Interobserver agreement for the assessment of handicap in stroke patients.

Swieten, John van; Koudstaal, Peter J.; Visser, Marieke C.; Schouten, H J; Gijn, J. van

doi:10.1161/01.str.19.5.604

Cited by 5,162 publications

(3,426 citation statements)

References 27 publications

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“…Next, we assessed the clinical outcome using a modified Rankin scale (mRS) score at 6 months (± 1 week) after the onset of the acute stroke (van Swieten, Koudstaal, Visser, Schouten, & van Gijn, 1988). We further divided patients with PPD into two groups with follow‐up mRS (FmRS) scores of >2 and ≤2.…”

Section: Methodsmentioning

confidence: 99%

Characteristics of paramedian pontine arteries disease and its association with hemoglobinA1c

Shu

Hu³

et al. 2018

Brain and Behavior

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ObjectivesThe association of branch atherosclerotic disease (BAD) and diabetes mellitus (DM) in the territory of posterior circulation is rarely discussed. Intracranial BAD was divided into two different types: paramedian pontine arteries (PPA) disease (PPD) and lenticulostriate arteries (LSA) disease. The goal of the study was to evaluate the clinical characteristics of PPD and its association with hemoglobinA1c (HbA1c) in China.Materials and MethodsRadiologically confirmed PPD was defined as an isolated unilateral infarction extending to the ventral surface of the pons. Small deep cerebral infarctions are usually caused by two different pathological changes of arteries: BAD and lipohyalinotic degeneration (LD). We compared the vascular risk factors between BAD and LD in PPA territory. A total of 159 stroke patients were analyzed (PPD, n = 75; LD, n = 84). Patients with PPD were also categorized into two groups according to follow‐up modified Rankin Scale (FmRS) scores. Logistic regression analyses were used for the evaluation of independent risk factors of PPD and prognosis.ResultsComparison between PPD and LD revealed statistical significance in fasting glucose, HbA1c, estimated glomerular filtration rate (eGFR), and uric acid (p = .011, p = .005, p = .027, p = .018, respectively). Compared with LD, PPD was only related to HbA1c (p = .011) in logistic regression analysis. There were statistically significant differences between the two groups based on the stratification of FmRS scores in fasting glucose, HbA1c, homocysteine, eGFR, and the occurrence of DM. After multivariate analysis, only HbA1c was related with poor prognosis of PPD (p = .002).ConclusionsThe subtypes and prognosis of small deep brain infarcts are significantly influenced by elevated HbA1c level in PPA territory. DM might play an important role in the pathogenesis of PPD.

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Section: Methodsmentioning

confidence: 99%

Characteristics of paramedian pontine arteries disease and its association with hemoglobinA1c

Shu

Hu³

et al. 2018

Brain and Behavior

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“…Two different dependent variables were used in the study; mRS12 6 months after stroke and change in mRS from baseline to 6 months. mRS evaluates the patient's functional competency in seven levels (0–6) where scores from 0 to 2 signify independency, 3–5 varying degrees of dependency and 6 death of the patient.…”

Section: Methodsmentioning

confidence: 99%

“…The main results of this study have been published previously 11. The aim of the present study was to identify possible predictors for (1) the patients' functional level 6 months after stroke (evaluated by mRS12 at 6 months), and (2) the change in functional level from stable baseline (1 week post‐stroke, or at discharge if discharged earlier) to 6 months after stroke (evaluated by change in mRS).…”

