Time Spent at Home Poststroke

Self Cite

412

180

Background and Purpose-Robust measures of functional outcome are required to determine treatment effects in stroke trials. Of the various measures available, the Barthel index (BI) is one of the more prevalent. We aimed to describe validity, reliability, and responsiveness (clinimetric properties) of the BI in stroke trials. Methods-Narrative review of published articles describing clinimetric properties or use of the BI as a stroke trial end point. Results-Definitive statements on properties of BI are limited by heterogeneity in methodology of assessment and in the content of "BI" scales. Accepting these caveats, evidence suggests that BI is a valid measure of activities of daily living; sensitivity to change is limited at extremes of disability (floor and ceiling effects), and reliability of standard BI assessment is acceptable. However, these data may not be applicable to contemporary multicenter stroke trials. Conclusions-Substantial literature describing BI clinimetrics in stroke is available; however, questions remain regarding certain properties. The "BI" label is used for a number of instruments and we urge greater consistency in methods, content, and scoring. A 10-item scale, scoring 0 to 100 with 5-point increments, has been used in several multicenter stroke trials and it seems reasonable that this should become the uniform stroke trial BI. (Stroke. 2011;42:1146-1151.)

Section: Validitymentioning

confidence: 99%

Barthel Index for Stroke Trials

Quinn

Langhorne

Stott

2011

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412

180

“…1 Although there are several measures available to assess functional outcomes after acute ischemic stroke including the modified Rankin Scale (mRS) and the Barthel Index, these scales have potential limitations including significant interobserver variability. [1][2][3][4][5] Moreover, these indexes are not uniformly collected in routine clinical practice, and thus frequently not available in clinical registries, electronic health records, or administrative data sets. 1 In addition, even when part of a prospective functional outcome assessment, incomplete follow-up may contribute to missing data.…”

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confidence: 99%

“…Home-time has been previously defined as the number of days after stroke onset that a patient spends in their own home or in that of a relative as opposed to within institutional care of any sort. 5 This has been proposed as a graded and objective functional outcome measure for international acute ischemic stroke trials and has been shown to correlate with mRS in clinical trial populations and demonstrate gains in response to effective stroke therapies, such as intravenous tissue-type plasmiogen activator and mechanical thrombectomy treatment. [5][6][7] More recently, stroke survivors have identified home-time as a meaningful and highly prioritized outcome.…”

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confidence: 99%

“…5 This has been proposed as a graded and objective functional outcome measure for international acute ischemic stroke trials and has been shown to correlate with mRS in clinical trial populations and demonstrate gains in response to effective stroke therapies, such as intravenous tissue-type plasmiogen activator and mechanical thrombectomy treatment. [5][6][7] More recently, stroke survivors have identified home-time as a meaningful and highly prioritized outcome. [8][9][10] Home-time may thus represent an outcome measure that is more easily understood by patients with stroke, their families, and clinicians.…”

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confidence: 99%

See 1 more Smart Citation

Assessment of Home-Time After Acute Ischemic Stroke in Medicare Beneficiaries

Fonarow

Thomas

et al. 2016

Background and Purpose-Stroke survivors have identified home-time as a meaningful outcome. We evaluated home-time as a patient-centered outcome in Medicare beneficiaries with ischemic stroke in comparison with modified Rankin Scale (mRS) score at 90 days and at 1 year post event. Methods-Patients enrolled in Get With The Guidelines-Stroke (GWTG-Stroke) and Adherence Evaluation After Ischemic Stroke-Longitudinal (AVAIL) registries were linked to Medicare claims to ascertain home-time, defined as time spent alive and out of a hospital, inpatient rehabilitation, or skilled nursing facilities, at 90 days and at 1 year after admission. The correlation of home-time with mRS at 90 days and at 1 year was evaluated by Pearson correlation coefficients, and the ability of home-time to discriminate mRS (0-2) was assessed by c-index. Results-There

“…18 Patients and investigators were blinded to treatment allocation. Investigators underwent standardized training and certification on the administration of the NIHSS and mRS. 22 The primary efficacy outcome was the mRS score at day 90 or at last rating. 18 The score was compared between treatment groups using the Cochran-Mantel-Haenszel test with modified ridit scores (shift, or distribution, analysis).…”

Section: Designmentioning

confidence: 99%

Results of Membrane-activated Chelator Stroke Intervention Randomized Trial of DP-b99 in Acute Ischemic Stroke

Lees

Bornstein

Diener

et al. 2013

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Background and Purpose-DP-b99, a lipophilic moderate-affinity chelator of zinc, was postulated to improve recovery after acute ischemic stroke. We evaluated the safety and therapeutic effects of DP-b99 in patients with acute hemispheric ischemic stroke. Methods-The Membrane-Activated Chelator Stroke Intervention trial was a randomized, double-blind, placebo-controlled, multicenter, parallel-group trial of intravenous DP-b99 administered for 4 consecutive days (NCT00893867). Acute ischemic stroke patients within 9 hours of onset, but untreated by alteplase, with a baseline National Institutes of Health Stroke Scale score of 10 to 16, and evidence of language dysfunction, visual field defect, and neglect were eligible. The primary efficacy analysis compared distributions of functional status measured by modified Rankin score in the intentto-treat population of patients with any post-treatment outcome, adjusted for initial severity. Functional and neurological recovery were secondary measures. Home time was an exploratory end point. Results-Enrollment terminated at n=446 after the planned interim analysis determined futility; follow-up continued. Final modified Rankin score distributions were equal between DP-b99 and placebo-treated groups (P=0.10; P adj adjusted for baseline age and National Institutes of Health Stroke Scale=0.21). Fewer patients recovered to modified Rankin score ≤1 in the DP-b99-treated group (45/218; 20.6%) than after placebo (63/219; 28.8%) (P=0.05; P adj =0.10). Similarly, fewer patients attained National Institutes of Health Stroke Scale ≤1 after DP-b99 (42/