Classification of Mild Stroke: A Mapping Review

Schwartz, Jaclyn; Capó-Lugo, Carmen E.; Akinwuntan, Abiodun Emmanuel; Roberts, Pamela; Krishnan, Shilpa; Belagaje, Samir; Kovic, Mark; Burns, Suzanne Perea; Hu, Xiaolei; Danzl, Megan; Devos, Hannes; Page, Stephen J.

doi:10.1002/pmrj.12142

Cited by 11 publications

(9 citation statements)

References 45 publications

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“…Since patients with a NIHSS score ≤ 3 had the best short-and medium-term outcome, the authors suggested to use this easily-applicable definition [18]. Although this definition has been used in some studies [19,20], a recent review of this topic reported that the NIHSS-with a score ranging from 0 to 5-is the most commonly used tool to define a "mild stroke" [21]. Similarly, we utilized an NIHSS score of 0 to 5 for identifying patients with supposed "mild" symptoms; our patients had a median NIHSS score of 2.…”

Section: Discussionmentioning

confidence: 99%

To Treat or Not to Treat: Importance of Functional Dependence in Deciding Intravenous Thrombolysis of “Mild Stroke” Patients

Merlino

Smeralda

Lorenzut

et al. 2020

JCM

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Intravenous thrombolysis (IVT) in patients with a low National Institutes of Health Stroke Scale (NIHSS) score of 0–5 remains controversial. IVT should be used in patients with mild but nevertheless disabling symptoms. We hypothesize that response to IVT of patients with “mild stroke” may depend on their level of functional dependence (FD) at hospital admission. The aims of our study were to investigate the effect of IVT and to explore the role of FD in influencing the response to IVT. This study was a retrospective analysis of a prospectively collected database, including 389 patients stratified into patients receiving IVT (IVT+) and not receiving IVT (IVT −) just because of mild symptoms. Barthel index (BI) at admission was used to assess FD, dividing subjects with BI score < 80 (FD+) and with BI score ≥ 80 (FD−). The efficacy endpoints were the rate of positive disability outcome (DO+) (3-month mRS score of 0 or 1), and the rate of positive functional outcome (FO+) (mRS score of zero or one, plus BI score of 95 or 100 at 3 months). At the multivariate analysis, IVT treatment was an independent predictor of DO+ (OR 3.12, 95% CI 1.34−7.27, p = 0.008) and FO+ (OR: 4.70, 95% CI 2.38−9.26, p = 0.001). However, FD+ IVT+ patients had a significantly higher prevalence of DO+ and FO+ than those FD+ IVT–. Differently, IVT treatment did not influence DO+ and FO+ in FD– patients. In FD+ patients, IVT treatment represented the strongest independent predictor of DO+ (OR 6.01, 95% CI 2.59–13.92, p = 0.001) and FO+ (OR 4.73, 95% CI 2.29–9.76, p = 0.001). In conclusion, alteplase seems to improve functional outcome in patients with “mild stroke”. However, in our experience, this beneficial effect is strongly influenced by FD at admission.

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Section: Discussionmentioning

confidence: 99%

To Treat or Not to Treat: Importance of Functional Dependence in Deciding Intravenous Thrombolysis of “Mild Stroke” Patients

Merlino

Smeralda

Lorenzut

et al. 2020

JCM

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“…This finding of better discrimination of EF and GC at the higher end of the mRS may also explain why individuals with strokes often continue their care with untreated cognitive impairments, as previously reported. 42,43 It is possible that implementation of Neuro-QoL measures of EF and/or GC in clinical contexts may help address this shortcoming in patient care, particularly during the first 90 days of recovery. Moreover, implementation of these measures in stroke trials may help uncover differential effects of distinct treatment approaches that may go undetected when using the mRS alone.…”

