Look closer: The multidimensional patterns of post-stroke burden behind the modified Rankin Scale

Abstract

Background The utility-weighted modified Rankin Scale, representing patient perspectives of quality of life, is a newly proposed measure to improve the interpretability of the modified Rankin Scale. Despite obvious advantages, such weighting imperfectly reflects the multidimensional patterns of post-stroke burden. Aims To investigate multidimensional patterns of post-stroke burden formed by individual domains of Assessment of Quality of Life and Barthel Index for each modified Rankin Scale category. Methods In the A Very Early Rehabilitation Trial (n = 2104), modified Rankin Scale scores and modified Rankin Scale-stratified Barthel Index scores of Self-care and Mobility, and Assessment of Quality of Life scores of Independent Living, Senses, Mental Health and Relationships were collected at three months. The multivariate relationship between individual Assessment of Quality of Life and Barthel Index domains, and modified Rankin Scale was investigated using random effects linear regression models with respective interaction terms. Results Of 2104 patients, simultaneously collected Assessment of Quality of Life, Barthel Index and modified Rankin Scale scores at three months were available in 1870 patients. While individual Assessment of Quality of Life and Barthel Index domain scores decreased significantly as modified Rankin Scale increased (p < 0.0001), the patterns of decrease differed by domains (p < 0.0001). Patients with modified Rankin Scale 0–1 had the largest post-stroke burden in the Mental Health and Relationship domains, while patients with modified Rankin Scale >3 showed the greatest burden in Independent Living, Mobility and Self-care domains. Conclusions Across the modified Rankin Scale, individual domains are varyingly impacted demonstrating unique patterns of post-stroke burden, which facilitates appropriate assessment, articulation and interpretation of the modified Rankin Scale and utility-weighted modified Rankin Scale.

Factors associated with time to independent walking recovery post-stroke

“…27 However, our findings have additionally demonstrated the importance of initial stroke severity for independent walking, a highly valued outcome for survivors post-stroke, 4 but one which is inadequately captured by common post-stroke outcomes (eg, mRS). 8 The observed significant differences between the levels of severity (ie, mild, moderate, severe) and long-term walking outcomes signifies the need to investigate appropriate tailoring of rehabilitation interventions to each severity subgroup in future clinical trials.…”

“…Prestroke variables were comorbidities noted in the medical history (hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus, atrial fibrillation; all defined as present or absent). Stroke-related variables were stroke severity (National Institutes of Health Stroke Scale, NIHSS), 22 considered as a continuous variable and in subgroups (mild (0-7), moderate (8)(9)(10)(11)(12)(13)(14)(15)(16), severe (>16)), stroke type (ischaemic, haemorrhagic), Oxfordshire Stroke Classification 23 subgroups (total anterior circulation infarct (TACI), partial anterior circulation infarct (PACI), posterior circulation infarct (POCI), lacunar infarct (LACI), intracerebral haemorrhage (ICH)), ischaemic stroke location (large cortical, small cortical, hemispheric lacunar, brainstem, cerebellum, other, no infarct on imaging), stroke hemisphere (left, right, brainstem, not evident on imaging, unknown) and thrombolysis treatment with recombinant tissue plasminogen activator (yes, no). Stroke-related variables of stroke type, ischaemic stroke location and stroke hemisphere were reported based on information from routine neuroimaging (CT or MRI) performed at the local hospital.…”

“…6 7 Understanding the factors associated with recovery of independent walking is important to establish rehabilitation goals and inform discharge planning. A direct measure of walking (eg, 10 Metre Walk Test) is more informative of walking ability as compared with the modified Rankin Scale (mRS), which does not uniformly measure walking ability, 8 yet has been used for this purpose in the past. In the context of a direct measure of walking, it appears that both pre-stroke and acute stroke factors may be associated with independent walking.…”

Neurodegeneration Over 3 Years Following Ischaemic Stroke: Findings From the Cognition and Neocortical Volume After Stroke Study

“…There is no doubt that these treatments have transformed stroke care. However, stroke clinicians are now shifting their focus to improvements in rehabilitation and post-acute care (63)(64)(65)(66). Post-stroke cognitive impairment is identified as a key priority area for research and support by stroke survivors, but predictive models for individualised risk factors for cognitive decline are sorely needed (67).…”

Distance-based Classification and Regression Trees for the analysis of complex predictors in health and medical research

“…a score of 0 or 1 meaning excellent function, or a score between 0 and 2 meaning good function), it is a measure of global impairment and does not consider the specific areas that a stroke survivor may have been impacted by their stroke, nor the relative severity of this impact across each area. 33 As a result of this, other measures are often used to provide a more detailed understanding of patient outcomes. One such measure is the 4-dimensional Assessment of Quality of Life 34 (AQoL-4D), a multi-attribute outcome scoring system which assigns a utility value across the quality of life domains Independent Living (mobility as well as ability to perform self-care and household tasks), Relationships (friendships, role in family, level of isolation), Mental Health (pain, worry and sleeping habits), and Senses (ability to see, hear and communicate).…”