caregivers of Alzheimer patients: (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)

Caregivers of Elderly: (Thornton and Travis, 2003)

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

Caregivers of Cancer Patients: (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)

Caregivers of Frail Elderly: (Marks, 1988; n= 50, Frail elderly)

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

Criterion Validity (Predictive/Concurrent)

Not Established

Construct Validity (Convergent/Discriminant)

Caregivers of Stroke Patients: (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.

Content Validity

Caregivers of Elderly: (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.

Face Validity

Not Established

Floor/Ceiling Effects

Caregivers of Stroke Patients: (van Exel N et al, 2004)

  • Excellent (No floor or ceiling effects seen)


Caregivers of Stroke Patients: (Post et al, 2007)

  • Moderate responsiveness

Professional Association Recommendations


  • 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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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 Healthc 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

Year published


Instrument in PDF Format

Approval Status Approved 
Created at 1/31/2013 2:22 PM  by Jason Raad 
Last modified at 12/18/2013 3:37 PM  by Jason Raad