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Šaňák D, Gurková E, Štureková L, Šaňáková Š, Zapletalová J, Franc D, Bartoníčková D. Quality of Life in Patients with Excellent 3-Month Clinical Outcome after First-Ever Ischemic Stroke: A Time to Redefine Excellent Outcome? Eur Neurol 2024; 87:1-10. [PMID: 38232714 DOI: 10.1159/000535685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 12/03/2023] [Indexed: 01/19/2024]
Abstract
INTRODUCTION Ischemic stroke (IS) may have impact on long-term health-related quality of life (HRQoL) even in the patients with good clinical outcome, and tools mostly used for the assessment of outcome may underestimate or not reflect all relevant sequels after IS. We aimed to analyze HRQoL in the patients with excellent outcome after IS. METHODS We analyzed consecutive IS patients enrolled in the prospective FRAILTY study (ClinicalTrials.gov: NCT04839887) with excellent 3-month clinical outcome (score 0-1 in modified Rankin Scale [mRS]). Stroke Impact Scale (SIS) version 3.0 and Hospital Anxiety and Depression Scale (HADS) were used for the HRQoL, anxiety, and depression assessments, and subgroup comparisons were performed according to NIHSS score (0, ≥1), age (50<, ≥50 years), and sex. RESULTS In total, 158 patients (55.7% men, mean age 60.3 ± 13.4 years) were analyzed, and 72.2% of them had score 0 in mRS. The overall lowest median scores were found in the SIS domain "emotion," "strength," and "participation." Patients with NIHSS ≥1 had lower scores in all SIS domains except "emotions" and "mobility." Patients ≥50 years had lower score in "mobility" (p = 0.004) and females in domain of "social participation" (p = 0.044). No differences were found among all subgroups in HADS anxiety and depression. Age, NIHSS score, and depression were found negative predictors for the physical domains of HRQoL. DISCUSSION/CONCLUSIONS Despite excellent 3-month clinical outcome after IS, patients had affected substantially their HRQoL, especially those with NIHSS ≥1. Patients ≥50 years had more affected "mobility" and females "social participation."
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Affiliation(s)
- Daniel Šaňák
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
| | - Jana Zapletalová
- Department Medical Biophysics, Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czechia
| | - David Franc
- Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czechia
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University, Olomouc, Czechia
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Health-related quality of life using WHODAS 2.0 and associated factors 1 year after stroke in Korea: a multi-centre and cross-sectional study. BMC Neurol 2022; 22:501. [PMID: 36564762 PMCID: PMC9789571 DOI: 10.1186/s12883-022-03032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/16/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Little is known about the self-perceived level of disability of stroke survivors in the community. We aimed to characterise Health-related quality of life (HRQoL) 1 year after stroke and investigate how sociodemographic and stroke-related factors and medical adherence explain the self-perceived level of disability in a Korean stroke population. METHODS This was a multicentre cross-sectional study. A total of 382 ischaemic stroke survivors at 1 year after onset from 11 university hospitals underwent a one-session assessment, including socioeconomic variables, the modified Rankin Scale (mRS), various neurological sequelae, the Morisky, Green and Levin-Medication Adherence Questionnaire (MGL), and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) 36-items. The relationship between disability and different variables was analysed using ordinal logistic regression. RESULTS The prevalence of disability based on global WHODAS 2.0 was 62.6% (mild, 41.6%; moderate, 16.0%; severe, 5.0%). The prevalence of severe disability was higher in participation in society (16.8%) and getting around (11.8%) than in other domains. Low MGL- motivation was the only factor determining a significant association between all six domains of disability after adjustment. Different predictors for specific domains were age, mRS, dysarthria, trouble seeing, cognition problems, and MGL-motivation for understanding and communicating; age, recurrent stroke, mRS, hemiplegia, facial palsy, general weakness, and MGL-motivation for getting around; age, education, mRS, hemiplegia, and MGL-motivation for self-care; education, recurrent stroke, hemiplegia, dysarthria, and MGL-motivation for getting along with people; age, education, income, mRS, hemiplegia, dysarthria, MGL-knowledge, and MGL-motivation for life activities; living without a spouse, mRS, hemiplegia, dysarthria, trouble seeing, cognition problems, general weakness, and MGL-motivation for participation in society. CONCLUSIONS Self-perceived disability according to the WHODAS 2.0 at 1 year after stroke was highly prevalent. Each disability domain showed a different prevalence and associated factors. Interventions promoting medical adherence to motivation seemed to help achieve high HRQoL in all domains.
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Hu J, Fang Z, Lu X, Wang F, Zhang N, Pan W, Fu X, Huang G, Tan X, Chen W. Influence Factors and Predictive Models for the Outcome of Patients with Ischemic Stroke after Intravenous Thrombolysis: A Multicenter Retrospective Cohort Study. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:3363735. [PMID: 36035225 PMCID: PMC9402302 DOI: 10.1155/2022/3363735] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/24/2022] [Accepted: 07/28/2022] [Indexed: 12/26/2022]
Abstract
Objective Intravenous thrombolysis (IVT) is currently the main effective treatment for patients with ischemic stroke. This study aimed to analyze the factors affecting the early neurological recovery and prognosis of thrombolytic therapy after surgery and to construct predictive models. Materials and Methods A total of 849 patients with ischemic stroke who received IVT treatment at six centers from June 2017 to March 2021 were included. Patients were divided into the training cohort and the validation cohort. Based on the independent factors that influence the early recovery of neurological function and the prognosis, the respective predictive nomograms were established. The predictive accuracy and discrimination ability of the nomograms were evaluated by ROC and calibration curve, while the decision curve and clinical impact curve were adopted to evaluate the clinical applicability of the nomograms. Results The nomogram constructed based on the factors affecting the prognosis in 3 months had ideal accuracy as the AUC (95% CI) was 0.901 (0.874~0.927) in the training cohort and 0.877 (0.826~0.929) in the validation cohort. The accuracy of the nomogram is required to be improved, since the AUC (95% CI) of the training cohort and the validation cohort was 0.641 (0.597~0.685) and 0.627 (0.559~0.696), respectively. Conclusions Based on this ideal and practical prediction model, we can early identify and actively intervene in patients with ischemic stroke after IVT to improve their prognosis. Nevertheless, the accuracy of predicting nomograms for the recovery of early neurological function after IVT still needs improvement.
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Affiliation(s)
- Jin Hu
- Department of Neurology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Zhixian Fang
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Xia Lu
- Department of Neurology, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Fei Wang
- Department of Neurology, The First People's Hospital of Jiashan County, Jiaxing, China
| | - Ningyuan Zhang
- Department of Neurology, The First People's Hospital of Tongxiang, Jiaxing, China
| | - Wenliang Pan
- Department of Neurology, The People's Hospital of Haiyan, Jiaxing, China
| | - Xinzheng Fu
- Department of Neurology, The People's Hospital of Haining, Jiaxing, China
| | - Gongchun Huang
- Department of Neurology, The First People's Hospital of Pinghu, Jiaxing, China
| | - Xiaoli Tan
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Wenyu Chen
- Department of Respiration, The Affiliated Hospital of Jiaxing University, Jiaxing, China
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Braadt L, Meisinger C, Linseisen J, Kirchberger I, Zickler P, Naumann M, Ertl M. Influence of educational status and migration background on the long-term health related quality of life after stroke. Eur J Neurol 2022; 29:3288-3295. [PMID: 35836373 DOI: 10.1111/ene.15503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/10/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute stroke treatment and secondary prevention have tremendously improved functional outcomes after stroke. However, this does not always imply a likewise improvement in health-related quality of life (HRQoL). Knowledge on factors influencing HRQoL after stroke is still scarce, especially regarding social aspects like the level of education and the presence of migration background. METHODS In the present stroke cohort study, participants were interviewed during their hospital stay and completed a postal questionnaire at three and twelve months post stroke. Functional outcomes were assessed by the modified Rankin Scale (mRS) and HRQoL by evaluating the detailed Stroke Impact Scale (SIS). Logistic regression models were used to determine associations between education, migration background and quality of life endpoints. RESULTS A total of 945 (mean age 69 years; 56% male) stroke patients were enrolled. After adjusting for confounders, a lower educational level was associated with worse functional outcomes in the SIS domain "strength" (OR 2.67, 95% CI 1.6 - 4.4, p < 0.001). Migration background was associated with worse outcomes in the SIS-domain "emotion" (p = 0.007, OR 1.71, 95% CI 1.2 - 2.5). Additionally, for female patients worse HRQoL-outcomes were found in multiple other SIS-domains. CONCLUSIONS Migration background and a lower educational level were significantly associated with lower long-term HRQoL after stroke. These aspects should be considered in targeted rehabilitation programs and follow-up support of stroke patients.
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Affiliation(s)
- Lino Braadt
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, Augsburg, Germany.,Institute for Medical Information Processing, Biometry and Epidemiology-IBE, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Philipp Zickler
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Markus Naumann
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology and Clinical Neurophysiology, University Hospital Augsburg, Augsburg, Germany
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Lapin B, Thompson N, Schuster A, Katzan IL. Optimal Methods for Reducing Proxy-Introduced Bias on Patient-Reported Outcome Measurements for Group-Level Analyses. Circ Cardiovasc Qual Outcomes 2021; 14:e007960. [PMID: 34724804 DOI: 10.1161/circoutcomes.121.007960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Caregivers, or proxies, often complete patient-reported outcomes (PROs) on behalf of patients; yet, research has demonstrated proxies rate patient outcomes worse than patients rate their own outcomes. To improve interpretability of PROs in group-level analyses, our study aimed to identify optimal approaches for reducing proxy-introduced bias in the analysis of PROs. METHODS Data were simulated based on 200 patients with stroke and their proxies who both completed 9 PROMIS domains as part of a cross-sectional study. The sample size was varied as 50, 100, 200, and 500, and the proportion of patients with proxy-respondents was varied as 10%, 20%, and 50%. Six methods for handling proxy-completions were investigated: (1) complete case analysis; (2) proxy substitution; (3) Method 2 plus proxy adjustment; (4) Method 3 including inverse-probability of treatment weighting; (5) multiple imputation; (6) linear equating. These methods were evaluated by comparing average bias in PROMIS T-scores (estimated versus observed patient-only responses), as well as by comparing estimated regression coefficients to models using patient-only responses. RESULTS Overall mean T-score differences ranged from 0 to 1.75. The range of mean differences varied by the 6 methods with methods 1 and 5 providing estimates closest to the observed mean. In regression models, all but inverse-probability of treatment weighting resulted in low bias when proxy-completions were 10% to 20%. With 50% proxy-completions, method 5 resulted in less accurate estimations while methods 1 to 3 provided less proxy-introduced bias. Bias remained low across domain and varying sample sizes but increased with larger percentages of proxy-respondents. CONCLUSIONS Our study found modest proxy-introduced bias when estimating PRO scores or regression estimates across multiple domains of health. This bias remained low, even when sample size was 50 and there were large proportions of proxy-completions. While many of these methods can be chosen for including proxies in stroke PRO research with <20% proxy-respondents, proxy substitution with adjustment resulted in low bias with 50% proxy-respondents.
