Assessment Methods in Sexual Rehabilitation After Stroke.

Disability and Rehabilitation
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Assessment methods in sexual rehabilitation

after stroke: a scoping review for rehabilitation
professionals
Louis-Pierre Auger, Mélanie Aubertin, Myrian Grondin, Claudine Auger,

Johanne Filiatrault & Annie Rochette
To cite this article: Louis-Pierre Auger, Mélanie Aubertin, Myrian Grondin, Claudine Auger,
Johanne Filiatrault & Annie Rochette (2021): Assessment methods in sexual rehabilitation after
stroke: a scoping review for rehabilitation professionals, Disability and Rehabilitation, DOI:
10.1080/09638288.2021.1889047
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DISABILITY AND REHABILITATION
https://doi.org/10.1080/09638288.2021.1889047
REVIEW ARTICLE
Assessment methods in sexual rehabilitation after stroke: a scoping review for

rehabilitation professionals
Louis-Pierre Augera,b , Melanie Aubertinc, Myrian Grondind , Claudine Augera,b , Johanne Filiatraulta,e and
Annie Rochettea,b
a
School of Rehabilitation, Faculty of Medicine, Universite de Montreal, Montreal, Canada; bCentre for Interdisciplinary Research in Rehabilitation
of Greater Montreal, Montreal, Canada; cSchool of Rehabilitation, Universite de Sherbrooke, Sherbrooke, Canada; dMarguerite-d’Youville Library,
Universite de Montreal, Montreal, Canada; eMontreal Geriatric University Institute Research Center, Montreal, Canada
ABSTRACT ARTICLE HISTORY

Purpose: The aim was to identify and describe the assessment methods used by rehabilitation professio- Received 7 August 2020
nals to evaluate sexuality for individuals post-stroke, as well as the domains of sexuality addressed. Revised 5 February 2021
Methods: Seven databases were selected for this scoping review. Articles needed to meet these inclusion Accepted 8 February 2021
criteria: published studies with a sample of 50% stroke clients and describing a quantitative or qualita-
KEYWORDS
tive assessment method that could be used by rehabilitation professionals. This study was conducted fol- Stroke; sexuality; clinicians;
lowing the PRISMA guidelines and domains of sexuality were categorized using the ICF core set for assessment; evaluation;
stroke. rehabilitation
Results: Of the 2447 articles reviewed, the 96 that met the selection criteria identified a total of 116
assessment methods classified as standardized assessment tools (n ¼ 62), original questionnaires (n ¼ 28),
semi-structured interviews (n ¼ 16) or structured interviews (n ¼ 10). Sexual functions were predominantly
assessed using standardized tools, while intimate relationships and partner’s perspective were generally
addressed more by original questionnaires and qualitative methods. A stepwise approach combining rele-
vant assessment methods is presented.
Conclusions: Individually, these diverse assessment methods addressed a limited scope of relevant
domains. Future research should combine quantitative and qualitative methods to encompass most
domains of sexuality of concern to post-stroke individuals.
ä IMPLICATIONS FOR REHABILITATION

Most of the studies reviewed here used quantitative methods to assess sexuality, rather than qualita-
tive methods, and mostly used standardized assessment tools.
Few assessment methods covered all domains related to sexuality.
Qualitative methods and standardized assessment tools were shown to be complementary, therefore
emphasizing the added value of mixed methods in assessing sexuality after a stroke.
Among the methods that were reviewed, certain would be more suitable for the identification of the
need to address sexuality (e.g., Life Satisfaction Checklist-11) and others to assess more thoroughly
sexuality (e.g., Change in Sexual Functioning Questionnaire (CSFQ-14)).
Introduction clinicians initiate a conversation on the subject with a client and

follow up with an assessment of sexuality. In fact, in a cross-sec-
Sexuality is among the domains that can be affected by a stroke
tional study conducted among 813 healthcare professionals,
[1] and is related to quality of life [2,3] and depression [4,5] in
including physicians (n ¼ 110), nurses (n ¼ 593), occupational
individuals post-stroke. Sexuality is part of the International
therapists (n ¼ 37) and physical therapists (n ¼ 73), 94% were
Classification of Functioning, Disability and Health (ICF) core set
unlikely to address sexuality with their clients. Furthermore, thera-
for stroke as a relevant domain to be addressed [6]. However, pists were even less likely to initiate a discussion on the subject
stroke survivors rarely have the opportunity to address sexuality than nurses or doctors [12]. Yet, rehabilitation professionals such
during rehabilitation [7–9] even though it is recommended that as occupational and physical therapists are in a privileged position
therapists address it with clients [10]. Among the factors explain- to address sexuality with their clients in stroke rehabilitation
ing this situation are the taboo related to sexuality, the fear [13,14] and could significantly increase the proportion of people
among both clinicians and clients of being inappropriate or caus- who have the opportunity to address sexuality concerns in that
ing offense, and the lack of concrete clinical guidelines for evalu- context [15]. A recent qualitative study conducted with seven
ation and treatment [11]. These factors can influence whether occupational therapists confirmed that they feel they lack
CONTACT Louis-Pierre Auger [email protected] Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Institut universitaire
sur la readaptation en deficience physique de Montreal – Lindsay Pavilion, 6363 chemin Hudson, Montreal, QC, H3S 1M9, Canada
Supplemental data for this article can be accessed here.
ß 2021 Informa UK Limited, trading as Taylor & Francis Group
2 L.-P. AUGER ET AL.
knowledge and know-how regarding proper assessment of sexual- Search strategy

