We appreciate that the reviewer raised this issue and have tried to look into where the assessments took place in 36 replied trials. We found that 2 assessments were took place in nursing home and 3 assessments were in patients’ home. There were 4 trial authors reported that patients were assessed at hospital, patients’ home or/and community service centers. While 4 trial authors did not specify where the assessments took place, there were 23 assessments conducted in clinical settings. These 23 assessments were being used to assess one or more of the 4 constructs of ADL. However, it is not clear if all four constructs are appropriate to be used as outcome measures. Capability would be better to assess in an individual home environment. As each individual will be assessed in a different home context, with varying task demands and skills requirements, capability scores may not appropriate for between-person (group) comparisons which is the typical analysis used in an RCT. Ability represents a person’s performance of standardized ADL tasks in a clinical setting. While such information can be useful for identifying difficulties in performing ADL tasks and for ADL intervention planning, once an individual is discharged to the community, there are many factors that can influence ADL performance, such as motivation and living environment. Thus, ability that is assessed in clinical settings may not necessarily represent level of dependence (disability) in the community. In brief, neither capability nor ability fully reflects the level of disability or independence in patients with stroke
We have expanded our discussion to cover this topic and added a table to summarize our findings on page .
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