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Affiliation(s)
- Brittany Lapin
- Quantitative Health Sciences, Lerner Research Institute (B.L., N.T.), Cleveland Clinic, Ohio.,Center for Outcomes Research & Evaluation, Neurological Institute (B.L., N.T., A.S., I.L.K.), Cleveland Clinic, Ohio
| | - Nicolas Thompson
- Quantitative Health Sciences, Lerner Research Institute (B.L., N.T.), Cleveland Clinic, Ohio.,Center for Outcomes Research & Evaluation, Neurological Institute (B.L., N.T., A.S., I.L.K.), Cleveland Clinic, Ohio
| | - Andrew Schuster
- Center for Outcomes Research & Evaluation, Neurological Institute (B.L., N.T., A.S., I.L.K.), Cleveland Clinic, Ohio
| | - Irene L Katzan
- Center for Outcomes Research & Evaluation, Neurological Institute (B.L., N.T., A.S., I.L.K.), Cleveland Clinic, Ohio
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Mitchell E, Philips N, Ahern E, McGettrick G, Mockler D, Fitzpatrick K, Trepel D. The effectiveness of community neurorehabilitation for persons with an acquired brain injury: protocol for a systematic review. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13196.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Acquired brain injury (ABI) refers to any type of brain damage after birth. ABI from either traumatic or non-traumatic origin is a leading cause of death and long-term disability globally. The impact of an ABI can be cognitive and/ or physical, greatly affecting their ability to function independently. With a lack of specialist inpatient rehabilitation facilities and services many of these survivors reside within the community either alone, with family or in residential facilities. Up-to-date evidence is required to indicate which forms of community rehabilitation are most effective in improving cognitive and physical outcomes for survivors. This systematic review aims to explore the clinical effectiveness of community neuro-rehabilitation services for persons living with an ABI. Methods: A systematic review of relevant electronic databases will be undertaken to identify eligible published randomised controlled trials. The PRISMA statement will be used to guide the systematic review. From running the initial search, we aim to submit the paper for publishing within 6 months. This process will be completed using Covidence software. Two reviewers will independently screen the search results and select studies using pre-defined selection criteria, extract data from and assess risk of bias for selected studies. Discussion: This systematic review will aim to explore the clinical effectiveness of community neuro-rehabilitation services for persons with an ABI. It plans to review and synthesize the current best available evidence base. A goal of this study is to positively inform ongoing service development within a quality framework. Systematic review registration: PROSPERO CRD42020148604 (26/02/2020)
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Psychometric properties of measures of upper limb activity performance in adults with and without spasticity undergoing neurorehabilitation-A systematic review. PLoS One 2021; 16:e0246288. [PMID: 33571238 PMCID: PMC7877653 DOI: 10.1371/journal.pone.0246288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 01/15/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction This systematic review appraises the measurement quality of tools which assess activity and/or participation in adults with upper limb spasticity arising from neurological impairment, including methodological quality of the psychometric studies. Differences in the measurement quality of the tools for adults with a neurological impairment, but without upper limb spasticity, is also presented. Methods 29 measurement tools identified in a published review were appraised in this systematic review. For each identified tool, we searched 3 databases (Medline, Embase, CINAHL) to identify psychometric studies completed with neurorehabilitation samples. Methodological quality of instrument evaluations was assessed with use of the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) checklist. Synthesis of ratings allowed an overall rating of the psychometric evidence for each measurement tool to be calculated. Results 149 articles describing the development or evaluation of psychometric properties of 22 activity and/or participation measurement tools were included. Evidence specific to tool use for adults with spasticity was identified within only 15 of the 149 articles and provided evidence for 9 measurement tools only. Overall, COSMIN appraisal highlighted a lack of evidence of measurement quality. Synthesis of ratings demonstrated all measures had psychometric weaknesses or gaps in evidence (particularly for use of tools with adults with spasticity). Conclusions The systematic search, appraisal and synthesis revealed that currently there is insufficient measurement quality evidence to recommend one tool over another. Notwithstanding this conclusion, newer tools specifically designed for use with people with neurological conditions who have upper limb spasticity, have emergent measurement properties that warrant further research. Systematic review registration PROSPERO CRD42014013190.
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Lapin BR, Thompson NR, Schuster A, Honomichl R, Katzan IL. The validity of proxy responses on patient-reported outcome measures: Are proxies a reliable alternative to stroke patients' self-report? Qual Life Res 2021; 30:1735-1745. [PMID: 33511498 DOI: 10.1007/s11136-021-02758-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Caregivers, or proxies, often complete patient-reported outcome measures (PROMs) on behalf of patients with stroke. The objective of our study was to assess the validity and responsiveness of proxy-responses compared to patient-responses across multiple domains of health. METHODS Stroke patients and their proxies were recruited to complete PROMs between 7/2018-11/2019. PROMs included Neuro-QoL cognitive function, PROMIS physical function, satisfaction with social roles, anxiety, fatigue, pain interference, sleep disturbance, Global Health, and PHQ-9. Internal consistency and convergent validity were compared between patient- and proxy-reported measures. Known-groups validity was assessed across levels of stroke disability. Internal responsiveness was evaluated using paired t-tests for a subset of patients who attended rehabilitation following stroke. Analyses were stratified by patients ≤ 3 vs > 3 months from stroke. RESULTS This cross-sectional study included 200 stroke patients (age 62.2 ± 13.3, 41.5% female) and their proxies (age 56.5 ± 13.9, 70% female, 72% spouses). PROMs had high internal consistency and were significantly correlated for patients and proxies. Patient- and proxy-reported measures worsened with increasing stroke disability. For 34 (17%) patients who attended rehabilitation, patients self-reported improvement on 5 domains whereas proxies reported no improvement. Compared to patient self-reports, validity was worse for proxy-reports on patients ≤ 3 months but better > 3 months from stroke. CONCLUSIONS Both patient- and proxy-reported PROMs demonstrated strong validity. Only patient-reported PROMs were responsive to change, and proxies had worse validity for patients ≤ 3 months from stroke but better validity for patients > 3 months from stroke. These findings justify the utilization of proxy responses in stroke patients > 3 months from stroke.
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Affiliation(s)
- Brittany R Lapin
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, JJ3-603,, Cleveland, OH, 44195, USA. .,Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Nicolas R Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, JJ3-603,, Cleveland, OH, 44195, USA.,Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Andrew Schuster
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ryan Honomichl
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, JJ3-603,, Cleveland, OH, 44195, USA.,Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Irene L Katzan
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Herten A, Chen B, Saban D, Santos A, Wrede K, Jabbarli R, Zhu Y, Schmidt B, Kleinschnitz C, Forsting M, Sure U, Dammann P. Health-related quality of life in patients with untreated cavernous malformations of the central nervous system. Eur J Neurol 2020; 28:491-499. [PMID: 32961598 DOI: 10.1111/ene.14546] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE To estimate health-related quality of life (HRQOL) in patients with untreated cavernous malformation of the CNS [cavernous cerebral malformations (CCMs)]. METHODS We performed a cross-sectional observational study on patients with CCMs admitted to our department from 1 November 2017 to 10 January 2020 using standardized interviews [short-form-36 questionnaire, hospital anxiety and depression score (HADS-A/D), CCM perception questionnaire]. Included criteria were diagnosis of an untreated CCM and information about the diagnosis in a specialized CCM consultation. Health-related quality of life (HRQOL) data were analyzed and compared to the German normal population. Uni- and multivariate analyses were carried out to identify variables with impact on outcome. RESULTS Two hundred nineteen (93%) of 229 eligible patients were included. Mean age was 46.3 ± 14.7 (18-86) years; 136 (62%) were female. Ninety-eight (45%) patients presented with symptomatic hemorrhage (SH), and 17 (8%) with repetitive SH. Ninety-two (42%) patients were asymptomatic. Thirty-seven patients (17%) suffered from cavernoma-related epilepsy. Twenty-eight patients (13%) suffered from familial CCMs. Patients showed significantly decreased component scores and subdomain scores compared to the normal population, with effects ranging from small to large. This accounted largely also for asymptomatic patients (except for physical component score and main physical subdomains). Multivariate regression analysis confirmed impact of functional impairment on physical component score. HADS-A was significantly increased. HADS-A/D strongly correlated with mental component score and individual perception of the CCM. CONCLUSIONS Patients with the diagnosis of a CCM showed decreased HRQOL compared to the normal population even when not suffering functional impairment or neurological symptoms. Our data may function as benchmarks in evaluation of different (future) management strategies.
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Affiliation(s)
- A Herten
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - B Chen
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - D Saban
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - A Santos
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - K Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - R Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Y Zhu
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - C Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - M Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - U Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - P Dammann
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
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Dammann P, Herten A, Santos AN, Rauschenbach L, Chen B, Darkwah Oppong M, Schmidt B, Forsting M, Kleinschnitz C, Sure U. Multimodal outcome assessment after surgery for brainstem cavernous malformations. J Neurosurg 2020; 135:401-409. [PMID: 33065532 DOI: 10.3171/2020.6.jns201823] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The object of this study was to assess outcome after surgery for brainstem cavernous malformations (BSCMs) using functional, health-related quality of life (HRQOL), and psychological surveys to analyze the interrelation of these measurements, and to compare HRQOL and anxiety and depression scores with those in a healthy population. METHODS The authors performed a cross-sectional outcome study of all patients surgically treated for BSCM in their department between January 1, 2003, and December 31, 2019. They assessed functional outcome via the modified Rankin Scale (mRS), health-related quality of life (HRQOL) via the SF-36 and 9-item Life Satisfaction Questionnaire (LISAT-9), cranial nerve and brainstem function using a questionnaire, symptom-based psychological outcome via the Hospital Anxiety and Depression Scale (HADS), and timepoint of a return to previous employment. They analyzed the correlation between absolute (mRS score ≤ 2) and relative (postoperative deterioration in initial mRS score) outcome endpoints and the interrelation of the outcome measures and performed a comparison of HRQOL and HADS scores with findings in a healthy population. RESULTS Seventy-four patients were eligible for inclusion in the study. HRQOL was impaired after surgery for BSCM compared to that in a healthy population. This impairment was substantial in patients with an unfavorable functional outcome (mRS > 2) but was also present in those with a favorable outcome (mRS ≤ 2) in selected domains. Psychological impairment was negligible in patients with a favorable outcome and grave in those with an unfavorable outcome. LISAT-9 results revealed that brainstem and cranial nerve symptoms reduce satisfaction mainly in self-care abilities for both unfavorable and favorable outcome patients. Among the brainstem and cranial nerve symptoms, balance impairment showed the most significant impact on HRQOL. Absolute outcome endpoints were superior to relative outcome endpoints in reflecting impairment in HRQOL after surgery. CONCLUSIONS The study data can improve patient counseling and decision-making in BSCM treatment and may function as a benchmark. The authors report outcomes after BSCM surgery in high detail, emphasizing the specific impact of cranial nerve and brainstem symptoms on HRQOL. When reporting BSCM surgery outcome, absolute outcome endpoints should be applied.
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Affiliation(s)
| | - Annika Herten
- 1Department of Neurosurgery, University Hospital Essen
| | | | | | - Bixia Chen
- 1Department of Neurosurgery, University Hospital Essen
| | | | - Börge Schmidt
- 2Institute for Medical Informatics, Biometry and Epidemiology, University Hospital Essen
| | - Michael Forsting
- 3Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen; and
| | - Christoph Kleinschnitz
- 4Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ulrich Sure
- 1Department of Neurosurgery, University Hospital Essen
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Lapin BR, Thompson NR, Schuster A, Katzan IL. Magnitude and Variability of Stroke Patient-Proxy Disagreement Across Multiple Health Domains. Arch Phys Med Rehabil 2020; 102:440-447. [PMID: 33035512 DOI: 10.1016/j.apmr.2020.09.378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/03/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To quantify the extent and variability of bias introduced when caregivers, or proxies, complete patient-reported outcome measures (PROM) on behalf of stroke patients. DESIGN Cross-sectional survey study conducted between July 2018 and November 2019. SETTING Ambulatory clinic of a cerebrovascular center or rehabilitation unit. PARTICIPANTS A consecutive sample of stroke patients (N=200) and their proxies who were able and willing to complete PROMs. Proxies completed PROMs as they believed the patient would answer. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES PROMs included Neuro-QoL cognitive function, PROMIS physical function, social role satisfaction, anxiety, fatigue, pain interference, sleep disturbance, Patient Health Questionnaire-9 translated to PROMIS Depression, and PROMIS Global Health. RESULTS The study included 200 stroke patients (age, 62.2±13.3; 41.5% women) and their proxies (age 56.5±13.9; 70% women, 72% spouses). Proxies reported worse functioning and more symptoms across all PROM domains compared with patients (average difference, 0.3-3.0 T score points). Reliability between dyad responses was moderate across all domains (intraclass correlation coefficients (2,1), 0.49-0.76) and effect sizes were small (d=0.04-0.35). Cognitive function, anxiety, and depression had the lowest agreement, whereas physical function, pain, and sleep had the highest agreement based on the Bland-Altman method. At the individual level, a large proportion of dyads had meaningfully different scores across domains (range, 40%-57%; dyads differed >5 T score points). Few predictors of disagreement were identified through multinomial regression models. CONCLUSIONS At the aggregate level, small differences were detected between stroke patient-proxy pairs, with lower agreement on more subjective domains. At the individual level, a large proportion of dyads reported meaningfully different scores on all domains, affecting the interpretability of proxy responses on PROMs in a clinical setting.