ity, and mentioned that better access to assessment methods
The search strategy was developed collaboratively with the sup-
could positively influence their practice [16].
port of the librarian (MG) on the research team. A combination of
Even though sexuality after a stroke has been addressed in
keywords and descriptors were searched in MEDLINE, Embase,
many studies over the last three decades, it remains unclear what PsycINFO and CINAHL. Additional searches were conducted in
assessment methods are available for this domain and which Web of Science, PEDro and OTseeker. Relevant articles were also
should be used in rehabilitation practice and research. To our identified by examining reference lists of selected papers. The
knowledge, only two studies have addressed assessment of sexu- search strategy was customized for each database and included
ality post-stroke: one systematic review for women with neuro- two key concepts: stroke and sexuality. A typical search strategy
logical conditions [17] and one narrative review focusing on men for one database (i.e., Medline) is shown in Appendix 1.
recovering from a stroke [18]. Courtois et al. [17] identified assess-
ment methods according to three categories: 1) physiological
Data collection process
assessments of reflexes and perineal sensitivity testing; 2) electro-
physiological assessments; and 3) self-reported questionnaires on A literature search was conducted in each database from its
sexual function and sexual satisfaction (i.e., standardized assess- inception up to May 29, 2020. For data extraction, all references
ment tools). Calabro et al. [18] recommended a multifactorial from the initial search were first exported to EndNote X8 software
assessment conducted by a multidisciplinary team, including and duplicates were removed. The first and third authors of the
methods such as neurological and genital examinations, endo- present study carried out data collection independently based on
crine and metabolic testing and standardized assessment tools to the inclusion and exclusion criteria. To standardize the process
measure sexual functioning. However, most of the methods iden- after the initial search, the two reviewers analysed the titles and
tified by these two studies are mainly used by medical practi- abstracts from the database CINAHL and compared their results.
tioners such as neurologists and urologists, rather than Most differences between reviewers on whether or not to include
standardized assessment tools that can be used by most rehabili- the study were resolved by consensus-based discussion, in some
tation professionals in clinical practice. Although these reviews cases followed by consultation with a third reviewer (last author).
Once a common understanding of the inclusion and exclusion cri-
contribute to knowledge on the subject, they do not address the
teria was achieved, the two reviewers screened the remaining
available standardized tools that can be used to assess sexuality
studies by title and abstract independently, and their results were
with individuals post-stroke. Interestingly, past studies that
pooled, again by consensus-based discussion and consultation
showed that stroke can impact sexuality have used assessments
with a third reviewer as needed. Subsequently, the full text con-
to document the effect. Consequently, reviewing those assess- tent of the articles was screened by the first and last authors.
ment methods may establish a knowledge base that could orient Data from the selected articles was then extracted by the second
clinicians and investigators in the future. author using templates that were designed by the research team.
The aim here was therefore to identify and describe the meth- During data extraction, the first and last authors supervised the
ods used in studies evaluating sexuality among individuals post- process and provided support as needed. More precisely, each
stroke that could be used by rehabilitation professionals, and to assessment method identified in the articles included in the
identify which domains of sexuality were assessed. review was categorized by type: 1) standardized assessment tool;
2) original questionnaire (i.e., specifically designed for the purpose
of the study with no validation process); 3) semi-structured inter-
Materials and methods
view; or 4) structured interview. For standardized assessment
This scoping review was conducted using the Preferred Reporting tools, a description of each tool and, when applicable, items/ques-
Items for Systematic Review and meta-analysis extension for scop- tions specific to sexuality, were presented, along with scoring
ing reviews (PRISMA-ScR) guidelines [19]. methods and interpretation of scores (e.g., interpretation of cut-
off scores, if applicable). Additional non-exhaustive searches were
conducted after consulting the reference lists of the eligible full
Eligibility criteria texts in order to retrieve studies that examined the psychometric
In order to be included in the present review, studies needed to properties of standardized assessments tools for the stroke popu-
report having used an assessment method to address sexuality lation or, if unavailable, the original study of the tool’s develop-
ment and psychometric properties. Raw data of psychometric
post-stroke. Therefore, if a tool not specific to sexuality (e.g., an
properties with original authors’ interpretations (e.g., fair, moder-
occupation-based assessment) was used to yield a better under-
ate, high) were extracted, when available. Standardized tools are
standing of domains related to sexuality in a study involving
described according to the “Consensus-based standards for the
stroke participants, it was included. All research designs were con-
selection of health measurement instruments (COSMIN)” criteria
sidered, and at least half of the total study sample needed to be
[20]. For original questionnaires, semi-structured interviews and
individuals who had sustained a stroke. Studies that involved only structured interviews, study objectives, questions participants
specialized neurological assessments (i.e., physiological assess- were asked and response scale (if applicable), were extracted.
ments of reflexes and perineal sensitivity testing, electrophysio-
logical assessments) were excluded, as this review focused on
assessment methods that could be used by rehabilitation profes- Synthesis of results
sionals in a rehabilitation context. Methods used by physicians or In order to identify the domains of sexuality considered by each
other specialists that had the potential to be used by rehabilita- approach, two independent reviewers (first and second authors)
tion clinicians (e.g., self-reported questionnaires) were included. coded the methods. They used a data extraction grid based on
Only published papers written in English or French were the three categories (and their codes) relating to sexuality in the
considered. comprehensive ICF core set for stroke [6]: Sexual Functions
ASSESSMENT OF SEXUALITY IN STROKE REHABILITATION 3
(b640), Intimate Relationships (d770) and Environmental factors which refers to the ability to use the results of the standardized
(i.e., Support and Relationships – e3). Sexual Functions (b640) assessment tool in a useful or informative way within the clinical
included four ICF sub-categories: “Arousal” (b6400; i.e., desire, setting [21], was evaluated. Scoring and related interpretations,
libido, sexual interest), “preparatory” (b6401; i.e., performance, time of administration and sexual domains addressed for each
penile erection, clitoral erection, vaginal lubrication), “orgasm” tool were analyzed. Tools were considered more clinically useful if
(b6402; including ejaculation) and “satisfaction”, which is based they provided cut-off scores indicating the presence of sexual dys-
on the ICF sub-category “resolution” (b6403; i.e., satisfaction and function, required less than 20 min to administer and addressed
relaxation after orgasm) but also included notions of the individu- more than four sexual domains.
al’s satisfaction with their own sexual life. Intimate relationships
(d770) included three sub-categories: “Romantic Relationships”
(d7700; which included “Spousal Relationship” (d7701), as it was Results
challenging to separate the two during the analysis), “Sexual Study selection
Relationships” (d7702; e.g., frequency, duration, type of sexual
activities) and “Individual sexual activities”, which was added by Data extracted
the research team to cover aspects such as masturbation and fan- A total of 2447 articles remained after duplicates were removed
tasies. Environmental factors were related to the inclusion of the from the initial database search and manual searches (see Figure
partner in the assessment, and included one sub-category: 1). After irrelevant articles were excluded, 96 matched the inclu-
“Immediate family” (e310). A final category, “Other”, was included sion criteria. Justifications for exclusion of full texts are presented
in the data extraction grid for concepts covered in the assess- in Figure 1.
ments that could not be matched to the eight domains of sexual-
ity drawn from the ICF. How is sexuality after a stroke assessed in the literature?
Among the 96 studies included, a total of 116 methods of assess-
Data analysis ing sexuality were extracted (many studies used more than one
Both reviewers (first and second authors) analyzed each assess- assessment method), of which 90 were quantitative and 26 were
ment method and completed the data extraction grid independ- qualitative. Among the 90 quantitative assessments, 27 standar-
ently, then compared their results and reached consensus when dized tools were used a total of 62 times and original question-
differences were noted. Descriptive statistics (frequency and per- naires 28 times. The most frequently used standardized
centages) were computed for: 1) the sexual domains evaluated by assessment tools were the International Index for Erectile
each specific assessment method out of a maximum of eight); 2) Function 5 (IIEF-5, n ¼ 13), the Change in Sexual Function
the proportions (%) of domains evaluated by each type of assess- Questionnaire (CSFQ-14, n ¼ 5), the Life Satisfaction Checklist with
ment (standardized assessment tools, questionnaires and inter- eleven (LiSat-11, n ¼ 5) and nine items (LiSat-11, n ¼ 4), the
views); and 3) the proportion that each of the three categories International Index for Erectile Function 15 (IIEF-15, n ¼ 4) and
(i.e., Sexual Functions (b640), Intimate Relationships (d770) and the Female Sexual Function Index (FSFI, n ¼ 3). Among standar-
Environmental factors) represented of the total sexual domains dized assessment tools, 20 out of 27 were used in only one study.
evaluated among all assessment methods. The clinical utility, Tools specific to men (i.e., IIEF-5, IIEF15, KEED) were used in 18
3645 studies imported for screening

• Records identified through 1198 duplicates removed
database searching (3642)
• Additional records identified
through other sources (3)
2447 studies screened 2206 studies irrelevant
241 full-text studies assessed for eligibility 145 studies excluded

