Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations

Holland, Richard; Drachler, Maria de Lourdes; Mares, Kathryn; Harvey, Ian

doi:10.1191/0269215506cr948oa

Cited by 28 publications

(16 citation statements)

References 10 publications

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“…Outcome scale cutoff values were determined based on those in earlier literature. 17,22 Results for this study are reported as statistically significant if the p value was less than 0.05.…”

Section: Methodsmentioning

confidence: 94%

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

Mooney¹,

Brigeman²,

Bohl³

et al. 2018

Journal of Neurosurgery

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OBJECTIVE Overlapping surgery is a controversial subject in medicine today; however, few studies have examined the outcomes of this practice. The authors analyzed outcomes of patients with acutely ruptured saccular aneurysms who were treated with microsurgical clipping in a prospectively collected database from the Barrow Ruptured Aneurysm Trial. Acute and long-term outcomes for overlapping versus nonoverlapping cases were compared. METHODS During the study period, 241 patients with ruptured saccular aneurysms underwent microsurgical clipping. Patients were separated into overlapping (n = 123) and nonoverlapping (n = 118) groups based on surgical start/stop times. Outcomes at discharge and at 6 months, 1 year, 3 years, and 6 years after surgery were analyzed. RESULTS Patient variables (e.g., age, smoking status, cardiovascular history, Hunt and Hess grade, Fisher grade, and aneurysm size) were similar between the 2 groups. Aneurysm locations were similar, with the exception of the overlapping group having more posterior circulation aneurysms (18/123 [15%]) than the nonoverlapping group (8/118 [7%]) (p = 0.0495). Confirmed aneurysm obliteration at discharge was significantly higher for the overlapping group (109/119 [91.6%]) than for the nonoverlapping group (95/116 [81.9%]) (p = 0.03). Hospital length of stay, discharge location, and proportions of patients with a modified Rankin Scale (mRS) score > 2 at discharge and up to 6 years postoperatively were similar. The mean and median mRS, Glasgow Outcome Scale, Mini-Mental State Examination, National Institutes of Health Stroke Scale, and Barthel Index scores at all time points were not statistically different between the groups. CONCLUSIONS Compared with nonoverlapping surgery, overlapping surgery was not associated with worse outcomes for any variable at any time point, despite the complexity of the surgical management in this patient population. These findings should be considered during the discussion of future guidelines on the practice of overlapping surgery.

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“…Outcome scale cutoff values were determined based on those in earlier literature. 17,22 Results for this study are reported as statistically significant if the p value was less than 0.05.…”

Section: Methodsmentioning

confidence: 94%

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

Mooney¹,

Brigeman²,

Bohl³

et al. 2018

Journal of Neurosurgery

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“…Previous research has demonstrated the reliability of phone BI assessments [ 17 ]. The scale may be analyzed as a continuous variable for increased power to detect associations, ability to describe the course of change over time in linear form, and avoidance of potential misclassification due to crude categorization [ 18 – 20 ]. BI measurements from the time of MRI forward were included.…”

Section: Methodsmentioning

confidence: 99%

Cerebral white matter disease and functional decline in older adults from the Northern Manhattan Study: A longitudinal cohort study

et al. 2018

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BackgroundCerebral white matter hyperintensities (WMHs) on MRI are common and associated with vascular and functional outcomes. However, the relationship between WMHs and longitudinal trajectories of functional status is not well characterized. We hypothesized that whole brain WMHs are associated with functional decline independently of intervening clinical vascular events and other vascular risk factors.Methods and findingsIn the Northern Manhattan Study (NOMAS), a population-based racially/ethnically diverse prospective cohort study, 1,290 stroke-free individuals underwent brain MRI and were followed afterwards for a mean 7.3 years with annual functional assessments using the Barthel index (BI) (range 0–100) and vascular event surveillance. Whole brain white matter hyperintensity volume (WMHV) (as percentage of total cranial volume [TCV]) was standardized and treated continuously. Generalized estimating equation (GEE) models tested associations between whole brain WMHV and baseline BI and change in BI, adjusting for sociodemographic, vascular, and cognitive risk factors, as well as stroke and myocardial infarction (MI) occurring during follow-up. Mean age was 70.6 (standard deviation [SD] 9.0) years, 40% of participants were male, 66% Hispanic; mean whole brain WMHV was 0.68% (SD 0.84). In fully adjusted models, annual functional change was −1.04 BI points (−1.20, −0.88), with −0.74 additional points annually per SD whole brain WMHV increase from the mean (−0.99, −0.49). Whole brain WMHV was not associated with baseline BI, and results were similar for mobility and non-mobility BI domains and among those with baseline BI 95–100. A limitation of the study is the possibility of a healthy survivor bias, which would likely have underestimated the associations we found.ConclusionsIn this large population-based study, greater whole brain WMHV was associated with steeper annual decline in functional status over the long term, independently of risk factors, vascular events, and baseline functional status. Subclinical brain ischemic changes may be an independent marker of long-term functional decline.

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“…Previous research has demonstrated the reliability of phone assessments of function using the BI (Shinar et al, 1987 ). Although it is an ordinal scale, the scale may be analyzed as a continuous variable for increased power to detect associations, ability to describe the course of change over time in linear form, and avoidance of potential misclassification due to crude categorization (Song et al, 2006 ; Bath et al, 2007 ; Saver, 2011 ).…”

Section: Methodsmentioning

confidence: 99%

Differential Effect of Left vs. Right White Matter Hyperintensity Burden on Functional Decline: The Northern Manhattan Study

Dhamoon

Cheung

Bagci

et al. 2017

Front. Aging Neurosci.

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Asymmetry of brain dysfunction may disrupt brain network efficiency. We hypothesized that greater left-right white matter hyperintensity volume (WMHV) asymmetry was associated with functional trajectories.Methods: In the Northern Manhattan Study, participants underwent brain MRI with axial T1, T2, and fluid attenuated inversion recovery sequences, with baseline interview and examination. Volumetric WMHV distribution across 14 brain regions was determined separately by combining bimodal image intensity distribution and atlas based methods. Participants had annual functional assessments with the Barthel index (BI, range 0–100) over a mean of 7.3 years. Generalized estimating equations (GEE) models estimated associations of regional WMHV and regional left-right asymmetry with baseline BI and change over time, adjusted for baseline medical risk factors, sociodemographics, and cognition, and stroke and myocardial infarction during follow-up.Results: Among 1,195 participants, greater WMHV asymmetry in the parietal lobes (−8.46 BI points per unit greater WMHV on the right compared to left, 95% CI −3.07, −13.86) and temporal lobes (−2.48 BI points, 95% CI −1.04, −3.93) was associated with lower overall function. Greater WMHV asymmetry in the parietal lobes (−1.09 additional BI points per year per unit greater WMHV on the left compared to right, 95% CI −1.89, −0.28) was independently associated with accelerated functional decline.Conclusions: In this large population-based study with long-term repeated measures of function, greater regional WMHV asymmetry was associated with lower function and functional decline. In addition to global WMHV, WHMV asymmetry may be an important predictor of long-term functional status.

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Statistical methods for analysing Barthel scores in trials of poststroke interventions: a review and computer simulations

Cited by 28 publications

References 10 publications

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

Analysis of overlapping surgery in patients undergoing microsurgical aneurysm clipping: acute and long-term outcomes from the Barrow Ruptured Aneurysm Trial

Cerebral white matter disease and functional decline in older adults from the Northern Manhattan Study: A longitudinal cohort study

Differential Effect of Left vs. Right White Matter Hyperintensity Burden on Functional Decline: The Northern Manhattan Study

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