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Affiliation(s)
- Brittany R Lapin
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Nicolas R Thompson
- Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio; Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andrew Schuster
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Irene L Katzan
- Center for Outcomes Research & Evaluation, Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio
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12
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Asaithambi G, Tipps ME. Quality of life among ischemic stroke patients eligible for endovascular treatment: analysis of the DEFUSE 3 trial. J Neurointerv Surg 2020; 13:703-706. [PMID: 32753555 DOI: 10.1136/neurintsurg-2020-016399] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/07/2020] [Accepted: 07/13/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND The endovascular treatment (ET) for acute ischemic stroke is increasing among eligible patients. Assessing patients' perspectives on quality of life (QOL) can supplement the use of formal outcome scales and enable the assessment of outcomes across multiple domains affected by stroke. METHODS We analyzed publicly available data from the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE 3) trial. We evaluated patients who survived beyond the time of discharge from their acute hospitalizations and completed all Neuro-QOL short forms at 90-day follow-up. RESULTS Our final analysis included 128 patients (median age 67 [range 23-90] years, 50.8% men). As modified Rankin Scale (mRS) scores increased, there was a consistent increase in the severity of Neuro-QOL measures. T-scores for mobility, cognitive function, and the ability to participate in social roles declined significantly while depression T-scores increased significantly. We found that QOL T-scores for patients with mRS 3 did not differ significantly from T-scores for patients with mRS 2 in any domain. CONCLUSIONS Among ischemic stroke patients eligible for ET, QOL scores help validate and supplement quantitatively measured outcomes.
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Affiliation(s)
- Ganesh Asaithambi
- Neurosciences, Allina Health United Hospital, St. Paul, Minnesota, USA
| | - Megan E Tipps
- Neuroscience Research, Allina Health, Minneapolis, Minnesota, USA
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Chen EP, Arslanian-Engoren C, Newhouse W, Egleston D, Sahgal S, Yande A, Fagerlin A, Zahuranec DB. Development and usability testing of Understanding Stroke, a tailored life-sustaining treatment decision support tool for stroke surrogate decision makers. BMC Palliat Care 2020; 19:110. [PMID: 32689982 PMCID: PMC7370629 DOI: 10.1186/s12904-020-00617-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Surrogate decision makers of stroke patients are often unprepared to make critical decisions on life-sustaining treatments. We describe the development process and key features for the Understanding Stroke web-based decision support tool. METHODS We used multiple strategies to develop a patient-centered, tailored decision aid. We began by forming a Patient and Family Advisory Council to provide continuous input to our multidisciplinary team on the development of the tool. Additionally, focus groups consisting of nurses, therapists, social workers, physicians, stroke survivors, and family members reviewed key elements of the tool, including prognostic information, graphical displays, and values clarification exercise. To design the values clarification exercise, we asked focus groups to provide feedback on a list of important activities of daily living. An ordinal prognostic model was developed for ischemic stroke and intracerebral hemorrhage using data taken from the Virtual International Stroke Trials Archive Plus, and incorporated into the tool. RESULTS Focus group participants recommended making numeric prognostic information optional due to possible emotional distress. Pie charts were generally favored by participants for graphical presentation of prognostic information, though a horizontal stacked bar chart was also added due to its prevalence in stroke literature. Plain language descriptions of the modified Rankin Scale were created to accompany the prognostic information. A values clarification exercise was developed consisting of a list of 13 situations that may make an individual consider comfort measures only. The final version of the web based tool (which can be viewed on tablets) included the following sections: general introduction to stroke, outcomes (prognostic information and recovery), in-hospital and life-sustaining treatments, decision making and values clarification, post-hospital care, tips for talking to the health care team, and a summary report. Preliminary usability testing received generally favorable feedback. CONCLUSION We developed Understanding Stroke, a tailored decision support tool for surrogate decision makers of stroke patients. The tool was well received and will be formally pilot tested in a group of stroke surrogate decision makers. TRIAL REGISTRATION ClinicalTrials.gov ( NCT03427645 ).
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Affiliation(s)
- Emily P Chen
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, USA
| | - Cynthia Arslanian-Engoren
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, USA
| | - William Newhouse
- Center for Health Communications Research, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | - Diane Egleston
- Center for Health Communications Research, University of Michigan Institute for Healthcare Policy and Innovation, Ann Arbor, USA
| | | | | | - Angela Fagerlin
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, USA
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, USA
| | - Darin B Zahuranec
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, USA.
- Department of Neurology, University of Michigan Medical School, Ann Arbor, USA.
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14
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Pound G, Jones D, Eastwood GM, Paul E, Hodgson CL. Survival and functional outcome at hospital discharge following in-hospital cardiac arrest (IHCA): A prospective multicentre observational study. Resuscitation 2020; 155:48-54. [PMID: 32697963 DOI: 10.1016/j.resuscitation.2020.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 06/20/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
AIM To evaluate the functional outcome of patients after in-hospital cardiac arrest (IHCA) and to identify associations with good functional outcome at hospital discharge. METHOD Emergency calls were prospectively screened and data collected for IHCAs in seven Australian hospitals. Patients were included if aged > 18 years, admitted as an acute care hospital in-patient and experienced IHCA; defined by a period of unresponsiveness with no observed respiratory effort and commencement of external cardiac compressions. Data collected included patient demographics, clinical and cardiac arrest characteristics, survival and functional outcome at hospital discharge using the modified Rankin Scale (mRS) and Katz Index of Independence in ADLs (Katz-ADL). RESULTS 152 patients suffered 159 IHCAs (male 66.4%; mean age 70.2 (± 13.9) years). Sixty patients (39.5%) survived, of whom 43 (71.7%) had a good functional outcome (mRS ≤ 3) and 38 (63.3%) were independent with activities of daily living (ADLs) at hospital discharge (Katz-ADL = 6). Younger age (OR 0.95; 95% CI 0.91-0.98; p = 0.003), shorter duration of CPR (OR 0.84; 95% CI 0.77-0.91; p < 0.0001) and shorter duration of hospital admission prior to IHCA (OR 0.96; 95% CI 0.93-0.998; p = 0.04) were independently associated with a good functional outcome at hospital discharge. CONCLUSION The majority of survivors had a good functional outcome and were independent with their ADLs at hospital discharge. Factors associated with good functional outcome at hospital discharge were identified.
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Affiliation(s)
- G Pound
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Physiotherapy Department, St. Vincent's Hospital, Melbourne, Australia; Physiotherapy Department, The Alfred Hospital, Melbourne, Australia.
| | - D Jones
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Intensive Care Department, The Austin Hospital, Melbourne, Australia
| | - G M Eastwood
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Intensive Care Department, The Austin Hospital, Melbourne, Australia
| | - E Paul
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C L Hodgson
- Australian and New Zealand Intensive Care Research Centre (ANZIC-RC), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Physiotherapy Department, The Alfred Hospital, Melbourne, Australia
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15
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Cumming TB, Churilov L, Collier J, Donnan G, Ellery F, Dewey H, Langhorne P, Lindley RI, Moodie M, Thrift AG, Bernhardt J. Early mobilization and quality of life after stroke: Findings from AVERT. Neurology 2019; 93:e717-e728. [PMID: 31350296 DOI: 10.1212/wnl.0000000000007937] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 03/21/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine whether early and more frequent mobilization after stroke affects health-related quality of life. METHODS A Very Early Rehabilitation Trial (AVERT) was an international, multicenter (56 sites), phase 3 randomized controlled trial, spanning 2006-2015. People were included if they were aged ≥18 years, presented within 24 hours of a first or recurrent stroke (ischemic or hemorrhagic), and satisfied preordained physiologic criteria. Participants were randomized to usual care alone or very early and more frequent mobilization in addition to usual care. Quality of life at 12 months was a prespecified secondary outcome, evaluated using the Assessment of Quality of Life 4D (AQoL-4D). This utility-weighted scale has scores ranging from -0.04 (worse than death) to 1 (perfect health). Participants who died were assigned an AQoL-4D score of 0. RESULTS No significant difference in quality of life at 12 months between intervention (median 0.47, interquartile range [IQR] 0.07-0.81) and usual care (median 0.49, IQR 0.08-0.81) groups was identified (p = 0.86), nor were there any group differences across the 4 AQoL-4D domains. The same lack of group difference in quality of life was observed at 3 months. When cohort data were analyzed (both groups together), quality of life was strongly associated with acute length of stay, independence in activities of daily living, cognitive function, depressive symptoms, and anxiety symptoms (all p < 0.001). Quality of life in AVERT participants was substantially lower than population norms, and the gap increased with age. CONCLUSIONS Earlier and more frequent mobilization after stroke did not influence quality of life. CLINICAL TRIAL REGISTRATION anzctr.org.au; ACTRN12606000185561 CLASSIFICATION OF EVIDENCE: This study provides Class II evidence that for people with stroke, earlier and more frequent mobilization did not influence quality of life over the subsequent year.
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Affiliation(s)
- Toby B Cumming
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Leonid Churilov
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Janice Collier
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Geoffrey Donnan
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Fiona Ellery
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Helen Dewey
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Peter Langhorne
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Richard I Lindley
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Marj Moodie
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Amanda G Thrift
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia
| | - Julie Bernhardt
- From Florey Institute of Neuroscience and Mental Health (T.B.C., L.C., J.C., G.D., F.E., J.B.), University of Melbourne; Eastern Health Clinical School (H.D.) and Department of Medicine, School of Clinical Sciences at Monash Health (A.G.T.), Monash University, Melbourne, Australia; Institute of Cardiovascular and Medical Sciences (P.L.), University of Glasgow, UK; Westmead Hospital Clinical School (R.I.L.), University of Sydney and George Institute for Global Health, Sydney; Faculty of Health (M.M.), Deakin University, Melbourne, Australia.
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Yun RY, Park HE, Hong JW, Shin YB, Yoon JA. Correlation of Swallowing Function With Bilateral Diaphragmatic Movement in Hemiplegic Stroke Patients. Ann Rehabil Med 2019; 43:156-162. [PMID: 31072082 PMCID: PMC6509578 DOI: 10.5535/arm.2019.43.2.156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 08/29/2018] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate difference in bilateral diaphragm movement of patients with tracheal aspiration according to post stroke residue severity and determine correlations of Penetration-Aspiration Scale (PAS), residue scale, and bilateral diaphragm movement. Methods A total of 47 patients diagnosed with hemiplegic stroke were enrolled in this study. PAS, severity of valleculae, and pyriform sinus retention during videofluoroscopic swallowing study (VFSS) were assessed. Bilateral fluoroscopic diaphragm movements during spontaneous breathing and forced breathing were measured. Results Patients with tracheal aspiration (PAS≥6) had significantly (p=0.035) lower ipsilateral diaphragm movement during spontaneous breathing. Post-swallow residue severity showed statistically significant (p=0.028) difference in patients with ipsilateral diaphragm movement during forced breathing. In linear regression analysis, PAS showed weak correlations with ipsilateral spontaneous diaphragm movement (r=0.397, p=0.006), ipsilateral forced diaphragm movement (r=0.384, p=0.008), and contralateral forced diaphragm movement (r=0.323, p=0.027). Weak correlation was also observed between post swallow residue severity and ipsilateral diaphragm movement during spontaneous breathing (r=0.331, p=0.023) and forced breathing (r=0.343, p=0.018). Conclusion We confirmed the relationship between swallowing function and bilateral diaphragm movement in this study. The severity of dysphagia after hemiplegic stroke was correlated with bilateral diaphragm movement. Further longitudinal studies are needed to assess the effect of breathing exercise on post-stroke dysphagia.