Reasons :
• Too general (70)
• Irrelevant subject (20)
• Irrelevant assessments (3)
• Pharmacological focus (17)
• Wrong study design (15)
• Protocols (2)
• Wrong population (16)
• Assessment not available (2)
96 studies included
Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart of articles selection process.
studies, whereas tools specific to women were used (i.e., FSFI) in and the services sought or offered regarding sexual rehabilitation
three. Among the qualitative assessments, 16 were semi-struc- (type, frequency, appreciation).
tured interviews and 10 were structured interviews. Original ques-
tionnaires, structured interviews and semi-structured interviews Clinical utility of standardized assessment tools
are described in a table available as Supplementary Material. Among the 27 standardized assessment tools included in this
Among the 96 studies included, two used mixed methods [22,23] review, 13 focused specifically on sexuality [32,46,53,57,63,65,67,
to assess sexuality post-stroke. The study by Thomas [22] com- 69–71,74,75,77], two were non-specific to sexuality [24,28] and 12
bined the Canadian Occupational Performance Measure, the had some questions regarding sexuality, ranging from a single
Quality of Sexual Function Scale and the Stroke Impact Scale with item (n ¼ 6) [79,89,102,106,117,127] to multiple items (n ¼ 6)
a semi-structured interview, and Millenbruch [23] combined a [30,99,109,113,119,121]. Among the 13 tools that focused on sexu-
semi-structured interview with the use of the Sexual Self Schema ality, seven had cut-off scores indicating the presence of a sexual
Scale. dysfunction [32,46,53,57,63,65,67]. The scores for the remaining
five tools must be interpreted in proportion to the total score, as
Description of standardized assessment tools a higher score generally indicates a higher degree of sexual dys-
The 27 standardized assessment tools identified in this review are function. Although the Canadian Occupational Performance
described in detail in Table 1. Reliability data were available for Measure (COPM) [24,125] is not a standardized assessment tool
25 tools, with internal consistency (n ¼ 22) and test-retest reliabil- specific to sexuality, but rather an occupation-based tool that
ity (n ¼ 20) being the psychometric properties most frequently addresses performance, satisfaction and importance, it was the
examined. Intra-rater reliability was reported for seven tools. only tool in which scores related to sensitivity to change were
Validity data were available for 23 tools, with construct validity available, i.e., a change between 0.90/10 and 1.90/10 for evalu-
being the most frequently reported (n ¼ 21), followed by content ation improvement perceived by the client [25]. The COPM was
validity (n ¼ 11), criterion validity (n ¼ 11) and responsiveness used by Thomas [22] to assess sexual activities.
(n ¼ 7). The Stroke Impact Scale (SIS) [28], the Quality of Life Index
– Stroke version [30] and the Canadian Occupational Performance
Discussion
Measure (COPM) [24,125] were the only three tools reporting psy-
chometric properties specific to individuals post-stroke. Il must be The aim of this study was to identify and describe the assessment
noted that the COPM was not initially developed for a stroke methods used to evaluate sexuality among individuals post-stroke
population. that could be used by rehabilitation professionals, and to identify
which domains of sexuality were assessed. An inventory of the
Domains of sexuality assessed standardized assessment tools used to evaluate sexuality after a
The complete list of sexual domains considered by the studies stroke, including psychometric and clinical utility data, was cre-
covered by this review is provided in Table 2. Assessment meth- ated alongside an analysis of the sexual domains targeted by
ods covered from zero to all eight of the sexual domains included each method.
in the data extraction grid. Assessments that did not specifically This review shows that sexuality post-stroke is most often
address any pre-defined sexual domain still addressed “other” assessed through quantitative methods. In the majority of studies,
dimensions that relate to sexuality (see below), which justified these methods involved standardized assessment tools specific to
their inclusion. The assessment methods covering the most sexual sexuality (e.g., IIEF-5, CSFQ-14) or generic tools that included
domains were the Quality of Sexual Function Scale [69] (8/8) and items related to sexuality (e.g., LiSat-11). Gender-specific assess-
Mitchel-Pedersen et al.’s [163] semi-structured interview (7/8). The ments were used six times more for men (i.e., IIEF-5, IIEF-15,
CSFQ-14 [57], the Eleven Questions about Sexual Functioning KEED) than women (i.e., FSFI). This finding supports the issue
(ESF) [75], Giaquinto et al.’s questionnaire [133] and Lemieux raised previously by Lever and Pryor [165] that women are under-
et al.’s semi-structured interview [166] each covered six sexual represented in studies related to sexuality post-stroke. Even
domains. Specific proportions of measured categories are pre- though standardized assessment tools were used predominantly,
sented in Table 2. All assessment methods combined, domains of 31.1% of the quantitative assessments were based on original
sexual body functions were the most frequently assessed (61.4%), questionnaires that were not submitted to a validation process.
followed by activity/participation in intimate relationships (34.1%) This suggests that certain domains related to sexuality are not
and environmental factors (4.5%). More specifically, the sexual assessed by existing standardized assessment tools, or that the
domains assessed, in decreasing frequency, were sexual relation- authors of these studies did not have access to tools covering
ships (20.9%), arousal functions (17.3%), satisfaction (17.3%), pre- both the construct and domains relevant to their research objec-
paratory functions (14.1%), orgasmic functions (12.7%), romantic tives [175]. For example, five studies included in our review based
relationships (10.5%), immediate relationships (4.5%) and individ- their questionnaires or structured interviews on Monga et al.’s
ual sexual activities (2.7%). [128] methods, which covered aspects such as attitudes related to
sexuality, fear of impotence, fear of sexuality causing a stroke,
Other sexuality-related domains assessed post-stroke ability to discuss sexuality and unwillingness to participate in
Many assessment methods addressed “other” domains related to sexuality. The important proportion of original questionnaires
sexuality. Standardized assessment tools, original questionnaires used may also be related to the fact that the only three standar-
and structured interviews mostly explored themes related to per- dized assessment tools in this review that had been previously
sonal factors, such as beliefs and knowledge regarding sexuality, validated with a post-stroke population were non-specific to sexu-
sexual inhibition, fears and appearance. Semi-structured interviews ality, i.e., the Stroke Impact Scale [28], the Canadian Occupational
included broader questions related to sexuality, which could Performance Measure (COPM) [24,125] and the Quality of Life
therefore not be associated to specific sexual domains. However, Index – Stroke Version [30]. Among these three tools, the COPM
most semi-structured interviews addressed sexual changes related seems to be the most promising for addressing sexuality post-
to the stroke, the person’s perspective on various sexual issues, stroke, since it can be contextualized to a sexual activity (e.g.,
Table 1. Description of standardised tools used to assess sexuality in stroke literature (n ¼ 27) according to their psychometric properties and clinical characteristics.
Assessement tool Description Reliability Validity Clinical utility
Validated for the stroke population
Canadian Occupational Standardized semi-structured Test-retest: Construct validity: Time: 20–40 min
Performance Measure (Law interview where the client r ¼ 0.89 for performance and Good construct responsiveness Therapist training: Not
et al. [24]) identifies the five most 0.88 for satisfaction (p˂ [25]; mandatory, reading of the
Used in [22] important activities for 0.001) for the stroke Convergent and discriminant manual and consultation of
him/her, and then rate the population [26]; validity significantly caot.ca and thecopm.ca for
performance and r ¼ 0.88–0.89 for the stroke different from the KB-ADL more information
satisfaction for each of population [27]; scale and not strongly Cost and ordering
them. He then rates his Intra/inter-rater: correlated with the SPSQ or information: About 50$
satisfaction and his Not found the FIM [27] http://www.thecopm.
performance in those Internal consistency: Criterion validity: ca/buy/
activities. The client can Not found Not found
choose to abord sexuality. Content validity:
Scoring: The importance is Not found
rated in a 10 points scale Responsiveness:
from 1 (“Not important at AUC (area under the curve) ¼
all”) to 10 (“Extremely 0.79–0.85 for the criterion
important”). The responsiveness. Good
satisfaction is rated in a 10 discriminatory power to
points scale from 1 (“Not detect improvement. [25]
satisfied at all”) to 10
(“Extremely satisfied”). The
performance is rated in a
10 points scale from 1
(“Not able to do it at all”)
to 10 (“Able to do it
extremely well”). A Cutoff
between 0.90 and 1.90 as
perceived by the client
suggests significant
improvement ([25])
Stroke Impact Scale Self-reported questionnaire of Test-retest: ICCs: 0.7 0.92 Construct validity: Time: 15–20 min
(Duncan et al. [28]) 64 items to determine the for the 8 domains except Reasonable: item-domain Therapist training: None
Used in [29] impact of the stroke on the for emotion (0.57) [28] correlations 0.4 (except 1 Cost and ordering
health and life of the Intra/inter-rater: Not found in the emotion domain) information: Free, available
person. Strength, hand Internal consistency: [28] online: https://www.
function, activities of daily Cronbach’s alpha: Discriminant validity: strokengine.ca/pdf/sis.pdf
living (ADL), mobility, 0.83–0.90 [28] Excellent [28] or in the Appendix of
communication, emotion, Criterion validity: Good [28] Duncan et al. [28], cost
memory and social Content validity: “Potential according to the value of
participation are the eight for floor effect in hand in the article.
domains assessed. No hand function domain and
direct question about possibility for a ceiling
sexuality but 4 indirect effect in communication
questions about sexuality: 3 domain.” (Duncan
questions on control of the et al. [28])
bladder and bowels and 1 Responsiveness: Sensitivity to
question about the ability change regarding the
to feel emotionally severity and time since
connected to another stroke [28]
person.
Scoring: Scale from 1 to 5 for
each item, with a higher
score indicating a higher
functioning and less
limitations from stroke. A
change of 10 to 15 points
represents a clinically
meaningful change. Adding
each item’s score on a
scale of 1 to 100 at the
end to indicate the level of
recovery since the stroke.
Quality of Life Index - Stroke Questionnaire of 76 items Test-retest: 0.87 for two Construct validity: Good: Time: 5–10 min
version (Ferrans and assessing Quality of life weeks and 0.81 for one r > 0.3 between factors [31] Therapist training: None
Powers [30]) (QOL) after stroke. 4 month [30] Convergent validity: Good: Cost and ordering
Used in [23] domains are assessed: Intra/inter-rater: Not found r ¼ 0.77 with the single- information: Free, available
health and functioning, Internal consistency: item life satisfaction online https://qli.org.uic.
socioeconomic, Cronbach’s alpha ¼ 0.93 for assessment [31] edu/questionaires/pdf/
psychological-spiritual and the entire instrument, 0.87 Criterion validity: Not found strokeversionIII/stroke.PDF
family; 4 questions are for the health and Content validity: The content
about the degree of functioning subscale, 0.82 was based on a literature
satisfaction and importance for the socioeconomic review of issues related to
(continued)
Table 1. Continued.
of the sex life and the subscale, 0.90 for the QOL and on the reports of
partner. psychological/spiritual patients [30]
Scoring: 6-points Likert-type subscale and 0.77 for the Responsiveness: Not found
scale for each item from 1 family subscale [31];
("very unsatisfied" or “very Cronbach’s
unimportant”) to 6 ("very alpha ¼ 0.90–0.93 [30]
satisfied" or "very
important"). A higher score
indicates a higher QOL.
SEXUALITY-SPECIFIC TOOLS
International Index for Erectile Self-reported questionnaire of Test-retest: Sufficient [45] Construct validity: Sufficient Time: ˂ 5 min
Function 5 5 items assessing erectile Inter/intra-rater: Not found [45] Therapist training: None
(IIEF-5) dysfunction (ED). The five Inernal consistency: Criterion validity: Sufficient Cost and ordering
(Rosen et al. [32]) items are: patient’s Indeterminate [45] [45] information: Free, available
Used in [18,33–44] confidence to maintain an Sensitivity: 0.98 [32] online https://www.
erection, level of penile Specificity: 0.88 [32] urofrance.org/fileadmin/
tumescence, ability to Content validity: Not found medias/scores/score-
maintain an erection at the Responsiveness: IIEF5.pdf
beginning of sexual Indeterminate [45]
intercourse, ability to
maintain the erection until
completion of sexual
intercourse and overall
sexual satisfaction.
Scoring: Maximum score of 5
for each item and 25 for
the total score. Score of 21
or below suggests ED;
22–25 points: no ED, 17–21
points: mild ED, 12–16
points: mild to moderate
ED, 8–11 points: moderate
ED, 1–7 points: severe ED.
International Index for Erectile Self-reported questionnaire of Test-retest: Relatively high Construct validity: Adequate Time: 5–10 min
Function (IIEF-15) 15 items assessing erectile (r ¼ 0.82 for the total scale) (Rosen et al.,[46]) Therapist training: None
(Rosen et al. [46]) dysfunction (ED). The 5 [46]; Discriminant validity: Highly Cost and ordering
Used in [47–50] themes addressed are: Inconsistent [45] significant differences information: Free, available
erectile function, orgasmic Intra/inter-rater: Not found between patients with ED online: https://www.baus.
function, sexual desire, Internal consistency: Highly and control group [46] org.uk/_userfiles/pages/
intercourse satisfaction and consistent (alpha values Convergent and divergent files/Patients/Leaflets/
overall satisfaction. greater than 0.90 for the validity: No statistical iief.pdf
Scoring: 5 points scale for total scale) [46]; significance with the
each item, the total score is Inconsistent[45] Marital adjustment test [51]
the sum of the score of and the Marlowe–Crowne
each item. Degree of ED: Social Desirability Scale
severe (score 6–10), [46,52]
moderate (score 11–16), Criterion validity:
mild to moderate (score Sufficient[45]
17–21), mild (score 22–25) Sensitivity:
no dysfunction (26–30). High [46]
Specificity: High [46])
Content validity: Not found
Responsivness: Sufficient [45]
Female Sexual Function Index Self-reported questionnaire of Test-retest: r ¼ 0.88 for the Construct validity: Time: 5–10 min
(FSFI) 19 items about sexual total scale [53] Inconsistent [56] Therapist training: None
(Rosen et al. [53]) function for women. Desire, Intra/inter-rater: Not found Discriminant validity: Good Cost and ordering
Used in [47,54,55] arousal, lubrification, Internal consistency: [53] information: Free, available
orgasm, satisfaction and Cronbach’s alpha 0.82 Divergent validity: “Low” to online : https://eprovide.
pain are assessed. and higher [53]; “Very low” correlations with mapi-trust.org/instruments/
Scoring: 6 grade scale for Sufficient [56] the Marital Adjustment Test female-sexual-function-