Section: Introductionmentioning

confidence: 94%

Subjective health complaints predict functional outcome six months after stroke

et al. 2016

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ObjectivesCerebrovascular stroke is a main cause of lasting disability in older age, and initial stroke severity has been established as a main determinant for the degree of functional loss. In this study, we searched for other predictors of functional outcome in a cohort of stroke patients participating in an early supported discharge randomised controlled trial.MethodsThirty candidate variables related either to premorbid history or to the acute stroke were examined by ordered logistic regression in 229 stroke patients. Dependent variables were modified Rankin Scale (mRS) at 6 months and mRS change from baseline to 6 months.ResultsFor mRS at 6 months, Barthel Index at stable baseline post‐stroke was the main predictor, with sex, age, previous cerebrovascular disease, previous peripheral artery disease and the necessity for tube feeding in the acute phase also contributing to the final model. For mRS change, only age and previous cerebrovascular disease were significant predictors. Prestroke subjective health complaints added significantly to all final models concurrently with sex losing its predictive power.ConclusionsInitial stroke severity was the main predictor of functional outcome. Subjective health complaints score was a potent predictor for both outcome and improvement from baseline to 6 months and at the same time ameliorated the predictive impact of sex. The poorer functional prognosis for women after stroke may therefore be related to their higher load of subjective health complaints rather than to their sex itself. Treating these complaints may possibly improve the functional prognosis.

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“…The most commonly used primary outcome measure in acute stroke trials is the modified Rankin Scale (mRS),14, 15 at least partly because it is simple to administer, has good reproducibility, and avoids major floor or ceiling effects 16. Although most functional recovery poststroke happens in the first few months,17 recovery beyond 6 months does occur,18 but there are few published data on the relationship between early mRS and long‐term disability.…”

Section: Introductionmentioning

confidence: 99%

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

Ganesh

Luengo-Fernández

Wharton

et al. 2017

JAHA

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BackgroundOutcome in stroke trials is often based on a 3‐month modified Rankin scale (mRS). How 3‐month mRS relates to longer‐term outcomes will depend on late recovery, delayed stroke‐related deaths, recurrent strokes, and nonstroke deaths. We evaluated 3‐month mRS and death/disability at 1 and 5 years in a population‐based cohort study.Methods and ResultsIn 3‐month survivors of ischemic stroke (Oxford Vascular Study; 2002‐2014), we related 3‐month mRS to disability (defined as mRS >2) at 1 and 5 years and/or death rates (age/sex adjusted). Accrual of disability and index‐stroke‐related and nonstroke deaths in each poststroke year was categorized according to 3‐month mRS. Among 1606 patients with acute ischemic stroke, 181 died within 3 months, but 126 index‐stroke‐related deaths and 320 other deaths occurred during the subsequent 4866 patient‐years of follow‐up up to 5 years. Although 69/126 (54.8%) post‐3‐month index‐stroke‐related deaths occurred after 1 year, mRS>2 at 1 year strongly predicted these deaths (adjusted hazard ratio=21.94, 95%CI 7.88‐61.09, P<0.0001). Consequently, a 3‐month mRS >2 was a strong independent predictor of death at both 1 year (adjusted hazard ratio=6.67, 95%CI 4.16‐10.69, P<0.0001) and 5 years (adjusted hazard ratio=2.93, 95%CI 2.38‐3.60, P<0.0001). Although mRS improved by ≥1 point from 3 months to 1 year in 317/1266 (25.0%) patients with 3‐month mRS ≥1, improvement in mRS after 1 year was limited (improvement by ≥1 point: 91/858 [10.6%]; improvement to mRS ≤2: 13/353 [3.7%]).ConclusionsOur results reaffirm use of the 3‐month mRS outcome in stroke trials. Although later recovery does occur, extending follow‐up to 1 year would capture most long‐term stroke‐related disability. However, administrative mortality follow‐up beyond 1 year has the potential to demonstrate translation of early disability gains into additional reductions in long‐term mortality without much erosion by non‐stroke‐related deaths.

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Interobserver agreement for the assessment of handicap in stroke patients.

Cited by 5,162 publications

References 27 publications

Characteristics of paramedian pontine arteries disease and its association with hemoglobinA1c

Characteristics of paramedian pontine arteries disease and its association with hemoglobinA1c

Subjective health complaints predict functional outcome six months after stroke

Time Course of Evolution of Disability and Cause‐Specific Mortality After Ischemic Stroke: Implications for Trial Design

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