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Affiliation(s)
- Ra Yu Yun
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ho Eun Park
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Ji Won Hong
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Yong Beom Shin
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Jin A Yoon
- Department of Rehabilitation Medicine, Pusan National University School of Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
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Dammann P, Wittek P, Darkwah Oppong M, Hütter BO, Jabbarli R, Wrede K, Wanke I, Mönninghoff C, Kaier K, Frank B, Müller O, Kleinschnitz C, Forsting M, Sure U. Relative health-related quality of life after treatment of unruptured intracranial aneurysms: long-term outcomes and influencing factors. Ther Adv Neurol Disord 2019; 12:1756286419833492. [PMID: 30886649 PMCID: PMC6410394 DOI: 10.1177/1756286419833492] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/02/2018] [Indexed: 11/17/2022] Open
Abstract
Health-related quality of life (HRQOL) is an important clinical outcome parameter. Its analysis is particularly meaningful to patients with minor functional impairment. The main goal of this study was to assess long-term data of HRQOL and their variables for patients undergoing treatment for unruptured intracranial aneurysms (UIAs). Therefore, a cross-sectional study of HRQOL (SF-36 questionnaire) was conducted in patients treated for UIA using a telephone survey assessing numerous medical and sociodemographic variables. A total of 96 patients with a follow up longer than 36 months post-treatment were included. HRQOL results were compared with the German reference population. Uni- and multivariate analyses were performed to detect variables with an impact on outcome. After a mean follow up of 57.75 ± 13.56 months, patients with treated UIAs showed a significant decrease in the mental health domains ‘role emotional’ and ‘social functioning’ and the ‘mental health component score’ (MHCS) compared with the age- and sex-matched reference population. Overall, 47% of the patients showed a clinically and psychosocially relevant decrease compared with the mean MHCS of the reference population. Multivariate analysis suggests that mainly the treatment modality (coiling versus clipping) and additional remaining untreated UIAs negatively impacted mental HRQOL. In conclusion, the partly significant losses in HRQOL identify the necessity for less-wearing treatment strategies and a better prediction of risk of UIA rupture. Our results indicate that certain factors in the guidance and management of patients undergoing endovascular treatment may negatively affect their mental HRQOL. The relevance of additional UIAs remaining untreated on HRQOL is a new finding that should be considered in the counseling of patients with multiple UIAs.
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Affiliation(s)
- Philipp Dammann
- Department of Neurosurgery, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany
| | - Paula Wittek
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Bernd-Otto Hütter
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Karsten Wrede
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | - Isabel Wanke
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Christoph Mönninghoff
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Benedikt Frank
- Department of Neurology, University Hospital Essen, Essen, Germany
| | - Oliver Müller
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
| | | | - Michael Forsting
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery, University Hospital Essen, Essen, Germany
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Abdul-Rahim AH, Dickie DA, Selvarajah JR, Lees KR, Quinn TJ. Stroke aetiological classification reliability and effect on trial sample size: systematic review, meta-analysis and statistical modelling. Trials 2019; 20:107. [PMID: 30736833 PMCID: PMC6368715 DOI: 10.1186/s13063-019-3222-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/25/2019] [Indexed: 12/15/2022] Open
Abstract
Background Inter-observer variability in stroke aetiological classification may have an effect on trial power and estimation of treatment effect. We modelled the effect of misclassification on required sample size in a hypothetical cardioembolic (CE) stroke trial. Methods We performed a systematic review to quantify the reliability (inter-observer variability) of various stroke aetiological classification systems. We then modelled the effect of this misclassification in a hypothetical trial of anticoagulant in CE stroke contaminated by patients with non-cardioembolic (non-CE) stroke aetiology. Rates of misclassification were based on the summary reliability estimates from our systematic review. We randomly sampled data from previous acute trials in CE and non-CE participants, using the Virtual International Stroke Trials Archive. We used bootstrapping to model the effect of varying misclassification rates on sample size required to detect a between-group treatment effect across 5000 permutations. We described outcomes in terms of survival and stroke recurrence censored at 90 days. Results From 4655 titles, we found 14 articles describing three stroke classification systems. The inter-observer reliability of the classification systems varied from ‘fair’ to ‘very good’ and suggested misclassification rates of 5% and 20% for our modelling. The hypothetical trial, with 80% power and alpha 0.05, was able to show a difference in survival between anticoagulant and antiplatelet in CE with a sample size of 198 in both trial arms. Contamination of both arms with 5% misclassified participants inflated the required sample size to 237 and with 20% misclassification inflated the required sample size to 352, for equivalent trial power. For an outcome of stroke recurrence using the same data, base-case estimated sample size for 80% power and alpha 0.05 was n = 502 in each arm, increasing to 605 at 5% contamination and 973 at 20% contamination. Conclusions Stroke aetiological classification systems suffer from inter-observer variability, and the resulting misclassification may limit trial power. Trial registration Protocol available at reviewregistry540. Electronic supplementary material The online version of this article (10.1186/s13063-019-3222-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Azmil H Abdul-Rahim
- Institute of Neuroscience and Psychology, University of Glasgow, Room 0.07, Office Block, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK.
| | | | - Johann R Selvarajah
- Institute of Neuroscience and Psychology, University of Glasgow, Room 0.07, Office Block, Queen Elizabeth University Hospital, G51 4TF, Glasgow, UK.,Department of Neurology, Institute of Neurological Sciences, Queen Elizabeth University Hospital, Glasgow, UK
| | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Yeoh YS, Koh GCH, Tan CS, Lee KE, Tu TM, Singh R, Chang HM, De Silva DA, Ng YS, Ang YH, Yap P, Chew E, Merchant RA, Yeo TT, Chou N, Venketasubramanian N, Young SH, Hoenig H, Matchar DB, Luo N. Can acute clinical outcomes predict health-related quality of life after stroke: a one-year prospective study of stroke survivors. Health Qual Life Outcomes 2018; 16:221. [PMID: 30463574 PMCID: PMC6249770 DOI: 10.1186/s12955-018-1043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health-related quality of life (HRQoL) is a key metric to understand the impact of stroke from patients' perspective. Yet HRQoL is not readily measured in clinical practice. This study aims to investigate the extent to which clinical outcomes during admission predict HRQoL at 3 months and 1 year post-stroke. METHODS Stroke patients admitted to five tertiary hospitals in Singapore were assessed with Shah-modified Barthel Index (Shah-mBI), National Institute of Health Stroke Scale (NIHSS), Modified Rankin Scale (mRS), Mini-Mental State Examination (MMSE), and Frontal Assessment Battery (FAB) before discharge, and the EQ-5D questionnaire at 3 months and 12 months post-stroke. Association of clinical measures with the EQ index at both time points was examined using multiple linear regression models. Forward stepwise selection was applied and consistently significant clinical measures were analyzed for their association with individual dimensions of EQ-5D in multiple logistic regressions. RESULTS All five clinical measures at baseline were significant predictors of the EQ index at 3 months and 12 months, except that MMSE was not significantly associated with the EQ index at 12 months. NIHSS (3-month standardized β = - 0.111; 12-month standardized β = - 0.109) and mRS (3-month standardized β = - 0.122; 12-month standardized β = - 0.080) were shown to have a larger effect size than other measures. The contribution of NIHSS and mRS as significant predictors of HRQoL was mostly explained by their association with the mobility, self-care, and usual activities dimensions of EQ-5D. CONCLUSIONS HRQoL at 3 months and 12 months post-stroke can be predicted by clinical outcomes in the acute phase. NIHSS and mRS are better predictors than BI, MMSE, and FAB.
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Affiliation(s)
- Yen Shing Yeoh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore
| | - Kim En Lee
- Farrer Park Hospital, 1 Farrer Park Station Road, #10-08 Connexion, Singapore, Singapore
| | - Tian Ming Tu
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Rajinder Singh
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Hui Meng Chang
- National Neuroscience Institute, 11 Jalan Tan Tock Seng, Singapore, Singapore
| | - Deidre A De Silva
- Department of Neurology, Singapore General Hospital campus, National Neuroscience Institute, 20 College Road, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, 20 College Road, Singapore, Singapore
| | - Yan Hoon Ang
- Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - Philip Yap
- Geriatric Medicine, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, Singapore
| | - Effie Chew
- Department of Rehabilitation Medicine, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - Reshma Aziz Merchant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Tseng Tsai Yeo
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - Ning Chou
- Department of Neurosurgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, 585 North Bridge Road, Singapore, Singapore
| | - Sherry H Young
- Department of Rehabilitation Medicine, Changi General Hospital, 2 Simei Street 3, Singapore, Singapore
| | - Helen Hoenig
- Veterans Affairs Medical Center, 508 Fulton St, Durham, NC, USA.,Duke University Medical Center, Duke Box, Durham, NC, 3003, USA
| | - David Bruce Matchar
- Duke-NUS Medical School, 8 College Road, Singapore, Singapore.,Center for Clinical Health Policy Research, Duke University Medical Center, First Union Tower, 2200 W Main St, Suite, Durham, NC, 230, USA
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, Block MD1, 12 Science Drive 2, Singapore, 117549, Singapore.
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20
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Habegger S, Wiest R, Weder BJ, Mordasini P, Gralla J, Häni L, Jung S, Reyes M, McKinley R. Relating Acute Lesion Loads to Chronic Outcome in Ischemic Stroke-An Exploratory Comparison of Mismatch Patterns and Predictive Modeling. Front Neurol 2018; 9:737. [PMID: 30254601 PMCID: PMC6141854 DOI: 10.3389/fneur.2018.00737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 08/13/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To investigate the relationship between imaging features derived from lesion loads and 3 month clinical assessments in ischemic stroke patients. To support clinically implementable predictive modeling with information from lesion-load features. Methods: A retrospective cohort of ischemic stroke patients was studied. The dataset was dichotomized based on revascularization treatment outcome (TICI score). Three lesion delineations were derived from magnetic resonance imaging in each group: two clinically implementable (threshold based and fully automatic prediction) and 90-day follow-up as final groundtruth. Lesion load imaging features were created through overlay of the lesion delineations on a histological brain atlas, and were correlated with the clinical assessment (NIHSS). Significance of the correlations was assessed by constructing confidence intervals using bootstrap sampling. Results: Overall, high correlations between lesion loads and clinical score were observed (up to 0.859). Delineations derived from acute imaging yielded on average somewhat lower correlations than delineations derived from 90-day follow-up imaging. Correlations suggest that both total lesion volume and corticospinal tract lesion load are associated with functional outcome, and in addition highlight other potential areas associated with poor clinical outcome, including the primary somatosensory cortex BA3a. Fully automatic prediction was comparable to ADC threshold-based delineation on the successfully treated cohort and superior to the Tmax threshold-based delineation in the unsuccessfully treated cohort. Conclusions: The confirmation of established predictors for stroke outcome (e.g., corticospinal tract integrity and total lesion volume) gives support to the proposed methodology-relating acute lesion loads to 3 month outcome assessments by way of correlation. Furthermore, the preliminary results indicate an association of further brain regions and structures with three month NIHSS outcome assessments. Hence, prediction models might observe an increased accuracy when incorporating regional (instead of global) lesion loads. Also, the results lend support to the clinical utilization of the automatically predicted volumes from FASTER, rather than the simpler DWI and PWI lesion delineations.
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Affiliation(s)
- Simon Habegger
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Roland Wiest
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Bruno J Weder
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Pasquale Mordasini
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jan Gralla
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
| | - Levin Häni
- Department of Neurosurgery, Inselspital, University of Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, Inselspital, University of Bern, Bern, Switzerland.,Neurovascular Imaging Research Core, Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Mauricio Reyes
- Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
| | - Richard McKinley
- Support Center for Advanced Neuroimaging, Institute for Diagnostic and Interventional Neuroradiology, Inselspital, University of Bern, Bern, Switzerland
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21
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Legris N, Devilliers H, Daumas A, Carnet D, Charpy JP, Bastable P, Giroud M, Béjot Y. French validation of the Stroke Specific Quality of Life Scale (SS-QoL). NeuroRehabilitation 2018; 42:17-27. [PMID: 29400672 DOI: 10.3233/nre-172178] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To adapt the SS-QoL into French and test its psychometric properties. METHODS Seventy-seven patients from a population-based registry were enrolled 3 months after their stroke. SS-QoL, NIHSS score, Barthel index, HAD, FSS, SF-36 scales, and MMSE were administered at enrolment. SS-QoL was re-administered at 15 days and 2 months. Internal consistency was assessed by Cronbach's α coefficients, factorial validity by an exploratory factor analysis and external validity by Mann-Whitney test and Spearman's correlations (ρ), comparing SS-QoL scores with those obtained from established scales. Reliability was assessed by intra-class correlation coefficients (ICC) and responsiveness by standardized effect sizes (ES). RESULTS Test-retest and inter-observer reliabilities were excellent (ICC> 0.88). Internal consistency was acceptable (α= 0.65-0.91), except for the Personality domain (α= 0.58). Factor analysis individualized eight homogenous axes. SS-QoL scores were different between groups opposed by their modified Rankin score at enrolment or their overall quality of life compared with pre-stroke status (p < 0.001). Ten of the twelve domains correlated moderately (ρ> 0.35) to strongly (ρ> 0.5) with established measures. Nine domains were mildly to moderately responsive to change (ES> 0.3). CONCLUSION The French version of the SS-QoL is a valid, reliable and moderately responsive instrument.