Section: Discussionmentioning

confidence: 99%

Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures

et al. 2020

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Introduction: We aimed to describe the physical and cognitive health of patients with differing levels of post-stroke disability, as defined by modified Rankin Scale (mRS) scores. We also compared cross-sectional correlations between the mRS and the Quality of Life in Neurological Disorders (Neuro-QoL) T-scores to longitudinal correlations of change estimates from each measure.Methods: Mean Neuro-QoL T-scores representing mobility, dexterity, executive function, and cognitive concerns were compared among mRS subgroups. Fixed-effects regression models with robust standard errors estimated correlations among mRS and Neuro-QoL domain scores and correlations among longitudinal change estimates. These change estimates were then compared to distribution-based estimates of minimal clinically important differences.Results: Seven hundred forty-five patients with ischemic stroke (79%) or transient ischemic attack (21%) were enrolled in this longitudinal observational study of post-stroke outcomes. Larger differences in cognitive function were observed in the severe mRS groups (ie, 4-5) while larger differences in physical function were observed in the mild-moderate mRS groups (ie, 0-2). Cross-sectional correlations among mRS and Neuro-QoL T-scores were high (r = 0.61-0.83), but correlations among longitudinal change estimates were weak (r = 0.14-0.44).Conclusions: Findings from this study undermine the validity and utility of the mRS as an outcome measure in longitudinal studies in ischemic stroke patients. Nevertheless, strong correlations indicate that the mRS score, obtained with a single interview, is efficient at capturing important differences in patient-reported quality of life, and is useful for identifying meaningful cross-sectional differences among clinical subgroups.

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“…1,2 A mild stroke (the National Institutes of Health Stroke Scale ≤4 and the modified Rankin Scale 0-1) causes residual infarction, but minimal to no residual physical deficits. 1,3 There is generally no need for rehabilitation services following a TIA or mild stroke. 1,4 Although this patient population is assumed to return to prestroke functional and physical activity capabilities, 1,2,4 evidence shows a long-term risk of recurrent stroke.…”

Section: Introductionmentioning

confidence: 99%

“…Transient ischemic attack (TIA) is a short-lived neurological disturbance resulting from cerebral vascular occlusion 1,2. A mild stroke (the National Institutes of Health Stroke Scale ≤4 and the modified Rankin Scale 0-1) causes residual infarction, but minimal to no residual physical deficits 1,3. There is generally no need for rehabilitation services following a TIA or mild stroke 1,4.…”

Section: Introductionmentioning

confidence: 99%

Physical Activity After Transient Ischemic Attack or Mild Stroke Is Business as Usual

Sammut

Haracz

Shakespeare

et al. 2022

Journal of Neurologic Physical Therapy

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Background and Purpose: Regular, sustained moderate-to-vigorous physical activity (MVPA) is a recommended strategy to reduce the risk of recurrent stroke for people who have had transient ischemic attack (TIA) or mild stroke. This study aimed to explore attitudes toward, and experience of engaging in physical activity by adults following a TIA or mild stroke. Methods: Constructivist grounded theory methodology informed data collection and analysis. Interviews from 33 adults with TIA or mild stroke (mean age 65 [SD 10] years, 48% female, 40% TIA) were collected. Results: Business as usual characterized physical activity engagement post-TIA or mild stroke. Most participants returned to prestroke habits, as either regular exerciser or nonexerciser, with only a small number making changes. Influencing factors for physical activity participation included information, challenges, strategies, and support. Business as usual was associated with a perceived lack of information to suggest a need to change behaviors. Nonexercisers and those who decreased physical activity emphasized challenges to physical activity, while regular exercisers and those who increased physical activity focused on strategies and support that enabled participation despite challenges. Discussion and Conclusion: Information about the necessity to engage in recommended physical activity levels requires tailoring to the needs of the people with TIA or mild stroke. Helpful information in combination with support and strategies may guide how to navigate factors preventing engagement and might influence the low level of physical activity prevalent in this population. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A376).

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Classification of Mild Stroke: A Mapping Review

Cited by 11 publications

References 45 publications

To Treat or Not to Treat: Importance of Functional Dependence in Deciding Intravenous Thrombolysis of “Mild Stroke” Patients

To Treat or Not to Treat: Importance of Functional Dependence in Deciding Intravenous Thrombolysis of “Mild Stroke” Patients

Trade-Offs in Quality-of-Life Assessment Between the Modified Rankin Scale and Neuro-QoL Measures

Physical Activity After Transient Ischemic Attack or Mild Stroke Is Business as Usual

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