each item, from 0 to 5. A [51,53] index
higher score shows a better Criterion validity: Sufficient
sexual function. A 0 score [56]
implies no sexual Content validity: Not found
intercourse within the last Responsiveness:
month. A cut off score of Indeterminate [56]
26 or less indicates female
sexual dysfunction.
Change in Sexual Functioning Self-reported questionnaire of Test-retest: Not found Construct validity: Good, Time: Average
Questionnaire Short Form 14 question about currents Intra/inter-rater: Not found >0.4 for each item (except time ¼ 15–19min
(CSFQ-14Q) sexual behaviors and Internal consistency: 14) [57]
(Keller, McGarvey and Clayton problems. Male and female Cronbach’s alpha for the Criterion validity: Sensitivity: Therapist training: None
[57]) version. Desire/frequency, toral score ¼ 0.90 for 92.9% for male and 91.9% Cost and ordering
Used in [14,58–61] arousal/excitement, for female version [62] information: Free, available
(continued)
Table 1. Continued.
orgasm/completion and female and 0.89 for male Specificity: 59.5% for male and online: https://www.
pleasure are assessed. version [57] 62.5% for female version dbsalliance.org/wp-content/
Scoring: 5-point scale [62] uploads/2019/02/Restoring_
frequency, from 1 (“Never”) Content validity: Not found Intimacy_CSFQ_
to 5 (“Every day/Always”) Responsiveness: Not found Handout.pdf
(items 10 and 14 are
reversed). The total score is
the sum of the score of
each item. Total score
ranges from 14 and 70. Cut
off scores indicating sexual
dysfunction: total
score 41; desire
phase 15; arousal
phase 12; orgasm
phase 11; desire/
frequency phase 6;
desire/interest phase 9;
pleasure phase 4.
Hudson’s Index of Sexual 25-item questionnaire Test-retest: 0.93 [63] Construct validity: Good; Time: 5–10min
Satisfaction (ISS) measuring sexual discord Intra/inter-rater: Not found Excellent measurement error Therapist training: None
(Hudson, Harrisson and or dissatisfaction with a Internal consistency: characteristics [63] Cost and ordering
Crosscup [63]) partner as seen by the Excellent: Cronback alpha Discriminant validity information: See Table 1 of
Used in [64] respondent. It was between 0.906 0.925 [63] Good [63] Hudson et al. [63], cost
designed for therapist to Criterion validity: Not found according to the value of
use in repeated Content validity: Not found the article.
administration. Responsiveness: Not found
Scoring : 5-point scale for
each item. 1 ¼ “Rarely or
none of the time”, 2 ¼ “A
little of the time”, 3 ¼
“Some of the time”, 4 ¼
“Good part of the time”, 5
¼ “Most or all of the time”.
The score is calculated by
reverse-scoring the 12
positive items and then by
adding each item’s score. A
higher score indicated
greater sexual problems.
Cut off score ¼ 28 [63]
Arizona Sexual Experience 5-item Self-reported Test-retest: Strong (r ¼ 0.801 Construct validity: Positive Time: Less than 5 min
Scale (ASEX) (McGahuey questionnaire assessing for patients and r ¼ 0.892 predictive value (PPV) ¼ Therapist training: None
et al. [65]) sexual functioning, for controls, p˂0.01) [65] 88% and negative Cost and ordering
Used in [18] including drive, arousal, Intra/inter-rater: Not found predictive value (NPV)¼ information: Free, available
penile erection/vaginal Internal consistency: 85%; items correlated with online : https://www.
lubrification, ability to Excellent: Cronbach’s the Brief mirecc.va.gov/visn22/
reach orgasm and alpha ¼ 0.901 [65] Index of Sexual Functioning Arizona_Sexual_
satisfaction with orgasm. for Women [66] factors [65] Experiences_Scale.pdf
Scoring: 6-point scale from 1 Criterion validity: Sensitivity: or http://depts.washington.
(“Extremely”) to 6 (“Never”). 82% [65] edu/psychres/wordpress/
The total score is the sum Specificity: 90% [65] wp-content/uploads/2017/
of individual scores and Content validity: Not found 09/asex_scale.pdf
ranges from 5 to 30. A Responsiveness: Area under
higher score indicates the curve ¼ 0.929 [65]
higher sexual dysfunction.
Arbitrary cut off from the
author: total score > 19,
any one item with an
individual score > 5, or
any three items with
individual scores > 4.
Kflner [Cologne] Evaluation of 18-item Self-reported Test-retest: Not found Construct validity: Not found Time: 5–10min
Erectile Dysfunction (KEED) questionnaire to identify Intra/inter-rater: Not found Criterion validity: Predictive Therapist training: None
(Braun et al. [67]) symptoms of erectile Internal consistency: Not value ¼ 0.98 [67] Cost and ordering
Used in [68] dysfunction (ED) and its found Sensitivity: 0.97 [67] information: Appendix 1 of
effects on quality of life. Specificity: 0.93 [67] Braun et al. [39], cost
The tool evaluates Content validity: Not found according to the value of
sociodemographic Responsiveness: Not found the article.
characteristics, medical
history, medication,
smoking and alcohol
consumption habits, sexual
desire and frequency of
(continued)
Table 1. Continued.
sexual activities, erectile
and orgasmic function,
satisfaction with sex life
and general well-being.
Scoring: 5-point Likert scale
for questions 11–16. A
higher score indicates
higher ED symptoms. Cut
off score of >17 points
indicate presence of ED.
Quality of Sexual Function Self-reported questionnaire of Test-retest: Not found Construct validity: Time: Less than 10 min
Scale (Heinemann et al. 40 items. 4 domains are Intra/inter-rater: Not found Correlations of the Therapist training: None,
[69]) assessed: quality of life, Internal consistency: subscales with the total Cost and ordering
Used in [22,29] sexual activity level, sexual Cronbach’s alpha ¼ 0.8 for scale range from 0.30 to information: Appendix of
dysfunction and satisfaction the total scale, 0.90 for the 0.77. Correlations among Heinemann et al. [69], cost
from the patient subscale "psycho-somatic the subscales are in according to the value of
perspective and sexual quality of life", 0.82 for majority well under 0.20 the article.
dysfunction and satisfaction "sexual activity", 0.75 for " with many not significant
from the partner’s sexual (dys)function-self- [69].
perspective. reflection" and 0.57 for Criterion validity: Not found
Scoring: Scales from 1 (no/ "sexual (dys)function- Content validity: Promising
little problems or partner’s view" [69] [69]
complains) to 5 (most Responsiveness: Not found
problematic) for each
question, 0 indicates “no
partner”. The total score is
obtained with the sum of
each item’s score. A higher
score indicates greater
impairments in sexual
function.
Sexual Beliefs and Information 25 items Self-reported Test-retest: 0.82, p˂0.001 [70] Construct validity: Not found Time: 5–10min
Questionnaire (SBIQ) questionnaire to evaluate Intra/inter-rater: Not found Criterion validity: Not found Therapist training: None
(Adams et al. [70]) sexual knowledge and Internal consistency: r ¼ 0.82 Content validity: Not found Cost and ordering
Used in [58] belief. (p˂0.001) [70]; Responsiveness: Not found information: Appendix of
Scoring: Respondents select r ¼ 0.71 [58] Adams et al. [70], cost
"True", "False" or "don’t according to the value of
know (?)" for each item. the article.
Correct answers are scored
1, incorrect were scored 0
and "?" are scored 9. The
total score is calculated by
summing the number of
correct responses, ranging
from 0 to 24. A higher
score indicates higher
sexual knowledge.
Derogatis Sexual Functioning Self-reported questionnaire of Test-retest: Good: r ¼ 0.42 to Construct validity: Good [71] Time: 45–60 min
Inventory (Derogatis and 254 items evaluating 0.96 [71] Criterion validity: Not found Therapist training: None
Melisaratos, [71]) current sexual functioning Intra/inter-rater: Not found Content validity: Not found Cost and ordering
Used in [58] of men and women. The Internal consistency: Very Responsiveness: Not found information: Distributed
10 domains assessed are: good, Cronbach’s alpha exclusively by Clinical
information, experience, ranges from 0.56 to Psychometric Research, Inc.
drive, attitude 0.97 [71] (www.derogatis-tests.com)
psychological symptoms,
affects, gender role
definition, fantasy, body
image, sexual satisfaction
Scoring: Scoring formats vary
from dichotomic answers
to multiple-point Likert
scales. Two scores are
calculated: 1) The Sexual
Functioning Index (total
score of the DSFI) and 2)
The Global Sexual
Satisfaction Index, which
reflects subjective
perception of sexual
behaviour.
Sexual Inhibition/Sexual Self-reported questionnaire Test-retest: Version for men: Construct validity: Version for Time: 5–10min
Excitation Scale assessing sexual r ¼ 0.73 for SES, r ¼ 0.74 for men: Therapist training: None
Version for men: (Janssen responsiveness. The version SIS1 and r ¼ 0.62 for SIS2 r ¼ 0.73 for SES, r ¼ 0.74 for Cost and ordering
et al. [72]) for men contains 45 items [72] SIS1 and r ¼ 0.62 for SIS2 information: Version for
(continued)
Table 1. Continued.
Version for women: (Graham and three factors are Version for women: SE ¼ 0.81 [72] men:
et al. [73]) measured: propensity for and SI ¼ 0.82 at p˂0.005 Version for women: Appendix of Janssen et al.
Version for men and women: sexual excitation (SES), [73] SE ¼ 0.81 and SI ¼ 0.82 (p˂ [72], cost according to the
(Milhausen et al. [74]) propensity for sexual Version for men and women: 0.05) [73] value of the article.
Used in [49] inhibition because of the r ranges from 0.66 to 0.82 Version for men and women:
threat of performance with a mean correlation of r ranges from 0.66 to 0.82
failure (SIS1) and 0.76 at p˂0.005 [74] with a mean correlation of
propensity for sexual Intra/inter-rater: Not found 0.76 (p˂0.05) [74]
inhibition because of the Internal consistency: Version Criterion validity: Not found
threat of performance for men: Cronbach’s alpha Content validity: Not found
consequences (SIS2). The for three samples ¼ 0.89, Responsiveness: Not found
version for women contains 0.89 and 0.88 for the SES;
36 items and has two 0.81, 0.78 and 0.83 for SIS1;
sections: sexual excitation 0.73, 0.69 and 0.75 for SIS2
(SE) factors and sexual [72])
inhibitions (SI) factors. Version for women:
Scoring: 4-point scales Cronbach’s alpha ¼ 0.70 for
ranging from 1 ¼ “Strongly SE section and 0.55 for SI
agree”, 2 ¼ “Agree”, 3 ¼ section; Pearson correlation
“Disagree”, 4 ¼ “Strongly between SE and SI ¼ 0.28
disagree”. A lower score at (p˂0.01), indicating relative
the SES and SE factors independence them [73]
indicates a greater
propensity for sexual
excitation. A lower score at
the SIS1, SIS2 and SI factors
indicates a greater
propensity for sexual
inhibition.
Eleven Questions about Sexual 11 item self-reported Test-retest: Not found Construct validity: Not found Time: 5–10min
Functioning (ESF) questionnaire identifying Intra/inter-rater: Criterion validity: Not found Therapist training: None
(Vroege [75]) duration and frequency of Not found Content validity: Not found Cost and ordering
Used in [76] sexual problems due to Internal consistency: Not Responsiveness: Not found information: Table 2 of
health condition. Sexual found Meesters et al. [76], cost
fantasy, solo sex, desire for according to the value of
sexual contact, actual the article.
sexual contact, reduced
quality of stiffness/
lubrification, reduced
duration of stiffness/
lubrification, actually
having an orgasm, having a
postponed orgasm, having
a premature orgasm,
experiencing pain in
genitals and general
satisfaction are assessed in
the questionnaire.
Scoring: 7-point and 5-point
Likert scales
Sexual Self Schema Scale Self-reported questionnaire Test-retest: Construct validity: Not found Time: 5–10 min
Version for women: (Andersen measuring cognitions Version for women: Criterion validity: Not found Therapist training: None
and Cyranowski, [77]) associated with sexual r ¼ 0.89 (p˂0.0001) for Content validity: Not found Cost and ordering
Version for men: feelings and expressions to 2 weeks and 0.88 (p˂ Responsiveness: Not found information: Version for
(Andersen, Cyranowski and assess the "Sexual self- 0.0001) for 9 weeks [77] women is available in the
Espindle, [78]) view". The assessment is Version for men: Appendix of Andersen and
Used in [23] made by rating 50 trait R ¼ 0.81 (p ¼ 0.0001) at Cyranowski [77] and the
adjectives for women and 9 weeks [78] version for men is available
45 for men. Factors Intra/inter-rater: Not found in the Appendix B of
evaluated are, for women: Internal consistency: Version Andersen et al. [78]. Cost
Romantic/passionate, Open/ for women: according to the value of
direct views of the self and Cronbach’s alpha ¼ 0.82 for the articles.
Embarrassment and/or the full scale, 0.81 for
conservatism, and for men: Factor 1; 0.77 for factor 2
Passionate and loving and 0.66 for Factor 3 [77]
traits, Powerful and Version for men:
aggressive trait and Open- Cronbach’s alpha ¼ 0.86 for
mindedness and liberal the total scale; 0.89 for
thinking. Factor 1; 0.78 for Factor 2;
Scoring: 7-point Likert-type 0.65 for Factor 3 [78]
scale, ranging from 0 (“Not
at all descriptive of me”) to
6 (“Very much descriptive
of me”). For women, the
(continued)
Table 1. Continued.
total score is obtained by
adding the scores of
Factors 1 and 2 and
subtracting the score of
Factor 3. For men, the total
score is the sum of the 3
factors. [23]
GENERIC TOOLS
Life Satisfaction Checklist Checklist of 9 items about life Test-retest: Construct validity: Divergent Time: 10–30 min
(LiSat-9) satisfaction with 1 item Kappa ¼ 0.82 for sexual life; validity: Therapist training: None
(Fugl-Meyer, Br€anholm and about sexual life. Explore p ¼ 0.74 for the mean score r ¼ 0.52 with the Mental Cost and ordering
Fugl-Meyer [79]) the degree of satisfaction [84] (chronic pain Health Scale (SF-36) [86]; , information: Free, available
Used in [80–83] in activities of daily life population) r ¼ 0.66 with the Hospital online: https://www.sralab.
(ADL), leisure situations, Intra/inter-rater: Not found Anxiety and depression org/rehabilitation-measures/
vocational situations, Internal consistency: scale [87]; r ¼ 0.45 with life-satisfaction-
financial situations, sexual Chronbach’s alpha ¼ 0.75 the Social Dimension of the questionnaire-9
life, partnership relations, [85](Spinal cord injury Sickness Impact Profile 68
family life and contacts population) [88]. [85]
with friends and Criterion validity: r ¼ 0.59
acquaintances. [85]
Scoring: 6-grade ordinal scale Content validity: No floor or
for each item: 1 ¼ “Very ceiling effects [85]
dissatisfying”, 2 ¼ Responsiveness: Not found
“Dissatisfying”, 3 ¼ “Rather
dissatisfying”, 4 ¼ “Rather
satisfying”, 5 ¼ “Satisfying”,
6 ¼ “Very satisfying”. Cut
off: 1–4 ¼ dissatisfied;
5–6 ¼ satisfied
Life Satisfaction Checklist Checklist of 11 items about Test-retest: For all the items, Construct validity: Not found Time: 5 min
(LiSat-11) life satisfaction. Can be the kappa coefficient Criterion validity: Not found Therapist training: None
(Fugl-Meyer, Melin and Fugl- self-administrated or used ranged from 0.59 to 0.97 Content validity: Not found Cost and ordering
Meyer [89]) as an interview tool. The and the percent agreement Responsiveness: Not found information: Free, available
Used in [90,91,92,93,94] items can be divided into (PA 1) from 89% to 100% online: https://www.
four themes : closeness for the chronic stroke fsfiquestionnaire.com/FSFI%
(sexual life, partner population. Kappa ¼ 0.84 20questionnaire2000.pdf;
relationship, family life), and PA 1 ¼ 91 for sexual
health (ability to care for life. [92]; ICC ¼ 0.71 [95]
self/ADL, physical health, Intra/inter-rater: Not found
mental health), spare time Internal consistency: Good:
(leisure, contact with Cronbach’s
friends and acquaintances), alpha ¼ 0.89 [95]
provision (vocational and
financial situations).
Scoring: Six grade ordinal
scales for each item: 1 ¼
“Very dissatisfying”, 2 ¼