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Affiliation(s)
- Nicolas Legris
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Hervé Devilliers
- Department of Internal Medicine and Systemic Disease, University Hospital and Medical School of Dijon, University of Burgundy, France.,Clinical Investigation Center INSERM CIC 1423, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Anaïs Daumas
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Didier Carnet
- Department of Medical English, Medical School of Dijon, University of Burgundy, France
| | - Jean-Pierre Charpy
- Department of Medical English, Medical School of Dijon, University of Burgundy, France
| | - Philip Bastable
- Department of Internal Medicine and Systemic Disease, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Maurice Giroud
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
| | - Yannick Béjot
- Department of Neurology, Dijon Stroke Registry, University Hospital and Medical School of Dijon, University of Burgundy, France
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22
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Dijkland SA, Voormolen DC, Venema E, Roozenbeek B, Polinder S, Haagsma JA, Nieboer D, Chalos V, Yoo AJ, Schreuders J, van der Lugt A, Majoie CBLM, Roos YBWEM, van Zwam WH, van Oostenbrugge RJ, Steyerberg EW, Dippel DWJ, Lingsma HF. Utility-Weighted Modified Rankin Scale as Primary Outcome in Stroke Trials: A Simulation Study. Stroke 2018. [PMID: 29535271 PMCID: PMC5895119 DOI: 10.1161/strokeaha.117.020194] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background and Purpose— The utility-weighted modified Rankin Scale (UW-mRS) has been proposed as a new patient-centered primary outcome in stroke trials. We aimed to describe utility weights for the mRS health states and to evaluate the statistical efficiency of the UW-mRS to detect treatment effects in stroke intervention trials. Methods— We used data of the 500 patients enrolled in the MR CLEAN (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands). Utility values were elicited from the EuroQol Group 5-Dimension Self-Report Questionnaire assessed at 90 days after inclusion, simultaneously with the mRS. Utility weights were determined by averaging the utilities of all patients within each mRS category. We performed simulations to evaluate statistical efficiency. The simulated treatment effect was an odds ratio of 1.65 in favor of the treatment arm, similar for all mRS cutoffs. This treatment effect was analyzed using 3 approaches: linear regression with the UW-mRS as outcome, binary logistic regression with a dichotomized mRS (0–1/2–6, 0–2/3–6, and 0–4/5–6), and proportional odds logistic regression with the ordinal mRS. The statistical power of the 3 approaches was expressed as the proportion of 10 000 simulations that resulted in a statistically significant treatment effect (P≤0.05). Results— The mean utility values (SD) for mRS categories 0 to 6 were: 0.95 (0.08), 0.93 (0.13), 0.83 (0.21), 0.62 (0.27), 0.42 (0.28), 0.11 (0.28), and 0 (0), respectively, but varied substantially between individual patients within each category. The UW-mRS approach was more efficient than the dichotomous approach (power 85% versus 71%) but less efficient than the ordinal approach (power 85% versus 87%). Conclusions— The UW-mRS as primary outcome does not capture individual variation in utility values and may reduce the statistical power of a randomized trial.
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Affiliation(s)
- Simone A Dijkland
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.).
| | - Daphne C Voormolen
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Esmee Venema
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Bob Roozenbeek
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Suzanne Polinder
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Juanita A Haagsma
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Daan Nieboer
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Vicky Chalos
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Albert J Yoo
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Jennifer Schreuders
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Aad van der Lugt
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Charles B L M Majoie
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Yvo B W E M Roos
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Wim H van Zwam
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Robert J van Oostenbrugge
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Ewout W Steyerberg
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Diederik W J Dippel
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
| | - Hester F Lingsma
- From the Department of Public Health (S.A.D., D.C.V., E.V., S.P., J.A.H., D.N., V.C., E.W.S., H.F.L.), Department of Neurology (E.V., B.R., V.C., J.S., D.W.J.D.), and Department of Radiology (B.R., V.C., A.v.d.L.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Division of Neurointervention, Texas Stroke Institute, Dallas (A.J.Y.); Department of Neurology, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands (J.S.); Department of Radiology (C.B.L.M.M.) and Department of Neurology (Y.B.W.E.M.R.), Academic Medical Center, Amsterdam, the Netherlands; Department of Radiology, Maastricht University Medical Center, the Netherlands (W.H.v.Z.); Department of Neurology, Cardiovascular Research Institute, Maastricht University Medical Center, the Netherlands (R.J.v.O.); and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, the Netherlands (E.W.S.)
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Liang Y, Chen YK, Deng M, Mok VCT, Wang DF, Ungvari GS, Chu CWW, Kamiya A, Tang WK. Association of Cerebral Small Vessel Disease Burden and Health-Related Quality of Life after Acute Ischemic Stroke. Front Aging Neurosci 2017; 9:372. [PMID: 29180960 PMCID: PMC5693845 DOI: 10.3389/fnagi.2017.00372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/31/2017] [Indexed: 01/12/2023] Open
Abstract
Objective: Cerebral small vessel disease (SVD) is associated with increased mortality, disability and cognitive decline, depression in stroke survivors. This study examined the association between SVD burden, defined by a combination of SVD markers, and health-related quality of life (HRQoL) in acute ischemic stroke. Methods: Patients admitted with acute ischemic stroke of any etiology were prospectively screened between January 2010 to December 2014 and enrolled in the study if they met study entry criteria. HRQoL was evaluated with the 12-item Stroke Specific Quality of Life (SSQoL) at 3 months after the onset of acute ischemic stroke. SVD was ascertained by the presence of any of the SVD markers including lacune, white matter hyperintensities (WMH), cerebral microbleeds (CMB) and enlarged perivascular spaces (EPVS) in the basal ganglia or their combinations on brain magnetic resonance imaging (MRI). The presence of each individual marker scored 1 point and was summed up to generate an ordinal "SVD score" (0-4) capturing total SVD burden. Linear regression was used to determine the associations between SVD burden and HRQoL. Results: Of the743 acute ischemic stroke patients that formed he study sample (mean age: 66.3 ± 10.6 years; 41.7% women), 49.3%, 22.5%, 16.0%, 9.2% and 3.1% had SVD scores of 0, 1, 2, 3 and 4, respectively. After adjusting for demographic, clinical and imaging variables, the SVD score was independently associated with lower overall score of SSQoL (B = -1.39, SE = 0.56, p = 0.01), and its domains of mobility (B = -0.41, SE = 0.10, p < 0.001) and vision (B = -0.12, SE = 0.06, p = 0.03). Acute infract volume (B = -1.44, SE = 0.54, p = 0.01), functional independence (B = 5.69, SE = 0.34, p < 0.001) and anxious (B = -1.13, SE = 0.23, p < 0.001) and depressive symptoms (B = -3.41, SE = 0.22, p < 0.001) were also the significant predictors of the overall score of SSQoL. Conclusion: The brain's SVD burden predicts lower HRQoL, predominantly in domains of mobility and vision at 3 months after acute ischemic stroke. The evaluation of SVD burden could facilitate developing individual treatment strategies.
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Affiliation(s)
- Yan Liang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Yang-Kun Chen
- Department of Neurology, Dongguan People's Hospital, Dongguan, China
| | - Min Deng
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Vincent C T Mok
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - De-Feng Wang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Gabor S Ungvari
- Australia/Marian Centre, University of Notre Dame, Perth, WA, Australia
| | - Chiu-Wing W Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China
| | - Akane Kamiya
- Department of Rehabilitation, Sagamihara Minami Hospital, Sagamihara, Japan
| | - Wai-Kwong Tang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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24
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Shams T, Auchus AP, Oparil S, Wright CB, Wright J, Furlan AJ, Sila CA, Davis BR, Pressel S, Yamal JM, Einhorn PT, Lerner AJ. Baseline Quality of Life and Risk of Stroke in the ALLHAT Study (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial). Stroke 2017; 48:3078-3085. [PMID: 28954920 DOI: 10.1161/strokeaha.117.016062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The visual analogue scale is a self-reported, validated tool to measure quality of life (QoL). Our purpose was to determine whether baseline QoL predicted strokes in the ALLHAT study (Antihypertensive and Lipid Lowering Treatment to Prevent Heart Attack Trial) and evaluate determinants of poststroke change in QoL. In the ALLHAT study, among the 33 357 patients randomized to treatment arms, 1525 experienced strokes; 1202 (79%) strokes were nonfatal. This study cohort includes 32 318 (97%) subjects who completed the baseline visual analogue scale QoL estimate. METHODS QoL was measured on a visual analogue scale and adjusted using a Torrance transformation (transformed QoL [TQoL]). Kaplan-Meier curves and adjusted proportional hazards analyses were used to estimate the effect of TQoL on the risk of stroke, on a continuous scale (0-1) and by quartiles (≤0.81, >0.81≤0.89, >0.89≤0.95, >0.95). We analyzed the change from baseline to first poststroke TQoL using adjusted linear regression. RESULTS After adjusting for multiple stroke risk factors, the hazard ratio for stroke events for baseline TQoL was 0.93 (95% confidence interval, 0.89-0.98) per 0.1 U increase. The lowest baseline TQoL quartile had a 20% increased stroke risk (hazard ratio=1.20 [95% confidence interval, 1.00-1.44]) compared with the reference highest quartile TQoL. Poststroke TQoL change was significant within all treatment groups (P≤0.001). Multivariate regression analysis revealed that baseline TQoL was the strongest predictor of poststroke TQoL with similar results for the untransformed QoL. CONCLUSIONS The lowest baseline TQoL quartile had a 20% higher stroke risk than the highest quartile. Baseline TQoL was the only factor that predicted poststroke change in TQoL. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000542.
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Affiliation(s)
- Tanzila Shams
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.).
| | - Alexander P Auchus
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Suzanne Oparil
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Clinton B Wright
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Jackson Wright
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Anthony J Furlan
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Cathy A Sila
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Barry R Davis
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Sara Pressel
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Jose-Miguel Yamal
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Paula T Einhorn
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
| | - Alan J Lerner
- From the Departments of Neurology (T.S., A.J.F., C.A.S., A.J.L.) and Medicine (J.W.), University Hospitals Case Medical Center, Cleveland, OH; Department of Neurology, University of Mississippi Medical Center, Jackson (A.P.A.); Department of Medicine, University of Alabama, Birmingham (S.O.); National Institute of Neurological Disorders and Stroke, Bethesda, MD (C.B.W.); Case Western Reserve University, Cleveland, OH (J.W., A.J.F., C.A.S., A.J.L.); University of Texas School of Public Health, Houston (B.R.D., S.P., J.-M.Y.); and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD (P.T.E.)
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Stroke Survivor and Family Caregiver Reports of Caregiver Engagement in Stroke Care. Rehabil Nurs 2017; 44:302-310. [PMID: 31689247 DOI: 10.1097/rnj.0000000000000100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Zahuranec DB, Skolarus LE, Feng C, Freedman VA, Burke JF. Activity limitations and subjective well-being after stroke. Neurology 2017; 89:944-950. [PMID: 28733341 PMCID: PMC5577967 DOI: 10.1212/wnl.0000000000004286] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 06/06/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE As limitations in activities of daily living are major components of many stroke outcome scales, we examined how well activity limitations predicted subjective well-being among stroke survivors in a nationally representative survey. METHODS Individuals with a self-reported history of stroke were identified from the National Health and Aging Trends Study. Subjective well-being (primary outcome) was assessed with a validated 7-item measure (higher = greater well-being) assessing emotions (cheerful, bored, full of life, and upset) and self-realization (purpose in life, self-acceptance, and environmental mastery). Activity limitations were defined by the receipt of help in any of 11 activities of daily living/instrumental activities of daily living. Multivariable linear regression assessed predictors of well-being including medical, physical, cognitive, psychological, and environmental factors. RESULTS A total of 738 stroke survivors age 65 or older were included (57% female, 9% African American, 6% Hispanic). Activity limitations were modestly associated with well-being after adjusting for demographic characteristics and availability of assistance (estimate -0.49, 95% confidence interval -0.61 to -0.37). However, in the fully adjusted model (R2 = 0.28), neither activity limitations nor physical capacity was associated with subjective well-being. Predictors of lower well-being in the final model included depressive symptoms, chewing/swallowing problems, pain that limited activity, and restricted participation in valued life activities. Income and executive function were modestly associated with improved well-being, while comorbidities and communication technology access were not associated. CONCLUSIONS Activity limitations were not associated with stroke survivors' subjective well-being after adjustment for other factors. While some predictors of well-being after stroke were identified, the determinants of well-being remained largely unexplained.
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Affiliation(s)
- Darin B Zahuranec
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor.
| | - Lesli E Skolarus
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - Chunyang Feng
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - Vicki A Freedman
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
| | - James F Burke
- From the Stroke Program, Department of Neurology (D.B.Z., L.E.S., C.F., J.F.B.), and Institute for Social Research (V.A.F.), University of Michigan, Ann Arbor
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27
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Katzan IL, Thompson NR, Lapin B, Uchino K. Added Value of Patient-Reported Outcome Measures in Stroke Clinical Practice. J Am Heart Assoc 2017; 6:JAHA.116.005356. [PMID: 28733434 PMCID: PMC5586276 DOI: 10.1161/jaha.116.005356] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background There is uncertainty regarding the clinical utility of the data obtained from patient‐reported outcome measures (PROMs) for patient care. We evaluated the incremental information obtained by PROMs compared to the clinician‐reported modified Rankin Scale (mRS). Methods and Results This was an observational study of 3283 ischemic stroke patients seen in a cerebrovascular clinic from September 14, 2012 to June 16, 2015 who completed the routinely collected PROMs: Stroke Impact Scale‐16 (SIS‐16), EQ‐5D, Patient Health Questionnaire‐9, PROMIS Physical Function, and PROMIS fatigue. The amount of variation in the PROMs explained by mRS was determined using r2 after adjustment for age and level of stroke impairment. The proportion with meaningful change was calculated for patients with ≥2 visits. Concordance with change in the other scales and the ability to discriminate changes in health state as measured by c‐statistic was evaluated for mRS versus SIS‐16. Correlation between PROMs and mRS was highest for SIS‐16 (r=−0.64, P<0.01). The r2 ranged from 0.11 (PROMIS fatigue) to 0.56 (SIS‐16). Change in scores occurred in 51% with mRS and 35% with SIS‐16. There was lower agreement and less ability to discriminate change in mRS than in SIS‐16 with change in the other measures. Conclusions PROMs provide additional valuable information compared to the mRS alone in stroke patients seen in the ambulatory setting. SIS‐16 may have a better ability to identify change than mRS in health status of relevance to the patient. PROMs may be a useful addition to mRS in the assessment of health status in clinical practice.
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Affiliation(s)
- Irene L Katzan
- Neurological Institute Center for Outcomes Research & Evaluation Cleveland Clinic, Cleveland, OH .,Cerebrovascular Center, Cleveland Clinic, Cleveland, OH
| | - Nicolas R Thompson
- Neurological Institute Center for Outcomes Research & Evaluation Cleveland Clinic, Cleveland, OH
| | - Brittany Lapin
- Neurological Institute Center for Outcomes Research & Evaluation Cleveland Clinic, Cleveland, OH
| | - Ken Uchino
- Cerebrovascular Center, Cleveland Clinic, Cleveland, OH
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Dávalos A, Cobo E, Molina CA, Chamorro A, de Miquel MA, Román LS, Serena J, López-Cancio E, Ribó M, Millán M, Urra X, Cardona P, Tomasello A, Castaño C, Blasco J, Aja L, Rubiera M, Gomis M, Renú A, Lara B, Martí-Fàbregas J, Jankowitz B, Cerdà N, Jovin TG. Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial. Lancet Neurol 2017; 16:369-376. [PMID: 28318984 DOI: 10.1016/s1474-4422(17)30047-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/25/2017] [Accepted: 02/13/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The REVASCAT trial and other studies have shown that the neurovascular thrombectomy improves outcomes at 90 days post stroke. However, whether the observed benefit is sustained in the long term remains unknown. We report the results of the prespecified 12-month analysis of the REVASCAT trial. METHODS Patients with acute ischaemic stroke who could be treated within 8 h of symptom onset were randomly assigned to medical therapy (including intravenous alteplase when eligible) and neurovascular thrombectomy with Solitaire FR or medical therapy alone. The main secondary outcome measure at 1 year follow-up was disability, measured using the modified Rankin Scale (mRS), ranging from 0 (no symptoms) to 6 (death) with categories 5 (severe disability) and 6 (death) collapsed into one category (severe disability or death), analysed as the distribution of the mRS. Additional prespecified secondary outcome measures included health-related quality of life measured with the EuroQol five dimensions questionnaire (EQ-5D) utility index (ranging from -0·3 to 1, higher values indicate better quality of life), the rate of functional independence (mRS 0-2), and cognitive function measured with the Trail Making Test (reported elsewhere). Treatment allocation was open label but endpoints at 12 months were assessed by masked investigators. The trial was registered at ClinicalTrials.gov, number NCT01692379. FINDINGS From Nov 24, 2012, to Dec 12, 2014, 206 patients were randomly assigned to medical therapy plus endovascular treatment (n=103) or medical treatment alone (n=103), at four centres in Catalonia, Spain. At 12 months post randomisation, based on 205 of 206 outcomes available at 12 months, thrombectomy reduced disability over the range of the mRS (common adjusted odds ratio [aOR] 1·80, 95% CI 1·09-2·99), and improved functional independence (mRS=0-2; 45 [44%] of 103 patients vs 31 [30%] of 103 patients; aOR 1·86, 95% CI 1·01-3·44). Health-related quality of life was superior in the thrombectomy group (mean EQ-5D utility index score, 0·46 [SD 0·38] in the thrombectomy group vs 0·33 [0·33] in the control group, difference 0·12 [95% CI 0·03-0·22]; p=0·01). 1-year mortality was 23% (24 of 103 patients) in the thrombectomy group versus 24% (25 of 103 patients) in the control group. INTERPRETATION At 12 months follow-up, neurovascular thrombectomy reduced post-stroke disability and improved health-related quality of life, indicating sustained benefit. These findings have important clinical and public health implications for evaluating the cost-effectiveness of the intervention in the long term. FUNDING Fundació Ictus Malaltia Vascular through an unrestricted grant from Medtronic.
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Affiliation(s)
- Antoni Dávalos
- Department of Neuroscience, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Erik Cobo
- Department of Statistics and Operations Research, Barcelona-Tech, Barcelona, Spain
| | | | | | - M Angeles de Miquel
- Department of Radiology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Luis San Román
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | | | - Elena López-Cancio
- Trial Office Coordination, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Marc Ribó
- Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Mónica Millán
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Xabier Urra
- Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Carlos Castaño
- Section of Interventional Neuroradiology, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Jordi Blasco
- Department of Radiology, Hospital Clínic, Barcelona, Spain
| | - Lucía Aja
- Department of Radiology, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Marta Rubiera
- Stroke Unit, Hospital Vall d'Hebrón, Barcelona, Spain
| | - Meritxell Gomis
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Arturo Renú
- Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Blanca Lara
- Stroke Unit, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Brian Jankowitz
- Department of Neurosurgery, Stroke Institute, UPMC, Pittsburgh, PA, USA
| | - Neus Cerdà
- Biostatistics Unit, Bioclever CRO, Barcelona, Spain
| | - Tudor G Jovin
- Department of Neurology, Stroke Institute, UPMC, Pittsburgh, PA, USA.
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MacIsaac RL, Ali M, Taylor-Rowan M, Rodgers H, Lees KR, Quinn TJ. Use of a 3-Item Short-Form Version of the Barthel Index for Use in Stroke: Systematic Review and External Validation. Stroke 2017; 48:618-623. [PMID: 28154094 DOI: 10.1161/strokeaha.116.014789] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. METHODS We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). RESULTS From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P<0.001). Using rehabilitation trial data (n=332), SF-BI demonstrated modest correlation with quality of life measures Stroke Impact Scale and 5 domain EuroQOL (ρ≥0.50, P<0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P<0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. CONCLUSIONS There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use.
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Affiliation(s)
- Rachael L MacIsaac
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.)
| | - Myzoon Ali
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.)
| | - Martin Taylor-Rowan
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.)
| | - Helen Rodgers
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.)
| | - Kennedy R Lees
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.)
| | - Terence J Quinn
- From the Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (R.L.M., M.A., M.T.-R., K.R.L., T.J.Q.); and Stroke Research Group Institute for Neuroscience and Institute for Ageing, Newcastle University, United Kingdom (H.R.).
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30
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Hametner C, MacIsaac RL, Kellert L, Abdul-Rahim AH, Ringleb PA, Lees KR, Alexandrov A, Bath P, Bluhmki E, Bornstein N, Chen C, Claesson L, Davis S, Donnan G, Diener H, Fisher M, Ginsberg M, Gregson B, Grotta J, Hacke W, Hennerici M, Hommel M, Kaste M, Lyden P, Marler J, Muir K, Venketasubramanian N, Sacco R, Shuaib A, Teal P, Wahlgren N, Warach S, Weimar C. Sex and Stroke in Thrombolyzed Patients and Controls. Stroke 2017; 48:367-374. [DOI: 10.1161/strokeaha.116.014323] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/02/2016] [Accepted: 09/19/2016] [Indexed: 01/22/2023]
Abstract
Background and Purpose—
We hypothesized that any sex-related difference in outcome poststroke is explained by other prognostic factors and that the response to intravenous recombinant tissue-type plasminogen activator (r-tPA) is equal in males and females after adjustment for such factors.
Methods—
We accessed an independent collection of randomized clinical trials—the VISTA (Virtual International Stroke Trials Archive). Data were preprocessed by selecting complete cases (n=8028) and matching females to males (coarsened exact matching, n=4575, 24.3% r-tPA). Outcome was assessed by the 7-point modified Rankin Scale (mRS) measured at 90 days after ischemic stroke. Relationship among variables was estimated by adjusted regression analysis.
Results—
In nonthrombolyzed patients, ordinal analysis of mRS adjusting for stroke- and sex-related prognostic factors suggested comparable outcomes for females and males (odds ratio, 0.96; 95% confidence interval, 0.85–1.06). Females responded comparably to r-tPA as did males, irrespective of the outcome definition of mRS (ordinal:
P
Interaction
=0.46, relative excess risk because of interaction=0). The number needed to treat was 6.8 and 11.2 for 1 female to achieve mRS score of 0 to 2 and 0 to 1, which was highly congruent with males. Analysis for a nonlinear variation of age-by-sex revealed a good outcome for females <45 years with significant disadvantage thereafter (mRS score of 0–2:
P
Interaction
=0.004). No relationship between sex, r-tPA, and bleeding complications was evident.
Conclusions—
Functional outcome (mRS) without r-tPA was overall similar between the sexes, as was the response to r-tPA. Nonlinear sex-by-age interaction improved estimates of functional independence; this should be considered in sex-related studies in stroke.
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Affiliation(s)
- Christian Hametner
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
| | - Rachael L. MacIsaac
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
| | - Lars Kellert
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
| | - Azmil H. Abdul-Rahim
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
| | - Peter A. Ringleb
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
| | - Kennedy R. Lees
- From the Department of Neurology, Division of Vascular Neurology, University of Heidelberg, Germany (C.H., L.K., P.A.R.); Queen Elizabeth University Hospital (R.L.M., A.H.A.-R.) and BHF Cardiovascular Research Centre (K.R.L.), Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom; and Department of Neurology, Ludwig-Maximilians-University Munich, Germany (L.K.)