“Dissatisfying”, 3 ¼ “Rather
dissatisfying”, 4 ¼ “Rather
satisfying”, 5 ¼ “Satisfying”,
6 ¼ “Very satisfying”. Cut
off : 1–4 ¼ Dissatisfied;
5–6 ¼ Satisfied
World Health Organization Self-reported questionnaire of Test-retest: Not found Construct validity: Significant Time: Less than 5 min
Quality of Life scale 26 items measuring a Intra/inter-rater: Not found correlations with the Therapist training: None
abbreviated health condition’s impact Internal consistency: Overall Quality of Life score Cost and ordering
(WHOQOL-BREF) on quality of life in 4 Cronbach’s alpha ¼ 0.7 for ranging from r ¼ 0.244 to information: Free, available
(WHOQOL group [96]) domains: physical health, the total sample; ¼ 0.68 0.676 for all domains [96] online https://www.who.
Used in [48,97] psychological well being, for relationship domain Criterion validity: Not found int/mental_health/media/
social relationships and [98]; Content validity: Pearson en/76.pdf
environment satisfaction. Cronbach’s correlations (˂ 0.0001)
Only one direct question alpha ¼ 0.65–093 [96] range from 0.46 to 0.67
about sexuality: "How with 0.45 for sex and 0.57
satisfied are you with your for personal relationship.
sex life?" and one indirect No evidence of ceiling or
question: “How satisfied are floor effects [98].
you with your personal Responsiveness: Not found
relationships ?”
Scoring: 5-points Likert scale
from 1 (“Very poor”, “Very
dissatisfied”, “Not at all”,
“An extreme amount or
Always”) to 5 (“Very good”,
“Very satisfied”, “An
(continued)
Table 1. Continued.
extreme amount”, “Not at
all” or “Never”). A higher
score indicates a higher
quality of life. The total
score is obtained by a
manual calculation of
individual score. It is
possible to convert the
total score on a 4–20 scale
or on a 0–100 scale.
Grid for Measurements of ICF-derived [101] assessment Test-retest: Not found Construct validity: Not found Time: 15–30min
Activity and Participation tool evaluating activity Intra/inter-rater: Not found Criterion validity: Not found Therapist training: None
(G-MAP) limitation and participation Internal consistency: Content validity: According to Cost and ordering
(Belio et al. [99]) restriction. It consists of a Cronbach’s Belio et al. [99], data information: Appendixes 1
Used in [100] 26 items Grid for alpha ¼ 0.89 [99] obtained were in and 2 of Belio et al. [99],
Measurements of Activity agreement with clinicians cost according to the value
and Participation which is and patients of the article.
filled at the end of a semi- representatives’ opinions.
structured interview. 6 Responsiveness: Not found
categories are assessed:
Personal care, Domestic life,
Interpersonal relationships
and interactions (including
spouse/partner and sexual
relationships), Economic
and social productivity,
Leisure, Community and
civic life.
Scoring: Each item is scored
on 3 categories of scales: 1)
Severity of activity
limitations, from 0
(absence) to 2 (total); 2)
Environmental factors; 3)
Severity of participation
restriction, from 1
(absence) to 3 (total).
Beck Depression Inventory Self-reported questionnaire of Test-retest: 0,60–0,83 for Construct validity: Convergent Time: 5–10min
(Beck et al. [102]) 21-question assessing nonpsychiatric patients and validity Therapist training: None
Used in [8] depressive symptoms. The 0,48–0,86 for psychiatric r ¼ 060–0,72 with clinical Cost and ordering
last item is about loss of patients for the BDI ratings and 0,73–0,74 with information: Free, available
Libido. [103]Instability of the Hamilton Psychiatric Rating online : https://www.
Scoring: 4-point scale scores over short time Scale for Depression [103]; ismanet.org/
evaluating the degree of intervals [104] r ¼ 0.93 (p˂0.01) between doctoryourspirit/pdfs/Beck-
severity of depressive Intra/inter-rater: Agreement the BDI and the BDI-II Depression-Inventory-
symptom. 0 ¼ “None”, 1 ¼ in the rating of [105]; BDI.pdf
“Mild”, 2 ¼ “Moderate” and depression ¼ 97% of the Discriminant validity
3 ¼ “Severe”. A higher cases; Interrater : high Against anxiety, validity in
score indicates greater degree of consistency differentiating between
depressive symptom. The among interviewers for the depressed and
total score is the sum of mean score [102] nondepressed subjects
each score. Cut off scores: Internal consistency: All [104]
1–10 ¼ normal, categories have a Criterion validity: Not found
11–16 ¼ mild, significant relationship to Content validity: High,
17–20 ¼ borderline clinical the total score (p˂0.001 reflects well 6 of the
depression, except for one category); 9 DSM-III criteria [104]
21–30 ¼ moderate, Pearson coefficient ¼ 0.86 Responsiveness: In 85% of
31–40 ¼ severe, over and rose to 0.93 with a the cases the BDI adequatly
40 ¼ extreme. Spearman-Brown correctly predicted a
correction [102] change in the score in 85%
of the cases [102]
Hamilton Depression Rating The tool should be use in an Test-retest: Poor [108] Construct validity: Not Time: 15–20 min
Scale unstructured interview Intra/inter-rater: Interrater: found[108] Therapist training: Yes
(Hamilton [106]) conducted by a health care r ¼ 0.84 [106]; Poor [108]; Criterion validity: Not found Cost and ordering
Used in [43,107] professional. The Internal consistency: Content validity: Not found information: Free, available
questionnaire measures the Adequate, range from 0.46 Responsiveness: Not found online : https://dcf.
severity of depressive to 0.97, with 0.70 in 10 psychiatry.ufl.edu/files/
symptoms with 17 items. studies [108]. 2011/05/HAMILTON-
One question is about DEPRESSION.pdf
genital symptoms,
including libido.
Scoring: Each item is rated
using a scale from 0 to 2
or from 0 to 4. The 0
(continued)
Table 1. Continued.
indicates that the symptom
is absent. A higher score
indicates a higher degree
of symptoms. A total score
of 0–7 is considered
normal, 8–16 suggest mild
depression, 17–23
moderate depression and
over 24 severe depression.
The maximum score is 52.
Social Functioning 28 items semi-structured Test-retest: High, for the total Construct validity: Correlation Time: 10–30 min
Examination (SFE) interview assessing social score r ¼ 0.90 (p˂0.01) coefficient with the Social Therapist training: None
(Starr, Robinson and Price functioning. Questions 1 to [111] Ties Checklist is r ¼ 0.65 Cost and ordering
[109]) 10 are about closeness, Intra/inter-rater: High, (p˂0.01) and with the information: Tables 2 and
Used in [110] independence, interrater: r ¼ 0.92 (p˂0.01) Hollingshead social class is 3 of Starr et al. [111] and
compatibility, sexual [111] r ¼ 0.41 (p˂0.05) [111]; Table 3 of Starr et al. [109].
adjustment and satisfaction Internal consistency: Not No significant correlation with Cost according to the value
with the significant other. found the Hamilton depression of the articles.
Scoring: 3-point scale about scale [106] and the Mini-
sexual satisfaction. 0 ¼ Mental State Examination
“Normal”, 1 ¼ “Moderately [109,112]
dissatisfied”, 2 ¼ “Severely Criterion validity: Not found
dissatisfied”. Content validity: Not found
Responsiveness: Not found
Psychological Adjustment to 45 questions semi-structured Test-retest: Not found Construct validity: Time: 20–30min
Illness Scale (PAIS) interview to measure Intra/inter-rater: Inter-rater: For 5 of the 7 domains ranges Therapist training: Yes
(Morrow, Chiarello and adjustment to a medical r ¼ 0.83 for the total score from r ¼ 0.34 to 0.47 (p˂ Cost and ordering
Derogatis [113]) illness. It can be and 0.81 for the sexual 0.05) with 0.47 for sexual information: Distributed
Used in [114] administered to the patient relationship domain relationships. For 2 exclusively by Clinical
or the partner. The tool is (Morrow et al. [113]); domains, r ¼ 0.08 and 0.22 Psychometric Research, Inc.
divided into 7 domains: 1) Internal consistency: [113]; (www.derogatis-tests.com)
Health care orientation, 2) "the reliability coefficient Partially established [115]
Vocational environment, 3) ranged from r ¼ 0.82 to Criterion validity:
Domestic environment, 4) r ¼ 0.33 on subtests." Strong [113]; Partially
Sexual relationship, 5) (Weissman et al.[115]); established [115]
Extended family High, Cronbach’s alpha ranges Content validity:
relationships, 6) Social in mean from 0.60 to 0.90 Not found
environment and 7) for the 7 domains with 3 Responsiveness:
Psychological distress. The different populations [116] Not found
domain "Sexual
relationship" assess quality
and frequency of sexual
activities, sexual interest,
sexual satisfaction, sexual
dysfunction, and
interpersonal conflict.
Scoring:
4-point scale. A higher score
indicates a higher
impairment.
Post-Stroke Checklist 15 item checklist to identify Test-retest: Construct validity: Not found Time: 5–10min
(Philp et al. [117]) long-term problems Not found Criterion validity: Not found Therapist training: None
Used in [118] following a stroke. One Intra/inter-rater: Not found Content validity: Cost and ordering
item assesses intimate Internal consistency: Not Not found information: Philp et al.
relationships in the latest found Responsiveness: Not found [117]. The 15 items are
version of Turner listed in Table 4 of Turner
et al.[118]. et al. [118].
Scoring: Yes or No choices
Maudsley Marital Self-reported questionnaire Test-retest: Appropriate: Construct validity: Time: 5–10min
Questionnaire (MMQ-rs) about marital functioning r ¼ 0.60–0.90 [119] Significantly intercorrelation of Therapist training: None
(Arrindell, Boelens and containing 20 items. It is Intra/inter-rater: Not found the 3 scales: M-S r ¼ 0.60, Cost and ordering
Lambert [119]) composed of three scales: Internal consistency: M-GL r ¼ 0.46, S-GL r ¼ 0.33 information: Appendix of
Used in [76] marital (M), sexual (S) and Cronbach’s alpha ¼ 0.90 for at p˂0.001 (Joseph Arrindell, Boelens and
general life adjustment the M scale, 0.80 for the S et al.[120]) Lambert [119], cost
(GL). The sexual scales scale and 0.66 for GL scale Correlation with global according to the value of
assess frequency and [120]; Cronbach’s alpha for desirability scale ¼ 0.27 the article.
satisfaction of intercourses husbands and wives ¼ 0.87 (p ¼ 0.001) for M, 0.09 (p˂
and feeling during contact (M scale), 0.82 (S scale), 0.05) for S and 0.25 (p˂
with partner. 0.63 (GL scale) for 0.05) for GL [119];
Scoring: 9-point Likert scale, distressed group and 0.88 Criterion validity:
from 0 ¼ “No (M), 0.64 (S) and 0.60 (GL) Not found
dissatisfaction” to 8 ¼ for normal group; Content validity: Not found
“Great dissatisfaction”. Total Cronbach’s alpha ¼ 0.90 for Responsiveness: Not found
score ranges from 0 to 80. M, 0.61 for S and 0.73 for
A higher score indicates GL at retest [119]
(continued)
Table 1. Continued.
greater dissatisfaction. A
score higher than 25
indicates that patients
experience limitation. A
score higher than 36
indicates severe limitation.
Assessment of Life Habits Self-reported questionnaire Test-retest: Long form: Construct validity: Time: 20–40 min for the short
(LIFE-H) assessing the 12 domains ICC ¼ 0.73 for children and Discriminant validity form. 20–120min for the
(Fougeyrollas et al. [121]) of life habits proposed by 0.74 for adult; Short form: Good [124] long form
Used in [122] the handicap creation ICC ¼ 0.67 for children and Convergent validity Therapist training: None
process. The first 6 0.83 for adult [121] Moderately correlated Cost and ordering
domains are the activities Intra/inter-rater: Inter-rater (r ¼ 0.70) with the SMAF, information: Can be
of daily living: nutrition, reliability: " highly reliable no significant association obtained by emailing the
fitness, personal care, (ICC 0.89) [123] for the “Interpersonal International Network on
communication, residence, Internal consistency: relationships” domain [124] the Disability Creation
mobility. The last 6 are Not found Criterion validity: Not found Process (iNDCP) at ripph@
social roles: responsibility, Content validity: A consensus irdpq.qc.ca. The cost is
family relations, of experts concluded that 288.00$ for 3 years.
interpersonal relations the tool covered the major
(including sexual and part of life habits and that
affective relations), it could be used to
community, education, evaluate handicap
employment, recreation. situations. [121]
Available in a long and Responsiveness: Not found
short form.
Scoring: The participant
indicates the level of
difficulty and the type of
assistance. Those two
elements are then
combined and rated on a 0
to 9 descriptive scale. The
total score is the sum of
each score divided by the
number of items. The
subject also rates the level
of satisfaction on a 5
grades scale from “Very
satisfied” to “Very
dissatisfied”.
ICC: Intraclass correlation coefficient; Data presented is related to the English version of the test, unless when specified.
Psychometric properties established by the original study are presented and when stroke data were not found, data for other populations were included for
informative purpose.
According to the COSMIN checklist [20].
kissing, masturbation, intercourse) for the person and because it clients have the opportunity to address sexuality with a profes-
addresses his/her perception of the performance, satisfaction and sional, even fewer are likely to have the chance to be reassessed
importance of the activity. In our view, the COPM addresses sexu- after receiving an intervention, which underlines the importance
ality issues more thoroughly than the Stroke Impact Scale or the of a thorough assessment of sexuality when the subject is
Quality of Life Index – Stroke version, since these two only addressed. Mixed methods [177] are thus promising for assessing
include one general question regarding sexuality or intimacy and sexuality after a stroke, but few studies have used such
relationships. However, specific studies should be conducted to approaches to date [22,23].
confirm this hypothesis, since the validation study of the COPM Since few standardized assessment tools for evaluating sexual-
with a stroke population did not include sexual activities. ity have been validated with the stroke population despite the
Qualitative methods are by nature relevant for screening and potential benefits, future research and clinical practice should
gaining an in-depth understanding of a complex phenomenon, seek to fill this gap. Moreover, considering that this review is
such as how a stroke impacts an individual’s sexuality. The fact dedicated to assessment methods that could be used by rehabili-
that 22.4% of the reviewed assessment methods were of a quali- tation professionals, clinical utility was evaluated in order to iden-
tative nature suggests that such methods can contribute to the tify the standardized assessment tools that provide a cut-off
assessment of sexuality after a stroke, in a way that complements score, which is likely to facilitate decision-making for clinicians. In
quantitative methods [176]. For example, combining both meth- fact, by clearly indicating the presence or absence of a sexual dys-
ods could provide a clearer indication of the importance of spe- function, the assessment tool may be more useful for a rehabilita-
cific sexual issues and their impact on sexual functioning. Such a tion professional not specialized in sexuality in the process of
combined approach would also better orient sexual rehabilitation assessment, intervention and/or referral to a specialist. Among the
interventions and foster understanding of the prescribed treat- 27 standardized assessment tools reviewed, 12 had a single item
ment and associated impacts. Moreover, considering that few addressing sexuality and could therefore be considered generic
Table 2. Sexual domains covered in each assessment method according to the International Classification of Function and Disability Core Set for Stroke [6].
14
Sexual functions Intimate relationships