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31
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Abstract
Malignant cerebral edema is a potential consequence of large territory cerebral infarction, as the resultant elevation in intracranial pressure may progress to transtentorial herniation, brainstem compression, and death. In appropriate patients, decompressive hemicraniectomy (DHC) reduces mortality without increasing the risk of severe disability. However, as the foundational DHC randomized, controlled trials excluded patients greater than 60 years of age, the appropriateness of DHC in older adults remains controversial. Recent clinical trials among elderly participants, including DESTINY II, reported that DHC reduces mortality, but may leave patients with substantial morbidity. Nationwide analyses have demonstrated generalizability of such data. However, what constitutes an acceptable outcome - the perspective on quality of life after survival with substantial disability - varies between clinicians, patients, and caregivers. Consequently, quality of life measures are being increasingly incorporated into stroke research. This review summarizes the impact of DHC in space-occupying cerebral infarction, and the influence of patient age on postoperative survival, functional capacity, and quality of life-all key factors in the clinical decision process. Ultimately, these data underscore the inherent complexity in balancing scientific evidence, clinical expertise, and patient and family preference when pursuing hemicraniectomy among the elderly.
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Affiliation(s)
- Faith C Robertson
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Hormuzdiyar H Dasenbrock
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.,Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - William B Gormley
- Harvard Medical School, Boston, Massachusetts, United States of America.,Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.,Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
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32
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Lohse KR, Schaefer SY, Raikes AC, Boyd LA, Lang CE. Asking New Questions with Old Data: The Centralized Open-Access Rehabilitation Database for Stroke. Front Neurol 2016; 7:153. [PMID: 27703445 PMCID: PMC5028724 DOI: 10.3389/fneur.2016.00153] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 09/05/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This paper introduces a tool for streamlining data integration in rehabilitation science, the Centralized Open-Access Rehabilitation database for Stroke (SCOAR), which allows researchers to quickly visualize relationships among variables, efficiently share data, generate hypotheses, and enhance clinical trial design. METHODS Bibliographic databases were searched according to inclusion criteria leaving 2,892 titles that were further screened to 514 manuscripts to be screened by full text, leaving 215 randomized controlled trials (RCTs) in the database (489 independent groups representing 12,847 patients). Demographic, methodological, and statistical data were extracted by independent coders and entered into SCOAR. RESULTS Trial data came from 114 locations in 27 different countries and represented patients with a wide range of ages, 62 year [41; 85] [shown as median (range)] and at various stages of recovery following their stroke, 141 days [1; 3372]. There was considerable variation in the dose of therapy that patients received, 20 h [0; 221], over interventions of different durations, 28 days [10; 365]. There was also a lack of common data elements (CDEs) across trials, but this lack of CDEs was most pronounced for baseline assessments of patient impairment and severity of stroke. CONCLUSION Data integration across hundreds of RCTs allows clinicians and researchers to quickly visualize data from the history of the field and lays the foundation for making SCOAR a living database to which researchers can upload new data as trial results are published. SCOAR is a useful tool for clinicians and researchers that will facilitate data visualization, data sharing, the finding of relevant past studies, and the design of clinical trials by enabling more accurate and comprehensive power analyses. Furthermore, these data speak to the need for CDEs specific to stroke rehabilitation in randomized controlled trials. PROSPERO 2014 CRD42014009010.
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Affiliation(s)
- Keith R Lohse
- School of Kinesiology, Auburn University , Auburn, AL , USA
| | - Sydney Y Schaefer
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA; Department of Health, Physical Education and Recreation, Utah State University, Logan, UT, USA
| | - Adam C Raikes
- Department of Health, Physical Education and Recreation, Utah State University , Logan, UT , USA
| | - Lara A Boyd
- Department of Physical Therapy, University of British Columbia , Vancouver, BC , Canada
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
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33
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Lo SHS, Chang AM, Chau JPC. Establishing equivalence of a Chinese version of the stroke specific quality of life measure for stroke survivors. Disabil Rehabil 2016; 39:1079-1086. [PMID: 27216634 DOI: 10.1080/09638288.2016.1178348] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The Stroke Specific Quality of Life Scale is a stroke-specific measure of health-related quality of life. However, there has been no Chinese (Hong Kong) version of the scale. METHODS A descriptive study was conducted to examine the reliability, validity and factor structure of the translated version (SSQOL-C) among stroke survivors. Participants completed SSQOL-C, and the Chinese versions of the Medical Outcomes Study Short-Form Health Survey (SF-36), Stroke Self-Efficacy Questionnaire (SSEQ-C) and Frenchay Activities Index (FAI). Thirty of these participants completed the same questionnaires after 4 weeks. RESULTS A total of 135 stroke survivors (mean age 58.90 ± 9.75) were recruited. SSQOL-C had good internal consistency with Cronbach's alphas for each domain ranging from 0.63 to 0.90. Most domains had moderate to high correlations with similar dimensions of SF-36, SSEQ-C, FAI and Barthel ADL Index total scores (Spearman's rho: 0.40-0.77, p < 0.01), suggesting acceptable convergent validity. Principal component analyses suggested an 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained. DISCUSSION The results suggest SSQOL-C is a reliable and valid tool for measuring Chinese stroke survivors' health-related quality of life. More studies are needed to confirm the 11-factor model of the scale. Implications for rehabilitation The translated Chinese version of the Stroke Specific Quality of Life Scale is a reliable and valid tool for measuring Chinese stroke survivors' health-related quality of life. An 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained.
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Affiliation(s)
- Suzanne Hoi Shan Lo
- a School of Nursing , Faculty of Health, Queensland University of Technology , Brisbane , Queensland , Australia.,b The Nethersole School of Nursing , Faculty of Medicine, The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Anne Marie Chang
- a School of Nursing , Faculty of Health, Queensland University of Technology , Brisbane , Queensland , Australia
| | - Janita Pak Chun Chau
- b The Nethersole School of Nursing , Faculty of Medicine, The Chinese University of Hong Kong , Shatin , Hong Kong
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34
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Abstract
BACKGROUND Accurate assessment of stroke knowledge (SK) is fundamental to the successful understanding of, monitoring of, and intervening to improve the SK of patients and the public. PURPOSE The purpose of this study is to perform a systematic review of the existing SK tests and appraise their conceptual basis, feasibility, and psychometric properties. We conducted 2-step searching of MEDLINE, CINAHL, PsycINFO, and Scopus electronic databases from January 1, 2000, to December 31, 2014, to identify relevant SK tests for the appraisal. RESULTS Our study found 59 SK tests, out of a total of 93 articles, with full content available that had been referred to in the published literature. Ten of them had been used in more than 1 study, and 2 (the Stroke Knowledge Test and the Stroke Action Test) of them have had at least 1 of their psychometric properties validated. Only 1 test (the Stroke Knowledge Test) was developed using rigorous methodology, covers a wide range of concepts, and met all feasibility criteria; however, its limitations include no articulated conceptual basis, inadequate internal consistency reliability (α = .65), and lack of some validated psychometric properties. CONCLUSIONS Our study revealed that current available tools are not sufficiently able to accurately and reliably assess SK to promote stroke prevention and management. CLINICAL IMPLICATIONS This study highlights the attention of applying current SK tests and need for revising existing tests or developing a new test.
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35
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MacIsaac R, Ali M, Peters M, English C, Rodgers H, Jenkinson C, Lees KR, Quinn TJ. Derivation and Validation of a Modified Short Form of the Stroke Impact Scale. J Am Heart Assoc 2016; 5:JAHA.115.003108. [PMID: 27207963 PMCID: PMC4889183 DOI: 10.1161/jaha.115.003108] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Stroke Impact Scale (SIS) is a stroke-specific, quality of life measure recommended for research and clinical practice. Completion rates are suboptimal and could relate to test burden. We derived and validated a short form SIS (SF-SIS). METHODS AND RESULTS We examined data from the Virtual International Stroke Trial Archive, generating derivation and validation populations. We derived an SF-SIS by selecting 1 item per domain of SIS, choosing items most highly correlated with total domain score. Our validation described agreement of SF-SIS with original SIS and the SIS-16 and correlation with Barthel Index, modified Rankin Scale, National Institutes of Health Stroke Scale, and Euro-QoL 5 dimensions visual analog scales. We assessed discriminative validity (associations between SF-SIS and factors known to influence outcome [age, physiological parameters, and comorbidity]). We assessed face validity and acceptability by sharing the SF-SIS with a focus group of stroke survivors and multidisciplinary stroke healthcare staff. From 5549 acute study patients (mean age 68.5 [SD 13] years, mean SIS 64 [SD 32]) and 332 rehabilitation patients (mean age 65.7 [SD 11] years, mean SIS 61 [SD 11]), we derived an 8-item SF-SIS that demonstrated good agreement with original SIS and good correlation with our chosen functional and quality of life measures (all ρ>0.70, P<0.0001). Significant associations were seen with our chosen predictors of stroke outcome in the acute group (P<0.0001). The focus group agreed with the choice of items for SF-SIS across 7 of 8 domains. CONCLUSIONS Using multiple, complementary methods, we have derived an SF-SIS and demonstrated content, convergent, and discriminant validity. This shortened SIS should allow collection of robust quality of life data with less associated test burden.
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Affiliation(s)
- Rachael MacIsaac
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Myzoon Ali
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Michele Peters
- Nuffield Department of Population Health, University of Oxford, UK
| | - Coralie English
- School of Health Sciences, University of Newcastle, Australia
| | - Helen Rodgers
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - Kennedy R Lees
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
| | - Terence J Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, UK
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36
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Katzan IL, Thompson N, Uchino K. Innovations in Stroke: The Use of PROMIS and NeuroQoL Scales in Clinical Stroke Trials. Stroke 2016; 47:e27-30. [PMID: 26732572 DOI: 10.1161/strokeaha.115.011377] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 12/08/2015] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Ken Uchino
- From the Neurological Institute, Cleveland Clinic, OH
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37
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Sangha RS, Caprio FZ, Askew R, Corado C, Bernstein R, Curran Y, Ruff I, Cella D, Naidech AM, Prabhakaran S. Quality of life in patients with TIA and minor ischemic stroke. Neurology 2015; 85:1957-63. [PMID: 26537051 DOI: 10.1212/wnl.0000000000002164] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/29/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE We investigated health-related quality of life (HRQOL) in patients with TIA and minor ischemic stroke (MIS) using Neuro-QOL, a validated, patient-reported outcome measurement system. METHODS Consecutive patients with TIA or MIS who had (1) modified Rankin Scale (mRS) score of 0 or 1 at baseline, (2) initial NIH Stroke Scale score of ≤5, (3) no acute reperfusion treatment, and (4) 3-month follow-up, were recruited. Recurrent stroke, disability by mRS and Barthel Index, and Neuro-QOL scores in 5 prespecified domains were prospectively recorded. We assessed the proportion of patients with impaired HRQOL, defined as T scores more than 0.5 SD worse than the general population average, and identified predictors of impaired HRQOL using logistic regression. RESULTS Among 332 patients who met study criteria (mean age 65.7 years, 52.4% male), 47 (14.2%) had recurrent stroke within 90 days and 41 (12.3%) were disabled (mRS >1 or Barthel Index <95) at 3 months. Any HRQOL impairment was noted in 119 patients (35.8%). In multivariate analysis, age (adjusted odds ratio [OR] 1.02, 95% confidence interval [CI] 1.01-1.04), initial NIH Stroke Scale score (adjusted OR 1.39, 95% CI 1.17-1.64), recurrent stroke (adjusted OR 2.10, 95% CI 1.06-4.13), and proxy reporting (adjusted OR 3.94, 95% CI 1.54-10.10) were independent predictors of impaired HRQOL at 3 months. CONCLUSIONS Impairment in HRQOL is common at 3 months after MIS and TIA. Predictors of impaired HRQOL include age, index stroke severity, and recurrent stroke. Future studies should include HRQOL measures in outcome assessment, as these may be more sensitive to mild deficits than traditional disability scales.
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Affiliation(s)
- Rajbeer S Sangha
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Fan Z Caprio
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Robert Askew
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Corado
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Richard Bernstein
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Yvonne Curran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ilana Ruff
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Andrew M Naidech
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shyam Prabhakaran
- From the Departments of Neurology (R.S.S., F.Z.C., C.C., R.B., Y.C., I.R., A.M.N., S.P.) and Medical Social Sciences (R.A., D.C.), Northwestern University Feinberg School of Medicine, Chicago, IL.