Environment
Individual Immediate Sub-total
Sexuality assessments Arousal Preparatory Orgasmic Satisfaction sex Romantic Sexual family (/8) Other aspects
Standardized tests
Canadian occupational performance measure (COPM) [125, 24] X X 2 Importance of sexuality
Stroke Impact Scale [28] 0 Relationships in general (family/
friends) or social activities
L.-P. AUGER ET AL.
Quality of Life Index - Stroke version [30] X X 2 Importance of sex life and partner
International Index of Erectile Function – 5 (IIEF-5) [32] X X 2
International Index of Erectile Function – 15 (IIEF-15) [46] X X X X 4
Female Sexual Function Index (FSFI) [53] X X X X 4 Pain
Change in Sexual Functioning Questionnaire Short Form X X X X X X 6
(CSFQ-14) [57]
Hudson’s Index of Sexual Satisfaction (ISS) [63] X X X 3
Arizona Sexual Experience Scale (ASEX) [65] X X X X 4
Kflner [Cologne] Evaluation of Erectile Dysfunction X X X X X 5
(KEED) [126]
Quality of Sexual Function Scale [69] X X X X X X X X 8 Urogen/sexual complaints
Sexual Beliefs and Information Questionnaire (SBIQ) [70] 0 Beliefs and knowledge
Derogatis Sexual Functioning Inventory [71] X X 2 Knowledge, attitudes, psychological
symptoms, affects, gender role
definition, fantasy, body image
Sexual Inhibition/Sexual Excitation Scale [74] X 1 Sexual inhibition
Eleven Questions about Sexual Functioning (ESF) [75] X X X X X X 6 Duration and frequency of sexuality
issues in relation to the health
condition, pain in genitals, sexual
fantasies
Sexual Self Schema Scale [77, 78] X 1 Perceptions of self as sexual
Life Satisfaction Checklist (LiSat-9) [79] X X 2
Life Satisfaction Checklist (LiSat-11) [89] X X 2
World Health Organization Quality of Life scale (WHOQOL- X 1
BREF) [127]
Grid for measurements of activity and participation (G- X X X 3 Attitudes
MAP) [99]
Beck Depression Inventory [102] X 1
Hamilton Depression Rating Scale [106] X 1
Social Functioning Examination (SFE) [109] X X 2
Psychological Adjustment to Illness Scale (PAIS) [113] X X X X X 5 Sexual dysfunction
Post-Stroke Checklist [117] X 1
Maudsley Marital Questionnaire (MMQ-rs) [119] X X X X 4 Related psychophysical effects
Assessment of Life Habits (LIFE-H) [121] X X 2
Sub-total 13 8 8 18 3 10 12 2
Questionnaires
Monga, Lawson et Inglis [128] X X X X X 5 Enjoyment/pleasure
McCall and Hosenfel [129] X X X 3
Korpelainen et al. [4] X X X X X 5 Attitudes, fear of impotence, fear of
another stroke, ability to discuss
sexuality with partner,
unwillingness to participate in
sexuality
Korpelainen et al. [130] X X X X X 5
Jung [38] X X X 3 Conditions preventing intercourse,
methods used to improve sexual
function, sexual information, fears
(continued)
Table 2. Continued.
Environment
of sexual intercourse after stroke,
need for sexual treatment
Sjogren and Fugl-Meyer [131] X 1
Humphrey [132] X 1
Giaquinto et al. [133] X X X X X X 6 Positioning, drug use
Edmans [134] X 1 Needs and preferences for sexuality
related services
de Freitas et al. [135] X X X X 4
Choi-Know and Kim [136] X X X 3
Cheung [137] X X X X X 5 Importance of sexuality, fear of
impotence, fear of a recurrent
stroke, beliefs of stroke affecting
sexuality, ability to discuss
sexuality with partner,
unwillingness to engage in
sexuality
Berry et al. [138] X 1
Akinpelu et al. [139] X X X X X 5 Fear of impotence, fear of another
stroke, ability to discuss sexuality,
unwillingness to engage in
sexuality, importance of sexuality
Agarwal and Jain [140] X X 2
Song et al. [58] X 1
Kim [5] X X 2
Dusenbury and al. [141] X 1
Na and al. [142] X 1 Fear of rejection by the partner,
premorbid sexual dysfunction
Habot et al [143] X X 2
Epprecht et al. [47] X 1 Past sexual experiences
Stead and White [144] X X 2
Howes et al. [145] X 1 Appearance of sexual organs
Bugnicourt [146] X X X X 4
Sub-total 12 9 8 11 2 5 17 1
Structured interviews
Boldrini et al. [147] X X X X X 5 Overall feelings about sexual life
after stroke
Aloni et al. [148] X X X X X 5
Aloni et al. [149] X X X 3 Menstrual cycle
Tamam [150] X X X X X 5 Fear of impotence, fear of another
stroke, ability to discuss sexuality
with spouse, unwillingness to
participate in sexual activity
Aloni et al. [151] X X X 3
Sjrogen, 1981 [152] X X X 3 Frequency of sexual difficulties
Sjogren et al. [153] X X X X X 5 Couple’s communication regarding
sexuality, partners’ reactions to
the other’s advances, partner’s
interest in the post-stroke
individual, sexual stigmatism
ASSESSMENT OF SEXUALITY IN STROKE REHABILITATION
Sjogren, 1983 [154] X X X X 4 Shown interest in partner, thought of

mutual sexuality
Fugl-Meyer and Jaasko [155] X 1 Couple’s communication
(continued)
15
Table 2. Continued.
16

Environment
Coslett et al. [156] X X 2
Buzzelli et al.[157] X X X 3 Importance of sexuality, frustrations,
medications taken
Bray et al.[158] X X X 3 Menstruation, importance of sexual
L.-P. AUGER ET AL.
functioning
Allsup-Jackson, 1981 [159] X X X 3
Sub-total 8 10 10 4 0 1 10 2
Semi-structured interview
Yilmaz et al. [160] 0 General changes in sex life since
stroke, support received by
clinicians regarding sexuality
Thomas [22] X 1 Perceptions regarding sexual
difficulties
Schmitz and Finkelstein [161] X 1 Questions other post-stroke
individuals may ask themselves
regarding sexuality, support and
services offered regarding
sexuality and related appreciation
Nilsson et al. [162] 0 Description of changes regarding
sexuality, professional support
received regarding sexuality and
related preferences
Mitchel-Pedersen, 1994 [163] X X X X X X X 7 Bodily sexual sensations (zones and
intensity), pain during intercourse,
couple’s communication regardinf
sexuality, fears or concerns
regarding sexuality, sexual
interest; search for services
regarding sexuality and related
preferences
Millenbruch [23] X X X 3 Health conditions and medication
affecting sexuality, functional
impact of stroke and impact on
sexuality, quality of life,
description of sexuality pre-post
stroke, efforts for resuming/
maintaining sexuality, perception
of self as a sexual being,
professional services searched and
received
McCarthy and Bauer [164] 1 1 2 Stroke’s impact on the person, on
the partner and on the
couple’s life
Lever and Pryor [165] 1 1 Identity as a woman
Lemieux et al. [166] 1 1 1 1 1 1 6 Emotional lability, importance of
sexuality, fears, clinician
addressing sexuality
Carod et al. [167] 1 1 1 3
Kattari [168] 1 1 Couple’s communication about
sexuality, confidence
Hawton [169] 1 1 1 1 4 Couple’s communication about
sexuality
(continued)
screening tools for this domain. Although the answer to a single
General questions regarding intimacy