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Adams HP, Chollet F, Thijs V. Measuring Autonomy and Functional Recovery after Stroke. J Stroke Cerebrovasc Dis 2015; 24:2429-33. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/30/2015] [Accepted: 08/16/2015] [Indexed: 01/22/2023] Open
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Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage. Neurocrit Care 2015; 24:404-12. [DOI: 10.1007/s12028-015-0185-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Googling Stroke ASPECTS to Determine Disability: Exploratory Analysis from VISTA-Acute Collaboration. PLoS One 2015; 10:e0125687. [PMID: 25961856 PMCID: PMC4427483 DOI: 10.1371/journal.pone.0125687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/18/2015] [Indexed: 12/02/2022] Open
Abstract
The summed Alberta Stroke Program Early CT Score (ASPECTS) is useful for predicting stroke outcome. The anatomical information in the CT template is rarely used for this purpose because traditional regression methods are not adept at handling collinearity (relatedness) among brain regions. While penalized logistic regression (PLR) can handle collinearity, it does not provide an intuitive understanding of the interaction among network structures in a way that eigenvector method such as PageRank can (used in Google search engine). In this exploratory analysis we applied graph theoretical analysis to explore the relationship among ASPECTS regions with respect to disability outcome. The Virtual International Stroke Trials Archive (VISTA) was searched for patients who had infarct in at least one ASPECTS region (ASPECTS ≤9, ASPECTS=10 were excluded), and disability (modified Rankin score/mRS). A directed graph was created from a cross correlation matrix (thresholded at false discovery rate of 0.01) of the ASPECTS regions and demographic variables and disability (mRS>2). We estimated the network-based importance of each ASPECTS region by comparing PageRank and node strength measures. These results were compared with those from PLR. There were 185 subjects, average age 67.5± 12.8 years (55% Males). Model 1: demographic variables having no direct connection with disability, the highest PageRank was M2 (0.225, bootstrap 95% CI 0.215-0.347). Model 2: demographic variables having direct connection with disability, the highest PageRank were M2 (0.205, bootstrap 95% CI 0.194-0.367) and M5 (0.125, bootstrap 95% CI 0.096-0.204). Both models illustrate the importance of M2 region to disability. The PageRank method reveals complex interaction among ASPECTS regions with respects to disability. This approach may help to understand the infarcted brain network involved in stroke disability.
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Affiliation(s)
- Lloyd Bradley
- Donald Wilson House Neurological Rehabilitation Centre, Western Sussex Hospitals Trust, Chichester, West Sussex, UK
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Comparing responsiveness of the EQ-5D-5L, EQ-5D-3L and EQ VAS in stroke patients. Qual Life Res 2014; 24:1555-63. [PMID: 25425288 PMCID: PMC4457098 DOI: 10.1007/s11136-014-0873-7] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2014] [Indexed: 11/25/2022]
Abstract
Aims To date, evidence to support the construct validity of the EQ-5D-5L has primarily focused on cross-sectional data. The aims of this study were to examine the responsiveness of EQ-5D-5L in patients with stroke and to compare it with responsiveness of EQ-5D-3L and visual analogue scale (EQ VAS). Methods We performed an observational longitudinal cohort study of patients with stroke. At 1 week and 4 months post-stroke, patients were assessed with modified Rankin Scale (mRS) and Barthel Index (BI) and were administered the EQ-5D-5L and EQ-5D-3L, including the EQ VAS. The EQ-5D-5L index scores were derived using the crosswalk methodology developed by the EuroQol Group. We classified patients according to two external criteria, based on mRS or BI, into 3 categories: ‘improvement,’ ‘stable’ or ‘deterioration’. We assessed the responsiveness of each measure in each patient subgroup using: effect size (ES), standardized response mean (SRM), F-statistic, relative efficiency and area under the receiver operating characteristic curve. Results A total of 112 patients (52 % females; mean age 70.6 years; 93 % ischemic stroke) completed all the instruments at both occasions. In subjects with clinical improvement, EQ-5D-5L was consistently responsive, showing moderate ES (0.51–0.71) and moderate to large SRM (0.69–0.86). In general, EQ-5D-3L index appeared to be more responsive (ES 0.63–0.82; SRM 0.77–1.06) and EQ VAS less responsive (ES 0.51–0.65; SRM 0.59–0.69) than EQ-5D-5L index. Conclusions The EQ-5D-5L index, based on the crosswalk value set, seems to be appropriately responsive in patients with stroke, 4 months after disease onset. As far as EQ-5D-5L index is scored according to crosswalk approach, the EQ-5D-3L index appears to be more responsive in stroke population.
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Wang YL, Pan YS, Zhao XQ, Wang D, Johnston SC, Liu LP, Meng X, Wang AX, Wang CX, Wang YJ. Recurrent stroke was associated with poor quality of life in patients with transient ischemic attack or minor stroke: finding from the CHANCE trial. CNS Neurosci Ther 2014; 20:1029-35. [PMID: 25307297 DOI: 10.1111/cns.12329] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Revised: 08/22/2014] [Accepted: 08/25/2014] [Indexed: 11/27/2022] Open
Abstract
AIMS To examine the health-related quality of life (HRQOL) in patients with transient ischemic attack (TIA) or minor stroke and assess the impact of recurrent stroke on HRQOL. METHODS Health-related quality of life data on patients participated in the Clopidogrel in High-risk patients with Acute Nondisabling Cerebrovascular Events (CHANCE) trial were analyzed. The available 90-day EuroQoL data (EQ-5D) were used to calculate EQ-5D index score. Poor HRQOL was defined as an EQ-5D index score ≤0.5. The characteristics of HRQOL and factors predicting poor HRQOL in these patients were then explored. RESULTS Among the total 5170 patients enrolled, 90-day HRQOL data were obtained from 5104 patients for analysis. The mean EQ-5D index score at day 90 was 0.88 ± 0.21 for all patients, but only 0.42 ± 0.35 for those with recurrent strokes. Poor 90-day HRQOL was found in 294 (5.8%) patients. Patients with poor HRQOL had more strokes during follow-up than patients with good HRQOL (94.9 vs. 4.7%, P < 0.001). Age, history of hypertension and diabetes, and NIHSS at baseline were independent risk factors for predicting poor HRQOL. Stroke recurrence, NIHSS at baseline, age, and minor stroke on admission became independent risk factors once stroke recurrence was added into the model. CONCLUSIONS Stroke recurrence was associated with poor HRQOL in patients with TIA or minor strokes. Interventions focusing on controlling risk factors and prevention of worsening of neurological function may prevent poor HRQOL in these patients.
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Affiliation(s)
- Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China
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Gao H, Li X, Gao X, Ma B. Contralateral needling at unblocked collaterals for hemiplegia following acute ischemic stroke. Neural Regen Res 2014; 8:2914-22. [PMID: 25206612 PMCID: PMC4146169 DOI: 10.3969/j.issn.1673-5374.2013.31.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 10/06/2013] [Indexed: 11/18/2022] Open
Abstract
Hemiplegia caused by stroke indicates dysfunction of the network between the brain and limbs, namely collateral shock in the brain. Contralateral needling is the insertion of needles into acupoints on the relative healthy side of the body to treat diseases such as apoplexy. However, there is little well-designed and controlled clinical evidence for this practice. This study investigated whether contralateral needling could treat hemiplegia after acute ischemic stroke in 106 randomly selected patients with acute ischemic stroke. These patients were randomly assigned to three groups: 45 in the contralateral needling group, receiving acupuncture on the unaffected limbs; 45 in the tional acupuncture group, receiving acupuncture on the hemiplegic limbs; and 16 in the control group, receiving routine treatments without acupuncture. Acupuncture at acupoints Chize (LU5) in the upper limb and Jianliao (TE14) in the lower limb was performed for 45 minutes daily for 30 consecutive days. The therapeutic effective rate, Neurological Deficit Score, Modified Barthel Index and Fugl-Meyer Assessment were evaluated. The therapeutic effective rate of contralateral needling was higher than that of conventional acupuncture (46.67% vs. 31.11%, P < 0.05). The neurological deficit score of contralateral needling was significantly decreased compared with conventional acupuncture (P < 0.01). The Modified Barthel Index and Fugl-Meyer Assessment score of contralateral needling increased more significantly than those of conventional acupuncture (both P < 0.01). The present findings suggest that contralateral needling unblocks collaterals and might be more effective than conventional acupuncture in the treatment of hemiplegia following acute ischemic stroke.
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Affiliation(s)
- Huanmin Gao
- Department of Neurology, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan 750002, Ningxia Hui Autonomous Region, China
| | - Xugang Li
- Department of Intensive Care Unit, People's Hospital of Rizhao City, Rizhao 276826, Shandong Province, China
| | - Xia Gao
- Department of Rehabilitation, the Second Affiliated Hospital of Qingdao University Medical College, Qingdao 266042, Shandong Province, China
| | - Benxu Ma
- Department of Rehabilitation, the Second Affiliated Hospital of Qingdao University Medical College, Qingdao 266042, Shandong Province, China
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Jaracz K, Grabowska-Fudala B, Górna K, Kozubski W. Consequences of stroke in the light of objective and subjective indices: A review of recent literature. Neurol Neurochir Pol 2014; 48:280-6. [DOI: 10.1016/j.pjnns.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 07/10/2014] [Indexed: 10/25/2022]
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Abstract
Introduction: Comorbidity of depression and stroke significantly reduces the quality of life of patients after the stroke. Squeal after stroke also determines the quality of life and have impact on the occurrence of depression after the stroke. In our study we investigated the occurrence of depression in patients after different types and subtypes of stroke measured by the Hamilton scale compared to the level of disability measured by NIHSS scale. Goal: The goal was to make a comparative analysis of depression after stroke, according to gender and age, side of the lesion and the severity of neurological deficit. Material and Methods: Material for our work are 210 patients with stroke treated at the Neurology Clinic, Clinical Center of Sarajevo University in 2012, 105 male and 105 female. The mean age of the patients was 67.12±9.5 years. Ischemic stroke was present in 65% cases. There was no statistically significant difference between ischemic and hemorrhagic stroke among genders. In case of hemorrhagic M-56.7%, F-43.3%; ischemic M-48.3%, F-51.7% (chi-square=6.563, p=0.082). Depression was more prevalent among younger patients (52-60 years) with 39.2% then in the group of older patients (61-70 years) with 32% of depressed. In relation to gender there was significantly more patients with depression among women compared to men (63.8:27.2%, chi-square=14.38, p=0.00019). Depression was more frequent in patients with stroke in the left hemisphere medial localization (63%). NIHSS scale average was 16.07 with the minimum of 11 and maximum of 22, F=52.56, p=0.001. Conclusions: We can conclude that depression after stroke is more frequent in younger patients, female patients, patients with localized stroke in the medial left hemisphere and with higher disability score.
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McArthur K, Fan Y, Pei Z, Quinn T. Optimising outcome assessment to improve quality and efficiency of stroke trials. Expert Rev Pharmacoecon Outcomes Res 2013; 14:101-11. [PMID: 24350886 DOI: 10.1586/14737167.2014.870479] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Substantial progress has been made in treatment of stroke and much of this has been driven by large scale, multi-centre, randomised controlled trials. Although stroke is a frequent cause of mortality, stroke-related disability and functional decline is of equal or greater concern to patients and carers. Thus, to prove efficacy of an intervention for stroke, we need robust methods of describing recovery. Various functional assessment scales are available, the tool recommended as trial end point by many specialist societies and regulatory authorities is the modified Rankin Scale (mRS). We will use the mRS as exemplar to discuss contemporary research around functional assessment for stroke trials, including recent work around structured assessments, assessor training and end point adjudication panels. We will present an overview and critique of these studies and give examples where strategies to improve mRS assessment are impacting on the quality of stroke clinical trials.
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Affiliation(s)
- Kate McArthur
- University of Glasgow, Institute of Cardiovascular and Medical Sciences, Walton Building, Glasgow Royal Infirmary, Glasgow G4 0SF, UK
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