Factors challenging the relationship
Performance anxiety, acceptance of
question provides too little information to draw conclusions about
changes, sexual conditioning

sexuality post-stroke, generic tools such as the LiSat-11 [89],
whose main purpose is to assess life satisfaction, may represent a
Other aspects
relevant approach to routinely screen for the need to address

sexuality in rehabilitation in a stroke population. This approach
could meet stroke rehabilitation guidelines [10] and promote
and relations
appropriate use of resources, considering that around 50% of
post-stroke individuals will not experience sexual issues [4], and
therefore do not require a thorough assessment in this regard.
Moreover, using generic tools for screening could facilitate the
integration of sexuality in clinical practice, by addressing some of
Sub-total
the barriers that rehabilitation professionals may experience [11].

220
100
(/8)
2
1
1
2
1
Among the other 27 standardized assessment tools included in

this review, 13 focused specifically on sexuality and would be
more suitable for in-depth evaluation of sexuality with individuals
Environment
Immediate
post-stroke. Although investigators or clinicians should choose the

family
4.5
10
5
1
appropriate method for the specific context of their client, the

CSFQ-14 [57] appears promising for assessing sexuality since it
includes different versions for use with men and women, reports
Sexual
psychometric properties and provides cut-off scores for the pres-

20.9
46
7
1
1
1
ence of dysfunction in the four categories of sexual body func-

Intimate relationships
tions included in this review (i.e., arousal, preparatory, orgasmic

Romantic
functions and satisfaction). For rehabilitation professionals, cut-off

10.5
23
7
1
1
scores are likely to better demonstrate the need to screen for a

sexual dysfunction (e.g., to professionals not specialized in sexual-
ity), and support referral to a specialized professional to guide
Individual
sex
2.7
diagnosis, when applicable. Therefore, considering that none of

1
6
the sexuality-specific standardized tools reviewed has been vali-

dated for the stroke population, and that the other tools included
Satisfaction
in this review that presented cut-off scores focused on only one

17.3
38
or two categories of sexual functioning, the CSFQ-14 meets most

5
of our study’s clinical utility criteria. Moreover, in a recent system-

atic review that documented intervention studies in sexual
Orgasmic
rehabilitation after a stroke, the CSFQ-14 was used in four of the

Sexual functions
12.7
28
2
eight studies included [178]. Therefore, using this standardized

assessment tool in future research could facilitate comparison of
results between studies and benefit clinical practice.
Preparatory
Regarding the sexual domains assessed in studies on sexuality

14.1
31
4
after a stroke, this review shows that sexual body functions are
emphasized more than activity/participation in sexual relation-
ships and the environmental factors (i.e., partners). This suggests
Arousal
that sexuality has been mostly assessed in a restrictive way in the

17.3
38
5
1
literature, focusing on its physiological aspects over activity/par-

ticipation, and even less on environmental factors that may also
affect participation [121,179]. It may also be that the search terms
did not enable identification of assessments focusing on relation-
ships or their environment. However, this is unlikely since the
search strategy was designed to be broad and included every
study pertaining to sexuality and stroke. Sexual relationships were
evaluated, especially in regard to the frequency of intercourse,
along with aspects of the relationship from the post-stroke indi-
viduals’ point of view, although individual sexual activities were
addressed in only 3% of the methods. This suggests an omission
of this subject and a focus on partnered sexual activities. The
Beal and Millenbruch [171]
environment of the post-stroke individual was the least addressed

in the review, since only the social aspects (i.e., partner) were cov-
McCormick et al. [172]
Sexuality assessments
Pryor and Lever [174]

McCarthy et al. [173]
Table 2. Continued.
Goddess et al. [170]
ered. In fact, semi-structured interviews addressed the most

aspects related to partners, and the Quality of Sexual Function
Scale [69] was the only standardized assessment tool specific to
Sub-total
Total (%)
sexuality that addressed the partner’s perspective. Interestingly,

Total (n)
no method addressed the physical environment, such as the

accessibility of the home (e.g., bedroom). The standardized
assessment tools that addressed the greatest variety of sexual the most promising approach to address all potentially relevant
domains were the Quality of Sexual Function Scale [69], followed domains during assessment of sexuality post-stroke.
by the CSFQ-14 [57] and the “11 questions on sexual function”
tool [75]. Considering that they cover a wider range of relevant
domains related to sexuality, these tools should be prioritized in Acknowledgments
future studies with the stroke population. The authors gratefully acknowledge that the first author was sup-
ported by doctoral scholarships from the Canadian Institutes for
Strengths and limitations Health Research, the Fonds de recherche du Quebec en sante
(FRQS), the School of Rehabilitation of the Universite de Montreal
One of the strengths of this scoping review is the fact that it was (UdeM) and the Ordre des ergotherapeutes du Quebec. The
conducted according to the PRISMA guidelines for such reviews fourth and last author were supported by a career award from
[19]. Moreover, the research team included an American Library the FRQS. Our sincere thanks to the bibliotheques/UdeM for ena-
Association accredited librarian who was involved in the whole bling the participation of the third author in this research project.
process and ensured that a comprehensive search strategy was
The authors would also like to thank Dr. Johanne Higgins, and
developed. Finally, blinded data collection, as well as data extrac-
Isabelle Quintal, MSc, for their insights on the manuscript.
tion according to the COSMIN criteria [20] and the ICF core set
for stroke [6], attest to the quality and transferability of the data
reported, and its usefulness for clinical and research purposes. Disclosure statement
This review also has limitations. First, the process of extracting The authors report no conflict of interest.
standardized tools’ psychometric data did not include an assess-
ment of the risk of bias of the original studies, since it was not
the focus of this study. This limits the inventory of the standar- ORCID
dized assessment tools to a presentation of the data that requires Louis-Pierre Auger http://orcid.org/0000-0003-1897-6338
further analysis by the reader. Moreover, the analysis of sexual Myrian Grondin http://orcid.org/0000-0002-3236-8155
domains focused on aspects directly related to sexuality (e.g., sex- Claudine Auger http://orcid.org/0000-0003-0159-2004
ual functions, intimate relationships), which may have led the
reviewers to omit other relevant elements relating to a stroke
that could affect sexuality. However, the category “other” was cre- References
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Assessment methods in sexual rehabilitation

Louis-Pierre Auger, Mélanie Aubertin, Myrian Grondin, Claudine Auger,

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Assessment methods in sexual rehabilitation after stroke: a scoping review for

ABSTRACT ARTICLE HISTORY

ä IMPLICATIONS FOR REHABILITATION

Introduction clinicians initiate a conversation on the subject with a client and

knowledge and know-how regarding proper assessment of sexual- Search strategy

3645 studies imported for screening

2447 studies screened 2206 studies irrelevant

241 full-text studies assessed for eligibility 145 studies excluded

Sexual functions Intimate relationships

Sjogren, 1983 [154] X X X X 4 Shown interest in partner, thought of

Sexual functions Intimate relationships

screening tools for this domain. Although the answer to a single

General questions regarding intimacy

changes, sexual conditioning

relevant approach to routinely screen for the need to address

the barriers that rehabilitation professionals may experience [11].

Among the other 27 standardized assessment tools included in

post-stroke. Although investigators or clinicians should choose the

appropriate method for the specific context of their client, the

psychometric properties and provides cut-off scores for the pres-

ence of dysfunction in the four categories of sexual body func-

tions included in this review (i.e., arousal, preparatory, orgasmic

functions and satisfaction). For rehabilitation professionals, cut-off

scores are likely to better demonstrate the need to screen for a

diagnosis, when applicable. Therefore, considering that none of

the sexuality-specific standardized tools reviewed has been vali-

in this review that presented cut-off scores focused on only one

or two categories of sexual functioning, the CSFQ-14 meets most

of our study’s clinical utility criteria. Moreover, in a recent system-

rehabilitation after a stroke, the CSFQ-14 was used in four of the

eight studies included [178]. Therefore, using this standardized

Regarding the sexual domains assessed in studies on sexuality

that sexuality has been mostly assessed in a restrictive way in the

literature, focusing on its physiological aspects over activity/par-

environment of the post-stroke individual was the least addressed

Pryor and Lever [174]

Goddess et al. [170]

ered. In fact, semi-structured interviews addressed the most

sexuality that addressed the partner’s perspective. Interestingly,

no method addressed the physical environment, such as the

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